For a postpartum client with a displaced fundus to the right, which action should the nurse take?

For a postpartum client with a displaced fundus to the right, which action should the nurse take?

• A. Administer analgesics.
• B. Check dilation of cervix.
• C. Ask the client when she last voided.
• D. Perform perineal assessment.

Answer: (C)

Displacement of the postpartum fundus to the right most often indicates a full bladder pushing the uterus off midline. The first action is to determine whether the client has voided recently. Asking when she last voided and assisting her to void (or arranging catheterization if she cannot void) can relieve the bladder distention. Once the bladder is emptied, the uterus is likely to shift back to midline and regain a firm tone, reducing hemorrhage risk. Analgesics don’t address the underlying bladder issue, cervical dilation check isn’t related to fundal position, and a perineal assessment doesn’t correct bladder distention. After voiding, recheck the fundus for position and firmness.

Displacement of the postpartum fundus to the right most often indicates a full bladder pushing the uterus off midline. The first action is to determine whether the client has voided recently. Asking when she last voided and assisting her to void (or arranging catheterization if she cannot void) can relieve the bladder distention. Once the bladder is emptied, the uterus is likely to shift back to midline and regain a firm tone, reducing hemorrhage risk. Analgesics don’t address the underlying bladder issue, cervical dilation check isn’t related to fundal position, and a perineal assessment doesn’t correct bladder distention. After voiding, recheck the fundus for position and firmness.