Postpartum Hemorrhage > Maternal & Newborn
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Showing 5 questions, Sign in for moreA nurse is caring for a client who had a postpartum hemorrhage due to uterine atony.
Which of the following interventions should the nurse perform first?
Explanation
This is the first intervention that the nurse should perform to stimulate uterine contractions and prevent excessive bleeding due to uterine atony.Uterine atony is a condition where the uterus does not contract enough after delivery and is the most common cause of postpartum hemorrhage.
The other statements are wrong because:
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A. Administer oxytocin as prescribed.
This is a medication that can help with uterine contractions, but it is not the first intervention.The nurse should first try a nonpharmacologic method such as fundal massage before giving any drugs.
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C. Assess vital signs and oxygen saturation.
This is an important assessment to monitor the patient’s condition, but it is not the first intervention.The nurse should first try to stop the bleeding by massaging the fundus.
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D. Insert an indwelling urinary catheter.
This is a procedure that can help with emptying the bladder and reducing pressure on the uterus, but it is not the first intervention.The nurse should first try to stimulate uterine contractions by massaging the fundus.
Normal ranges for vital signs and oxygen saturation are:
• Blood pressure: 110/60 to 140/90 mm Hg
• Pulse: 60 to 100 beats per minute
• Respirations: 12 to 20 breaths per minute
• Temperature: 36.5 to 37.5°C (97.7 to 99.5°F)
• Oxygen saturation: 95% to 100%
A nurse is teaching a client who is at risk for postpartum hemorrhage about the signs and symptoms to report.
Which of the following should the nurse include in the teaching? (Select all that apply.)
Explanation
The correct answer is choices A, B and D. These are signs and symptoms of postpartum hemorrhage, which is excessive bleeding after childbirth.
The nurse should teach the client to report these signs and symptoms to the health care provider immediately.
Choice C is wrong because having a temperature above 38°C (100.4°F) is a sign of infection, not hemorrhage.
The client should also report this symptom, but it is not related to the risk of bleeding.
Choice E is wrong because having a firm uterus with fundus at or below umbilicus is a normal finding after childbirth.
This indicates that the uterus is contracting and preventing bleeding.
A soft or boggy uterus with fundus above umbilicus is a sign of uterine atony, which is a common cause of postpartum hemorrhage.
A nurse is reviewing the laboratory results of a client who had a postpartum hemorrhage.
The nurse notes that the client’s hematocrit level is 28%.
Which of the following actions should the nurse take?
Explanation
Encourage oral intake of iron-rich foods.A hematocrit level of 28% indicates mild anemia, which can be treated with dietary iron supplementation.The normal range of hematocrit for women is 36% to 48%.
Choice A is wrong because a blood transfusion is not indicated for mild anemia and may carry risks of infection or transfusion reaction.
Choice C is wrong because increasing the rate of intravenous fluids may dilute the blood and lower the hematocrit level further.
Choice D is wrong because notifying the provider of the finding is not a direct action that the nurse can take to treat the anemia.The provider may already be aware of the laboratory results and may not need to be notified unless there are signs of worsening anemia or bleeding.
A nurse is assessing a client who had a vacuum-assisted vaginal delivery and is experiencing a postpartum hemorrhage.
Which of the following findings should alert the nurse to a possible laceration of the birth canal?
Explanation
This indicates that the bleeding is from an arterial source, such as a laceration of the birth canal.
Fundal massage stimulates uterine contractions and may increase the blood flow from the laceration site.
Choice A is wrong because a boggy uterus with fundus above umbilicus suggests uterine atony, which is the most common cause of postpartum hemorrhage.
Uterine atony is the failure of the uterus to contract and retract after delivery, leading to bleeding from the placental site.
Choice C is wrong because a firm uterus with fundus at umbilicus indicates that the uterus is well contracted and not likely to be the source of bleeding.
A well-contracted uterus prevents excessive bleeding from the placental site.
Choice D is wrong because dark red bleeding that decreases with fundal massage suggests that the bleeding is from a venous source, such as a hematoma.
Fundal massage may help to compress the hematoma and reduce the bleeding.
Normal ranges for blood loss after vaginal delivery are up to 500 mL and after cesarean delivery are up to 1000 mL.Postpartum hemorrhage is defined as blood loss of more than 1000 mL or signs of hypovolemia within 24 hours of delivery.
A nurse is planning care for a client who has chorioamnionitis and is at risk for postpartum hemorrhage.
Which of the following interventions should the nurse include in the plan? (Select all that apply)
Explanation
The correct answer is choice A, C, D and E. Here is why:
• Choice A: Administer antibiotics as prescribed.
This is correct because chorioamnionitis is a bacterial infection of the membranes and amniotic fluid surrounding the fetus.Antibiotics can help treat the infection and prevent complications for the mother and the baby.
• Choice B: Monitor temperature every 4 hours.
This is wrong because temperature should be monitored more frequently (at least every 2 hours) for signs of infection.Fever is an important symptom of chorioamnionitis and occurs in 95 to 100% of cases.
• Choice C: Provide warm blankets and fluids.
This is correct because chorioamnionitis can cause dehydration and hypothermia due to fever and sweating.Warm blankets and fluids can help maintain fluid balance and body temperature.
• Choice D: Assess lochia for amount and color.
This is correct because chorioamnionitis can cause excessive bleeding and abnormal lochia (vaginal discharge) after delivery.Lochia should be assessed for amount, color, odor and consistency to detect signs of infection or hemorrhage.
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