Chapter 35 The Postpartum Family at Risk
1) The charge nurse is assessing several postpartum clients. Which client has
the greatest risk for postpartum hemorrhage?
1. The client who was overdue and delivered vaginally
2. The client who delivered by scheduled cesarean delivery
3. The client who had oxytocin augmentation of labor
4. The client who delivered vaginally at 36 weeks
Answer: 3
Explanation: 3. Uterine atony is a cause of postpartal hemorrhage. A
contributing factor to uterine atony is oxytocin augmentation of labor.
Page Ref: 968
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of
technology and standardized practices that support safety and quality. |
AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused
physical, behavioral, psychological, spiritual, socioeconomic, and
environmental assessments of health and illness parameters in patients, using
developmentally and culturally appropriate approaches. | NLN Competencies:
Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of
postpartum hemorrhage.
1
Copyright 2016 Pearson Education, Inc.
2) The nurse is assisting a multiparous woman to the bathroom for the first
time since her delivery 3 hours ago. When the client stands up, blood runs
,down her legs and pools on the floor. The client turns pale and feels weak. What
would be the first action of the nurse?
1. Assist the client to empty her bladder
2. Help the client back to bed to check the fundus
3. Assess her blood pressure and pulse
4. Begin an IV of lactated Ringers solution
Answer: 2
Explanation: 2. Massaging the fundus is the top priority because of the
excessive blood loss. If the fundus is not firm, gentle fundal massage is
performed until the uterus contracts.
Page Ref: 969
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum
and Newborn Care
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of
technology and standardized practices that support safety and quality. |
AACN Essentials Competencies: IX. 8. Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan. | NLN Competencies: Quality and
Safety: Current best practices. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of postpartum
hemorrhage.
2
Copyright 2016 Pearson Education, Inc.
3) A client is experiencing excessive bleeding immediately after the birth of her
newborn. After speeding up the IV fluids containing oxytocin, with no
noticeable decrease in the bleeding, the nurse should anticipate the physician
requesting which medications?
,Note: Credit will be given only if all correct choices and no incorrect choices
are selected.
Select all that apply.
1. Methergine
2. Coumadin
3. Misoprostol
4. Serotonin reuptake inhibitors (SSRIs)
5. Nonsteroidal anti-inflammatory drugs
Answer: 1, 3
Explanation: 1. Methergine is commonly used orally for postpartum
hemorrhage.
3. Misoprostol is commonly used rectally for postpartum hemorrhage.
Page Ref: 971, 972
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of
technology and standardized practices that support safety and quality. |
AACN Essentials Competencies: IX. 8. Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan. | NLN Competencies: Relationship-
Centered Care: Current best practices. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of
postpartum hemorrhage.
3
Copyright 2016 Pearson Education, Inc.
4) The client has experienced a postpartum hemorrhage at 6 hours
postpartum. After controlling the hemorrhage, the clients partner asks what
, would cause a hemorrhage. How should the nurse respond?
1. Sometimes the uterus relaxes and excessive bleeding occurs.
2. The blood collected in the vagina and poured out when your partner stood
up.
3. Bottle-feeding prevents the uterus from getting enough stimulation to
contract.
4. The placenta had embedded in the uterine tissue abnormally.
Answer: 1
Explanation: 1. Uterine atony (relaxation of the uterus) is the leading cause of
early postpartum hemorrhage, accounting for over 50% of postpartum
hemorrhage cases.
Page Ref: 968
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum
and Newborn Care
Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple
dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7.
Provide appropriate patient teaching that reflects developmental stage, age,
culture, spirituality, patient preferences, and health literacy considerations to
foster patient engagement in their care. | NLN Competencies: Relationship-
Centered Care: Communicate information effectively; listen openly and
cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of postpartum
hemorrhage.
4
Copyright 2016 Pearson Education, Inc.
5) The nurse is assessing a client who has been diagnosed with an early
postpartum hemorrhage. Which findings would the nurse expect?
1) The charge nurse is assessing several postpartum clients. Which client has
the greatest risk for postpartum hemorrhage?
