Postpartum Hemorrhage > Maternal & Newborn
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Showing 24 questions, Sign in for moreA nurse is caring for a client who experienced a postpartum hemorrhage after delivering a large baby following oxytocin induction of labor.
Which of the following factors put this client at risk for developing postpartum hemorrhage? (Select all that apply)
Explanation
The correct answer is choice B, D and E. These are the factors that put this client at risk for developing postpartum hemorrhage:
• Uterine overdistention: This occurs when the uterus is stretched too much by a large baby, multiple babies, or excess amniotic fluid.This can impair the normal contraction of the uterus after delivery and lead to bleeding.
• Oxytocin use: This is a hormone that stimulates uterine contractions during labor.However, prolonged or excessive use of oxytocin can cause uterine atony, which is the failure of the uterus to contract and compress the blood vessels after delivery.
• Chorioamnionitis: This is an infection of the membranes and amniotic fluid that surround the baby.It can cause inflammation and damage to the uterine lining, which can interfere with blood clotting and increase the risk of bleeding.
Choice A and C are wrong because:
• Grand multiparity: This means having given birth five or more times.It is not a risk factor for postpartum hemorrhage by itself, but it may be associated with other risk factors such as uterine overdistention, oxytocin use, or placental abnormalities.
• Precipitous labor: This means having a very fast labor, lasting less than three hours.It is not a risk factor for postpartum hemorrhage by itself, but it may be associated with other risk factors such as trauma to the birth canal, retained placenta, or coagulation disorders.
A nurse is assisting with an emergency cesarean delivery for a client who has placenta previa and is experiencing profuse bleeding.
Which of the following medications should the nurse anticipate administering to this client after delivery?
Explanation
The correct answer is choice C. Misoprostol (Cytotec).This medication is used to prevent postpartum hemorrhage (excessive bleeding after delivery) in women with placenta previa.Placenta previa is a condition where the placenta covers the opening of the cervix and can cause severe bleeding during pregnancy.
Choice A is wrong because Methylergonovine (Methergine) is a medication that stimulates uterine contractions and can increase bleeding in women with placenta previa.
Choice B is wrong because Carboprost tromethamine (Hemabate) is also a medication that causes uterine contractions and can worsen bleeding in women with placenta previa.
Choice D is wrong because Terbutaline (Brethine) is a medication that relaxes uterine muscles and can delay labor, but it does not prevent postpartum hemorrhage in women with placenta previa.
Normal ranges for blood loss after delivery are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery.
A nurse is performing fundal massage for a client who has uterine atony and postpartum hemorrhage.
Which of the following actions should the nurse take when performing this procedure?
Explanation
Use one hand to stabilize the lower uterine segment while massaging the fundus with the other hand.
This action prevents the uterus from inverting and reduces the risk of trauma to the cervix and vagina.
The nurse should also monitor the amount and consistency of lochia.
Choice B is wrong because applying firm pressure on the fundus with both hands can cause uterine inversion, which is a life-threatening complication of postpartum hemorrhage.
The nurse should use gentle pressure and avoid overstimulation of the uterus.
Choice C is wrong because massaging the fundus in a circular motion with one hand while supporting the back with the other hand can cause displacement of the uterus and increase bleeding.
The nurse should massage the fundus in a downward motion from the top of the uterus to the umbilicus.
Choice D is wrong because rubbing the fundus vigorously with one hand until it becomes hard and expels clots can cause uterine rupture, which is another serious complication of postpartum hemorrhage.
The nurse should avoid excessive manipulation of the uterus and allow clots to pass naturally.
A nurse is caring for a client who has just delivered a baby and is experiencing postpartum hemorrhage due to uterine atony.
Which of the following medications should the nurse anticipate administering? Select all that apply:
Explanation
The correct answer is choice A, C, D and E. These medications are all uterotonic agents that can stimulate uterine contractions and reduce bleeding.
They act on different receptors in the uterus and have different side effects and contraindications.
Choice B is wrong because magnesium sulfate is a tocolytic agent that can relax uterine muscles and prevent preterm labor.
It is not indicated for postpartum hemorrhage and can worsen uterine atony.
Normal ranges for postpartum blood loss are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery.
