Maternal and Pediatric Nursing -
Midterm
Thevperinatalvnurse'svassessmentvwhilevcaringvforvavwomanvinvthevimmediatevpostvbirthvperiodvre
vealsvthatvthevwomanvisvexperiencingvprofusevbleeding.vWhatvisvthevmostvlikelyvetiologyvforvhervbl
eeding?
a.vUterinevatony
b.vUterinevinversion
c.vVaginalvhematoma
d.vVaginalvlacerationv-vvcorrectvanswersvANS:vA
Uterinevatonyvisvmarkedvhypotoniavofvthevuterus.vItvisvthevleadingvcausevofvpostpartumvhemorrhag
e.vUterinevinversionvmayvleadvtovhemorrhagevbutvitvisvnotvthevmostvlikelyvsourcevofvthisvwoman'svb
leeding.vFurthermorevifvthevwomanvwerevexperiencingvavuterinevinversionvitvwouldvbevevidencedv
byvthevpresencevofvavlargevredvroundedvmassvprotrudingvfromvthevintroitus.vAvvaginalvhematomav
mayvbevassociatedvwithvhemorrhage.vHowevervthevmostvlikelyvclinicalvfindingvwouldvbevpainvnotvt
hevpresencevofvprofusevbleeding.vAvvaginalvlacerationvmayvcausevhemorrhagevbutvitvisvmorevlikelyv
thatvprofusevbleedingvwouldvresultvfromvuterinevatony.vAvvaginalvlacerationvshouldvbevsuspectedvif
vvaginalvbleedingvcontinuesvinvthevpresencevofvavfirmvcontractedvuterinevfundus.
Whichvisvavprimaryvnursingvresponsibilityvwhenvcaringvforvavwomanvexperiencingvanvobstetricalvhe
morrhagevassociatedvwithvuterinevatony?
a.vEstablishvvenousvaccess.
,b.vPerformvfundalvmassage.
c.vPreparevthevwomanvforvsurgicalvintervention.
d.vCatheterizevthevbladder.v-vvcorrectvanswersvANS:vB
Thevinitialvmanagementvofvexcessivevpostpartumvbleedingvisvfirmvmassagevofvthevuterinevfundus.v
Althoughvestablishingvvenousvaccessvmayvbevavnecessaryvinterventionvthevinitialvinterventionvwou
ldvbevfundalvmassage.vThevwomanvmayvneedvsurgicalvinterventionvtovtreatvhervpostpartumvhemor
rhagevbutvthevinitialvnursingvinterventionvwouldvbevtovassessvthevuterus.vAftervuterinevmassagevth
evnursevmayvwantvtovcatheterizevthevpatientvtoveliminatevanyvbladdervdistensionvthatvmayvbevprev
entingvthevuterusvfromvcontractingvproperly.
Whichvisvthevmostvlikelyvcausevofvlatevpostpartumvhemorrhagev(PPH)?
a.vSubinvolutionvofvthevplacentalvsite
b.vDefectivevvascularityvofvthevdecidua
c.vCervicalvlacerations
d.vCoagulationvdisordersv-vvcorrectvanswersvANS:vA
LatevPPHvmayvbevthevresultvofvsubinvolutionvofvthevuterusvpelvicvinfectionvorvretainedvplacentalvfra
gments.vLatevPPHvisvnotvtypicallyvavresultvofvdefectivevvascularityvofvthevdeciduavcervicalvlaceration
svorvcoagulationvdisorders.
