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What should the nurse's first action be when postpartum hemorrhage from uterine atony is suspected?
- A. Teach the patient how to massage the abdomen and then get help.
- B. Start IV fluids to prevent hypovolemia and then notify the registered nurse.
- C. Begin massaging the fundus while another person notifies the physician.
Correct Answer: C
Rationale: Massaging the fundus is the immediate action to stimulate uterine contractions and control bleeding, while another person notifies the physician for further management.
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What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery?
- A. Well-contracted with its upper border at or just below the umbilicus
- B. Well-contracted with its upper border three or four fingerbreadths above the umbilicus
- C. Relaxed with its upper border level with the umbilicus
- D. Relaxed with its upper border two or three fingerbreadths below the umbilicus
Correct Answer: A
Rationale: Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a grapefruit, at the level of the umbilicus.
A woman asks about resumption of her menstrual cycle after childbirth. What should the nurse respond?
- A. A woman will not ovulate in the absence of menstrual flow.
- B. Most nonlactating women resume menstruation about 2 months postpartum.
- C. Generally, a woman does not ovulate in the first few cycles after childbirth.
- D. The return of menstruation is delayed when a woman does not breastfeed.
Correct Answer: B
Rationale: Menstrual periods resume in about 6 to 8 weeks if the woman is not breastfeeding.
After delivery, the nurse's assessment reveals a soft, boggy uterus located above the level of the umbilicus. What is the most appropriate nursing intervention?
- A. Notify the physician.
- B. Massage the fundus.
- C. Initiate measures that encourage voiding.
- D. Position the patient flat.
Correct Answer: B
Rationale: A poorly contracted uterus should be massaged until firm to prevent hemorrhage.
Although the nurse has massaged the uterus every 15 minutes, it remains flaccid, and the patient continues to pass large clots. What does the nurse recognize these signs indicate?
- A. Uterine atony
- B. Uterine dystocia
- C. Uterine hypoplasia
- D. Uterine dysfunction
Correct Answer: A
Rationale: Atony describes a lack of normal muscle tone. If the uterus is atonic, then muscle fibers are flaccid and will not compress bleeding vessels.
Which statement indicates the new mother is breastfeeding correctly?
- A. I will alternate breasts when feeding the baby.'
- B. I keep the baby on a 4-hour feeding schedule.'
- C. I let the baby stay on the first breast only 5 minutes.'
- D. I put only the nipple in the baby's mouth when I am breastfeeding.'
Correct Answer: A
Rationale: Alternating breasts for feeding increases milk production, particularly hindmilk, which has a higher protein and fat content.