Nokea
A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following?
- A. Weight of the uterine body is significantly reduced.
- B. Excess blood volume from pregnancy is circulating in the woman 's periphery.
- C. Cervix is fully dilated and the lochia flows freely.
- D. Maternal blood pressure drops precipitously once the baby 's head emerges.
Correct Answer: B
Rationale: During the first hour postpartum, the excess blood volume that was circulating to the uterus is redistributed to the woman's peripheral circulation, which can lead to cardiovascular instability.
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A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate?
- A. Take the woman 's temperature.
- B. Advise the woman to decrease her fluid intake.
- C. Reassure the woman that this is normal.
- D. Notify the neonate 's pediatrician.
Correct Answer: C
Rationale: Profuse diaphoresis is a common and normal occurrence in the first 24 hours postpartum as the body works to eliminate excess fluid accumulated during pregnancy.
What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?
- A. Uterine atony
- B. Lacerations of the genital tract
- C. Perineal hematoma
- D. Infection of the uterus
Correct Answer: A
Rationale: The steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests uterine atony. Uterine atony is a condition where the uterus fails to contract effectively after childbirth, resulting in postpartum hemorrhage. The firm fundus indicates that the uterus is not properly contracting to control bleeding, leading to the continuous flow of blood from the vagina. Prompt intervention is crucial to manage uterine atony and prevent further complications such as excessive blood loss.
The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply.
- A. Increases in maternal age
- B. Prepregnancy obesity
- C. Cesarean deliveries
- D. Inability to pay for health care
Correct Answer: B
Rationale: The correct answer is B: Prepregnancy obesity. This is because obesity is a well-established risk factor for severe maternal morbidity. Obesity increases the likelihood of complications during pregnancy and childbirth, such as gestational diabetes, preeclampsia, and cesarean deliveries.
A: Increases in maternal age may be a risk factor for certain complications but not directly related to SMM.
C: Cesarean deliveries can be a risk factor for SMM, but it is not the main cause.
D: Inability to pay for health care is a social determinant of health and may impact access to care, but it is not a direct cause of SMM.
A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her baby. Which of the following responses by the nurse is appropriate?
- A. Suggest that the woman bottle feed for a few days.
- B. Instruct the patient on how to massage her fundus.
- C. Instruct the patient to feed using an alternate position.
- D. Discuss the action of breastfeeding hormones.
Correct Answer: D
Rationale: Breastfeeding stimulates the release of oxytocin, which causes uterine contractions that may lead to cramping.
A breastfeeding client, 7 weeks postpartum, complains to an obstetrician 's triage nurse that when she and her husband had intercourse for the first time after the delivery, 'I couldn 't stand it. It was so painful. The doctor must have done something terrible to my vagina. ' Which of the following responses by the nurse is appropriate?
- A. After a delivery the vagina is always very tender. It should feel better the next time you have intercourse. '
- B. Does your baby have thrush? If so, you should be assessed for a yeast infection in your vagina. '
- C. Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort. '
- D. Sometimes the stitches of episiotomies heal too tight. Why don 't you come in to be checked? '
Correct Answer: C
Rationale: Vaginal dryness is a common issue for breastfeeding women, and using a vaginal lubricant can help reduce discomfort during intercourse.