A nurse is assessing a client who had a cesarean birth and is experiencing postpartum hemorrhage due to uterine dehiscence.

Which of the following manifestations should alert the nurse to this complication?

Abdominal pain and tenderness

Foul-smelling lochia and fever

Absent or decreased bowel sounds and distension

Heavy vaginal bleeding and clots

Answer and Explanation

The Correct Answer is D

Heavy vaginal bleeding and clots are symptoms of postpartum hemorrhage due to uterine dehiscence. Uterine dehiscence is the opening of the incision line after cesarean section and it is a rare complication. It can be caused by infection, hematoma, suture technique or trauma.

Choice A is wrong because abdominal pain and tenderness are more likely to be caused by other postpartum complications such as endometritis, wound infection, hematoma or uterine rupture.

Choice B is wrong because foul-smelling lochia and fever are signs of postpartum infection such as endometritis or wound abscess.

Choice C is wrong because absent or decreased bowel sounds and distension are not specific to postpartum hemorrhage. They can be caused by ileus, bowel obstruction, peritonitis or other abdominal disorders.

Normal ranges for blood loss after delivery are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery. Normal ranges for vital signs after delivery are pulse 50 to 90 beats/minute, blood pressure 85/60 to 140/90 mm Hg, respiratory rate 12 to 20 breaths/minute and temperature 36.2 to 37.6 °C.

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Correct Answer is B

Explanation

The client has a firm and midline uterus at the umbilicus.This indicates that the interventions for postpartum hemorrhage due to retained placental fragments are successful because the uterus has contracted and expelled the fragments, and there is no excessive bleeding.

Choice A is wrong because minimal cramping and discomfort are not specific signs of successful interventions for postpartum hemorrhage.

They may also occur in normal postpartum recovery.

Choice C is wrong because passing small clots with moderate lochia rubra may indicate that there are still some retained placental fragments or that the uterus is not contracting adequately.

Choice D is wrong because a pulse rate of 100 beats/min and a blood pressure of 110/70 mm Hg are not normal ranges for an adult.A pulse rate of 60 to 100 beats/min and a blood pressure of less than 120/80 mm Hg are considered normal.A high pulse rate and a low blood pressure may indicate hypovolemia or shock due to blood loss.

A. Urine output 200 mL for the past 8 hours B. Weight decrease of 2 pounds since delivery C. Hemoglobin, which is an indicator of the number of RBCs and decreases during hypovolemia and hemorrhage D. Hematocrit, which is the percent of RBCs in the total blood volume, and decreases during hypovolemia.

Correct Answer is C

Explanation

Hemoglobin, which is an indicator of the number of RBCs and decreases during hypovolemia and hemorrhage.

Hemoglobin is a protein that carries oxygen in the blood and is measured in grams per deciliter (g/dL).

A normal range for hemoglobin is 12 to 16 g/dL for women.

A low hemoglobin level indicates anemia, which can be caused by blood loss or other factors.

A postpartum hemorrhage is a loss of more than 500 mL of blood after delivery, which can lead to hypovolemia (low blood volume) and shock.

Choice A is wrong because urine output 200 mL for the past 8 hours is within the normal range for a postpartum woman.

The kidneys may retain fluid during pregnancy and release it after delivery, resulting in increased urine output.

A normal urine output is 30 to 50 mL per hour.

Choice B is wrong because weight decrease of 2 pounds since delivery is expected for a postpartum woman.

The weight loss reflects the loss of fluid, blood, and placental tissue during delivery.

A normal weight loss after delivery is 10 to 12 pounds.

Choice D is wrong because hematocrit, which is the percent of RBCs in the total blood volume, and decreases during hypovolemia, may not reflect the true extent of blood loss in a postpartum hemorrhage.

Hematocrit is measured as a percentage and a normal range for hematocrit is 37 to 47% for women.

However, hematocrit may be falsely elevated due to hemoconcentration (increased concentration of blood cells) caused by fluid loss.

Hematocrit may take several days to reflect the actual blood loss.

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A nurse is assessing a client who had a cesarean birth and is experiencing postpartum hemorrhage due to uterine dehiscence. Which of the following manifestations should alert the nurse to this complication?

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Naxlex Comprehensive Predictor Exams

A nurse is evaluating the effectiveness of interventions for a client who has postpartum hemorrhage due to retained placental fragments. Which of the following outcomes indicates that the interventions are successful?

Correct Answer is B

Explanation

Which of the following laboratory tests should the nurse report to the obstetrician when monitoring a client who is one day postpartum and has experienced significant postpartum hemorrhage?

Correct Answer is C

Explanation

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A nurse is assessing a client who had a cesarean birth and is experiencing postpartum hemorrhage due to uterine dehiscence.

Which of the following manifestations should alert the nurse to this complication?