Nokea
What is characteristic of a late (secondary) PPH?
- A. occurs within the first 24 hours
- B. is caused by subinvolution of the uterus
- C. does not occur after cesarean births
- D. cannot be treated with Methergine
Correct Answer: B
Rationale: The correct answer is B because late (secondary) postpartum hemorrhage (PPH) is typically caused by subinvolution of the uterus, leading to persistent bleeding after the first 24 hours postpartum. This is due to inadequate contraction of the uterus to stop bleeding from the placental site.
Choice A is incorrect because a late PPH occurs after the first 24 hours, not within it. Choice C is incorrect because late PPH can occur after cesarean births as well. Choice D is incorrect because Methergine is commonly used to treat late PPH by promoting uterine contractions and controlling bleeding.
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A woman had a cesarean section yesterday. She states that she needs to cough but that she is afraid to. Which of the following is the nurse 's best response?
- A. I know that it hurts but it is very important for you to cough.
- B. Let me check your lung fields to see if coughing is really necessary.
- C. If you take a few deep breaths in, that should be as good as coughing.
- D. If you support your incision with a pillow, coughing should hurt less.
Correct Answer: D
Rationale: Supporting the incision with a pillow while coughing reduces the strain on the surgical site, making it less painful.
What assessment finding would indicate a fluid volume deficit?
- A. skin tenting with testing of skin turgor
- B. hypertension
- C. bradycardia
- D. bounding pulse
Correct Answer: A
Rationale: Skin tenting indicates dehydration, a sign of fluid volume deficit.
The day after delivery, a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong: 'All I do is go to the bathroom. ' Which of the following is an appropriate nursing response?
- A. Catheterize the client per doctor 's orders.
- B. Measure the client 's next voiding.
- C. Inform the client that polyuria is normal.
- D. Check the specific gravity of the next voiding.
Correct Answer: C
Rationale: Polyuria, or frequent urination, is a normal phenomenon during the postpartum period as the body expels excess fluid.
If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition?
- A. Hysterectomy
- B. Laparoscopy
- C. Laparotomy
- D. Dilation and curettage (D&
Correct Answer: A
Rationale: The correct answer is A: Hysterectomy. Hysterectomy is the appropriate surgical procedure for late postpartum hemorrhage (PPH) when nonsurgical treatments fail. It involves the removal of the uterus, which can effectively stop the bleeding. Other choices like Laparoscopy (B) and Laparotomy (C) are surgical techniques used to access the abdomen but do not address the underlying cause of PPH. Dilation and curettage (D&C) (D) is a procedure to remove tissue from the uterus and would not be effective in treating late PPH.
A bottle-feeding woman, 11 1/2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated 2 pads in the past 1 hour. Which of the following responses by the nurse is appropriate?
- A. You must be doing too much. Lie down for a few hours and call back if the bleeding has not subsided.
- B. You are probably getting your period back. You will bleed like that for a day or two and then it will lighten up.
- C. It is not unusual to bleed heavily every once in a while after a baby is born. It should subside shortly.
- D. It is important for you to be examined by the doctor today. Let me check to see when you can come in.
Correct Answer: D
Rationale: Saturating 2 pads in 1 hour could indicate abnormal bleeding or a complication. Immediate evaluation by a healthcare provider is necessary.