A nurse on a postpartum unit is caring for a client. For each finding, click to specify if the finding is consistent with uterine atony or infection. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Rationale: • High parity: Multiple prior pregnancies overstretch the uterine muscle, reducing its ability to contract effectively after delivery. Decreased uterine tone interferes with compression of uterine blood vessels, increasing the risk of postpartum hemorrhage. This makes high parity a classic and well-established risk factor for uterine atony. • Prolonged rupture of membranes: Rupture of membranes lasting longer than 18–24 hours allows ascending vaginal flora to enter the uterine cavity. This significantly increases the risk of postpartum uterine infection, including endometritis. The client’s 28-hour rupture combined with fever and foul-smelling lochia strongly supports infection. • Polyhydramnios: Excessive amniotic fluid causes overdistention of the uterus, which can impair uterine muscle contraction after birth. Poor uterine contraction prevents effective involution and promotes uterine atony. • Prenatal anemia: Anemia weakens the body’s immune response and reduces tissue oxygenation, increasing susceptibility to infection. Clients with anemia are at higher risk for postpartum infectious complications, especially after cesarean delivery. Anemia contributes to vulnerability rather than uterine tone issues.