The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement indicates that teaching was effective?

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.

The Apgar score is calculated based on five criteria, each scored from 0 to 2:

1. Heart rate

   • 0 = Absent
   • 1 = Below 100 beats per minute ✅
   • 2 = 100 or more beats per minute

2. Respiratory effort

   • 0 = Absent
   • 1 = Slow, irregular ✅
   • 2 = Good, crying

3. Muscle tone

   • 0 = Limp
   • 1 = Some flexion of extremities ✅
   • 2 = Active motion

4. Reflex irritability (response to stimulation, e.g., suctioning)

   • 0 = No response
   • 1 = Grimace ✅
   • 2 = Crying, active withdrawal

5. Color

   • 0 = Blue, pale
   • 1 = Body pink, extremities blue
   • 2 = Completely pink

Apgar Score Calculation:

• Heart rate: 1
• Respiratory effort: 1
• Muscle tone: 1
• Reflex irritability: 1
• Color: 0

Total Apgar Score: 4

A score of 4 suggests the newborn is in distress and requires immediate medical intervention, such as oxygen support and further assessment.