Which physical assessment data should the practical nurse (PN) consider a normal finding for a primigravida client who is 12 hours postpartum?

Choice A rationale

Cheese is a good source of calcium and protein, but it is not a primary source of iron. Iron is essential for hemoglobin synthesis, and the client's hemoglobin and hematocrit levels are below normal ranges [Hemoglobin, pregnant female > 11 g/dL ( > 110 g/L); Hematocrit, pregnant female > 33% ( > 0.33 volume fraction)], indicating iron deficiency anemia.

Choice B rationale

Cauliflower is a cruciferous vegetable rich in vitamin C and fiber, but its iron content is relatively low. While vitamin C aids in iron absorption, cauliflower itself does not provide a significant amount of dietary iron to effectively address the client's anemic status.

Choice C rationale

Carrots are well-known for their beta-carotene content, a precursor to vitamin A, and provide fiber. However, carrots are not a significant source of iron. To combat iron deficiency anemia during pregnancy, foods rich in heme iron or non-heme iron with good bioavailability are required.

Choice D rationale

Chicken, particularly the dark meat, is a good source of heme iron, which is more readily absorbed by the body compared to non-heme iron found in plant-based foods. Given the client's anemic status, increasing dietary intake of iron-rich foods like chicken is crucial for improving hemoglobin and hematocrit levels.

Choice A rationale

Involution is the process by which the uterus returns to its non-pregnant state, involving uterine contractions that decrease uterine size and minimize blood loss. Problems with involution, such as subinvolution, would typically present with prolonged lochial discharge and a boggy uterus, not primarily severe cramping immediately following breastfeeding.

Choice B rationale

An ileus is a temporary lack of normal muscle contractions in the intestines, leading to a build-up of food material. This condition would manifest as abdominal distension, absent bowel sounds, nausea, and vomiting. While possible post-delivery, it is not directly related to breastfeeding and would not typically cause severe cramping immediately after nursing.

Choice C rationale

A retained placenta refers to fragments of the placenta remaining in the uterus after delivery. This condition typically causes persistent postpartum bleeding, uterine atony, and a risk of infection. While it can cause uterine cramping due to the body's attempts to expel the tissue, the severe cramping immediately after breastfeeding is more directly related to hormonal release.

Choice D rationale

Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a hormone that causes uterine contractions, which are essential for uterine involution and preventing postpartum hemorrhage by compressing blood vessels. These contractions, often referred to as "afterpains," are more pronounced during breastfeeding due to the surge in oxytocin.