Nokea
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.
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A patient delivered vaginally 20 minutes ago. Prophylactic Pitocin is infusing intravenously. During the initial postpartum assessment, the nurse notes a heavy amount of bleeding on the perineal pad. What are the priority nursing actions?
- A. Assess the perineum for lacerations and provide a clean peri-pad and ice pack.
- B. Assess the fundus and massage the uterus to determine uterine tone and location.
- C. Assess to see if the bladder is full and place an indwelling urinary catheter.
- D. Assess for clots, determine if this is a normal amount, and provide privacy during a pad change.
Correct Answer: B
Rationale: Assessing the fundus and massaging the uterus is crucial to evaluate uterine tone and location in postpartum hemorrhage.
Which client is at greatest risk for early PPH?
- A. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress
- B. Woman with severe preeclampsia on magnesium sulfate whose labor is being
- C. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
- D. Primigravida in spontaneous labor with preterm twins
Correct Answer: B
Rationale: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH
A client, G1 P1001, 1 hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time?
- A. Provide the woman with a bedpan.
- B. Advise the woman that the feeling is likely related to the trauma of delivery.
- C. Remind the woman that she still has a catheter in place from the delivery.
- D. Assist the woman to the bathroom.
Correct Answer: D
Rationale: After delivery, if the woman feels the need to urinate, assisting her to the bathroom is appropriate to allow for normal voiding. A catheter should not still be in place unless indicated.
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.
The nurse is aware the greatest source of bleeding during childbirth occurs following detachment of the placenta. Which physiological change takes place immediately after the expulsion of the placenta to decrease the amount of blood loss?
- A. Contractions of the uterine myometrium
- B. Factor VIII complex increases during gestation
- C. Platelet activity increases before labor and delivery
- D. Fibrin formation increases before the birth occurs
Correct Answer: A
Rationale: The correct answer is A: Contractions of the uterine myometrium. After the placenta is expelled, the uterine myometrium contracts, causing compression of blood vessels at the site of placental detachment, which helps to decrease blood loss. This contraction also helps to close off blood vessels and reduce the risk of postpartum hemorrhage.
Summary of other choices:
B: Factor VIII complex increases during gestation - Factor VIII is involved in blood clotting, but its increase during gestation is not directly related to decreasing blood loss after placental expulsion.
C: Platelet activity increases before labor and delivery - While platelet activity is important for blood clotting, the increase before labor and delivery does not specifically address the immediate decrease in blood loss after placental expulsion.
D: Fibrin formation increases before the birth occurs - Fibrin formation is part of the clotting process, but its increase before birth does not directly address the immediate decrease in blood loss post