Whatvwomanvisvatvgreatestvriskvforvearlyvpostpartumvhemorrhagev(PPH)?
a.vAvprimiparousvwomanvbeingvpreparedvforvanvemergencyvCaesareanvbirthvforvfetalvdistress
b.vAvwomanvwithvseverevpre-eclampsiavonvmagnesiumvsulphatevwhosevlabourvisvbeingvinduced
c.vAvmultiparousvwomanvwithvanv8-hourvlabour
d.vAvprimigravidavinvspontaneousvlabourvwithvpretermvtwinsv-vvcorrectvanswersvANS:vB
MagnesiumvsulphatevadministrationvduringvlabourvposesvavriskvforvPPH.vMagnesiumvactsvasvavsmo
othvmusclevrelaxantvtherebyvcontributingvtovuterinevrelaxationvandvatony.vAlthoughvmanyvcausesv
andvriskvfactorsvarevassociatedvwithvPPHvthevprimiparousvwomanvbeingvpreparedvforvanvemergenc
yvCaesarianvbirthvthevmultiparousvwomanvwithv8-
hourvlabourvandvthevprimigravidavinvspontaneousvlabourvarevnotvatvriskvforvearlyvPPH.
,Whatvisvthevinitialvpriorityvnursingvinterventionvwhenvavnursevobservesvprofusevpostpartumvbleedi
ng?
a.vCallvthevwoman'svprimaryvhealthvcarevprovider.
b.vAdministervthevstandingvordervforvanvoxytocic.
c.vPalpatevthevuterusvandvmassagevitvifvitvisvboggy.
d.vAssessvmaternalvbloodvpressurev(BP)vandvpulsevforvsignsvofvhypovolemicvshock.v-
vvcorrectvanswersvANS:vC
Thevinitialvmanagementvofvexcessivevpostpartumvbleedingvisvfirmvmassagevofvthevuterinevfundus.v
AlthoughvcallingvthevhealthvcarevprovidervadministeringvanvoxytocicvandvassessingvmaternalvBPvar
evappropriatevinterventionsvthevprimaryvinterventionvshouldvbevtovassessvthevuterus.vUterinevaton
yvisvthevleadingvcausevofvpostpartumvhemorrhage.
Whatvisvthevmostvobjectivevandvleastvinvasivevassessmentvofvadequatevorganvperfusionvandvoxyge
nationvwhenvcaringvforvavpostpartumvwomanvexperiencingvhemorrhagicvshock?
a.vAbsencevofvcyanosisvinvthevbuccalvmucosa
b.vCoolvdryvskin
c.vDiminishedvrestlessness
d.vUrinaryvoutputvofvatvleastv30vmL/hrv-vvcorrectvanswersvANS:vD
Hemorrhagevmayvresultvinvhemorrhagicvshock.vShockvisvanvemergencyvsituationvinvwhichvthevperf
usionvofvbodyvorgansvmayvbecomevseverelyvcompromisedvandvdeathvmayvoccur.vThevpresencevofva
dequatevurinaryvoutputvindicatesvadequatevtissuevperfusion.vThevassessmentvofvthevbuccalvmucos
avforvcyanosisvcanvbevsubjectivevinvnature.vThevpresencevofvcoolvpalevclammyvskinvwouldvbevanvindi
cativevfindingvassociatedvwithvhemorrhagicvshock.vHemorrhagicvshockvisvassociatedvwithvlethargyv
notvrestlessness.
Whichvisvonevofvthevfirstvsymptomsvofvpuerperalvinfectionvtovassessvforvinvthevpostpartumvwoman
?
a.vFatiguevcontinuingvforvlongervthanv1vweek
b.vPainvwithvvoiding
, c.vProfusevvaginalvbleedingvwithvambulation
d.vTemperaturevofv38.6°vCv-vvcorrectvanswersvANS:vD
Postpartumvorvpuerperalvinfectionvisvanyvclinicalvinfectionvofvthevgenitalvcanalvthatvoccursvwithinv2
8vdaysvaftervmiscarriagevinducedvabortionvorvchildbirth.vAvtemperaturevgreatervthanv38°vCvwarrant
svfurthervinvestigationvforvavpuerperalvinfection.vFatiguevwouldvbevavlatevfindingvassociatedvwithvin
fection.vPainvwithvvoidingvmayvindicatevavurinaryvtractvinfectionvbutvitvisvnotvtypicallyvonevofvthevea
rliervsymptomsvofvinfection.vProfusevlochiavmayvbevassociatedvwithvendometritisvbutvitvisvnotvthevfi
rstvsymptomvassociatedvwithvinfection.
