A nurse is caring for a 35-year-old female client who is immediately postpartum in the labor and delivery unit.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Answer and Explanation

The Correct Answer is []

Rationale for Correct Condition

Postpartum hemorrhage is defined as excessive blood loss (>500 mL in vaginal delivery) and is often caused by uterine atony, impaired uterine contraction, or trauma. This client exhibits a boggy uterus, heavy vaginal bleeding, and clot passage, all hallmark signs of postpartum hemorrhage rather than placenta previa, placental abruption, or preeclampsia.

Rationale for Correct Risk Factors

Fetal macrosomia contributes to uterine overdistension, increasing the risk of uterine atony and inefficient contractions post-delivery. History of smoking affects vascular integrity, increasing placental dysfunction risks, which can contribute to postpartum bleeding.

Rationale for Correct Assessment Findings

Uterine atony is the most common cause of postpartum hemorrhage. A boggy uterus indicates insufficient contraction to compress blood vessels after placental delivery. Heavy vaginal bleeding signifies excessive blood loss, requiring intervention to prevent hypovolemia and hemodynamic instability.

Rationale for Incorrect Conditions

Placenta previa presents with painless antepartum bleeding, not postpartum hemorrhage. Placental abruption leads to painful bleeding before delivery and can cause fetal distress. Preeclampsia involves hypertension and proteinuria, which are absent here.

Rationale for Incorrect Risk Factors

Prolonged labor can increase hemorrhage risk but is not relevant here. Primipara status does not apply, as the client is multiparous. Maternal weight may contribute but is not a primary hemorrhage risk factor.

Rationale for Incorrect Assessment Findings

Blood pressure helps assess hemorrhage severity but is not a direct finding of uterine atony. Urine output reflects fluid balance but does not confirm postpartum hemorrhage. Cramping is expected postpartum and does not indicate excessive bleeding.

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Correct Answer is ["B","C","E"]

Explanation

Choice A rationale

Severe cramping and pelvic pain are more indicative of an inevitable or incomplete abortion, where the pregnancy is no longer viable and the body is actively trying to expel the uterine contents. In a threatened abortion, the symptoms are typically milder.

Choice B rationale

A closed cervix upon examination is a key finding in a threatened abortion. It indicates that the uterus is not yet dilating or effacing, suggesting that the pregnancy might still be maintained. Cervical dilation signifies progression towards abortion.

Choice C rationale

Mild to moderate lower abdominal cramping is a common symptom of a threatened abortion. These cramps result from uterine irritability and contractions as the body reacts to potential pregnancy loss. The intensity is less severe than in later stages of abortion.

Choice D rationale

Passage of fetal tissue is a definitive sign of an incomplete or complete abortion, meaning the pregnancy has already been lost and the products of conception are being expelled. This would not be expected in a threatened abortion.

Choice E rationale

Bright red vaginal bleeding is a common symptom of a threatened abortion, indicating disruption at the decidual-trophoblastic interface. The bleeding can range from spotting to light bleeding and suggests a potential threat to the pregnancy.

A. "I can use the morning-after pill as a regular form of birth control.”. B. "I should take the morning-after pill as soon as possible after unprotected intercourse.”. C. "The morning-after pill does not protect against sexually transmitted infections.”. D. "The morning-after pill can be less effective if I take it more than 72 hours after unprotected sex.”. . . .

Correct Answer is A

Explanation

Choice A rationale

The morning-after pill, containing levonorgestrel, is intended for emergency contraception and should not be used as a regular method of birth control. Frequent use can disrupt the menstrual cycle and may be less effective over time compared to consistent contraception methods like oral contraceptives, IUDs, or barrier methods. These regular methods provide continuous protection against pregnancy.

Choice B rationale

The morning-after pill is most effective when taken as soon as possible after unprotected intercourse. Its efficacy decreases with time, and it is significantly less effective after 72 hours. The medication works primarily by delaying or preventing ovulation, and its effectiveness is highest when administered before ovulation occurs.

Choice C rationale

The morning-after pill does not provide any protection against sexually transmitted infections (STIs). It only reduces the risk of pregnancy. Individuals should use barrier methods like condoms during sexual activity to protect themselves and their partners from STIs. Emergency contraception addresses pregnancy risk, not STI transmission.

Choice D rationale

The efficacy of the morning-after pill declines significantly if taken more than 72 hours after unprotected sex. While it may still offer some protection up to 120 hours, its effectiveness is considerably reduced compared to when taken within the first 72 hours. Prompt use is crucial for maximizing its contraceptive effect. .

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["B","C","E"]

Explanation

A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception.Which of the following statements made by the client indicates a need for further teaching?

Correct Answer is A

Explanation

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