A nurse is caring for a client who had a vaginal birth 2 hours ago. They are currently receiving Oxytocin, 20 Units in 1000 ml Lactated Ringer's solution infusing at 125 ml/hr. Which of the following findings indicates that the medication is effective?

Choice A rationale Bright red lochia with large clots suggests uterine atony, which is a failure of the uterine muscles to contract properly. This indicates that the oxytocin is not effective in promoting uterine contraction, which is necessary to control postpartum bleeding. Uterine atony is a leading cause of postpartum hemorrhage, and this finding is a sign of an ongoing bleeding problem, not a sign of effective medication. Choice B rationale A firm fundus indicates the uterine muscles are contracting effectively, which compresses blood vessels and prevents excessive bleeding. Oxytocin is a synthetic analog of the naturally occurring hormone oxytocin, and it works by stimulating these smooth muscle contractions in the uterus. Therefore, a firm fundus is the desired therapeutic effect and indicates the medication is working as intended. Choice C rationale A boggy fundus signifies a relaxed, poorly contracted uterus. This allows for blood vessels to bleed freely, increasing the risk of postpartum hemorrhage. This is the opposite of the desired effect of oxytocin and indicates that the medication is not effectively promoting uterine contraction to control bleeding. Choice D rationale Absent lochia postpartum is not a normal finding and may indicate an issue such as uterine retention of placental fragments or a blood clot, or an abnormal uterine position. The normal progression of lochia (a vaginal discharge after childbirth) is a physiological process that should occur regardless of medication effectiveness. Absent lochia does not demonstrate a normal physiological response to oxytocin.