Nokea
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
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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: The correct answer is A because operative and precipitate births increase the risk of obstetric lacerations due to the rapid delivery or use of instruments. Operative births involve interventions like forceps or vacuum extraction, which can cause trauma. Precipitate births, characterized by rapid labor and delivery, may lead to tearing of the lower genital tract. Choices B, C, and D are incorrect as they do not directly influence the causes and incidence of obstetric lacerations. Adherent retained placenta, abnormal fetal presentation, and congenital abnormalities of maternal soft tissue are not primary factors contributing to lacerations during childbirth.
A 2-day-postpartum breastfeeding woman states, 'I am sick of being fat. When can I go on a diet? ' Which of the following responses is appropriate?
- A. It is fine for you to start dieting right now as long as you drink plenty of milk. '
- B. Your breast milk will be low in vitamins if you start to diet while breastfeeding. '
- C. You must eat at least 3,000 calories per day in order to produce enough milk for your baby. '
- D. Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day. '
Correct Answer: D
Rationale: Breastfeeding can help with postpartum weight loss, as the body burns calories producing milk.
What is the most common reason for cracked, sore nipples?
- A. hungry infant
- B. pumping
- C. ineffective latch
- D. lack of supportive bra
Correct Answer: C
Rationale: Ineffective latch causes sore nipples in breastfeeding mothers.
The third stage of labor has just ended for a client who has decided to bottle feed her baby. Which of the following maternal hormones will increase sharply at this time?
- A. Estrogen.
- B. Prolactin.
- C. Human placental lactogen.
- D. Human chorionic gonadotropin.
Correct Answer: B
Rationale: After delivery, prolactin levels rise to stimulate milk production, even if the mother has decided to bottle feed. Estrogen and other hormones also fluctuate, but prolactin will be the most significant in this case.
A woman is 1 hour postcesarean delivery with nausea and an estimated blood loss of 1,200 mL. She is currently experiencing heavy vaginal bleeding and has a uterus that firms with massage. She has a history of asthma with a current O2 saturation of 89%. The licensed provider has ordered Cytotec 800 mcg and Methergine 0.2 mg. What collaborative communication should occur between the nurse and provider?
- A. Since the total blood loss is under 1,500 mL, Cytotec and Methergine administration could be delayed for a time.
- B. Cytotec should be given rectally because the patient is already nauseated, and the Methergine route should be ordered.
- C. Recommend that the abdominal dressing be removed to inspect for incisional bleeding.
- D. Recommend that the patient not get Methergine because she has a history of asthma.
Correct Answer: D
Rationale: Given the patient’s asthma, Methergine should not be administered and alternative treatments should be discussed.