ATI RN
Postpartum Hormonal Changes Questions
Question 1 of 5
A nurse has administered Methergine (methylergonovine) 0.2 mg po to a grand multipara who delivered vaginally 30 minutes earlier. Which of the following outcomes indicates that the medication is effective?
Correct Answer: C
Rationale: The correct answer is C) Fundus firm at umbilicus. Postpartum hemorrhage is a significant concern after childbirth, especially in grand multiparas. Methergine is a medication commonly used to prevent or treat postpartum hemorrhage by promoting uterine contraction, which helps to control bleeding. A firm fundus at the umbilicus indicates that the medication is effective as it signifies proper uterine contraction, which is essential for preventing excessive bleeding. Option A, blood pressure 120/80, and option B, pulse rate 80 bpm and regular, are not direct indicators of the effectiveness of Methergine in preventing postpartum hemorrhage. While changes in blood pressure and pulse rate can occur as side effects of the medication, they do not directly confirm its effectiveness in controlling bleeding. Option D, an increase in prothrombin time, is incorrect because Methergine does not affect clotting factors or coagulation parameters like prothrombin time. Monitoring clotting factors would be more relevant if the patient was on anticoagulant therapy. This question is important in the context of postpartum care as it highlights the need for nurses to understand the actions of medications commonly used in the management of postpartum complications, such as hemorrhage. Recognizing the appropriate assessment findings that indicate the effectiveness of medications like Methergine is crucial for providing safe and effective care to postpartum patients.
Question 2 of 5
A woman states that all of a sudden her 4-day-old baby is having trouble feeding. On assessment, the nurse notes that the mother's breasts are firm, red, and warm to the touch. The nurse teaches the mother manually to express a small amount of breast milk from each breast. Which observation indicates that the nurse's intervention has been successful?
Correct Answer: B
Rationale: In this scenario, the correct answer is B) The baby swallows after every 5th suck. This observation indicates successful intervention because it demonstrates effective milk transfer and feeding by the infant. When a baby swallows, it signifies that they are extracting milk from the breast successfully. Option A) The mother's nipples being soft to the touch is not a reliable indicator of successful breastfeeding as it does not directly relate to the baby's feeding ability. Option C) The baby's pre- and postfeed weight change of 20 milliliters might indicate successful feeding, but it is not as immediate or direct an observation as the baby swallowing during feeds. Option D) The mother squeezing her nipples during manual expression is unrelated to the baby's feeding ability and does not provide insight into the infant's feeding success. In an educational context, it is crucial for healthcare providers to understand the signs of effective breastfeeding to support mothers and babies in establishing successful breastfeeding relationships. Observing infant feeding cues, such as swallowing, is essential for assessing breastfeeding effectiveness and ensuring adequate milk transfer for the baby's nourishment and growth.
Question 3 of 5
A nurse is caring for a client, PP2, who is preparing to go home with her infant. The nurse notes that the client's blood type is O− (negative), the baby's type is A+ (positive), and the direct Coombs' test is negative. Which of the following actions by the nurse is appropriate?
Correct Answer: B
Rationale: The correct answer is B: Make sure that the client receives a RhoGAM injection before she is discharged from the hospital. In the context of postpartum care, when a mother is Rh-negative and the baby is Rh-positive, there is a risk of Rh incompatibility. If fetal blood enters the maternal circulation during childbirth, the mother's immune system can mount an immune response against the Rh-positive blood cells, leading to potential issues in subsequent pregnancies. RhoGAM is administered to Rh-negative mothers to prevent this immune response. It works by binding to any fetal Rh-positive cells in the mother's bloodstream, preventing her immune system from reacting to them. Administering RhoGAM within 72 hours postpartum is crucial to prevent sensitization in future pregnancies. The other options are incorrect because: A) Waiting until the end of the week for the RhoGAM injection is too late to be effective. C) The baby's negative Coombs' test does not negate the need for the mother to receive RhoGAM. D) Discharge timing should not delay the administration of RhoGAM, as it is time-sensitive. Understanding the rationale behind the administration of RhoGAM in Rh-negative mothers is essential for nurses to provide safe and effective care to postpartum clients and their infants. It highlights the importance of timely interventions to prevent complications in future pregnancies due to Rh incompatibility.
Question 4 of 5
The physician declares after delivering the placenta of a client during a cesarean section that it appears that the client has a placenta accreta. Which of the following maternal complications would be consistent with this diagnosis?
Correct Answer: A
Rationale: In the scenario described, the correct answer is A) Blood loss of 2,000 mL. Placenta accreta is a condition where the placenta attaches too deeply into the uterine wall. During delivery, separating the placenta can lead to severe bleeding as the placenta cannot detach properly. This can result in significant blood loss, which is a common complication associated with placenta accreta. Option B) Blood pressure of 160/110 is not directly related to placenta accreta but could indicate hypertension, which is a different condition. Option C) Jaundiced skin color is not typically associated with placenta accreta. Jaundice usually occurs due to liver or bile duct issues, not directly related to placental attachment abnormalities. Option D) Shortened prothrombin time is not a common complication of placenta accreta. Prothrombin time measures how long it takes for blood to clot, and in placenta accreta, the main concern is excessive bleeding rather than clotting abnormalities. Understanding the maternal complications of placenta accreta is crucial for healthcare providers managing postpartum care. Recognizing the signs and symptoms can aid in prompt diagnosis and appropriate management to prevent severe maternal outcomes. It is essential for healthcare professionals to be well-versed in these complications to ensure the best possible care for their patients during the postpartum period.
Question 5 of 5
A serum electrolyte report for a client, 1 day post-cesarean delivery for eclampsia, has just been received by the nurse. The client is receiving 5% dextrose in 1/2 normal saline IV at 125 mL/hr and magnesium sulfate 2 G/hr IV via infusion pump. Which of the following values should the nurse report to the surgeon?
Correct Answer: A
Rationale: In this scenario, the nurse should report the magnesium level of 7 mg/dL to the surgeon. Postpartum eclampsia is a condition characterized by seizures and is treated with magnesium sulfate to prevent further seizures. Monitoring magnesium levels is crucial due to its narrow therapeutic range, and levels above 7-8 mg/dL can lead to magnesium toxicity, causing respiratory depression and cardiac arrest. The other options are incorrect because: - Option B, Sodium 136 mg/dL, is within the normal range. - Option C, Potassium 3.0 mg/dL, is slightly low but not critical in this context. - Option D, Calcium 9 mg/dL, is also within the normal range. Educationally, this case highlights the importance of monitoring electrolyte levels, especially magnesium, in postpartum eclampsia patients receiving magnesium sulfate therapy. Nurses should understand the significance of each electrolyte in relation to the patient's condition and treatment to provide safe and effective care. Regular monitoring and prompt reporting of abnormal values are essential in preventing complications and ensuring optimal patient outcomes.