35-year-old postpartum client.

Select the condition, risk factors and assessment findings that the client may be experiencing.

Answer and Explanation

The Correct Answer is []

Condition: Postpartum Hemorrhage (PPH)

Postpartum hemorrhage is defined as blood loss ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean delivery. In this case, the client has heavy bleeding, large clots, and lightheadedness, which are key indicators of excessive postpartum blood loss.

Risk Factors

1. Fetal Macrosomia: The baby weighs 9 lbs 4 oz (4196 grams), which is considered macrosomia (birth weight > 4000 g). Large fetal size increases the risk of uterine overdistension, which can impair uterine contractions and lead to uterine atony, the most common cause of postpartum hemorrhage.

2. Uterine Atony: The nurse initially noted a boggy uterus that required massage to become firm. Uterine atony occurs when the uterus fails to contract effectively after delivery, leading to excessive bleeding. This is the leading cause of PPH.

3. Prolonged Labor: A prolonged labor can cause uterine fatigue, reducing the uterus's ability to contract properly after delivery, thereby increasing the risk of uterine atony and PPH.

Assessment Findings

1. Heavy vaginal bleeding: The client has heavy bleeding with three quarter-sized clots, which is abnormal postpartum and indicates excessive blood loss.

2. Blood pressure: The client’s BP is 150/86 mmHg, which may indicate compensatory vasoconstriction due to ongoing blood loss. If hemorrhage continues, hypotension may develop.

3. Urine output: The client did not feel the urge to void, and catheterization drained 450 mL of urine. A full bladder can prevent proper uterine contraction, worsening uterine atony and bleeding.

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Correct Answer is C

Explanation

A. "There is an increased risk of introducing infection." – While infections can occur, the primary concern with internal examinations in placenta previa is hemorrhage rather than infection.

B. "There is an increased risk of rupture of the membranes." – While membrane rupture is a risk with any vaginal examination, it is not the primary concern in placenta previa.

C. "This could result in profound bleeding." – With placenta previa, the placenta partially or completely covers the cervix. Digital or speculum exams can disrupt the placenta, causing significant hemorrhage, which is why they are contraindicated.

D. "This could initiate preterm labor." – While stimulation of the cervix could lead to contractions, the primary risk with an internal exam in placenta previa is significant bleeding, not preterm labor.

A. The client's level of sexual stimulation B. If taken with a high fat meal, the medication is more effective C. The client's recent consumption of caffeine D. If client took an additional dose to achieve an erection

Correct Answer is A

Explanation

A. The client's level of sexual stimulation
Sildenafil requires sexual stimulation to be effective. It enhances blood flow to the penis but does not automatically cause an erection. The client should be educated that adequate sexual arousal is necessary for the medication to work.

B. If taken with a high-fat meal, the medication is more effective
Taking sildenafil with a high-fat meal can actually delay its absorption and reduce effectiveness. Clients should be advised to take it on an empty stomach or with a light meal for optimal results.

C. The client's recent consumption of caffeine
Caffeine intake does not interfere with sildenafil’s effectiveness. However, excessive caffeine consumption may contribute to vasoconstriction, which could indirectly affect erectile function.

D. If client took an additional dose to achieve an erection
Taking an extra dose of sildenafil is not recommended and can increase the risk of serious side effects such as hypotension, priapism (prolonged erection), and cardiovascular complications. The client should follow prescribed dosing guidelines.

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35-year-old postpartum client. Select the condition, risk factors and assessment findings that the client may be experiencing.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

Correct Answer is C

Explanation

A male client reports to the nurse that he took sildenafil for erectile dysfunction but did not achieve an erection. Which of the following considerations should the nurse evaluate to determine possible reasons for the lack of response?

Correct Answer is A

Explanation

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35-year-old postpartum client.

Select the condition, risk factors and assessment findings that the client may be experiencing.