18 - Foundations of Maternal-Newborn & Women’s Health Nursing Textbook Questions

3. A multiparous patient is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the patient void and massages her fundus; however, the fundus remains difficult to find and the rubra lochia remains heavy. Which action should the nurse take next? a. Recheck vital signs. b. Insert a Foley catheter. c. Notify the health care provider. d. Continue to massage the fundus. ANS: C Treatment of excessive bleeding requires the collaboration of the health care provider and the nurses. Do not leave the patient alone. The nurse should call the clinician while a second nurse rechecks the vital signs. The patient has voided successfully, therefore a Foley catheter is not needed at this time. The uterine muscle can be overstimulated by massage, leading to uterine atony and rebound hemorrhage. DIF: Cognitive Level: Application OBJ: Nursing Process Step: Implementation MSC: Patient Needs: Physiologic Integrity 4. Early postpartum hemorrhage is defined as a blood loss greater than a. 500 mL within 24 hours after a vaginal birth. b. 750 mL within 24 hours after a vaginal birth. c. 1000 mL within 48 hours after a cesarean birth. d. 1500 mL within 48 hours after a cesarean birth. ANS: B The average amount of bleeding after a vaginal birth is 500 mL. Early postpartum hemorrhage occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean birth averages 1000 mL. Late postpartum hemorrhage is 48 hours and later. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 5. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests a. uterine atony. b. perineal hematoma. c. infection of the uterus. d. lacerations of the genital tract. ANS: D Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations will not be affected by uterine contraction. The fundus would be boggy with a clinical finding of uterine atony. A hematoma would occur internally with swelling and discoloration. With an infection of the uterus, there would be an odor to the lochia and systemic symptoms such as fever and malaise. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 6. A postpartum patient would be at increased risk for postpartum hemorrhage if she delivered a(n) a. 5-lb, 2-oz infant with outlet forceps. b. 6.5-lb infant after a 2-hour labor. c. 7-lb infant after an 8-hour labor. d. 8-lb infant after a 12-hour labor. ANS: B A rapid labor and birth may cause exhaustion of the uterine muscle and prevent contraction. Delivering a 5-lb, 2-oz infant with outlet forceps would put this patient at risk for lacerations due to the use of forceps. A 7-lb infant after an 8-hour labor is a normal labor progression. Less than 3 hours is considered a rapid labor and can produce uterine muscle exhaustion. An 8-lb infant after a 12-hour labor is a normal labor progression. Less than 3 hours is a rapid birth and may cause the uterine muscles failure to contract. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment MSC: Patient Needs: Physiologic Integrity 7. The nurse should expect medical intervention for subinvolution to include a. oral fluids to 3000 mL/day. b. intravenous fluid and blood replacement. c. oxytocin intravenous infusion for 8 hours. d. oral methylergonovine maleate (Methergine) for 48 hours. ANS: D Methergine provides sustained contraction of the uterus. There is no correlation between dehydration and subinvolution. There is no indication that excessive blood loss has occurred. Oxytocin provides intermittent contractions. DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Planning MSC: Patient Needs: Physiologic Integrity 8. If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. Dilation and curettage (D&C) ANS: D D&C allows examination of the uterine contents and removal of any retained placenta or membranes. A hysterectomy is the removal of the uterus and is not indicated in this situation. A laparoscopy is the insertion of an endoscope through the abdominal wall to examine the peritoneal cavity and would also not be necessary at this juncture. A laparotomy is a surgical incision into the peritoneal cavity to explore the peritoneal cavity. This patient requires a D&C rather than a laparotomy. ...................................................................................................CONTINUE