ATI RN
Complications of Postpartum Questions
Question 1 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: In this scenario, 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 induce bronchospasm. As a nurse, it is crucial to communicate this contraindication to the provider to prevent exacerbation of the patient's asthma and potential respiratory distress. Option A is incorrect because delaying administration of Cytotec and Methergine could worsen the patient's condition, as she is experiencing heavy vaginal bleeding. Option B is incorrect as rectal administration of Cytotec is not necessary in this situation, and the route of Methergine is not the primary concern given the patient's asthma history. Option C is incorrect as removing the abdominal dressing to inspect for incisional bleeding is not the priority in managing postpartum hemorrhage and asthma exacerbation. Educationally, this scenario highlights the importance of understanding medication contraindications based on a patient's medical history and the critical role of effective communication between nurses and providers to ensure safe and individualized patient care.
Question 2 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 action for the nurse in this scenario is option A) Massage the uterus and resume the IV Pitocin drip. This response is appropriate because the patient is displaying signs of postpartum hemorrhage, a serious complication that requires urgent intervention. Massaging the uterus helps to promote uterine contractions, which can help control the bleeding. Resuming the IV Pitocin drip, a uterotonic medication, further aids in contracting the uterus to stop the hemorrhage. Option B) Change the peri-pad and reassess the bleeding is incorrect because simply changing the peri-pad does not address the underlying issue of postpartum hemorrhage. Immediate intervention to address the uterine atony is crucial in this situation. Option C) Call the provider to check for a cervical laceration is not the first action to take in this scenario. While cervical laceration may cause bleeding, the priority is to address uterine atony, as it is a more common cause of postpartum hemorrhage. Option D) Administer the ordered iron supplement and ibuprofen is also incorrect as it does not address the acute issue of postpartum hemorrhage. Iron supplements and ibuprofen are not indicated as the initial response to heavy vaginal bleeding in the postpartum period. In an educational context, it is essential for nurses to recognize the signs of postpartum hemorrhage and understand the appropriate interventions to manage this potentially life-threatening complication. Timely and effective interventions, such as uterine massage and uterotonic medications, can make a significant difference in the outcome for the patient. Nurses must be prepared to act quickly and decisively in such critical situations to ensure the safety and well-being of the mother.
Question 3 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: The correct answer is D. In this scenario, the nurse should explain to the patient that the incision is healing well and provide appropriate measures to manage the elevated temperature and pain. It is essential to address the patient's current symptoms and provide symptomatic relief while ensuring proper healing of the incision. Continuing with the ordered pain medication and advising the patient to take Tylenol for the elevated temperature are appropriate actions to manage the immediate concerns. Option A is incorrect because jumping to conclusions about a uterine infection without further assessment or diagnostic tests can lead to unnecessary anxiety for the patient. Option B is incorrect as it dismisses the concerning symptoms of fever and foul-smelling lochia, which could indicate an infection or other complication. Option C is incorrect because the patient's symptoms of uterine tenderness and elevated temperature require immediate attention and should not be dismissed as normal postoperative pain. In an educational context, it is crucial for nurses to recognize and respond to postpartum complications promptly. Understanding the signs and symptoms of postpartum infections, such as fever and foul-smelling discharge, is essential for providing appropriate care and preventing potential complications. Nurses play a key role in early identification and intervention in postpartum complications to ensure optimal patient outcomes.
Question 4 of 5
A patient who has been on prolonged bedrest for bleeding associated with placenta previa was taken to the operating room for an emergency cesarean delivery. Sixteen hours postoperatively, the patient complains that her left leg is hurting. The nurse finds that the entire left leg is swollen and has pitting edema, while the right leg appears to be normal. Which order does the nurse anticipate when paging the health care provider to the room?
Correct Answer: B
Rationale: In this scenario, the correct answer is B) Ultrasound of the leg. The patient's presentation of unilateral leg swelling and pitting edema raises suspicion for deep vein thrombosis (DVT), a common complication postpartum, especially in women who have been on prolonged bedrest. An ultrasound of the leg is the most appropriate diagnostic test to confirm the presence of DVT. Option A) White blood cell count (WBC) is unlikely to be the priority in this case as the patient's symptoms are more suggestive of a vascular issue rather than an infectious process. Option C) X-ray of the leg is not the preferred initial imaging modality for evaluating DVT. Ultrasound is more sensitive and specific for detecting DVT. Option D) Serum creatinine is not relevant to the patient's presentation of unilateral leg swelling and pitting edema. It is more indicative of renal function and not the primary concern in this context. From an educational perspective, it is crucial for healthcare providers to recognize the signs and symptoms of DVT in postpartum patients, as prompt diagnosis and treatment are essential to prevent serious complications such as pulmonary embolism. Understanding the appropriate diagnostic approach in such cases is vital for providing safe and effective care to this patient population.
Question 5 of 5
One hour after a woman gives birth vaginally, the nurse notes that her fundus is firm, 2 fingerbreadths above the umbilicus, and deviated to the right. Lochia rubra is moderate. Her perineum is slightly edematous, with no bruising; an ice pack is in place. The priority nursing action is to:
Correct Answer: B
Rationale: The priority nursing action in this scenario is to have the woman empty her bladder (Option B). This is essential because a full bladder can displace the uterus, leading to potential complications such as uterine atony or hemorrhage. By ensuring the bladder is empty, the nurse helps the uterus contract effectively, reducing the risk of postpartum hemorrhage. Option A is incorrect because while it is important to document normal assessments, addressing the full bladder takes precedence due to its potential impact on uterine contraction. Option C is incorrect as removing the ice pack could lead to increased swelling and discomfort in the perineal area, which is not a priority at this time. Option D is incorrect because increasing the rate of oxytocin infusion without addressing the full bladder first may not effectively manage the situation. In an educational context, it is crucial for nurses to prioritize interventions based on their potential impact on patient outcomes. Understanding the physiological processes postpartum and how different factors can influence them is key to providing safe and effective care to women during the postpartum period. This case highlights the importance of basic nursing assessments and interventions in preventing complications following childbirth.