A nurse is caring for a client immediately following the delivery of a stillborn fetus. Which of the following actions should the nurse take?

Explanation

Choice A Reason:

Obtaining a specimen for a Kleihauer-Betke test is incorrect. The Kleihauer-Betke test is used to determine the fetal-maternal hemorrhage in cases of Rh-negative mothers, particularly after delivery. However, in the immediate postpartum period with uterine atony and significant bleeding, the priority is to control bleeding and stabilize the patient's condition. Obtaining a Kleihauer-Betke test can be done later if indicated, but it is not the immediate action for managing uterine atony.

Choice B Reason:

Administering betamethasone IM is incorrect. Betamethasone is a corticosteroid commonly used to promote fetal lung maturity when preterm birth is anticipated. It is not indicated for managing uterine atony or postpartum hemorrhage.

Choice C Reason:

Avoiding performing sterile vaginal examinations is incorrect. Sterile vaginal examinations may be necessary to assess the extent of cervical dilation, evaluate the presence of any retained products of conception, or assist with the placement of interventions such as uterine massage or administration of medications. However, avoiding or minimizing vaginal examinations alone does not address the underlying cause of uterine atony or control postpartum hemorrhage. Therefore, it is not the most appropriate immediate action.

Choice D Reason:

Anticipating a prescription for misoprostol is correct. Uterine atony, characterized by the inability of the uterus to contract effectively after childbirth, is a significant cause of postpartum hemorrhage. Misoprostol, a prostaglandin E1 analogue, is commonly used to manage uterine atony and prevent or control postpartum hemorrhage. It helps to stimulate uterine contractions and reduce bleeding by promoting uterine muscle tone.

Explanation

Choice A Reason:

"You should have your provider refit you for a new diaphragm. “This is appropriate. After childbirth, a woman's body can undergo changes, including changes in vaginal tone and size. Therefore, it's essential for women who want to continue using a diaphragm for contraception postpartum to have their provider refit them for a new diaphragm. This ensures that the diaphragm fits properly and provides effective contraception.

Choice B Reason:

"You should keep the diaphragm in place for at least 4 hours after intercourse." While it's important to leave the diaphragm in place for a certain period after intercourse (typically at least 6-8 hours), the exact duration may vary depending on the type of diaphragm and the specific instructions provided by the healthcare provider or manufacturer. However, the recommended duration is typically longer than 4 hours.

Choice C Reason:

"You should use an oil-based vaginal lubricant when inserting your diaphragm." It is not recommended to use oil-based vaginal lubricants with diaphragms, as they can weaken the latex and increase the risk of the diaphragm tearing or becoming less effective as a contraceptive method. Water-based lubricants are typically recommended for use with diaphragms.

Choice D Reason:

"You should store your diaphragm in sterile water after each use." Storing the diaphragm in sterile water after each use is unnecessary and may not be practical. Instead, diaphragms should be cleaned with mild soap and water, dried, and stored in their case in a cool, dry place when not in use. Storing the diaphragm in sterile water is not a standard recommendation.