NURS 242 final exam Questions and Graded
Answers.
Postpartum hemorrhage risk factors - -Grand multiparity (five or more)
-Over distention of the uterus (large baby, twins)
-Rapid or prolonged labor
-Retained placenta
-Placenta previa or previous placenta accrete or abruptio placentae
-Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of oxytocin)
-Operative procedures (cesarean birth, vacuum extraction, forceps)
-Uterine fibroids
-History of PP hemorrhage
-Preeclampsia
-Coagulation defects
Infection risk factors (postpartum) - -Operative procedures (cesarean birth, vacuum
extraction, forceps)
-Multiple cervical examinations
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta or retained fragments
-Diabetes
-Catheterization
-Bacterial colonization of lower genital tract
Normal finding of fundal assessment - -Fundus firmly contracted
-Remains contract after massaging
-Located at level of umbilicus/midline
,Abnormal finding of fundal assessment - -Soft and boggy (massage until firm)
-Soft after massaging (call HCP; give oxytocin; apply pressure to express clots)
-Displaced from midline (empty bladder and reassess)
Lochia Rubra - -1-3 days
-Bloody; small clots; fleshy earthy odor; red/brown
-Abnormal: large clots; saturated pads; foul odor
Lochia Serosa - -4-10 days
-Pink or brown; serosanguineous
-Abnormal: too much; foul smell; continued/recurrent reddish color
Lochia Alba - -11-21 days (even until 6 weeks PP)
-White, cream, or light yellow
-Abnormal: persistent lochia serosa; return to lochia rubra; foul odor
Signs of mild fluid volume deficit - -Weight loss <5%
-Normal HR and BP
-Normal skin turgor
-Cap refill: <2 seconds; moist membranes
-Fontanel (normal/flat); normal eyes
Signs of moderate fluid volume deficit - -Weight loss 5-10%
-Normal/undetectable BP; increased HR
-Poor, prolonged skin recoil
-Cap refill: 2-3 seconds; dry membranes
-Fontanel (sunken); decreased tears
,Signs of severe fluid volume deficit - -Weight loss >10%
-Normal/undetectable BP; tachy/thready/brady
-Very poor skin turgor - tenting
-Cap refill: 3-4 seconds; parched membranes
-Fontanel (markedly sunken); no tears
Treatment for minimal fluid volume deficit - -ORT not needed
-Age-appropriate diet
-Re-evaluate
Treatment for mild-moderate fluid volume deficit - -50-100mL/kg ORS, plus replace
continuing losses over 3-4-hour period
-Breastfeed; resume regular diet after fixing F/E
-Oral dose of ondansetron (Zofran); re-evaluate
Treatment for severe fluid volume deficit - -Parenteral (IV) Therapy: IV fluid bolus
(20mL/kg) over period of 20-30 minutes
-Then replacement rate over next 24 hours
-If alert enough for ORS, 100mL/kg over 2-4 hours
S/S of hyponatremia - Behavior changes, headache, dizziness, increased HR, decreased
BP, cold/clammy skin, nausea, cramps
S/S of hypernatremia - FRIED or SALTIER
--
Fever (low grade), flushed skin
Restless (irritable)
Increased fluid retention and increased BP
, Edema (peripheral and pitting)
Decreased urinary output, dry mouth
SALTIER
--
Skin flushed, dry, flaky / Seizures
Agitation / Attention span decreased
Lethargy; Low grade fever
Thirst / twitching
Increased urine specific gravity
Edema (pulmonary)
Reduce cardiac contractility, urine output
Normal Na+ level - 135-145 mEq/L
S/S of hypokalemia - Leg cramps
Ileus (bowel obstruction)
Cardiac dysrhythmias (presence of U wave)
S/S of hyperkalemia - MURDER
-Muscle weakness, abdominal cramps
-Urine (oliguria, anuria)
-Resp distress
-Decreased cardiac contractility
-ECG changes (T tall, P small, QRS widened)
-Reflexes, hyperreflexia, or areflexia (flaccid)
Normal K+ level - 3.5-5.0 mEq/L
Answers.