Thevperinatalvnursevassistingvwithvestablishingvlactationvisvawarevthatvwhichvactionvcanvminimizeva
cutevmastitis?
a.vWashingvthevnipplesvandvbreastsvwithvmildvsoapvandvwatervoncevavday
b.vUsingvpropervbreastfeedingvtechniques
c.vWearingvavnipplevshieldvforvthevfirstvfewvdaysvofvbreastfeeding
d.vWearingvavsupportivevbrav24vhoursvavdayv-vvcorrectvanswersvANS:vB
Almostvallvinstancesvofvacutevmastitisvcanvbevavoidedvbyvusingvpropervbreastfeedingvtechniquevtov
preventvcrackedvnipples.vWashingvthevnipplesvandvbreastsvdailyvisvnovlongervindicated.vInvfactvthisv
canvcausevtissuevdrynessvandvirritationvwhichvcanvleadvtovtissuevbreakdownvandvinfection.vWearin
gvavnipplevshieldvdoesvnotvpreventvmastitis.vWearingvavsupportivevbrav24vhoursvavdayvmayvcontribu
tevtovmastitisvespeciallyvifvanvunderwirevbravisvwornvbecausevitvmayvputvpressurevonvthevuppervout
ervareavofvthevbreastvcontributingvtovblockedvductsvandvmastitis.
Whichvstatementvisvtruevwithvregardvtovpostpartumvhemorrhagev(PPH)?
a.vPPHvisveasyvtovrecognizevearlyvaftervallvthevwomanvisvbleeding.
b.vTraditionallyvitvtakesvmorevthanv1000vmLvofvbloodvaftervvaginalvbirthvandv2500vmLvaftervCaesare
anvbirthvtovdefinevthevconditionvasvPPH.
c.vIfvanythingvnursesvandvdoctorsvtendvtovoverestimatevthevamountvofvbloodvloss.
d.vTraditionallyvPPHvhasvbeenvclassifiedvasvearlyvorvlatevwithvrespectvtovbirth.v-
vvcorrectvanswersvANS:vD
Midterm
Thevperinatalvnurse'svassessmentvwhilevcaringvforvavwomanvinvthevimmediatevpostvbirthvperiodvre
vealsvthatvthevwomanvisvexperiencingvprofusevbleeding.vWhatvisvthevmostvlikelyvetiologyvforvhervbl
eeding?
a.vUterinevatony
b.vUterinevinversion
c.vVaginalvhematoma
d.vVaginalvlacerationv-vvcorrectvanswersvANS:vA
Uterinevatonyvisvmarkedvhypotoniavofvthevuterus.vItvisvthevleadingvcausevofvpostpartumvhemorrhag
e.vUterinevinversionvmayvleadvtovhemorrhagevbutvitvisvnotvthevmostvlikelyvsourcevofvthisvwoman'svb
leeding.vFurthermorevifvthevwomanvwerevexperiencingvavuterinevinversionvitvwouldvbevevidencedv
byvthevpresencevofvavlargevredvroundedvmassvprotrudingvfromvthevintroitus.vAvvaginalvhematomav
mayvbevassociatedvwithvhemorrhage.vHowevervthevmostvlikelyvclinicalvfindingvwouldvbevpainvnotvt
hevpresencevofvprofusevbleeding.vAvvaginalvlacerationvmayvcausevhemorrhagevbutvitvisvmorevlikelyv
thatvprofusevbleedingvwouldvresultvfromvuterinevatony.vAvvaginalvlacerationvshouldvbevsuspectedvif
vvaginalvbleedingvcontinuesvinvthevpresencevofvavfirmvcontractedvuterinevfundus.
Whichvisvavprimaryvnursingvresponsibilityvwhenvcaringvforvavwomanvexperiencingvanvobstetricalvhe
morrhagevassociatedvwithvuterinevatony?
a.vEstablishvvenousvaccess.