Uterine atony is the most common cause of postpartum hemorrhage and occurs when the uterus fails to contract adequately after delivery.
Risk factors include prolonged or rapid labor, overdistension of the uterus, multiparity, retained placenta, infection and anesthesia.
A nurse is caring for a client who has just delivered a baby and is experiencing postpartum hemorrhage due to retained placental fragments.
Which of the following interventions should the nurse anticipate? Select all that apply:
Explanation
The correct answer is choices A, B, C, and E.These are all medications that can help contract the uterus and stop the bleeding caused by retained placental fragments.Oxytocin (Pitocin) is the most effective and commonly used uterotonic agent.Methylergonovine maleate (Methergine) and carboprost tromethamine (Hemabate) are alternative drugs that can be used if oxytocin is ineffective or unavailable.Misoprostol (Cytotec) is a prostaglandin analogue that can also help reduce blood loss.
Choice D is wrong because manual removal of placenta fragments is not an intervention that the nurse should anticipate.Manual removal of placenta fragments is a last resort option that can cause more bleeding and infection, and should only be performed by a skilled provider.
A nurse is caring for a client who has just delivered a baby and is experiencing postpartum hemorrhage due to lacerations on her cervix and vagina caused by rapid birth(Precipitous birth).
Which of the following interventions should be included in her plan of care? Select all that apply:
Explanation
• Choice A: Administering oxytocin.Oxytocin is a uterotonic agent that stimulates uterine contractions and reduces bleeding from the placental site.It is the most effective intervention for preventing and treating postpartum hemorrhage.
• Choice B: Administering methylergonovine maleate.Methylergonovine maleate is another uterotonic agent that causes sustained uterine contraction and vasoconstriction.It can be used as an alternative or adjunct to oxytocin for postpartum hemorrhage.
• Choice C: Administering carboprost tromethamine.Carboprost tromethamine is a prostaglandin analog that induces strong and prolonged uterine contractions and decreases blood loss.
It can be used as a second-line treatment
Which of the following is the most common cause of postpartum hemorrhage?
Explanation
Uterine atony is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases.It occurs when the uterus does not contract enough to stop the bleeding from the placental site.Uterine atony can be caused by factors such as prolonged labor, multiple pregnancy, large baby, infection or use of certain medications.
The other statements are wrong because:
• B.Retained placenta is the second most common cause of postpartum hemorrhage, but it only accounts for about 10% of cases.It occurs when part or all of the placenta remains attached to the uterine wall and prevents the uterus from contracting properly.
• C.Lacerations are tears or cuts in the cervix, vagina or perineum that can cause bleeding after delivery.They are usually minor and can be repaired with stitches, but they can also be severe and require surgery.Lacerations are not very common causes of postpartum hemorrhage, and they usually occur along with other factors such as uterine atony or retained placenta.
• D.Hematomas are collections of blood under the skin or in the tissues that can result from trauma during delivery.They can cause pain, swelling and pressure in the affected area, but they are usually small and resolve on their own.Hematomas are rare causes of postpartum hemorrhage, and they usually occur along with other factors such as lacerations or coagulation disorders.
Normal ranges for blood loss after delivery are less than 500 mL for vaginal birth and less than 1000 mL for cesarean birth.Blood loss greater than these amounts can indicate postpartum hemorrhage and require immediate medical attention.
Which of the following is a risk factor for postpartum hemorrhage?A. B.
C.
D.
E.
Explanation
All of these conditions are risk factors for postpartum hemorrhage (PPH), which is severe bleeding after childbirth.
Choice A) Prolonged labor is a risk factor for PPH because it can cause uterine fatigue and atony, which is the inability of the uterus to contract and compress the blood vessels.
Choice B) Oligohydramnios is a risk factor for PPH because it can cause placental abruption, which is the premature separation of the
Which of the following is a nursing intervention for postpartum hemorrhage?
Explanation
Oxytocin is a uterotonic medication that stimulates uterine contractions and reduces bleeding.It is the most effective intervention for preventing and treating postpartum hemorrhage caused by uterine atony.
Uterine massage can also help to improve uterine tone and expel clots.
Choice B) Administering magnesium sulfate is wrong because magnesium sulfate is used to prevent seizures in patients with preeclampsia or eclampsia, not to control bleeding.
