Nokea
Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate?
- A. PPH is easy to recognize early; after all, the woman is bleeding.
- B. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH.
- C. If anything, nurses and physicians tend to overestimate the amount of blood loss.
- D. Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.
Correct Answer: B
Rationale: The most accurate statement regarding the basic definitions and incidence data of postpartum hemorrhage (PPH) is statement B. Traditionally, PPH is defined as losing more than 1000 ml of blood after vaginal birth and more than 2500 ml after cesarean birth. This definition helps healthcare providers recognize and diagnose PPH based on the amount of blood loss, which is crucial for prompt intervention and management.
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The nurse is assessing a patient who is 36 hours postpartum following a cesarean delivery. Which findings cause the nurse to conclude that a wound infection is developing? Select all that apply.
- A. Temperature increase from 99.8°F to 100.5°F
- B. Incisional tenderness with palpation
- C. Increased margins of incisional redness
- D. Notably warm skin around the incision
Correct Answer: C
Rationale: An increase in redness in the incisional margins is a likely sign of developing wound infection. When the skin around a surgical incision is notably warm to the touch, it is likely a sign of a developing wound infection.
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.
The nurse is preparing discharge teaching for a postpartum patient who exhibits signs and symptoms of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management?
- A. Application of hot packs to the perineal area
- B. Information applicable to medication therapy
- C. Instructions to improve circulation by ambulating
- D. Medicating for pain above level 4 on a 0 to 10 scale
Correct Answer: B
Rationale: The correct answer is B: Information applicable to medication therapy. The rationale is that proper pain management is crucial for patient comfort and healing. The nurse should educate the patient on the importance of taking the prescribed pain medication as directed to manage pain effectively. This includes information on dosage, frequency, and potential side effects. Hot packs (Choice A) may not be recommended for an infected episiotomy as heat can exacerbate the infection. Ambulation (Choice C) is important for circulation, but it may not directly address pain management. Medicating for pain above level 4 (Choice D) is vague and does not provide specific guidance on when to take pain medication.
Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence the causes and incidence of obstetric lacerations of the lower genital tract? (Select all that apply.)
- A. Operative and precipitate births
- B. Adherent retained placenta
- C. Abnormal presentation of the fetus
- D. Congenital abnormalities of the maternal soft tissue
Correct Answer: A
Rationale: A. Operative and precipitate births: Obstetric lacerations of the lower genital tract are more likely to occur during operative deliveries (such as forceps or vacuum-assisted deliveries) and precipitate births (very rapid deliveries) due to the increased forces and speed involved during these types of deliveries.
A client, G1 P1, who had an epidural, has just delivered a daughter, Apgar 9/9, over a mediolateral episiotomy. The physician used low forceps. While recovering, the client states, 'I 'm a failure. I couldn 't stand the pain and couldn 't even push my baby out by myself! ' Which of the following is the best response for the nurse to make?
- A. You 'll feel better later after you have had a chance to rest and to eat.
- B. Don 't say that. There are many women who would be ecstatic to have that baby.
- C. I am sure that you will have another baby. I bet that it will be a natural delivery.
- D. To have things work out differently than you had planned is disappointing.
Correct Answer: D
Rationale: The nurse should acknowledge the emotional distress and disappointment while offering validation and understanding about how things didn't go as expected.