Practice Quiz

CNM Certified Nurse Midwife

Category - Postpartum

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A nurse midwife is assessing four clients who recently gave birth to healthy newborns through vaginal delivery. All of the clients had uncomplicated labors. Which of the following clients needs further evaluation?
  1. A postpartum client who has a temperature of 100.4 °F. The client gave birth 24 hours ago.
  2. A postpartum client who soaked 8 perineal pads in the past 24 hours. The client gave birth 24 hours ago.
  3. A postpartum client who complains of uterine pain every time she breastfeeds her newborn. The client gave birth 48 hours ago.
  4. A postpartum client with clots larger than 1 cm across in the red lochia. The client gave birth 48 hours ago.
Explanation
Answer: D - The postpartum client with clots larger than 1 cm across in the red lochia needs further evaluation. Clots in the red lochia are usually observed in the initial period after labor, but they are normally smaller than 1 cm. This finding could suggest the occurrence of uterine atony or retained placental fragments. The other clients are exhibiting normal postpartum symptoms. A slight increase in body temperature is expected during the first 24 hours. A client who soaked more than 10 perineal pads in the last 24 hours is most likely diagnosed with hemorrhage, but 8 is within an expected range. Uterine pain during breastfeeding is expected. Suckling stimulates the secretion of oxytocin, which may stimulate the uterus.
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