A primipara about to be discharged with a newborn asks the nurse multiple Questions regarding how to care for the infant.
Which phase of maternal adjustment does this behavior illustrate?

Choice A rationale

While documentation of lochia amount and type is a necessary component of ongoing assessment, it is not the priority over directly assessing the physiological state of the uterus in the fourth stage of labor. Lochia is the normal discharge of blood, mucus, and uterine tissue post-delivery. A soaked pad (approximately 75 mL) of lochia rubra within a short period suggests a need to check the uterine tone immediately, as uterine atony is the primary cause of early postpartum hemorrhage.

Choice B rationale

Although a distended bladder can displace the uterus and impair its contractility, causing excessive bleeding, the direct physical assessment of the fundus (Choice D) is the priority. Emptying the bladder is an important intervention if the uterus is found to be boggy and displaced; however, the nurse must first confirm the status of the uterine fundus to rule out or quickly address uterine atony, which is a life-threatening complication.

Choice C rationale

Measuring hemoglobin and hematocrit provides valuable retrospective data about the client's blood loss status, but it is not an immediate action that will prevent further blood loss. The priority is to implement a direct, immediate intervention to stop or reduce hemorrhage. The lab results would only reflect the effect of the hemorrhage, whereas assessing the fundus helps determine the cause and guides immediate treatment. The normal range for Hgb is 12 to 16 g/dL and Hct is 37 to 47 percent.

Choice D rationale

Assessing the uterine fundus is the priority because a large amount of lochia rubra (which is bright red, blood-like) indicates potential postpartum hemorrhage. The most common cause is uterine atony, a failure of the uterus to contract and compress the placental vessels. A firm, well-contracted fundus above the symphysis pubis prevents hemorrhage, so immediate palpation confirms the presence of uterus firmness and height and guides the next intervention, such as massage.

Step 1 is to convert the oxytocin concentration from units to milliunits (mU):. 20 units× 1000 mU/unit = 20000 mU.

Step 2 is to determine the concentration in mU/mL:. 20000 mU÷ 1000 mL = 20 mU/mL.

Step 3 is to calculate the infusion rate in mL/min:. 4 mU/min÷ (20 mU/mL) = 0.2 mL/min.

Step 4 is to convert the infusion rate from mL/min to mL/hr:. 0.2 mL/min× 60 min/hr = 12 mL/hr. The final calculated answer is 12 mL/hr.