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Which is the initial treatment for the client with vWD who experiences a PPH?
- A. Cryoprecipitate
- B. Factor VIII and von Willebrand factor (vWf)
- C. Desmopressin
- D. Hemabate
Correct Answer: C
Rationale: The correct initial treatment for vWD client with PPH is desmopressin (Choice C) because it stimulates the release of von Willebrand factor and factor VIII from storage sites, helping to improve clotting. Cryoprecipitate (Choice A) contains multiple clotting factors and is usually reserved for severe bleeding. Factor VIII and vWf (Choice B) can be used for severe cases but are not typically the initial treatment. Hemabate (Choice D) is a medication used for postpartum hemorrhage due to uterine atony, not specifically for vWD-related bleeding.
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The nurse is developing a plan of care for the postpartum client during the 'taking hold ' phase. Which of the following should the nurse include in the plan?
- A. Provide the client with a nutritious meal.
- B. Encourage the client to take a nap.
- C. Assist the client with activities of daily living.
- D. Assure the client that she is an excellent mother.
Correct Answer: C
Rationale: During the 'taking hold' phase, the mother is more focused on newborn care and regaining control. Assisting with daily activities supports her autonomy.
What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony?
- A. Establishing venous access
- B. Performing fundal massage
- C. Preparing the woman for surgical intervention
- D. Catheterizing the bladder
Correct Answer: B
Rationale: The correct answer is B: Performing fundal massage. Fundal massage helps to stimulate contractions of the uterus, which can help control bleeding in cases of uterine atony. This is a primary nursing responsibility to address the immediate cause of the hemorrhage. Establishing venous access (choice A) is important but not the primary responsibility in this situation. Preparing for surgical intervention (choice C) may be necessary if conservative measures fail, but it is not the initial step. Catheterizing the bladder (choice D) is not directly related to managing obstetric hemorrhage associated with uterine atony.
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.
Nurses need to understand the basic definitions and incidence data regarding PPH. Which statement regarding this condition is most accurate?
- A. PPH is easy to recognize early; after all, the woman is bleeding.
- B. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH.
- C. If anything, nurses and physicians tend to overestimate the amount of blood loss.
- D. Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.
Correct Answer: B
Rationale: The most accurate statement regarding the basic definitions and incidence data of postpartum hemorrhage (PPH) is statement B. Traditionally, PPH is defined as losing more than 1000 ml of blood after vaginal birth and more than 2500 ml after cesarean birth. This definition helps healthcare providers recognize and diagnose PPH based on the amount of blood loss, which is crucial for prompt intervention and management.
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: The correct answer is D: Recommend that the patient not get Methergine because she has a history of asthma. Methergine is contraindicated in patients with a history of asthma due to its potential to cause bronchospasm and worsen respiratory function. As the patient has a history of asthma with a current low O2 saturation, administering Methergine could exacerbate her respiratory status. Collaborative communication between the nurse and provider is crucial to ensure patient safety and avoid potential complications.
Summary of other choices:
A: Delaying administration of Cytotec and Methergine is not appropriate as the patient is experiencing heavy vaginal bleeding and needs prompt management.
B: Giving Cytotec rectally and considering the route for Methergine do not address the contraindication of Methergine in a patient with asthma.
C: Removing the abdominal dressing to inspect for incisional bleeding may be necessary but does not address the contraindication of Methergine in a