Nokea
What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?
- A. Uterine atony
- B. Lacerations of the genital tract
- C. Perineal hematoma
- D. Infection of the uterus
Correct Answer: A
Rationale: The correct answer is A: Uterine atony. A steady trickle of bright red blood with a firm fundus suggests uterine atony, which is the inability of the uterus to contract effectively after childbirth. This can lead to postpartum hemorrhage. Other choices are incorrect as they do not align with the clinical presentation. B: Lacerations of the genital tract would present with more active bleeding and not a steady trickle. C: Perineal hematoma involves bleeding in the perineal area, not from the vagina. D: Infection of the uterus would typically present with other symptoms like fever and foul-smelling discharge.
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The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis?
- A. Absence of cyanosis in the buccal mucosa
- B. Cool, dry skin
- C. Calm mental status
- D. Urinary output of at least 30 ml/hr
Correct Answer: D
Rationale: Hemorrhagic shock is characterized by inadequate tissue perfusion due to severe blood loss, leading to decreased circulating volume. The body's compensatory mechanisms kick in to maintain blood pressure, causing the peripheral blood vessels to constrict. This constriction can lead to cool, clammy, and pale skin as the body shunts blood away from the skin's surface to the vital organs. The skin may also feel cool to the touch due to reduced perfusion. This observation is significant in indicating hemorrhagic shock because it signifies the body's response to the insufficient circulating volume and the need to prioritize perfusion to essential organs.
What is a risk factor for uterine atony?
- A. small for gestational age
- B. primipara
- C. multiple gestation
- D. intrauterine growth restriction
Correct Answer: C
Rationale: Multiple gestation increases the risk of uterine atony due to over-distention of the uterus.
Research has shown what intervention increases involvement of the adolescent partner postpartum?
- A. involvement of the partner during the prenatal period
- B. involvement of parents in decision making
- C. restricting people in the labor room
- D. providing newborn care in the nursery
Correct Answer: A
Rationale: Involving the partner early in the process increases their engagement and involvement postpartum.
The nurse is caring for a postpartum woman and her 2-hour-old baby. The new mother has been preoccupied with breastfeeding and visitors, but suddenly she complains of dizziness and is light-headed. Which response by the nurse is appropriate?
- A. Explain that she needs to drink more fluids and eat because she needs to replace fluids and calories.
- B. Encourage the patient to rest, and ask a family member to watch the newborn in the crib.
- C. Tell the patient that the dizziness is probably caused by her pain medication and that it is normal.
- D. Obtain vital signs, assess fundal tone, and observe for excessive lochia.
Correct Answer: D
Rationale: The correct response is D because the new mother's complaint of dizziness and light-headedness could indicate postpartum hemorrhage, a common complication. Obtaining vital signs will help assess for signs of shock. Assessing fundal tone can determine if the uterus is contracting properly to prevent excessive bleeding. Observing for excessive lochia is important to monitor for increased bleeding. Choice A is incorrect because the symptoms are not solely due to dehydration or lack of calories. Choice B is incorrect as the nurse should assess the mother first before delegating care to family members. Choice C is incorrect as dizziness is not a common side effect of pain medication in the postpartum period.
The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply.
- A. Increases in maternal age
- B. Prepregnancy obesity
- C. Cesarean deliveries
- D. Inability to pay for health care
Correct Answer: B
Rationale: Documented increases in maternal age is a likely cause for SMM; older women have increased risk. Obesity is a general health risk in the United States; prepregnancy obesity causes increased incidences of SMM. Cesarean deliveries are increasing, and surgical procedures always carry a risk for complications. Preexisting chronic medical conditions are a contributor to the increasing rates of SMM.