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A woman is 1 hour postcesarean delivery with nausea and an estimated blood loss of 1,200 mL. She is currently experiencing heavy vaginal bleeding and has a uterus that firms with massage. She has a history of asthma with a current O2 saturation of 89%. The licensed provider has ordered Cytotec 800 mcg and Methergine 0.2 mg. What collaborative communication should occur between the nurse and provider?
- A. Since the total blood loss is under 1,500 mL, Cytotec and Methergine administration could be delayed for a time.
- B. Cytotec should be given rectally because the patient is already nauseated, and the Methergine route should be ordered.
- C. Recommend that the abdominal dressing be removed to inspect for incisional bleeding.
- D. Recommend that the patient not get Methergine because she has a history of asthma.
Correct Answer: D
Rationale: Given the patient’s asthma, Methergine should not be administered and alternative treatments should be discussed.
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What postpartum infection can be transferred between the breast-feeding person and newborn if both are not treated appropriately?
- A. wound infection
- B. urinary tract infection
- C. thrush
- D. mastitis
Correct Answer: C
Rationale: The correct answer is C: thrush. Thrush is a fungal infection caused by Candida that can be transmitted between the breast-feeding person and the newborn if not treated appropriately. The infection can pass back and forth during breastfeeding. Thrush manifests as white patches on the tongue and inside the mouth of the newborn and as nipple pain and redness in the breast-feeding person. Wound infection (A) typically refers to an infection at the site of a surgical incision and is not transmitted between the breast-feeding person and newborn. Urinary tract infection (B) is a bacterial infection of the urinary tract and is not typically transmitted through breastfeeding. Mastitis (D) is a bacterial infection of the breast tissue and is not directly transferred between the breast-feeding person and the newborn.
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: Pain and recovery differ between cesarean and vaginal births.
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 correct answer is A. The nurse anticipates that a hematocrit will be drawn and the provider will check for retained placental fragments because heavy vaginal bleeding and extreme fatigue could indicate postpartum hemorrhage due to retained placental tissue. This is a serious complication that requires immediate medical attention to prevent further complications such as infection or hemorrhagic shock.
Choice B is incorrect because prescribing sleeping medication does not address the underlying cause of the symptoms. Choice C is incorrect because lacerations would typically have been evaluated and repaired during delivery, and would not likely be missed. Choice D is incorrect because reassuring the client without further evaluation could lead to potential serious consequences if the underlying issue of retained placental fragments is not addressed promptly.
The nurse is providing postpartum care for a patient after a vaginal delivery. Which assessment finding causes the nurse to suspect endometritis from beta-hemolytic streptococcus?
- A. Scant amount of odorless lochia
- B. Presence of headache, malaise, and chills
- C. Pain or discomfort in the midline lower abdomen
- D. Elevated temperature greater than 100.4°F (38°C)
Correct Answer: D
Rationale: Endometritis from beta-hemolytic streptococcus specifically exhibits scant, odorless lochia in addition to the more universal signs of infection.
The nurse notices the uterus is boggy and the bladder is full. What intervention should the nurse perform next?
- A. Call for help.
- B. Start IV bolus.
- C. Get the person out of bed to walk to restroom.
- D. Massage the fundus and assess the lochia.
Correct Answer: D
Rationale: Step-by-step rationale:
1. A boggy uterus indicates uterine atony, a common cause of postpartum hemorrhage.
2. A full bladder can prevent the uterus from contracting effectively.
3. Massaging the fundus helps stimulate contractions to prevent further bleeding.
4. Assessing lochia provides information on the amount and type of bleeding.
5. This intervention addresses the underlying issue and promotes uterine contraction, reducing the risk of hemorrhage.
Other choices are incorrect:
A: Calling for help is not the immediate intervention needed to address the uterine atony and full bladder.
B: Starting an IV bolus may be necessary later but is not the priority in this situation.
C: Getting the person out of bed is not appropriate when managing postpartum hemorrhage; addressing uterine atony is crucial.