Postpartum hemorrhage risk factors - -Grand multiparity (five or more)
-Over distention of the uterus (large baby, twins)
-Rapid or prolonged labor
-Retained placenta
-Placenta previa or previous placenta accrete or abruptio placentae
-Drugs (tocolytics, magnesium sulfate, general anesthesia, prolonged use of oxytocin)
-Operative procedures (cesarean birth, vacuum extraction, forceps)
-Uterine fibroids
-History of PP hemorrhage
-Preeclampsia
-Coagulation defects
Infection risk factors (postpartum) - -Operative procedures (cesarean birth, vacuum
extraction, forceps)
-Multiple cervical examinations
-Prolonged labor
-Prolonged rupture of membranes
-Manual extraction of placenta or retained fragments
-Diabetes
-Catheterization
-Bacterial colonization of lower genital tract
Normal finding of fundal assessment - -Fundus firmly contracted
-Remains contract after massaging
-Located at level of umbilicus/midline
,Abnormal finding of fundal assessment - -Soft and boggy (massage until firm)
-Soft after massaging (call HCP; give oxytocin; apply pressure to express clots)
-Displaced from midline (empty bladder and reassess)
Lochia Rubra - -1-3 days
-Bloody; small clots; fleshy earthy odor; red/brown
-Abnormal: large clots; saturated pads; foul odor
Lochia Serosa - -4-10 days
-Pink or brown; serosanguineous
-Abnormal: too much; foul smell; continued/recurrent reddish color
Lochia Alba - -11-21 days (even until 6 weeks PP)
-White, cream, or light yellow
-Abnormal: persistent lochia serosa; return to lochia rubra; foul odor
Signs of mild fluid volume deficit - -Weight loss <5%
-Normal HR and BP
-Normal skin turgor
-Cap refill: <2 seconds; moist membranes
-Fontanel (normal/flat); normal eyes
Signs of moderate fluid volume deficit - -Weight loss 5-10%
-Normal/undetectable BP; increased HR
-Poor, prolonged skin recoil
-Cap refill: 2-3 seconds; dry membranes
-Fontanel (sunken); decreased tears
,Signs of severe fluid volume deficit - -Weight loss >10%
-Normal/undetectable BP; tachy/thready/brady
-Very poor skin turgor - tenting
-Cap refill: 3-4 seconds; parched membranes
-Fontanel (markedly sunken); no tears
Treatment for minimal fluid volume deficit - -ORT not needed
-Age-appropriate diet
-Re-evaluate
Treatment for mild-moderate fluid volume deficit - -50-100mL/kg ORS, plus replace
continuing losses over 3-4-hour period
-Breastfeed; resume regular diet after fixing F/E
-Oral dose of ondansetron (Zofran); re-evaluate
Treatment for severe fluid volume deficit - -Parenteral (IV) Therapy: IV fluid bolus
(20mL/kg) over period of 20-30 minutes
-Then replacement rate over next 24 hours
-If alert enough for ORS, 100mL/kg over 2-4 hours
S/S of hyponatremia - Behavior changes, headache, dizziness, increased HR, decreased
BP, cold/clammy skin, nausea, cramps
S/S of hypernatremia - FRIED or SALTIER
--
Fever (low grade), flushed skin
Restless (irritable)
Increased fluid retention and increased BP
, Edema (peripheral and pitting)
Decreased urinary output, dry mouth
SALTIER
--
Skin flushed, dry, flaky / Seizures
Agitation / Attention span decreased
Lethargy; Low grade fever
Thirst / twitching
Increased urine specific gravity
Edema (pulmonary)
Reduce cardiac contractility, urine output
Normal Na+ level - 135-145 mEq/L
S/S of hypokalemia - Leg cramps
Ileus (bowel obstruction)
Cardiac dysrhythmias (presence of U wave)
S/S of hyperkalemia - MURDER
-Muscle weakness, abdominal cramps
-Urine (oliguria, anuria)
-Resp distress
-Decreased cardiac contractility
-ECG changes (T tall, P small, QRS widened)
-Reflexes, hyperreflexia, or areflexia (flaccid)
Normal K+ level - 3.5-5.0 mEq/L
