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.

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

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.

Correct Answer: B

Rationale: Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous woman being prepared for an emergency cesarean birth for fetal distress, a multiparous woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do not indicate risk factors or causes of early PPH

Correct Answer: C

Rationale: The most important strategy for the nurse to adopt in preventing puerperal infection is option C, which is the strict aseptic technique, including hand washing, by all health care personnel. Puerperal infection, also known as postpartum infection, is a serious complication following childbirth that can lead to severe consequences if not prevented. Maintaining proper hygiene practices, such as hand washing and using aseptic techniques, is crucial in preventing the spread of pathogens that can cause infections. This simple yet effective measure can significantly reduce the risk of puerperal infections among postpartum women. Large doses of vitamin C during pregnancy (option A) may have benefits for overall health but are not specifically proven to prevent puerperal infections. Prophylactic antibiotics (option B) may be used in certain cases but are not the primary strategy for prevention in all cases. Limiting protein and fat intake (option D) is not a recommended approach