,b.vPerformvfundalvmassage.
c.vPreparevthevwomanvforvsurgicalvintervention.
d.vCatheterizevthevbladder.v-vvcorrectvanswersvANS:vB
Thevinitialvmanagementvofvexcessivevpostpartumvbleedingvisvfirmvmassagevofvthevuterinevfundus.v
Althoughvestablishingvvenousvaccessvmayvbevavnecessaryvinterventionvthevinitialvinterventionvwou
ldvbevfundalvmassage.vThevwomanvmayvneedvsurgicalvinterventionvtovtreatvhervpostpartumvhemor
rhagevbutvthevinitialvnursingvinterventionvwouldvbevtovassessvthevuterus.vAftervuterinevmassagevth
evnursevmayvwantvtovcatheterizevthevpatientvtoveliminatevanyvbladdervdistensionvthatvmayvbevprev
entingvthevuterusvfromvcontractingvproperly.
Whichvisvthevmostvlikelyvcausevofvlatevpostpartumvhemorrhagev(PPH)?
a.vSubinvolutionvofvthevplacentalvsite
b.vDefectivevvascularityvofvthevdecidua
c.vCervicalvlacerations
d.vCoagulationvdisordersv-vvcorrectvanswersvANS:vA
LatevPPHvmayvbevthevresultvofvsubinvolutionvofvthevuterusvpelvicvinfectionvorvretainedvplacentalvfra
gments.vLatevPPHvisvnotvtypicallyvavresultvofvdefectivevvascularityvofvthevdeciduavcervicalvlaceration
svorvcoagulationvdisorders.
Whatvwomanvisvatvgreatestvriskvforvearlyvpostpartumvhemorrhagev(PPH)?
a.vAvprimiparousvwomanvbeingvpreparedvforvanvemergencyvCaesareanvbirthvforvfetalvdistress
b.vAvwomanvwithvseverevpre-eclampsiavonvmagnesiumvsulphatevwhosevlabourvisvbeingvinduced
c.vAvmultiparousvwomanvwithvanv8-hourvlabour
d.vAvprimigravidavinvspontaneousvlabourvwithvpretermvtwinsv-vvcorrectvanswersvANS:vB
MagnesiumvsulphatevadministrationvduringvlabourvposesvavriskvforvPPH.vMagnesiumvactsvasvavsmo
othvmusclevrelaxantvtherebyvcontributingvtovuterinevrelaxationvandvatony.vAlthoughvmanyvcausesv
andvriskvfactorsvarevassociatedvwithvPPHvthevprimiparousvwomanvbeingvpreparedvforvanvemergenc
yvCaesarianvbirthvthevmultiparousvwomanvwithv8-
hourvlabourvandvthevprimigravidavinvspontaneousvlabourvarevnotvatvriskvforvearlyvPPH.
,Whatvisvthevinitialvpriorityvnursingvinterventionvwhenvavnursevobservesvprofusevpostpartumvbleedi
ng?
a.vCallvthevwoman'svprimaryvhealthvcarevprovider.
b.vAdministervthevstandingvordervforvanvoxytocic.
c.vPalpatevthevuterusvandvmassagevitvifvitvisvboggy.
d.vAssessvmaternalvbloodvpressurev(BP)vandvpulsevforvsignsvofvhypovolemicvshock.v-
vvcorrectvanswersvANS:vC
Thevinitialvmanagementvofvexcessivevpostpartumvbleedingvisvfirmvmassagevofvthevuterinevfundus.v
AlthoughvcallingvthevhealthvcarevprovidervadministeringvanvoxytocicvandvassessingvmaternalvBPvar
evappropriatevinterventionsvthevprimaryvinterventionvshouldvbevtovassessvthevuterus.vUterinevaton
yvisvthevleadingvcausevofvpostpartumvhemorrhage.