Choice C) Administering heparin is wrong because heparin is an anticoagulant that prevents blood clotting.
It is used to treat or prevent thromboembolic disorders, not to stop bleeding.
Choice D) Administering insulin is wrong because insulin is used to lower blood glucose levels in patients with diabetes mellitus, not to manage hemorrhage.
Normal blood loss after vaginal delivery is less than 500 mL and after cesarean delivery is less than 1000 mL.
Postpartum hemorrhage is defined as blood loss of at least 100
Which of the following laboratory tests should the nurse report to the obstetrician when monitoring a client who is one day postpartum and has experienced significant postpartum hemorrhage?
Explanation
Hemoglobin, which is an indicator of the number of RBCs and decreases during hypovolemia and hemorrhage.
Hemoglobin is a protein that carries oxygen in the blood and is measured in grams per deciliter (g/dL).
A normal range for hemoglobin is 12 to 16 g/dL for women.
A low hemoglobin level indicates anemia, which can be caused by blood loss or other factors.
A postpartum hemorrhage is a loss of more than 500 mL of blood after delivery, which can lead to hypovolemia (low blood volume) and shock.
Choice A is wrong because urine output 200 mL for the past 8 hours is within the normal range for a postpartum woman.
The kidneys may retain fluid during pregnancy and release it after delivery, resulting in increased urine output.
A normal urine output is 30 to 50 mL per hour.
Choice B is wrong because weight decrease of 2 pounds since delivery is expected for a postpartum woman.
The weight loss reflects the loss of fluid, blood, and placental tissue during delivery.
A normal weight loss after delivery is 10 to 12 pounds.
Choice D is wrong because hematocrit, which is the percent of RBCs in the total blood volume, and decreases during hypovolemia, may not reflect the true extent of blood loss in a postpartum hemorrhage.
Hematocrit is measured as a percentage and a normal range for hematocrit is 37 to 47% for women.
However, hematocrit may be falsely elevated due to hemoconcentration (increased concentration of blood cells) caused by fluid loss.
Hematocrit may take several days to reflect the actual blood loss.
Postpartum hemorrhage is classified into two groups: early postpartum hemorrhage and late postpartum hemorrhage.
What is the most common cause of early postpartum hemorrhage?
Explanation
Uterine atony is the most common cause of early postpartum hemorrhage, accounting for up to 80% of cases.Uterine atony is when the uterus fails to contract after delivery of the placenta, leading to excessive bleeding from the blood vessels where the placenta was attached.
Choice B is wrong because trauma is not the most common cause of early postpartum hemorrhage.Trauma accounts for about 20% of cases and includes uterine rupture, cervical and vaginal lacerations, and uterine inversion.
Choice C is wrong because lacerations are not the most common cause of early postpartum hemorrhage.Lacerations are a type of trauma that can cause bleeding from the cervix, vagina, or perineum.
Choice D is wrong because hematomas are not the most common cause of early postpartum hemorrhage.Hematomas are a type of trauma that can cause bleeding into the tissues of the vulva, vagina, or perineum.
Normal ranges for blood loss after delivery are less than 500 ml for vaginal delivery and less than 1000 ml for cesarean delivery.Postpartum hemorrhage is defined as blood loss greater than these amounts or when bleeding causes symptoms of hypovolemia (low blood volume) or hemodynamic instability (low blood pressure or high heart rate).
What is the most common cause of late postpartum hemorrhage?
Explanation
Retained placental fragments are the most common cause of late postpartum hemorrhage.Retained placental fragments can lead to infection and subinvolution of the placental site, which prevents the uterus from contracting and stopping the bleeding.
Choice B is wrong because uterine atony is the most common cause of early postpartum hemorrhage, not late postpartum hemorrhage.Uterine atony occurs when the uterus fails to contract after delivery.
Choice C is wrong because trauma is a rare cause of late postpartum hemorrhage.Trauma can occur during delivery and cause lacerations or hematomas that can bleed later, but this is uncommon.
Choice D is wrong because lacerations are also a rare cause of late postpartum hemorrhage.Lacerations can occur in the cervix, vagina or perineum during delivery and cause bleeding, but this usually happens immediately or within 24 hours after delivery.
