A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which factor would the nurse identify as being a significant contributor to this condition?

short duration of labor

use of anesthetics

early ambulation

breastfeeding

Answer and Explanation

The Correct Answer is B

A. Short duration of labor is not typically associated with subinvolution. In fact, prolonged labor (not short) can be a risk factor due to increased uterine fatigue.

B. Use of anesthetics is correct. The use of certain anesthetics during labor, especially those that affect uterine tone (like general anesthesia or high doses of regional anesthesia), can contribute to uterine atony, which may lead to subinvolution—a condition where the uterus does not return to its normal size after childbirth.

C. Early ambulation actually promotes uterine involution and prevents complications like thrombophlebitis, making it a protective factor, not a contributing one.

D. Breastfeeding stimulates the release of oxytocin, which causes uterine contractions and promotes involution, making it a helpful factor in preventing subinvolution.

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Correct Answer is A

Explanation

A. Request the client to empty her bladder is the correct action. A fundus that is firm but deviated to the left and higher than expected (U+1) suggests that the bladder is full. A full bladder can displace the uterus, causing it to become misaligned and elevated. Asking the client to empty her bladder is often the first step to address this situation before proceeding with further assessment or intervention.

B. Follow PRN order to insert a straight urinary catheterization might be appropriate if the client is unable to empty her bladder voluntarily, but it is typically a last resort. Before resorting to catheterization, encourage the client to try to void first.

C. Start an IV and add 20 units Pitocin would be indicated if there were signs of uterine atony or hemorrhage. However, in this case, the issue seems related to bladder distention rather than uterine atony, so starting Pitocin is not the appropriate immediate response.

D. Massage fundus until it descends below the level of the umbilicus would be done if the fundus were boggy or soft, indicating uterine atony. However, in this case, the fundus is described as firm, so massaging is not necessary. The priority is addressing the bladder distention.

A. oligohydramnios B. chorioamnionitis C. preeclampsia D. post-term labor

Correct Answer is C

Explanation

A. Oligohydramnios is more commonly associated with conditions like fetal growth restriction or placental insufficiency, and it is less common in twin pregnancies, which are actually more prone to polyhydramnios, especially in cases of twin-to-twin transfusion syndrome.

B. Chorioamnionitis is an infection of the fetal membranes, which can occur in any pregnancy, particularly with prolonged rupture of membranes, but it is not uniquely or especially linked to twin pregnancies.

C. Preeclampsia is correct. Women carrying twins (or other multiples) are at significantly higher risk for developing preeclampsia due to the increased placental mass and associated vascular demands. Nurses should be particularly vigilant in monitoring for signs like elevated blood pressure, proteinuria, edema, and headaches in these clients.

D. Post-term labor is less likely in twin pregnancies, as multiples are more often born preterm, not post-term, due to uterine overdistension and other complications.

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A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which factor would the nurse identify as being a significant contributor to this condition?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a routine postpartum assessment following a normal vaginal delivery, the nurse notes the fundus is firm, but the level has changed from U-1 to U+1 and deviated to the left. Which action would be appropriate before continuing the assessment?

Correct Answer is A

Explanation

A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem?

Correct Answer is C

Explanation

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