A nurse is assessing a client who gave birth 12 hr ago and is experiencing excessive vaginal bleeding. Which of the following findings indicates the client is experiencing decreased cardiac output?

Bradycardia.

Flushed face.

Hypotension.

Polyuria.

Answer and Explanation

The Correct Answer is C

Choice C rationale:

Hypotension is a finding that indicates the client is experiencing decreased cardiac output. Excessive vaginal bleeding can lead to hypovolemia, reducing the volume of blood pumped by the heart and resulting in decreased cardiac output. The body responds to hypovolemia and decreased cardiac output by trying to maintain blood pressure, which leads to hypotension.

Choice A rationale:

Bradycardia is not a finding indicating decreased cardiac output in this scenario. While bradycardia (abnormally slow heart rate) can be associated with decreased cardiac output in certain situations, it is not the primary finding in a postpartum client experiencing excessive vaginal bleeding.

Choice B rationale:

A flushed face is not an indicator of decreased cardiac output. A flushed face may result from various factors such as fever or emotional stress, but it is not directly related to cardiac output.

Choice D rationale:

Polyuria (excessive urination) is not an indicator of decreased cardiac output. Polyuria may occur due to factors like diuresis or increased fluid intake but is not directly related to cardiac output in the context of excessive vaginal bleeding.

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Correct Answer is D

Explanation

Choice A reason:

Requesting a prescription for PRN aspirin is incorrect because aspirin is an antiplatelet agent and should not be combined with heparin without specific medical advice due to the increased risk of bleeding.

Choice B reason:

Massaging the injection site is not recommended as it can cause trauma to the tissue and increase the risk of bleeding, which is especially concerning in a patient with deep-vein thrombosis.

Choice C reason:

Instructing the client that they cannot breastfeed while receiving heparin is incorrect. Heparin does not pass into breast milk in significant amounts and is considered safe for use while breastfeeding.

Choice D reason:

Administer the injection in the client's abdomen. Heparin is typically administered subcutaneously in the abdomen to ensure proper absorption and minimize discomfort. Because it is an area with large amounts of subcutaneous fat

A. The fetal head is in the left occiput posterior position. B. The largest fetal diameter has passed through the pelvic outlet. C. The posterior fontanel is palpable. D. The lowermost portion of the fetus is at the level of the ischial spines.

Correct Answer is D

Explanation

Choice A rationale:

The clinical finding of 0 station does not provide information about the fetal head's position in the left occiput posterior position. Station refers to the level of the presenting part in relation to the ischial spines, not the position.

Choice B rationale:

The clinical finding of 0 station does not indicate that the largest fetal diameter has passed through the pelvic outlet. The station only tells us the level of the presenting part and does not provide information about the diameter passing through the pelvic outlet.

Choice C rationale:

The clinical finding of 0 station does not directly involve the palpability of the posterior fontanel. Station is determined based on the level of the presenting part in the birth canal.

Choice D rationale:

This is the correct interpretation of the clinical finding. 0 station means that the presenting part (usually the baby's head) is at the level of the ischial spines, which serves as a reference point during labor. As labor progresses and the baby moves further down the birth canal, the station becomes more negative (e.g., -1, -2) until delivery occurs.

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A nurse is assessing a client who gave birth 12 hr ago and is experiencing excessive vaginal bleeding. Which of the following findings indicates the client is experiencing decreased cardiac output?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is postpartum, has a deep-vein thrombosis, and is receiving heparin therapy via subcutaneous injections. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?

Correct Answer is D

Explanation

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