1. The client who was overdue and delivered vaginally
2. The client who delivered by scheduled cesarean delivery
3. The client who had oxytocin augmentation of labor
4. The client who delivered vaginally at 36 weeks
Answer: 3
Explanation: 3. Uterine atony is a cause of postpartal hemorrhage. A
contributing factor to uterine atony is oxytocin augmentation of labor.
Page Ref: 968
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of
technology and standardized practices that support safety and quality. |
AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused
physical, behavioral, psychological, spiritual, socioeconomic, and
environmental assessments of health and illness parameters in patients, using
developmentally and culturally appropriate approaches. | NLN Competencies:
Relationship-Centered Care: Factors that contribute to or threaten health. |
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of
postpartum hemorrhage.
1
Copyright 2016 Pearson Education, Inc.
2) The nurse is assisting a multiparous woman to the bathroom for the first
time since her delivery 3 hours ago. When the client stands up, blood runs
,down her legs and pools on the floor. The client turns pale and feels weak. What
would be the first action of the nurse?
1. Assist the client to empty her bladder
2. Help the client back to bed to check the fundus
3. Assess her blood pressure and pulse
4. Begin an IV of lactated Ringers solution
Answer: 2
Explanation: 2. Massaging the fundus is the top priority because of the
excessive blood loss. If the fundus is not firm, gentle fundal massage is
performed until the uterus contracts.
Page Ref: 969
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum
and Newborn Care
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of
technology and standardized practices that support safety and quality. |
AACN Essentials Competencies: IX. 8. Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan. | NLN Competencies: Quality and
Safety: Current best practices. | Nursing/Integrated Concepts: Nursing Process:
Implementation
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of postpartum
hemorrhage.
2
Copyright 2016 Pearson Education, Inc.
3) A client is experiencing excessive bleeding immediately after the birth of her
newborn. After speeding up the IV fluids containing oxytocin, with no
noticeable decrease in the bleeding, the nurse should anticipate the physician
requesting which medications?
,Note: Credit will be given only if all correct choices and no incorrect choices
are selected.
Select all that apply.
1. Methergine
2. Coumadin
3. Misoprostol
4. Serotonin reuptake inhibitors (SSRIs)
5. Nonsteroidal anti-inflammatory drugs
Answer: 1, 3
Explanation: 1. Methergine is commonly used orally for postpartum
hemorrhage.
3. Misoprostol is commonly used rectally for postpartum hemorrhage.
Page Ref: 971, 972
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Reduction of Risk Potential
Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of
technology and standardized practices that support safety and quality. |
AACN Essentials Competencies: IX. 8. Implement evidence-based nursing
interventions as appropriate for managing the acute and chronic care of patients
and promoting health across the lifespan. | NLN Competencies: Relationship-
Centered Care: Current best practices. | Nursing/Integrated Concepts: Nursing
Process: Implementation
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of
postpartum hemorrhage.
3
Copyright 2016 Pearson Education, Inc.
4) The client has experienced a postpartum hemorrhage at 6 hours
postpartum. After controlling the hemorrhage, the clients partner asks what
, would cause a hemorrhage. How should the nurse respond?
1. Sometimes the uterus relaxes and excessive bleeding occurs.
2. The blood collected in the vagina and poured out when your partner stood
up.
3. Bottle-feeding prevents the uterus from getting enough stimulation to
contract.
4. The placenta had embedded in the uterine tissue abnormally.
Answer: 1
Explanation: 1. Uterine atony (relaxation of the uterus) is the leading cause of
early postpartum hemorrhage, accounting for over 50% of postpartum
hemorrhage cases.
Page Ref: 968
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum
and Newborn Care
Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple
dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7.
Provide appropriate patient teaching that reflects developmental stage, age,
culture, spirituality, patient preferences, and health literacy considerations to
foster patient engagement in their care. | NLN Competencies: Relationship-
Centered Care: Communicate information effectively; listen openly and
cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: 1 Identify the causes, contributing factors, signs and
symptoms, clinical therapy, and nursing interventions for early and late
hemorrhage during the postpartum period.
MNL LO: 5.3.2 Compare the various etiologies and management of postpartum
hemorrhage.
4
Copyright 2016 Pearson Education, Inc.
5) The nurse is assessing a client who has been diagnosed with an early
postpartum hemorrhage. Which findings would the nurse expect?
