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A client, 1 day postpartum (PP), is being monitored administration.
carefully after a significant postpartum hemorrhage.
Which of the following should the nurse report to the 2. It is likely that the medication was added during the
obstetrician? 3rd stage of labor to promote placental delivery.
1. Urine output 200 mL for the past 8 hours.
2. Weight decrease of 2 pounds since delivery. 3. Placental delivery usually occurs between 5
3. Drop in hematocrit of 2% since admission. minutes and 30 minutes after the birth. This is an
4. Pulse rate of 68 beats per minute - -1 unlikely rationale for the medication administration.
1. This output is below the accepted minimum for 8 4. The client's 2nd stage of labor lasted 45 minutes.
hours. That is a relatively short period of time for a
primipara. As important, 20 units of oxytocin is an
2. This weight decrease following delivery is within unsafe dosage to be administered before the fetus is
normal limits. birthed.
3. A 2% drop in hematocrit is within normal limits. TEST-TAKING TIP: Postpartum hemorrhage (PPH) is
a leading cause of maternal death. One effective
4. This pulse rate is within normal limits. means of preventing PPH is active management of
the 3 rd stage of labor. In other words, oxytocin is
TEST-TAKING TIP: The nurse must divide the administered after the birth of the baby to promote
amount of urine output by the number of hours. The uterine contraction and placental delivery. The
output in the scenario is equal to 25 mL/hr. This is oxytocin is usually added to the client's IV infusion
well below the accepted output of 30 mL/ hr. Plus, and the infusion is continued until the fl uid is fully
because this is a postpartum client, the nurse would absorbed.
expect high urinary outputs. Postpartum clients often
have slowed heartbeats.
A nurse is caring for the following four laboring
patients. Which clients should the nurse be prepared
A mother, G1 P1, who delivered a 2,800 gram baby to monitor closely for signs of postpartum
vaginally 30 minutes earlier, is transferred to the hemorrhage (PPH)? Select all that apply.
postpartum unit. She pushed for 45 minutes and the 1. G1 P0000, delivered a fetal demise at 29 weeks'
placenta was delivered 10 minutes later. She is gestation.
receiving an intravenous with 20 units oxytocin 2. G2 P1001, prolonged first stage of labor.
added. The postpartum nurse questions why the 3. G2 P0010, delivered by cesarean section for
oxytocin was added to the IV bag. Which of the failure to progress.
following responses by the transferring nurse is most 4. G3 P0200, delivered vaginally a 42-week, 2,200-
likely? gram neonate.
1. "The medication was added 10 minutes ago to 5. G4 P3003, with a succenturiate placenta. - -
prevent excess bleeding during her transfer." 2 and 5 are correct.
2. "The medication was added immediately after the
baby's birth to promote placental delivery." 1. Preterm labor clients are not especially at high risk
3. "The medication was added after the placenta was for postpartum hemorrhage.
delivered because of its rapid separation."
4. "The medication was added while she was 2. Clients who have had a prolonged first stage of
pushing to speed up the baby's birth." - -2 labor are at high risk for postpartum hemorrhage
(PPH).
1. Patient transfer from labor and delivery to
postpartum does not stimulate excess bleeding. It is 3. Cesarean section clients are not especially at high
unlikely that this is the rationale for the medication risk for PPH.
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, Postpartum Hemorrhage Practice Questions Test #4 with
Verified Answers
postpartum hemorrhage?
4. Postdates clients who deliver small babies are not 1. Alteration in comfort related to afterbirth pains.
especially at high risk for PPH. 2. Risk for altered parenting related to grand
multiparity.
5. Clients with a succenturiate placenta are at high 3. Fluid volume deficit related to blood loss.
risk for PPH. 4. Risk for sleep deprivation related to mothering role.
- -3
TEST-TAKING TIP: The muscles of the uterus of a
client who has experienced a prolonged first stage of 1. This is an important nursing diagnosis, but it is not
labor are fatigued. In the postpartum period, the priority diagnosis.
therefore, they may fail to contract fully enough to
control bleeding at the site of placental separation. A 2. This is an important nursing diagnosis, but it is not
succenturiate placenta is characterized by one the priority diagnosis.
primary placenta that is attached via blood vessels to
satellite lobe(s). These clients must be monitored 3. Fluid volume deficit related to blood loss is the
carefully for postpartum hemorrhage. priority nursing diagnosis.
4. This is an important nursing diagnosis, but it is not
A client just delivered the placenta pictured below. the priority diagnosis.
For which of the following complications should the
nurse carefully observe the woman? TEST-TAKING TIP: It is likely that most clients will
1. Endometrial ischemia. have multiple nursing diagnoses. The nurse must
2. Postpartum hemorrhage. then determine which is (are) the priority
3. Prolapsed uterus. diagnosis(ses). It is essential that the nurse
4. Vaginal hematoma. - -2 remember Maslow's hierarchy of needs. Although
psychosocial needs are very important, the
1. Endometrial ischemia is not a complication of a physiological needs, especially those related to the
succenturiate placenta. respiratory and the cardiovascular systems, must
take precedence.
2. The nurse should carefully monitor this client for
signs of postpartum hemorrhage.
A mother, G6 P6006, is 15 minutes postpartum. Her
3. The client is not especially at high risk for a baby weighed 4,595 grams at birth. For which of the
prolapsed uterus. following complications should the nurse monitor this
client?
4. The client is not at high risk for a vaginal 1. Seizures.
hematoma. 2. Hemorrhage.
3. Infection.
TEST-TAKING TIP: Because a succenturiate 4. Thrombosis. - -2
placenta has extra lobe(s), the client is at high risk for
hemorrhage from one or more of the lobes. The 1. This client is not especially at high risk for seizures.
healthcare professional who performed the delivery
may have noted one lobe but may not have realized 2. The client should be monitored carefully for signs
that an additional lobe is still in utero. of postpartum hemorrhage.
3. This client is not especially at high risk for infection.
Which of the following is a priority nursing diagnosis
for a woman, G10 P6226, who is PP1 from a 4. This client is not especially at high risk for
spontaneous vaginal delivery with a significant thrombosis.
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