Nokea
The nurse is assessing a patient who is 12 hours postpartum. The uterus is firm to palpation, at midline, and is 1 cm below the umbilicus with continuous heavy vaginal bleeding. What is the nurse’s first action?
- A. Massage the uterus and resume the IV Pitocin drip.
- B. Change the peri-pad and reassess the bleeding.
- C. Call the provider to check for a cervical laceration.
- D. Administer the ordered iron supplement and ibuprofen.
Correct Answer: A
Rationale: The correct answer is A: Massage the uterus and resume the IV Pitocin drip. The patient is showing signs of uterine atony with heavy vaginal bleeding. Massaging the uterus helps stimulate contractions, controlling bleeding. Resuming IV Pitocin enhances uterine contractions further. Choices B, C, and D are incorrect. Changing the peri-pad does not address the underlying cause of bleeding. Checking for a cervical laceration may be needed later but is not the immediate priority. Administering iron supplement and ibuprofen does not address the acute issue of uterine atony and bleeding.
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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.
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: Desmopressin (DDAVP) is the initial treatment for a client with von Willebrand disease (vWD) who experiences a postpartum hemorrhage (PPH). Desmopressin works by releasing von Willebrand factor (vWF) stored in the endothelial cells, increasing the levels of vWF and factor VIII. This can help improve clotting function in patients with vWD, thereby helping to stop the bleeding. It is a safe and effective treatment for many individuals with vWD and is often used as the first-line therapy in cases of bleeding episodes or surgeries. Cryoprecipitate may also be used in severe bleeding situations if desmopressin is ineffective. Hemabate is not indicated for the treatment of vWD and PPH.
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.
The nurse is taking the postpartum patient’s vital signs. The newborn is across the room in the bassinet, and the postpartum person refuses to hold the newborn. What should the nurse do?
- A. Call CPS for risk of child abuse
- B. Ask the person if they are feeling depressed, hopeless, afraid, or overwhelmed.
- C. Ask the health-care provider to order an antidepressant.
- D. Discuss how good parents hold and talk to their newborns.
Correct Answer: B
Rationale: The correct answer is B. The nurse should ask the postpartum person if they are feeling depressed, hopeless, afraid, or overwhelmed. This is important because it can help assess the person's mental and emotional state, which could be contributing to their refusal to hold the newborn. It also shows empathy and support for the person's feelings.
Choice A is incorrect because calling Child Protective Services (CPS) would be premature and could escalate the situation unnecessarily. Choice C is incorrect as starting an antidepressant should only be considered after a thorough evaluation by a healthcare provider. Choice D is incorrect because it does not address the underlying issue of the person's emotional state and may come off as judgmental.
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 nurse will need to provide applicable discharge teaching for both antibiotic and analgesic therapy. Antibiotics need to be taken as ordered and until they are gone.