Whatvisvthevmostvobjectivevandvleastvinvasivevassessmentvofvadequatevorganvperfusionvandvoxyge
nationvwhenvcaringvforvavpostpartumvwomanvexperiencingvhemorrhagicvshock?
a.vAbsencevofvcyanosisvinvthevbuccalvmucosa
b.vCoolvdryvskin
c.vDiminishedvrestlessness
d.vUrinaryvoutputvofvatvleastv30vmL/hrv-vvcorrectvanswersvANS:vD
Hemorrhagevmayvresultvinvhemorrhagicvshock.vShockvisvanvemergencyvsituationvinvwhichvthevperf
usionvofvbodyvorgansvmayvbecomevseverelyvcompromisedvandvdeathvmayvoccur.vThevpresencevofva
dequatevurinaryvoutputvindicatesvadequatevtissuevperfusion.vThevassessmentvofvthevbuccalvmucos
avforvcyanosisvcanvbevsubjectivevinvnature.vThevpresencevofvcoolvpalevclammyvskinvwouldvbevanvindi
cativevfindingvassociatedvwithvhemorrhagicvshock.vHemorrhagicvshockvisvassociatedvwithvlethargyv
notvrestlessness.
Whichvisvonevofvthevfirstvsymptomsvofvpuerperalvinfectionvtovassessvforvinvthevpostpartumvwoman
?
a.vFatiguevcontinuingvforvlongervthanv1vweek
b.vPainvwithvvoiding
, c.vProfusevvaginalvbleedingvwithvambulation
d.vTemperaturevofv38.6°vCv-vvcorrectvanswersvANS:vD
Postpartumvorvpuerperalvinfectionvisvanyvclinicalvinfectionvofvthevgenitalvcanalvthatvoccursvwithinv2
8vdaysvaftervmiscarriagevinducedvabortionvorvchildbirth.vAvtemperaturevgreatervthanv38°vCvwarrant
svfurthervinvestigationvforvavpuerperalvinfection.vFatiguevwouldvbevavlatevfindingvassociatedvwithvin
fection.vPainvwithvvoidingvmayvindicatevavurinaryvtractvinfectionvbutvitvisvnotvtypicallyvonevofvthevea
rliervsymptomsvofvinfection.vProfusevlochiavmayvbevassociatedvwithvendometritisvbutvitvisvnotvthevfi
rstvsymptomvassociatedvwithvinfection.
Thevperinatalvnursevassistingvwithvestablishingvlactationvisvawarevthatvwhichvactionvcanvminimizeva
cutevmastitis?
a.vWashingvthevnipplesvandvbreastsvwithvmildvsoapvandvwatervoncevavday
b.vUsingvpropervbreastfeedingvtechniques
c.vWearingvavnipplevshieldvforvthevfirstvfewvdaysvofvbreastfeeding
d.vWearingvavsupportivevbrav24vhoursvavdayv-vvcorrectvanswersvANS:vB
Almostvallvinstancesvofvacutevmastitisvcanvbevavoidedvbyvusingvpropervbreastfeedingvtechniquevtov
preventvcrackedvnipples.vWashingvthevnipplesvandvbreastsvdailyvisvnovlongervindicated.vInvfactvthisv
canvcausevtissuevdrynessvandvirritationvwhichvcanvleadvtovtissuevbreakdownvandvinfection.vWearin
gvavnipplevshieldvdoesvnotvpreventvmastitis.vWearingvavsupportivevbrav24vhoursvavdayvmayvcontribu
tevtovmastitisvespeciallyvifvanvunderwirevbravisvwornvbecausevitvmayvputvpressurevonvthevuppervout
ervareavofvthevbreastvcontributingvtovblockedvductsvandvmastitis.
Whichvstatementvisvtruevwithvregardvtovpostpartumvhemorrhagev(PPH)?
a.vPPHvisveasyvtovrecognizevearlyvaftervallvthevwomanvisvbleeding.
b.vTraditionallyvitvtakesvmorevthanv1000vmLvofvbloodvaftervvaginalvbirthvandv2500vmLvaftervCaesare
anvbirthvtovdefinevthevconditionvasvPPH.
c.vIfvanythingvnursesvandvdoctorsvtendvtovoverestimatevthevamountvofvbloodvloss.
d.vTraditionallyvPPHvhasvbeenvclassifiedvasvearlyvorvlatevwithvrespectvtovbirth.v-
vvcorrectvanswersvANS:vD
