Nokea
A patient delivered vaginally 20 minutes ago. Prophylactic Pitocin is infusing intravenously. During the initial postpartum assessment, the nurse notes a heavy amount of bleeding on the perineal pad. What are the priority nursing actions?
- A. Assess the perineum for lacerations and provide a clean peri-pad and ice pack.
- B. Assess the fundus and massage the uterus to determine uterine tone and location.
- C. Assess to see if the bladder is full and place an indwelling urinary catheter.
- D. Assess for clots, determine if this is a normal amount, and provide privacy during a pad change.
Correct Answer: B
Rationale: Assessing the fundus and massaging the uterus is crucial to evaluate uterine tone and location in postpartum hemorrhage.
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The nurse evaluates a postpartum couplet for parent-infant attachment. What finding would be concerning?
- A. The postpartum person is sleepy.
- B. Parents are both caring for the infant.
- C. The parent is disinterested in the infant.
- D. The family is involved.
Correct Answer: C
Rationale: A lack of interest or emotional engagement with the infant is a concerning sign that may indicate attachment issues.
The nurse in the obstetric clinic received a telephone call from a bottle-feeding mother of a 3-day-old. The client states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform?
- A. Intermittently apply ice packs to her axillae and breasts.
- B. Apply lanolin to her breasts and nipples every 3 hours.
- C. Express milk from the breasts every 3 hours.
- D. Ask the primary health care provider to order a milk suppressant.
Correct Answer: A
Rationale: Ice packs can help reduce inflammation and pain associated with engorgement in women who choose to bottle-feed.
The nurse develops a plan to increase a patient’s milk supply. What is an intervention they can implement?
- A. Pump between nursing sessions.
- B. Nurse every 6 hours.
- C. Keep newborn in bassinet between sessions.
- D. Offer a pacifier when newborn cries.
Correct Answer: A
Rationale: Pumping between nursing sessions can increase milk supply.
A patient who has been on prolonged bedrest for bleeding associated with placenta previa was taken to the operating room for an emergency cesarean delivery. Sixteen hours postoperatively, the patient complains that her left leg is hurting. The nurse finds that the entire left leg is swollen and has pitting edema, while the right leg appears to be normal. Which order does the nurse anticipate when paging the health care provider to the room?
- A. White blood cell count (WBC)
- B. Ultrasound of the leg
- C. X-ray of the leg
- D. Serum creatinine
Correct Answer: B
Rationale: The correct answer is B: Ultrasound of the leg. In this scenario, the patient is at risk for deep vein thrombosis (DVT) due to prolonged bedrest and recent surgery. The symptoms of leg pain, swelling, and pitting edema raise suspicion for DVT. An ultrasound of the leg is the most appropriate diagnostic test to confirm the presence of a blood clot. This test is non-invasive, highly sensitive, and specific for detecting DVT. It allows for prompt diagnosis and initiation of appropriate treatment such as anticoagulation therapy to prevent potential complications like pulmonary embolism.
Summary:
- A: White blood cell count (WBC) is not indicated for evaluating leg pain and swelling in this context.
- C: X-ray of the leg is not useful for diagnosing DVT, as it primarily shows bones and is not sensitive for detecting blood clots.
- D: Serum creatinine is a test for kidney function and is not relevant for assessing
Which is the initial treatment for the client with vWD who experiences a PPH?
- A. Cryoprecipitate
- B. Factor VIII and von Willebrand factor (vWf)
- C. Desmopressin
- D. Hemabate
Correct Answer: C
Rationale: The correct initial treatment for vWD client with PPH is desmopressin (Choice C) because it stimulates the release of von Willebrand factor and factor VIII from storage sites, helping to improve clotting. Cryoprecipitate (Choice A) contains multiple clotting factors and is usually reserved for severe bleeding. Factor VIII and vWf (Choice B) can be used for severe cases but are not typically the initial treatment. Hemabate (Choice D) is a medication used for postpartum hemorrhage due to uterine atony, not specifically for vWD-related bleeding.