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A woman has an 8-lb, 9-oz baby after an 18-hour labor that required a vacuum extraction. Her membranes have been ruptured for 15 hours. Based on these facts, client teaching should emphasize:
- A. Reporting foul-smelling lochia and fever.
- B. Delaying intercourse for at least 6 weeks.
- C. Eating a diet that is high in iron and vitamin C.
- D. Losing weight over at least a 6-month period.
Correct Answer: A
Rationale: Prolonged rupture of membranes increases the risk of infectionand the woman should report any signs of infection such as foul-smelling lochia or fever.
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The nurse and provider estimate the blood loss at delivery to be 400 mL in the measuring drape; now when doing the initial perineal care, the nurse finds a large amount of blood underneath the patient. What action reflects safe and accurate nursing care?
- A. Estimate the amount of blood loss from the sheet and client clothing, and notify the physician.
- B. Encourage the mother to report any additional bleeding or clots.
- C. Draw the ordered hematocrit and notify the provider if the result is less than 28.
- D. Weigh the blood-soaked linens and notify the provider of the additional blood loss.
Correct Answer: D
Rationale: The correct answer is D. Weighing the blood-soaked linens provides an accurate measurement of the additional blood loss, which is crucial for assessing the patient's condition accurately. Here's the rationale step-by-step:
1. Weighing the blood-soaked linens is an objective and precise method to quantify the additional blood loss.
2. This measurement helps to determine the total blood loss accurately, which is essential for assessing postpartum hemorrhage.
3. Providing this quantitative data to the provider enables them to make informed decisions about further interventions.
4. Estimating blood loss visually is subjective and can be inaccurate, leading to potential underestimation or overestimation.
5. Drawing hematocrit levels (choice C) may provide valuable information but does not directly address the immediate need to quantify the additional blood loss.
6. Encouraging the mother to report bleeding (choice B) is important for ongoing assessment but does not provide an objective measurement of the blood loss.
In summary
What is characteristic of an early (primary) PPH?
- A. occurs after 12 weeks postpartum
- B. is not an emergency
- C. often occurs due to uterine atony
- D. is diagnosed after the person is discharged
Correct Answer: C
Rationale: The correct answer is C because early (primary) postpartum hemorrhage (PPH) often occurs due to uterine atony, which is the inability of the uterus to contract effectively after childbirth. This leads to excessive bleeding within 24 hours of delivery. Choice A is incorrect because early PPH occurs within 24 hours postpartum, not after 12 weeks. Choice B is incorrect because early PPH is indeed an emergency due to the risk of rapid blood loss. Choice D is incorrect as early PPH is typically diagnosed before or shortly after discharge, not after.
The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room?
- A. Ask the patient how many peripads she considered to be “soaked.”
- B. Collect blood in calibrated, under-buttocks drapes for vaginal birth.
- C. Place a basin at the foot of the delivery table to catch any blood.
- D. Rely on the primary health care provider’s estimate of blood loss.
Correct Answer: B
Rationale: Collecting blood in calibrated, under-buttocks drapes for vaginal birth and then weighing the drapes is the easiest way to estimate blood loss in the delivery room.
A client has just been transferred to the postpartum unit from labor and delivery. Which of the following tasks should the registered nurse delegate to the nursing care assistant?
- A. Assess client 's fundal height.
- B. Teach client how to massage her fundus.
- C. Take the client 's vital signs.
- D. Document quantity of lochia in the chart.
Correct Answer: C
Rationale: The nursing care assistant can take vital signs, while the registered nurse is responsible for more complex assessments like fundal height and teaching skills such as massaging the fundus.
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 increases the risk of bleeding and PPH.