ATI RN
Complications of Postpartum Questions
Question 1 of 5
The nurse is admitting a 38-year-old patient to triage in early labor with ruptured membranes. Her history includes a previous vaginal delivery 4 years ago and the presence of a uterine fibroid. What interventions are appropriate based on the hemorrhage risk for this patient?
Correct Answer: A
Rationale: Step 1: The patient is in early labor with ruptured membranes, which increases the risk of hemorrhage. Step 2: The presence of a uterine fibroid also contributes to the hemorrhage risk. Step 3: Previous vaginal delivery 4 years ago does not significantly alter the hemorrhage risk. Step 4: Ordering a type and screen will allow for rapid access to blood products if needed in case of hemorrhage. Step 5: This is a moderate hemorrhage risk situation, warranting the need for preparing for potential blood transfusion. Summary: - Choice B is incorrect as ordering 4 units of packed red blood cells is excessive for a moderate hemorrhage risk. - Choice C is incorrect as a hold tube will not provide immediate access to blood products in case of hemorrhage. - Choice D is incorrect as blood should be drawn to be prepared for potential hemorrhage in a moderate risk situation.
Question 2 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 3 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 4 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 5 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