A nurse is assessing a client who is experiencing postpartum hemorrhage. Which of the following findings should the nurse identify as an indication of excessive blood loss?

Tachycardia

Flushed skin

Polyuria

Firm fundus

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Tachycardia (rapid heart rate) is a common early indicator of excessive blood loss. It is the body's compensatory response to decrease in circulating blood volume.

Choice B rationale:

Flushed skin is not necessarily indicative of excessive blood loss. Pallor may be more characteristic.

Choice C rationale:

Polyuria (increased urine output) is not a reliable indicator of blood loss and is not commonly associated with postpartum hemorrhage.

Choice D rationale:

A firm fundus is a positive sign and indicates the uterus is contracting appropriately. It is not indicative of excessive blood loss.

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Correct Answer is B

Explanation

Choice A rationale:

A contraction stress test is not appropriate in this context and would not address the potential risks associated with the client's symptoms.

Choice B rationale:

The elevated blood pressure and upper abdominal pain suggest potential preeclampsia, a serious complication of pregnancy that can lead to significant maternal and fetal risks. Delivery may be indicated to prevent further complications.

Choice C rationale:

Increasing dietary salt intake is not recommended for managing elevated blood pressure in pregnancy.

Choice D rationale:

Administering ferrous sulfate is unrelated to the client's symptoms and concerns.

A. "You should perform 30 minutes of high-impact exercises twice each week." B. "You can become pregnant until 1 year passes without a menstrual period." C. "You should perform 10 pelvic muscle exercises each day." D. "You can use an all-based lubricant if you experience painful vaginal intercourse.

Correct Answer is B

Explanation

Choice A rationale:

High-impact exercises might not be suitable for all clients and could potentially exacerbate symptoms such as joint pain or discomfort.

Choice B rationale:

Menopause is confirmed after 12 consecutive months without a menstrual period. Until this point, there is still a risk of pregnancy, and contraceptive measures should be used.

Choice C rationale:

Pelvic muscle exercises (Kegel exercises) are important for strengthening pelvic floor muscles but are not specifically related to menopause.

Choice D rationale:

Using a water-based lubricant for painful vaginal intercourse is a helpful suggestion, but it is not the primary focus of menopause education.

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A nurse is assessing a client who is experiencing postpartum hemorrhage. Which of the following findings should the nurse identify as an indication of excessive blood loss?

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