Which assessment on the third postpartum day would indicate to the nurse that a client is experiencing uterine subinvolution?

Choice A rationale

A fundus 3 finger-breadths below the umbilicus after voiding on the third postpartum day is a normal finding. Fundal height typically descends approximately one finger-breadth per day following delivery. This physiological process, known as involution, involves myometrial contraction and autolysis, leading to the uterus returning to its pre-pregnant size.

Choice B rationale

Mild uterine cramping that resolves with NSAIDs is a normal postpartum finding. This cramping, often called afterpains, is caused by intermittent myometrial contractions. These contractions are stimulated by endogenous oxytocin and are essential for compressing uterine blood vessels and preventing postpartum hemorrhage. NSAIDs inhibit prostaglandin synthesis, which is a key mediator of pain and uterine contractions.

Choice C rationale

A fundus 2 finger-breadths above the pubic symphysis after voiding on the third postpartum day would be an extremely low finding and is not indicative of subinvolution. This position suggests that the uterus has already undergone a significant amount of involution, which is not the pathology of subinvolution. The fundus should still be palpable abdominally at this stage.

Choice D rationale

Uterine subinvolution is a condition where the uterus fails to return to its pre-pregnant state at the expected rate. A fundus palpated at the umbilicus on the third postpartum day is abnormal. The fundus should have descended approximately three finger-breadths below the umbilicus by this time. This assessment finding indicates a delay in the phys

Choice A rationale

Increasing weight loss is an incorrect characteristic. Nephrotic syndrome is marked by massive proteinuria, which leads to a decrease in plasma oncotic pressure. This fluid shift from the intravascular space to the interstitial space results in significant fluid retention, causing weight gain and edema, not weight loss. The body holds onto fluid, masking any potential muscle or fat wasting.

Choice B rationale

Increased urinary output is not a characteristic of nephrotic syndrome. The condition is associated with severe fluid retention and decreased plasma volume, leading to oliguria, or a decreased urinary output. The kidneys are not effectively filtering protein and fluid is being retained in the body, which directly reduces the amount of fluid that can be excreted as urine.

Choice C rationale

Generalized edema is the most common and striking characteristic of nephrotic syndrome. The massive loss of protein, particularly albumin, in the urine leads to a significant decrease in serum albumin levels. Albumin is crucial for maintaining plasma oncotic pressure. The resulting decrease in oncotic pressure causes fluid to shift from the bloodstream into the interstitial spaces, resulting in widespread or anasarca edema.

Choice D rationale

While hypertension can occur, it is not the most common characteristic associated with nephrotic syndrome. The primary physiological change is the massive proteinuria leading to hypoproteinemia and subsequent edema. Hypertension may develop as a result of volume overload, but it is not a hallmark sign. The most prominent and defining symptom is the severe edema.