A nurse is caring for a client who has just delivered her baby and is at risk for postpartum hemorrhage (PPH).
Which intervention should be included in this client’s plan of care?
Explanation
Oxytocin is a medication that helps the uterus contract and prevent excessive bleeding after birth.It is the most effective treatment for postpartum hemorrhage, even if already used for labor induction or augmentation or as part of active management of the third stage of labor.
Choice B) Encouraging frequent voiding is wrong because it does not directly affect the risk of postpartum hemorrhage.However, a full bladder can interfere with uterine contraction and cause bleeding, so voiding should be encouraged as part of routine care.
Choice C) Assessing vital signs every 4 hours is wrong because it is not enough to detect and treat postpartum hemorrhage early.Vital signs should be monitored more frequently in the first hour after delivery, when most cases of postpartum hemorrhage occur.
Choice D) Encouraging ambulation as soon as possible is wrong because it does not prevent postpartum hemorrhage.
Ambulation can help prevent thromboembolic complications and promote recovery, but it has no effect on uterine contraction
A nurse is caring for a client who has just delivered her baby and is at risk for PPH due to uterine atony.Which interventions should be included in this client’s plan of care? (Select all that apply)
Explanation
The correct answer is choice A and B. Administering oxytocin after delivery and encouraging frequent voiding are interventions that can help prevent or treat PPH due to uterine atony.Uterine atony is the most common cause of PPH and it occurs when the uterus fails to contract after birth, leading to excessive bleeding.Oxytocin is a medication that stimulates uterine contractions and reduces blood loss.Frequent voiding can help empty the bladder and allow the uterus to contract more effectively.
Choice C is wrong because assessing vital signs every 4 hours is not frequent enough for a client who is at risk for PPH.Vital signs should be monitored more closely to detect signs of hypovolemia and shock.
Choice D is wrong because encouraging ambulation as soon as possible can increase the risk of bleeding in a client who has uterine atony.Ambulation should be delayed until the uterus is firm and the bleeding is controlled.
Choice E is wrong because massaging the fundus is not an intervention for PPH due to uterine atony, but rather for PPH due to retained placental fragments.Massaging the fundus can help expel any remaining tissue from the uterus and prevent infection.
A nurse is caring for a client who has just delivered her baby and is at risk for PPH due to retained placental fragments.
Which interventions should be included in this client’s plan of care? (Select all that apply.)
Explanation
The correct answer is choice A and B.Administering oxytocin after delivery is an effective way to prevent and treat uterine atony, which is the most common cause of PPH.Encouraging frequent voiding can help reduce bladder distension, which can interfere with uterine contraction and increase bleeding.
Choice C is wrong because assessing vital signs every 4 hours is not frequent enough for a client who is at risk for PPH.Vital signs should be monitored every 15 minutes for the first hour, then every hour for the next 4 hours, and then every 4 hours thereafter.
Choice D is wrong because encouraging ambulation as soon as possible can increase the risk of bleeding and shock in a client who has retained placental fragments.Ambulation should be delayed until the fragments are removed and the bleeding is controlled.
A nurse is caring for a client who has postpartum hemorrhage and is receiving IV fluids and blood products.
Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)
Explanation
The correct answer is choice A, B and C. The nurse should monitor intake and output to assess the client’s fluid status and blood loss.
The nurse should elevate the head of the bed to reduce the risk of hypovolemic shock and improve tissue perfusion.
The nurse should apply oxygen via nasal cannula to increase oxygen delivery to the vital organs and prevent hypoxia.
Choice D is wrong because inserting a nasogastric tube is not indicated for a client who has postpartum hemorrhage.
A nasogastric tube is used to decompress the stomach or administer medications or feedings in some conditions.
Choice E is wrong because administering pain medication as needed is not a priority intervention for a client who has postpartum hemorrhage.
Pain medication can mask the signs of shock and lower the blood pressure further.
The nurse should focus on restoring the blood volume and preventing complications.
A nurse is evaluating the effectiveness of interventions for a client who has postpartum hemorrhage due to retained placental fragments.
Which of the following outcomes indicates that the interventions are successful?
