Lochia progresses in the following order:

Rubra, serosa, alba.

Rubra, alba, serosa.

Serosa, alba, rubra.

Alba, rubra, serosa.

Answer and Explanation

The Correct Answer is A

A) Rubra, serosa, alba:
The normal progression of lochia, the vaginal discharge after childbirth, follows a predictable sequence of stages. Lochia rubra is the initial stage, occurring within the first few days postpartum. It is bright red and consists primarily of blood, tissue, and debris from the placenta. After 3-4 days, the discharge changes to lochia serosa, which is pinkish-brown and contains a mixture of blood, serous fluid, and mucous. After 10-14 days, it progresses to lochia alba, which is white or pale yellow and consists mostly of leukocytes (white blood cells), mucus, and epithelial cells. This is the expected progression, which marks the natural healing process after childbirth.

B) Rubra, alba, serosa:
This order is incorrect because lochia serosa comes before lochia alba in the normal sequence. Lochia alba occurs after lochia serosa, not before. This progression would not accurately reflect the typical stages of lochia.

C) Serosa, alba, rubra:
This sequence is incorrect as lochia rubra is the first stage, not lochia serosa. The initial discharge following childbirth is always red and blood-tinged, which is lochia rubra. Serosa and alba come later in the progression, so this order does not follow the correct timeline.

D) Alba, rubra, serosa:
This order is completely incorrect. Lochia rubra (red blood discharge) is the first stage, not lochia alba (white discharge). After childbirth, rubra occurs first, followed by serosa, and then finally alba. This sequence does not reflect the normal postpartum discharge process.

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Correct Answer is A

Explanation

A) Manual Expression:
Manual expression is an excellent way to show a new mother that she does have milk or colostrum. By gently massaging and expressing the breast, the mother can see or feel the small amount of colostrum being released. This helps reassure her that milk production has begun, even if it’s not abundant right away. Colostrum is often produced in small amounts during the first few days postpartum, and learning how to express it can provide immediate visual confirmation that milk is available for the baby.

B) Massaging breast to bring milk to the nipple:
While massaging the breast can help facilitate the milk ejection reflex (let-down), it doesn’t necessarily show the mother that she has milk. The milk flow may not be immediately visible without manual expression. The process of massaging can help increase milk flow over time but is not the most effective way to demonstrate the presence of colostrum in the immediate postpartum period.

C) Using a nipple shield:
A nipple shield can sometimes be used to help babies latch more effectively if there are latch issues, but it won’t directly show the mother that she has milk or colostrum. In fact, frequent use of a nipple shield without proper latching technique can interfere with establishing breastfeeding. It’s more important to help the mother with proper latching and positioning, along with demonstrating manual expression.

D) Keeping infant skin to skin:
Skin-to-skin contact is incredibly beneficial for bonding and promoting breastfeeding, as it stimulates the release of oxytocin and encourages the baby to latch. However, it does not directly show the mother that she has milk or colostrum. While it can help initiate milk production, manual expression provides a more direct and immediate way to demonstrate that milk is available.

A. Fundus below the symphysis and not palpable B. Moderate, bright red lochia. C. Breasts warm, firm and tender D. Laceration slightly red and puffy

Correct Answer is A

Explanation

A) Fundus below the symphysis and not palpable:
The process of involution refers to the shrinking and returning of the uterus to its normal size and position after delivery. By postpartum day 14, the uterus should be largely involuted, with the fundus no longer palpable above the pubic symphysis. This is a normal finding, as the uterus typically shrinks to its pre-pregnancy size over this period. The fundus should be at or below the symphysis pubis and should not be palpable after about two weeks postpartum, indicating that the involution process is proceeding as expected.

B) Moderate, bright red lochia:
While bright red lochia (also known as lochia rubra) is common during the first few days postpartum, by postpartum day 14, lochia should have transitioned to a serosa (pinkish or brownish) or alba (white or yellowish) appearance. Bright red lochia on day 14 would suggest a possible issue, such as retained placental fragments or uterine atony, and would require further evaluation.

C) Breasts warm, firm and tender:
Breast tenderness and firmness can be normal in the early postpartum period, especially as milk comes in. However, by postpartum day 14, if the breasts remain tender and warm, this could indicate mastitis or engorgement that hasn't been resolved. While some tenderness may still occur, it should have decreased by this point. If tenderness persists, further assessment would be needed.

D) Laceration slightly red and puffy:
Postpartum lacerations or episiotomy sites should begin to heal within the first few days, but slight redness and swelling might still be present at two weeks. However, puffiness or continued redness after 14 days may indicate poor healing, infection, or other complications, which requires further evaluation and intervention. Normal healing should show a decrease in redness and swelling by this time.

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Lochia progresses in the following order:

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Naxlex Comprehensive Predictor Exams

A new mother is breastfeeding and concerned that she has no milk for baby. One way you can show her that she does have milk or colostrum is by teaching her:

Correct Answer is A

Explanation

Which documentation on a woman's chart after postpartum day 14 indicates a normal involution process?

Correct Answer is A

Explanation

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