ATI RN
Complications of Postpartum Questions
Question 1 of 5
A patient delivered vaginally 20 minutes ago. Prophylactic Pitocin is infusing intravenously. During the initial postpartum assessment, the nurse notes a heavy amount of bleeding on the perineal pad. What are the priority nursing actions?
Correct Answer: B
Rationale: The correct answer is B. Assess the fundus and massage the uterus to determine uterine tone and location. This is the priority action because heavy bleeding postpartum could indicate uterine atony, a common cause of postpartum hemorrhage. By assessing the fundus and massaging the uterus, the nurse can determine if the uterus is firm and well contracted, which helps to control bleeding. Other choices are incorrect as they do not address the immediate concern of uterine atony. Choice A focuses on the perineum and does not address the potential cause of bleeding. Choice C addresses bladder fullness, which is important but not as urgent as assessing for uterine atony. Choice D focuses on clots and privacy but does not address the primary concern of uterine tone.
Question 2 of 5
A woman is 1 hour postcesarean delivery with nausea and an estimated blood loss of 1,200 mL. She is currently experiencing heavy vaginal bleeding and has a uterus that firms with massage. She has a history of asthma with a current O2 saturation of 89%. The licensed provider has ordered Cytotec 800 mcg and Methergine 0.2 mg. What collaborative communication should occur between the nurse and provider?
Correct Answer: D
Rationale: The correct answer is D: Recommend that the patient not get Methergine because she has a history of asthma. Methergine is contraindicated in patients with a history of asthma due to its potential to cause bronchospasm and worsen respiratory function. As the patient has a history of asthma with a current low O2 saturation, administering Methergine could exacerbate her respiratory status. Collaborative communication between the nurse and provider is crucial to ensure patient safety and avoid potential complications. Summary of other choices: A: Delaying administration of Cytotec and Methergine is not appropriate as the patient is experiencing heavy vaginal bleeding and needs prompt management. B: Giving Cytotec rectally and considering the route for Methergine do not address the contraindication of Methergine in a patient with asthma. C: Removing the abdominal dressing to inspect for incisional bleeding may be necessary but does not address the contraindication of Methergine in a
Question 3 of 5
A postpartum patient calls the clinic 4 days after the birth of her newborn because she is extremely tired and her vaginal bleeding is heavier. Which does the nurse anticipate when advising her to come in to the office right now?
Correct Answer: A
Rationale: The correct answer is A. The nurse anticipates that a hematocrit will be drawn and the provider will check for retained placental fragments because heavy vaginal bleeding and extreme fatigue could indicate postpartum hemorrhage due to retained placental tissue. This is a serious complication that requires immediate medical attention to prevent further complications such as infection or hemorrhagic shock. Choice B is incorrect because prescribing sleeping medication does not address the underlying cause of the symptoms. Choice C is incorrect because lacerations would typically have been evaluated and repaired during delivery, and would not likely be missed. Choice D is incorrect because reassuring the client without further evaluation could lead to potential serious consequences if the underlying issue of retained placental fragments is not addressed promptly.
Question 4 of 5
The nurse is assessing a patient who is 12 hours postpartum. The uterus is firm to palpation, at midline, and is 1 cm below the umbilicus with continuous heavy vaginal bleeding. What is the nurse’s first action?
Correct Answer: A
Rationale: The correct answer is A: Massage the uterus and resume the IV Pitocin drip. The patient is showing signs of uterine atony with heavy vaginal bleeding. Massaging the uterus helps stimulate contractions, controlling bleeding. Resuming IV Pitocin enhances uterine contractions further. Choices B, C, and D are incorrect. Changing the peri-pad does not address the underlying cause of bleeding. Checking for a cervical laceration may be needed later but is not the immediate priority. Administering iron supplement and ibuprofen does not address the acute issue of uterine atony and bleeding.
Question 5 of 5
A postpartum cesarean patient comes into the rural health clinic at 1 week postdelivery for an incision check by the nurse. The vital signs reveal a temperature of 100.5°F, and the patient reports moderate foul-smelling lochia. The nurse determines that the skin incision is healing normally, but when palpating the uterus, she discovers the patient to have uterine and pelvic tenderness. What are the most appropriate nursing actions?
Correct Answer: D
Rationale: Step 1: The nurse's assessment reveals signs of infection (fever, foul-smelling lochia, uterine, and pelvic tenderness). Step 2: The nurse should address the immediate concerns - fever and pain. Tylenol helps reduce fever and pain. Step 3: The incision healing well indicates no immediate surgical intervention required. Step 4: Continuing pain medication ensures comfort until next visit. Step 5: Blood tests for infection are not urgent; they can be done at the next visit if symptoms persist. Summary: A: Immediate blood draw is not necessary without a clear indication of sepsis. B: Resting more won't address the infection; waiting a few days can worsen the condition. C: Normal postoperative pain doesn't include fever and foul-smelling lochia; waiting for the 6-week checkup is risky.