Explanation
The client has a firm and midline uterus at the umbilicus.This indicates that the interventions for postpartum hemorrhage due to retained placental fragments are successful because the uterus has contracted and expelled the fragments, and there is no excessive bleeding.
Choice A is wrong because minimal cramping and discomfort are not specific signs of successful interventions for postpartum hemorrhage.
They may also occur in normal postpartum recovery.
Choice C is wrong because passing small clots with moderate lochia rubra may indicate that there are still some retained placental fragments or that the uterus is not contracting adequately.
Choice D is wrong because a pulse rate of 100 beats/min and a blood pressure of 110/70 mm Hg are not normal ranges for an adult.A pulse rate of 60 to 100 beats/min and a blood pressure of less than 120/80 mm Hg are considered normal.A high pulse rate and a low blood pressure may indicate hypovolemia or shock due to blood loss.
A nurse is providing discharge instructions to a client who had postpartum hemorrhage and received blood transfusions during her hospital stay.
Which of the following information should the nurse include in the teaching? (Select all that apply)
Explanation
The correct answer is choice B, D and E. The nurse should include the following information in the teaching:
• Increase iron-rich foods in the diet.This can help replenish the blood loss and prevent anemia.
• Report any signs of infection, such as fever or foul-smelling lochia.These can indicate a serious complication that needs immediate medical attention.
• Resume sexual intercourse as soon as desired.There is no evidence that sexual activity increases the risk of bleeding or infection after postpartum hemorrhage.
Choice A is wrong because increasing fluid intake to at least 3 L per day is not necessary for postpartum hemorrhage recovery.Fluid intake should be based on thirst and urine output.
Choice C is wrong because avoiding strenuous activities for 6 weeks is not a specific recommendation for postpartum hemorrhage.The nurse should advise the client to gradually resume normal activities as tolerated and to rest when needed.
A nurse is caring for a client who delivered vaginally 4 hours ago and has a boggy uterus that is displaced to the right of midline.
Which of the following actions should the nurse take first?
Explanation
This is because a boggy uterus that is displaced to the right of midline indicates that the bladder is full and pushing the uterus out of place.A full bladder can prevent the uterus from contracting effectively after delivery, leading to excessive bleeding and postpartum hemorrhage (PPH).
Emptying the bladder can help the uterus return to its normal position and tone.
Choice A is wrong because applying ice packs to the perineum may help reduce swelling and pain, but it will not address the underlying cause of the boggy uterus.
Choice C is wrong because increasing the rate of IV fluids may worsen the bleeding by diluting the blood and reducing its clotting ability.
Choice D is wrong because administering carboprost, a medication that stimulates uterine contractions, may be indicated if other measures fail to restore uterine tone, but it is not the first action to take.Carboprost also has side effects such as fever, nausea, vomiting, and diarrhea.
Normal ranges for uterine size and position after delivery are:
• Immediately after delivery: at or slightly below the level of the umbilicus (navel)
• 6 hours after delivery: 1 fingerbreadth above the umbilicus
• 12 hours
A nurse is assessing a client who had a cesarean birth and is experiencing postpartum hemorrhage due to uterine dehiscence.
Which of the following manifestations should alert the nurse to this complication?
Explanation
Heavy vaginal bleeding and clots are symptoms of postpartum hemorrhage due to uterine dehiscence.Uterine dehiscence is the opening of the incision line after cesarean section and it is a rare complication.It can be caused by infection, hematoma, suture technique or trauma.
Choice A is wrong because abdominal pain and tenderness are more likely to be caused by other postpartum complications such as endometritis, wound infection, hematoma or uterine rupture.
Choice B is wrong because foul-smelling lochia and fever are signs of postpartum infection such as endometritis or wound abscess.
Choice C is wrong because absent or decreased bowel sounds and distension are not specific to postpartum hemorrhage.They can be caused by ileus, bowel obstruction, peritonitis or other abdominal disorders.
Normal ranges for blood loss after delivery are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery.Normal ranges for vital signs after delivery are pulse 50 to 90 beats/minute, blood pressure 85/60 to 140/90 mm Hg, respiratory rate 12 to 20 breaths/minute and temperature 36.2 to 37.6 °C.
