When assessing the fundus in a postpartum client, which palpation method is recommended?

Choice A rationale

Painting a picture requires fine motor skills and a level of artistic expression that may be beyond a typical toddler's developmental stage. While some toddlers may enjoy making marks on paper, the structured activity of painting a picture is more appropriate for preschoolers. Toddlers are still developing hand-eye coordination and may become frustrated with a task that requires precision.

Choice B rationale

Playing peek-a-boo is a game typically enjoyed by infants who are learning about object permanence. While a toddler may still find it amusing, it is not the most developmentally appropriate activity for a hospitalized toddler who is developing gross motor skills, independence, and exploring their environment. The game does not support the toddler's need for autonomy and movement.

Choice C rationale

Listening to music can be a soothing and pleasant activity for a toddler, especially in a hospital setting. However, it is a passive activity. The most appropriate play for a toddler is one that engages their newfound gross motor skills, sense of autonomy, and exploration. A passive activity like listening to music does not fully meet the developmental needs of this age group.

Choice D rationale

Playing with a push-pull toy is the most appropriate activity for a toddler. Toddlers are in the developmental stage of mastering walking and running. These toys support the development of gross motor skills, coordination, and balance. The activity also encourages independent exploration and a sense of mastery, which aligns with the toddler's psychosocial stage of autonomy versus shame and doubt.

Choice A rationale

Bright red lochia with large clots suggests uterine atony, which is a failure of the uterine muscles to contract properly. This indicates that the oxytocin is not effective in promoting uterine contraction, which is necessary to control postpartum bleeding. Uterine atony is a leading cause of postpartum hemorrhage, and this finding is a sign of an ongoing bleeding problem, not a sign of effective medication.

Choice B rationale

A firm fundus indicates the uterine muscles are contracting effectively, which compresses blood vessels and prevents excessive bleeding. Oxytocin is a synthetic analog of the naturally occurring hormone oxytocin, and it works by stimulating these smooth muscle contractions in the uterus. Therefore, a firm fundus is the desired therapeutic effect and indicates the medication is working as intended.

Choice C rationale

A boggy fundus signifies a relaxed, poorly contracted uterus. This allows for blood vessels to bleed freely, increasing the risk of postpartum hemorrhage. This is the opposite of the desired effect of oxytocin and indicates that the medication is not effectively promoting uterine contraction to control bleeding.

Choice D rationale

Absent lochia postpartum is not a normal finding and may indicate an issue such as uterine retention of placental fragments or a blood clot, or an abnormal uterine position. The normal progression of lochia (a vaginal discharge after childbirth) is a physiological process that should occur regardless of medication effectiveness. Absent lochia does not demonstrate a normal physiological response to oxytocin.