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: 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 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 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 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: 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.
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: The correct answer is B: Ultrasound of the leg. In this scenario, the patient is at risk for deep vein thrombosis (DVT) due to prolonged bedrest and recent surgery. The symptoms of leg pain, swelling, and pitting edema raise suspicion for DVT. An ultrasound of the leg is the most appropriate diagnostic test to confirm the presence of a blood clot. This test is non-invasive, highly sensitive, and specific for detecting DVT. It allows for prompt diagnosis and initiation of appropriate treatment such as anticoagulation therapy to prevent potential complications like pulmonary embolism. Summary: - A: White blood cell count (WBC) is not indicated for evaluating leg pain and swelling in this context. - C: X-ray of the leg is not useful for diagnosing DVT, as it primarily shows bones and is not sensitive for detecting blood clots. - D: Serum creatinine is a test for kidney function and is not relevant for assessing
Question 5 of 5
What is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony?
Correct Answer: B
Rationale: Performing fundal massage is the primary nursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony. Uterine atony is a common cause of postpartum hemorrhage, where the uterus fails to contract and retract after childbirth, leading to excessive bleeding. Fundal massage helps stimulate uterine contractions and assists in controlling the bleeding. Establishing venous access, preparing the woman for surgical intervention, and catheterizing the bladder are important interventions as well, but fundal massage takes priority in managing uterine atony and preventing further blood loss.