A nurse is performing a postpartum assessment on a patient 2 hr following delivery of a healthy newborn. Which finding indicates the patient's bladder is distended?

A. The lochia is small with scant clots is incorrect because scant lochia is a normal finding in the immediate postpartum period. Scant lochia reflects the normal shedding of the uterine lining and is not affected by bladder distention. While abnormal lochia patterns can indicate complications such as retained placental fragments or infection, small, scant lochia alone does not suggest a distended bladder. B. The fundus is at the umbilicus and midline is incorrect because a firm, midline fundus at the umbilicus is considered a normal finding 2 hours postpartum. This indicates that the uterus is contracting appropriately and that there is no interference from bladder distention. A normal fundal position rules out bladder distention as a cause for uterine displacement. C. The lochia is moderate with no clots is incorrect because moderate lochia is also within the expected range for 2 hours postpartum and represents normal uterine bleeding as the uterus continues involution. This finding does not indicate bladder distention, although excessive bleeding or clots could signal uterine atony or retained tissue. D. The fundus is deviated to the right at U+2 is correct because a lateral displacement of the fundus, most commonly to the right, is a hallmark sign of bladder distention. The full bladder physically pushes the uterus out of midline, preventing adequate contraction. If left unrelieved, this can increase the risk of uterine atony and postpartum hemorrhage. The nurse should assist the patient to void or catheterize if necessary, then reassess the fundal position to ensure the uterus is firm and midline.