The nurse is giving instructions for formula preparation.

Which statement from the client indicates teaching was effective?

Choice A rationale

Pitocin (synthetic oxytocin) is a powerful uterotonic drug that is used after placental delivery to prevent postpartum hemorrhage. Its action is to stimulate vigorous, sustained contractions of the uterine muscle cells, thereby clamping down on the bleeding blood vessels within the placental insertion site, not to promote progressive cervical change, which is a function of natural labor forces and cervical ripening agents.

Choice B rationale

Oxytocin's primary role in the postpartum period is stimulating uterine contraction; it has no significant analgesic or pain-relieving properties. Pain relief after birth is managed with analgesics or non-pharmacological methods, as Pitocin administration can actually cause painful cramping as the uterus contracts to prevent bleeding.

Choice C rationale

Pitocin stimulates contractions, directly opposing rest and relaxation of the uterus. The goal of administering Pitocin immediately after delivery of the placenta is to cause powerful, sustained uterine contractions (tetany) to achieve hemostasis by physically squeezing the myometrial arteries that supplied the placenta, preventing excessive blood loss.

Choice D rationale

Pitocin is administered after placental delivery as a prophylactic measure to stimulate strong, prolonged uterine contractions. These contractions constrict the blood vessels within the uterine wall at the placental attachment site, which is essential to achieve hemostasis and prevent the most common cause of postpartum hemorrhage, which is uterine atony.

Choice A rationale

By 3 weeks (21 days) postpartum, the normal process of uterine involution means the fundus should be entirely descended into the true pelvis. Once it drops below the level of the symphysis pubis, it becomes nonpalpable upon abdominal examination. This finding is the expected and desired outcome of the rapid shrinkage of the uterus following childbirth.

Choice B rationale

A fundus palpated 3 cm above the umbilicus (or any distance above the symphysis pubis) at 3 weeks postpartum is indicative of subinvolution, which is an abnormal finding. The fundus typically descends approximately 1 cm, or one finger breadth, per day and should be nonpalpable abdominally by 10 to 14 days.

Choice C rationale

The progression of lochia after 3 weeks should be moving toward lochia alba (white/yellowish-white) or possibly lochia serosa (pinkish-brown), not moderate bright red lochial flow (lochia rubra). The presence of moderate lochia rubra this late is a sign of abnormal involution or retained placental fragments, warranting further assessment.

Choice D rationale

The uterus is typically palpated halfway between the umbilicus and symphysis pubis around the 5th to 6th day postpartum. Finding the uterus at this location at 3 weeks postpartum indicates a significant delay in the normal involution process (subinvolution) and is therefore an abnormal finding requiring intervention.