A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the client's fundus and documents which finding as normal?

two fingerbreadths above the umbilicus

two fingerbreadths below the umbilicus

four fingerbreadths below the umbilicus

at the level of the umbilicus

Answer and Explanation

The Correct Answer is B

A. Two fingerbreadths above the umbilicus would not be a normal finding 48 hours postpartum. By this time, the uterus should be well on its way to returning to its pre-pregnancy size and position, typically about 1 to 2 fingerbreadths below the umbilicus.

B. Two fingerbreadths below the umbilicus is the expected finding 48 hours postpartum. After birth, the uterus begins to shrink (involution) and descend into the pelvic cavity. By 48 hours, the fundus is usually 1–2 fingerbreadths below the umbilicus.

C. Four fingerbreadths below the umbilicus would be more typical of a finding several days later, after the process of involution continues. This could be a sign that the uterus is shrinking at the expected rate.

D. At the level of the umbilicus is typically expected within the first 24 hours after delivery, but by 48 hours postpartum, the fundus should have descended slightly below the level of the umbilicus.

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Correct Answer is A

Explanation

A. "This is meconium stool and is normal for a newborn." is the correct and most appropriate response. Meconium is the newborn’s first stool, typically passed within the first 24 to 48 hours of life. It is black, tarry, and sticky in appearance and consists of materials the baby ingested while in the womb, such as amniotic fluid, mucus, and cells. It is completely normal and expected.

B. "You probably took iron during your pregnancy and that is what causes this type of stool." is incorrect. While iron supplements can darken adult stools, meconium is unrelated to maternal iron intake and is a normal physiological occurrence in all newborns.

C. “This is unusual, and I need to report this to your pediatrician." is incorrect and would be alarming to the parent unnecessarily. This is a normal finding, not something requiring physician notification.

D. "I'll take a sample and check it for possible bleeding" is also inappropriate unless there are other signs of concern (e.g., blood in stool later on). Meconium is not indicative of bleeding and does not warrant testing under normal circumstances.

A. 8.4 mEq/L B. 6.1 mEq/L C. 10.8 mEq/L D. 3.3 mEq/L

Correct Answer is B

Explanation

A. 8.4 mEq/L is above the therapeutic range and may indicate magnesium toxicity. Levels greater than 7.5–8 mEq/L can lead to loss of deep tendon reflexes, and higher levels can cause respiratory depression and cardiac arrest.
B. 6.1 mEq/L falls within the therapeutic range for magnesium sulfate when used to treat severe preeclampsia, which is generally 4.8–8.4 mEq/L (or 4–7 mEq/L depending on the source and unit of measurement). This level is considered safe and effective for preventing seizures.
C. 10.8 mEq/L is too high and indicates magnesium toxicity, placing the patient at risk for serious complications like respiratory or cardiac arrest.
D. 3.3 mEq/L is below the therapeutic range, suggesting that the dose may be inadequate to prevent eclamptic seizures in a woman with severe preeclampsia.

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A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the client's fundus and documents which finding as normal?

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Naxlex Comprehensive Predictor Exams

A new mother is changing the diaper of her 12-hour-old newborn and asks why the stool is black and sticky. Which response by the nurse would be most appropriate?

Correct Answer is A

Explanation

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result?

Correct Answer is B

Explanation

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A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the client's fundus and documents which finding as normal?