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

Meconium is an infant's first stool, composed of amniotic fluid, lanugo, bile, and intestinal epithelial cells. Most infants pass meconium within the first 24 hours of life. Failure to pass meconium within 24 hours can indicate a bowel obstruction, such as Hirschsprung's disease or meconium ileus, necessitating immediate medical evaluation.

Choice B rationale

The amount of formula consumed by a 24-hour-old infant can vary. While adequate feeding is important, not finishing a 3 oz bottle at this early stage may not be as immediately concerning as the absence of meconium, as gastric capacity is still developing.

Choice C rationale

While three wet diapers indicate adequate hydration and renal function, which is positive, the absence of meconium stool is a more critical physiological assessment requiring urgent attention due to potential underlying pathology.

Choice D rationale

The use of a bulb syringe suggests the infant may have some respiratory secretions, which can be normal variations. This finding, while noted, does not carry the same level of immediate concern as the absence of meconium passage in a 24-hour-old.

Choice A rationale

A soft, spongy fundus, often described as boggy, indicates uterine atony. This condition means the uterine muscles are not contracting effectively, which is abnormal postpartum and significantly increases the risk of postpartum hemorrhage due to inadequate compression of uterine blood vessels.

Choice B rationale

Unilateral lower leg pain, especially accompanied by warmth, redness, or swelling, is an abnormal finding and can be indicative of a deep vein thrombosis (DVT). Postpartum women are at an increased risk for DVT due to hypercoagulability and venous stasis, making this a critical assessment requiring immediate attention.

Choice C rationale

Saturating two perineal pads per hour is an excessive amount of lochia and suggests postpartum hemorrhage. Normal lochia flow should not saturate more than one pad per hour in the immediate postpartum period, indicating that the uterus is not contracting adequately to control bleeding.

Choice D rationale

A heart rate of 56 beats/minute, also known as puerperal bradycardia, is considered a normal physiological finding for a primigravida client 12 hours postpartum. This transient bradycardia often occurs due to the increased stroke volume and cardiac output that result from the significant decrease in uterine blood flow after delivery.