ATI RN
Complication Postpartum Questions
Question 1 of 5
What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?
Correct Answer: A
Rationale: The steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests uterine atony. Uterine atony is a condition where the uterus fails to contract effectively after childbirth, resulting in postpartum hemorrhage. The firm fundus indicates that the uterus is not properly contracting to control bleeding, leading to the continuous flow of blood from the vagina. Prompt intervention is crucial to manage uterine atony and prevent further complications such as excessive blood loss.
Question 2 of 5
The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room?
Correct Answer: B
Rationale: The correct method for estimating blood loss in the delivery room, as implemented in new protocols, is option B) Collect blood in calibrated, under-buttocks drapes for vaginal birth. This method is preferred because it provides a more accurate measurement of blood loss compared to the other options. By using calibrated drapes, the healthcare team can quantitatively assess the amount of blood lost during the postpartum period, leading to better monitoring and management of potential complications. Option A is incorrect because relying on a subjective assessment from the patient about the number of peripads soaked can be unreliable and inconsistent. Option C, placing a basin at the foot of the delivery table, may not capture all blood loss accurately and could lead to underestimation. Option D, relying on the primary healthcare provider's estimate, may lack precision and standardization, potentially resulting in inaccurate assessments. Educationally, understanding the importance of accurate estimation of postpartum blood loss is crucial for nurses working in labor and delivery settings. It ensures timely identification of complications such as postpartum hemorrhage, allowing for prompt intervention and improved patient outcomes. Implementing evidence-based practices, such as using calibrated drapes, enhances the quality of care provided to postpartum women and promotes patient safety.
Question 3 of 5
The nurse in a labor and delivery department carefully assesses postpartum patients for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign evaluation?
Correct Answer: C
Rationale: In postpartum care, assessing for signs of hemorrhage is crucial. Option C, "Changes in blood pressure may not be an immediate sign," is correct because postpartum hemorrhage can initially present with subtle changes in blood pressure or even normal readings before a sudden drop occurs. This delay in blood pressure changes can make it challenging to identify hemorrhage through vital sign evaluation alone. Option A, "Blood pressure may be elevated from prenatal conditions," is incorrect because elevated blood pressure from prenatal conditions would not necessarily mask signs of hemorrhage. Option B, "Respirations are increased due to activity of labor," is incorrect as increased respirations are not typically a primary indicator of postpartum hemorrhage. Option D, "Heart rate may increase with intensity of labor," is also incorrect as an increased heart rate during labor is expected and may not directly correlate with hemorrhage risk. Educationally, this question highlights the importance of understanding the nuances of vital sign assessment in postpartum patients to effectively identify complications like hemorrhage. It emphasizes the need for a comprehensive assessment that goes beyond routine vital signs to ensure early detection and prompt intervention in postpartum care.
Question 4 of 5
The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient?
Correct Answer: C
Rationale: In this scenario, the correct answer is C) Carboprost-tromethamine. The rationale behind this choice lies in understanding the pharmacology of these medications in managing postpartum complications. Carboprost-tromethamine is a prostaglandin analog that is used to prevent or treat postpartum hemorrhage, which is a significant risk in this patient due to her multiparity, precipitous birth, and history of hypertension. This medication helps in uterine contractions and vasoconstriction, thus aiding in controlling excessive bleeding during the third stage of labor. Regarding why the other options are incorrect: A) Methylergonovine is a uterotonic agent but is contraindicated in patients with hypertension due to its vasoconstrictive effects, which could exacerbate hypertension. B) Fresh frozen plasma is not indicated for postpartum hemorrhage. It is used to replace clotting factors in conditions like disseminated intravascular coagulation. D) Magnesium sulfate is used for conditions like preeclampsia and eclampsia to prevent seizures, not for managing postpartum hemorrhage. In an educational context, understanding the rationale behind choosing the correct medication is crucial for nurses caring for postpartum patients. It emphasizes the importance of considering the patient's history, risk factors, and the pharmacological effects of each medication to provide safe and effective care. This case highlights the critical role of pharmacology knowledge in nursing practice to ensure optimal patient outcomes.
Question 5 of 5
The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take?
Correct Answer: C
Rationale: In this scenario, the correct action for the nurse to take is to contact the primary care provider for further evaluation (Option C). This is the most appropriate response because the presence of severe perineal pain, discoloration, and tenderness in the perineal area could indicate a serious complication such as a hematoma or infection. Prompt communication with the primary care provider is essential to ensure timely assessment and management of the patient's condition to prevent potential complications. Option A, continuing to apply ice, is incorrect because in this situation, the priority is to assess and address the underlying cause of the perineal pain rather than solely focusing on pain management. Option B, monitoring vital signs, is important but not sufficient on its own to address the potential serious complication indicated by the physical examination findings. Option D, placing the patient in a side-lying position to relieve pressure, is not the most appropriate action when there are signs of a potential complication that require immediate medical attention. From an educational perspective, this question highlights the importance of thorough assessment and prompt reporting of concerning findings in postpartum patients. It emphasizes the nurse's role in recognizing abnormal postpartum symptoms and collaborating with the healthcare team to ensure timely and appropriate interventions to promote patient safety and well-being.