A nurse is caring for a female client following an emergency cesarean birth in the postpartum unit. Based on the 0715 assessment findings, the nurse identifies that the client is at greatest risk for developing _________ and ________.

Based on the 0715 assessment findings, the nurse identifies that the client is at greatest risk for developing postpartum hemorrhage and urinary tract infection. Rationale for correct answers Postpartum hemorrhage risk is indicated by a boggy fundus located 2 fingerbreadths above the umbilicus and deviated to the right, signifying uterine atony and bladder distention. Uterine atony causes inadequate contraction, increasing bleeding risk. Normal fundal position is firm, midline, at or below the umbilicus. The client’s saturated perineal pad confirms excessive bleeding. Urinary tract infection risk is suggested by urinary retention signs (urge to urinate but only voiding 50 mL) and straining, increasing bacterial colonization risk. Blood-tinged urine further supports urinary tract irritation or infection. Normal urine output in adults is approximately 0.5 mL/kg/hr; this client’s low output suggests retention. Rationale for incorrect answers Postpartum infection (B) and endometritis (C) are possible but less immediately likely; WBC is normal at 7,500/mm³ and temperature is only mildly elevated (37.7°C). Uterine inversion (D) is a rare, acute emergency with a prolapsed uterus, not described here. Endometritis (B) typically presents with fever, uterine tenderness, and elevated WBC, absent here. Rationale for incorrect answers Postpartum infection (A) and endometritis (B) again are unlikely given stable WBC and low-grade temperature. Uterine inversion (D) does not correlate with the clinical presentation of a boggy, displaced fundus and urinary retention. The urinary tract infection (C) is most consistent with symptoms of retention, pain, and bloody urine. Take home points Boggy, displaced fundus with heavy bleeding signals uterine atony and postpartum hemorrhage risk. Urinary retention increases risk for urinary tract infection post-cesarean birth. Mild temperature elevation and normal WBC do not confirm infection but warrant monitoring. Differentiating uterine atony from uterine inversion and infection is critical for timely intervention.