Nokea
A postpartum patient calls the clinic 4 days after the birth of her newborn because she is extremely tired and her vaginal bleeding is heavier. Which does the nurse anticipate when advising her to come in to the office right now?
- A. A hematocrit will be drawn, and the licensed provider will check for retained placental fragments.
- B. Her stress level and sleep deprivation will be evaluated, and a prescription for sleeping medication will be given.
- C. The perineum will be evaluated for lacerations that were missed.
- D. Reassure the client that this is all normal and provide a prescription for slow-release iron tablets.
Correct Answer: A
Rationale: The patient is presenting symptoms of postpartum hemorrhage and retained placental fragments, which requires prompt evaluation.
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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.
Why does the nurse encourage ambulation in a patient who has experienced a cesarean birth?
- A. Ambulation helps to prevent DVT.
- B. Ambulation causes the person to lose weight in the hospital.
- C. Ambulation helps with breast-feeding.
- D. Ambulation decreases peristalsis.
Correct Answer: B
Rationale: The correct answer is B because ambulation after a cesarean birth helps the patient to lose weight. Walking promotes circulation, aids in healing, and can prevent complications such as blood clots and pneumonia. It also helps to restore strength and energy levels. Choices A, C, and D are incorrect because ambulation primarily benefits the patient's overall well-being and recovery, rather than directly preventing DVT, aiding breastfeeding, or decreasing peristalsis.
What is one difference between recovery from a cesarean birth versus a vaginal birth?
- A. Breast-feeding is discouraged after cesarean birth due to pain medications taken.
- B. Lochia will be heavier after a cesarean birth.
- C. Pain with movement is more intense after a cesarean birth.
- D. Gas pain is more intense after a vaginal birth.
Correct Answer: C
Rationale: Recovery from a cesarean birth typically involves more intense pain due to abdominal incisions and a longer recovery period.
What is a risk factor for PPH found in the prenatal record?
- A. primipara
- B. rubella nonimmune
- C. von Willebrand disorder
- D. history of appendectomy
Correct Answer: C
Rationale: Von Willebrand disorder is a bleeding disorder that increases the risk of postpartum hemorrhage due to impaired clotting.
The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider? Select all that apply.
- A. Foul-smelling lochia
- B. Hot, red, painful breasts
- C. Mild headache
- D. Not sleeping well
Correct Answer: A
Rationale: The correct answer is A: Foul-smelling lochia. This indicates a possible infection in the uterus, which requires medical attention to prevent complications. Hot, red, painful breasts (B) may indicate mastitis, which also requires medical intervention. Mild headache (C) and not sleeping well (D) are common postpartum issues but do not typically require immediate medical attention. In summary, choices B, C, and D are incorrect because they are common postpartum symptoms that do not necessarily warrant contacting the primary care provider, unlike foul-smelling lochia (A), which could indicate a serious issue.