Which client is at greatest risk for early PPH?

Correct Answer: B

Rationale: The correct answer is B because a woman with severe preeclampsia on magnesium sulfate is at the greatest risk for early postpartum hemorrhage (PPH) due to the increased risk of placental abruption, coagulopathy, and uterine atony associated with preeclampsia and magnesium sulfate use. Preeclampsia can lead to poor placental perfusion, increasing the risk of hemorrhage during and after delivery. Magnesium sulfate can also affect blood clotting mechanisms, further increasing the risk of excessive bleeding. The other choices are less likely to be at greatest risk for early PPH. Choice A involves a primiparous woman with cesarean delivery, which may have controlled bleeding. Choice C is a multiparous woman with a relatively short labor duration, which is not a significant risk factor for early PPH. Choice D is a primigravida with preterm twins, which does not inherently increase the risk of early PPH

Correct Answer: B

Rationale: The correct answer is B because it accurately defines the criteria for postpartum hemorrhage (PPH). PPH is traditionally defined as losing more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth. This definition helps healthcare providers recognize and manage PPH effectively. Now, let's analyze why the other choices are incorrect: A: This statement is incorrect because PPH may not always be easy to recognize early based solely on visible bleeding. Other signs and symptoms, such as tachycardia and hypotension, also play a crucial role in identifying PPH. C: This statement is incorrect because underestimating, rather than overestimating, the amount of blood loss in PPH can lead to delayed intervention and potentially worsen the patient's condition. D: This statement is incorrect because PPH is not classified based on timing (early or late PPH), but rather on the amount of blood loss as defined in choice B.

Correct Answer: D

Rationale: The correct answer is D: Placenta abruptio. Placenta abruptio is not a type of abnormal adherence pattern; instead, it refers to the premature detachment of a normally implanted placenta. Placenta accreta, increta, and percreta are abnormal adherence patterns where the placenta attaches too deeply into the uterine wall. Accreta is when it attaches but does not penetrate, increta is when it penetrates into the myometrium, and percreta is when it penetrates through the myometrium. Therefore, Placenta abruptio is the correct answer as it does not fall under the category of abnormal adherence patterns like the other choices.

Correct Answer: C

Rationale: The correct initial treatment for vWD client with PPH is desmopressin (Choice C) because it stimulates the release of von Willebrand factor and factor VIII from storage sites, helping to improve clotting. Cryoprecipitate (Choice A) contains multiple clotting factors and is usually reserved for severe bleeding. Factor VIII and vWf (Choice B) can be used for severe cases but are not typically the initial treatment. Hemabate (Choice D) is a medication used for postpartum hemorrhage due to uterine atony, not specifically for vWD-related bleeding.

Correct Answer: A

Rationale: The correct answer is A: Hysterectomy. Hysterectomy is the appropriate surgical procedure for late postpartum hemorrhage (PPH) when nonsurgical treatments fail. It involves the removal of the uterus, which can effectively stop the bleeding. Other choices like Laparoscopy (B) and Laparotomy (C) are surgical techniques used to access the abdomen but do not address the underlying cause of PPH. Dilation and curettage (D&C) (D) is a procedure to remove tissue from the uterus and would not be effective in treating late PPH.