A nurse is providing discharge instructions to a client who had postpartum hemorrhage due to placenta accreta and underwent hysterectomy.
Which of the following statements by the client indicates an understanding of the teaching?
Explanation
“I will seek counseling if I have feelings of grief or loss.” This statement indicates that the client understands the potential psychological impact of having a hysterectomy due to postpartum hemorrhage and placenta accreta, which is a condition where the placenta invades the uterine wall and causes severe bleeding.The client may experience emotional distress, such as sadness, anger, guilt, or anxiety, due to the loss of fertility and the traumatic event.
Seeking counseling can help the client cope with these feelings and adjust to the changes in her life.
Choice A is wrong because iron supplements are not necessary for at least 6 months after a hysterectomy.Iron supplements are usually prescribed for anemia caused by blood loss, but the duration of treatment depends on the severity of the anemia and the client’s response to therapy.
The client should have regular blood tests to monitor her hemoglobin and iron levels and follow the advice of her health care provider regarding iron supplementation.
Choice B is wrong because avoiding lifting anything heavier than the baby for 2 weeks is not enough to prevent complications after a hysterectomy.
A hyster ...
A nurse is caring for a client who delivered vaginally 4 hours ago and has saturated two perineal pads in 15 minutes.
The nurse identifies this as which of the following types of postpartum hemorrhage?
Explanation
Early postpartum hemorrhage occurs within the first 24 hours after delivery.The client has saturated two perineal pads in 15 minutes, which indicates severe bleeding and a possible complication of the third stage of labor.
Choice B is wrong because late postpartum hemorrhage occurs 24 hours to 12 weeks postpartum.This type of hemorrhage is usually caused by retained placental fragments or infection.
Choice C is wrong because chronic postpartum hemorrhage is not a recognized term.
Postpartum hemorrhage is an acute condition that requires immediate attention.
Choice D is wrong because acute postpartum hemorrhage is not a specific type of hemorrhage, but a general term for any excessive bleeding after childbirth.Postpartum hemorrhage can be classified into mild, moderate, or severe based on the amount of blood loss.
A nurse is preparing to administer methylergonovine to a client who has a postpartum hemorrhage due to uterine atony.
Which of the following assessments should the nurse perform prior to administration?
Explanation
The nurse should assess the client’s blood pressure before administering methylergonovine because this medication can cause hypertension and vasoconstriction.The nurse should also monitor the client’s blood pressure after administration for any signs of hypertensive crisis.
Choice B.Temperature is wrong because methylergonovine does not affect the body temperature significantly.
However, the nurse should monitor the client’s temperature for any signs of infection or fever.
Choice C.Respiratory rate is wrong because methylergonovine does not affect the respiratory system significantly.
However, the nurse should monitor the client’s respiratory rate for any signs of distress or hypoxia.
Choice D.Oxygen saturation is wrong because methylergonovine does not affect the oxygen saturation significantly.
However, the nurse should monitor the client’s oxygen saturation for any signs of hypoxemia or cyanosis.
Methylergonovine is a uterine stimulant that helps prevent postpartum hemorrh
A nurse is evaluating a client who had a postpartum hemorrhage and received fluid resuscitation and blood transfusion therapy.
Which of the following findings indicates an improvement in the client’s condition?
Explanation
Urine output of 40 mL/hr indicates an improvement in the client’s condition.According to the MSF Medical Guidelines, the objective of resuscitation in postpartum hemorrhage is to maintain a urine output of at least 30 mL/hour.
A urine output of 40 mL/hr suggests that the client has adequate fluid replacement and blood transfusion therapy.
Choice B is wrong because a pulse rate of 110 beats/min is still high and indicates tachycardia.
Tachycardia is a sign of hypovolemia and shock due to blood loss.The normal pulse rate for an adult is 60 to 100 beats/min.
Choice C is wrong because a hematocrit level of 32% is low and indicates anemia.
Anemia is a complication of postpartum hemorrhage due to reduced red blood cell count.The normal hematocrit level for women is 36% to 48%.
Choice D is wrong because a blood pressure of 90/60 mm Hg is low and indicates hypotension.
Hypotension is a sign of hypovolemia and shock due to blood loss.The normal blood pressure for an adult is 120/80 mm Hg.
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