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A charge nurse is discussing risk factors for postpartum hemorrhage with a newly licensed nurse.
Which of the following conditions should the nurse include as a risk factor?
- A. Oligohydramnios.
- B. Breech presentation.
- C. Retained placental fragments.
- D. Urinary tract infection.
Correct Answer: C
Rationale: Retained placental fragments prevent uterine contraction, a significant risk factor for postpartum hemorrhage.
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Nurses' Notes: The client, who is 28 weeks gestation, gravida 4, para 3, reports a history of vaginal bleeding for the past 2 hours. She states, 'I started bleeding a couple of hours ago, but now I am saturating pads with bright red blood. I’m scared something is going to happen to my baby.' Blood is trickling down her legs. She denies abdominal pain. A perineal pad is saturated with bright red vaginal bleeding. Physical Examination Results: Fundal height is 27 cm. No uterine contractions or irritability. Fetal heart rate: 170/min, minimal variability, no decelerations. Diagnostic Results: Urine: Leukocyte esterase positive, Nitrites positive, Red blood cells: 6.
Complete the diagram by dragging from the choices below to specify: Potential Condition, Actions to Take (Select 2), Parameters to Monitor (Select 2). Potential Condition Choices: A. Placenta previa, B. Abruptio placentae, C. Preterm labor, D. Uterine rupture. Actions: A. Administer methotrexate, B. Administer broad-spectrum antibiotics, C. Prepare for an emergency cesarean birth, D. Reinforce bed rest and maintain IV access, E. Encourage ambulation. Parameters: A. Fetal heart rate, B. Maternal oxygen saturation, C. WBC count, D. Urine output, E. Uterine contractions.
- A. Placenta previa
- B. Prepare for an emergency cesarean birth
- C. Reinforce bed rest and maintain IV access
- D. Fetal heart rate
- E. Maternal oxygen saturation
Correct Answer: A,C,D,A,B
Rationale: Painless bleeding suggests placenta previa; cesarean and bed rest manage it; fetal heart rate and oxygen saturation monitor stability.
A nurse is caring for a client who is pregnant and has a vaginal culture that is positive for chlamydia.
Which of the following medications should the nurse plan to administer?
- A. Acyclovir.
- B. Metronidazole.
- C. Tetracycline.
- D. Amoxicillin.
Correct Answer: D
Rationale: Amoxicillin is a safe, effective antibiotic for treating chlamydia in pregnancy, avoiding fetal harm from alternatives like tetracycline.
A nurse is reinforcing teaching with a client who is at 24 weeks of gestation and has opioid use disorder.
Which of the following statements should the nurse make?
- A. You will be prescribed methadone.
- B. You will be prescribed aripiprazole.
- C. You will be prescribed diazepam.
- D. You will be prescribed naloxone.
Correct Answer: A
Rationale: Methadone is commonly prescribed for opioid use disorder in pregnancy, safely managing withdrawal and reducing relapse risk for mother and fetus.
A nurse is caring for a client who inquires about available methods of contraception.
Which of the following actions should the nurse take?
- A. Collect a dietary history.
- B. Assess the client's socioeconomic status.
- C. Perform unbiased teaching.
- D. Select the best method of contraception for the client.
Correct Answer: C
Rationale: Performing unbiased teaching provides comprehensive contraception information, empowering the client to make an informed decision autonomously.
Nurses' Notes (Postpartum Assessment) 1200: The client successfully delivered a viable newborn via vaginal delivery. 1300: The client reports feeling tired and anxious. Assessment reveals the fundus is deviated to the left, boggy, and located 1 cm above the umbilicus. The perineal pad is saturated with lochia rubra, indicating excessive bleeding. The client reports an inability to ambulate to the bathroom due to residual numbness from the labor epidural. Pain is reported as 0 on a scale of 0 to 10. Fundal massage performed during assessment has yielded no improvement in uterine tone. A nurse is caring for a 36-year-old female client in the labor and delivery unit at 39 weeks of gestation admitted for evaluation of postpartum bleeding following a vaginal delivery.
Select the 2 interventions the nurse should perform immediately.
- A. Weigh the client’s perineal pad.
- B. Insert a straight catheter for the client.
- C. Administer methylergonovine 0.2 mg IM.
- D. Draw a complete blood count.
- E. Apply oxygen via nasal cannula.
Correct Answer: B,C
Rationale: Inserting a catheter empties the bladder, aiding uterine contraction; methylergonovine stimulates contractions to reduce bleeding from a boggy uterus.