The nurse is completing a fundal assessment for her postpartum clients today. What will the nurse determine when assessing the fundus?
Shape, tone and height
Tone, position and height
Tone, shape and position
Shape, height and position
The Correct Answer is C
A. While shape and height are important aspects, tone is also a key component in assessing the fundus after childbirth.
B. Position is part of the assessment, but the shape and tone are equally crucial components.
C. This choice correctly includes all the essential aspects of a fundal assessment: tone, shape, and position.
D. While shape and height are important, tone and position are equally vital components in assessing the fundus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Client 4, who delivered 8 hours ago, having a fundus at the umbilicus is within the expected range for a client at this stage postpartum.
B. Client 2, two days postpartum with a fundus 2 cm above the umbilicus, is suggestive of uterine subinvolution, as the fundus should be descending, not rising, after delivery.
C. Client 1, three days postpartum with a fundus 3 cm below the umbilicus, is within the expected range for the postpartum period.
D. Client 3, one day postpartum with a fundus 1 cm below the umbilicus, is within the expected range for the postpartum period.
Correct Answer is ["2070"," 1440"]
Explanation
The calculation is as follows:
Intake = (20 + 10 + 15) mL x 3 (medication and flushes) + 240 mL (water intake) + 150 mL/h x 6 h (IV infusion) = 2070 mL
Output = 320 mL (Hemovac drainage) + 210 mL (chest tube drainage) + (275 + 325 + 310) mL (urine output) = 1440 mL
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