OB: Postpartum Complications NCLEX

Chapter 35: Postpartum Complications OB: Postpartum Complications NCLEX The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: A. Uterine atony B. Uterine inversion C. Vaginal hematoma D. Vaginal laceration - A A. Correct: Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. B. Incorrect: Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman was experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. C. Incorrect: A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. D. Incorrect: A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus. p. 976 A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: A. Establish venous access B. Perform fundal massage C. Prepare the woman for surgical intervention D. Catheterize the bladder - B A. Incorrect: Although this may be a necessary intervention, the initial intervention would be fundal massage. B. Correct: The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. C. Incorrect: The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus. D. Incorrect: After uterine massage, the nurse may want to catheterize the client to eliminate any bladder distension that may be preventing the uterus from contracting properly. p. 979 The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by: A. Subinvolution of the placental site B. Defective vascularity of the decidua C. Cervical lacerations D. Coagulation disorders - A A. Correct: Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments. B. Incorrect: Although this condition may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. C. Incorrect: Although this condition may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. D. Incorrect: Although this condition may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments. p. 977 What woman is at greatest risk for early postpartum hemorrhage? A. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress B. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced C. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor D. A primigravida in spontaneous labor with preterm twins - B A. Incorrect: Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. B. Correct: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. C. Incorrect: Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. D. Incorrect: Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH. p. 976 ..............