Nokea
What nursing diagnosis would be appropriate for the person with a coagulation disorder?
- A. risk for hypertension
- B. risk for bleeding
- C. risk for fluid overload
- D. risk for breast-feeding failure
Correct Answer: B
Rationale: Coagulation disorders like von Willebrand increase the risk for bleeding and hemorrhage.
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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: Hysterectomy is a surgical procedure that involves the removal of the uterus. In cases where nonsurgical treatment for late postpartum hemorrhage (PPH) is ineffective, and the cause of the condition is related to the uterus (such as retained placental tissue, uterine atony, or placenta accreta), a hysterectomy may be necessary to stop the bleeding and correct the underlying issue. Hysterectomy is considered a definitive treatment for PPH when other interventions have failed to control the bleeding.
What nursing intervention does the nurse include in the plan of care for a person with postpartum endometritis?
- A. Monitor for signs of sepsis.
- B. Discourage breast-feeding.
- C. Avoid fundal assessment.
- D. Increase family visiting hours.
Correct Answer: A
Rationale: Monitoring for signs of sepsis is crucial in cases of postpartum endometritis.
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.
Postpartum teaching related to urinary health should emphasize:
- A. Drinking any type of fluid whenever thirsty.
- B. Allowing the bladder to fill to promote emptying.
- C. Cleansing the perineum in a front-to-back direction.
- D. Eating two servings of acidic fruits or vegetables each day.
Correct Answer: C
Rationale: Proper perineal care such as wiping front to back is essential to prevent urinary tract infections after birth.
A client has been transferred to the post -anesthesia care unit from a cesarean delivery. The client had spinal anesthesia for the surgery. Which of the following interventions should the nurse perform at this time?
- A. Assess the level of the anesthesia.
- B. Encourage the client to urinate in a bedpan.
- C. Provide the client with the diet of her choice.
- D. Check the incision for signs of infection.
Correct Answer: A
Rationale: After spinal anesthesia, it's important to assess the level of anesthesia to monitor for any complications, such as a block or insufficient motor return, which can affect mobility and pain management.