When performing a fundal assessment, what should the nurse do first?

• A. Turn on her side
• B. Lie flat on her back with the knees and legs flat and straight
• C. Urinate and empty her bladder
• D. Massage the fundus gently before determining the level

Answer: (C)

A primary step in accurately assessing the fundus is ensuring the bladder is empty. A full bladder can elevate and shift the uterus, making it difficult to locate the fundus and to judge its height and firmness correctly. By asking the patient to urinate first, you remove this distortion and create a clean baseline for evaluation.

Once the bladder is empty, position the patient supine with knees bent to relax the abdominal muscles, then locate the fundus by gentle palpation. You’ll determine its height (how high it sits relative to the umbilicus), its position, and its tone. If the fundus feels boggy or oversized, you would address that after locating it, typically with gentle fundal massage to promote contraction. The other options—changing position or massaging before locating the fundus—do not support an accurate initial assessment.