Chapter 33: Postpartum Complications
Lowdermilk: Maternity & Women's
Health Care, 12th Edition Exam
Questions With 100% Complete
Solutions Rated A+
1. A perinatal nurse is caring for a woman in the immediate postbirth period.
Assessment reveals that the client is experiencing profuse bleeding. What is the most
likely cause for this bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration - ANSWER-ANS: A
Uterine atony is significant hypotonia of the uterus and is the leading cause of
postpartum hemorrhage. Uterine inversion may lead to hemorrhage; however, it is not
the most likely source of this client's bleeding. Further, if the woman were experiencing
a uterine inversion, it would be evidenced by the presence of a large, red, rounded
mass protruding from the introitus. A vaginal hematoma may be associated with
hemorrhage. However, the most likely clinical finding for vaginal hematoma is pain, not
the presence of profuse bleeding. A vaginal laceration should be suspected if vaginal
bleeding continues in the presence of a firm, contracted uterine fundus.
2. What is the primary nursing responsibility when caring for a client who is experiencing
an obstetric hemorrhage associated with uterine atony?
a. Establishing venous access
b. Performing fundal massage
, c. Preparing the woman for surgical intervention
d. Catheterizing the bladder - ANSWER-ANS: B
The initial management of excessive postpartum bleeding is a firm massage of the
uterine fundus. Although establishing venous access may be a necessary intervention,
fundal massage is the initial intervention. The woman may need surgical intervention to
treat her postpartum hemorrhage, but the initial nursing intervention is to assess the
uterus. After uterine massage, the nurse may want to catheterize the client to eliminate
any bladder distention that may be preventing the uterus from properly contracting.
3. What is the most common reason for late postpartum hemorrhage (PPH)?
a. Subinvolution of the uterus
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders - ANSWER-ANS: A
Late PPH may be the result of subinvolution of the uterus. Recognized causes of
subinvolution include retained placental fragments and pelvic infection. Although
defective vascularity, cervical lacerations, and coagulation disorders of the decidua may
also cause PPH, late PPH typically results from subinvolution of the uterus, pelvic
infection, or retained placental fragments.
4. Which client is at greatest risk for early postpartum hemorrhage (PPH)?
a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth
for fetal distress
b. Woman with severe preeclampsia on magnesium sulfate whose labor is being
induced
c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
d. Primigravida in spontaneous labor with preterm twins - ANSWER-ANS: B
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts
as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A
primiparous woman being prepared for an emergency cesarean birth for fetal distress, a
Lowdermilk: Maternity & Women's
Health Care, 12th Edition Exam
Questions With 100% Complete
Solutions Rated A+
1. A perinatal nurse is caring for a woman in the immediate postbirth period.
Assessment reveals that the client is experiencing profuse bleeding. What is the most
likely cause for this bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration - ANSWER-ANS: A
Uterine atony is significant hypotonia of the uterus and is the leading cause of
postpartum hemorrhage. Uterine inversion may lead to hemorrhage; however, it is not
the most likely source of this client's bleeding. Further, if the woman were experiencing
a uterine inversion, it would be evidenced by the presence of a large, red, rounded
mass protruding from the introitus. A vaginal hematoma may be associated with
hemorrhage. However, the most likely clinical finding for vaginal hematoma is pain, not
the presence of profuse bleeding. A vaginal laceration should be suspected if vaginal
bleeding continues in the presence of a firm, contracted uterine fundus.
2. What is the primary nursing responsibility when caring for a client who is experiencing
an obstetric hemorrhage associated with uterine atony?
a. Establishing venous access
b. Performing fundal massage
, c. Preparing the woman for surgical intervention
d. Catheterizing the bladder - ANSWER-ANS: B
The initial management of excessive postpartum bleeding is a firm massage of the
uterine fundus. Although establishing venous access may be a necessary intervention,
fundal massage is the initial intervention. The woman may need surgical intervention to
treat her postpartum hemorrhage, but the initial nursing intervention is to assess the
uterus. After uterine massage, the nurse may want to catheterize the client to eliminate
any bladder distention that may be preventing the uterus from properly contracting.
3. What is the most common reason for late postpartum hemorrhage (PPH)?
a. Subinvolution of the uterus
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders - ANSWER-ANS: A
Late PPH may be the result of subinvolution of the uterus. Recognized causes of
subinvolution include retained placental fragments and pelvic infection. Although
defective vascularity, cervical lacerations, and coagulation disorders of the decidua may
also cause PPH, late PPH typically results from subinvolution of the uterus, pelvic
infection, or retained placental fragments.
4. Which client is at greatest risk for early postpartum hemorrhage (PPH)?
a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth
for fetal distress
b. Woman with severe preeclampsia on magnesium sulfate whose labor is being
induced
c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
d. Primigravida in spontaneous labor with preterm twins - ANSWER-ANS: B
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts
as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A
primiparous woman being prepared for an emergency cesarean birth for fetal distress, a
