A nurse is caring for a client who is 1 hr postpartum and has uterine atony. The client is exhibiting a large amount of vaginal bleeding. Which of the following actions should the nurse take?

Avoid performing sterile vaginal examinations.

Anticipate a prescription for misoprostol.

Obtain a specimen for a Kleihauer-Betke test.

Administer betamethasone IM.

Answer and Explanation

The Correct Answer is B

Rationale:

A. Avoiding sterile vaginal examinations is not the appropriate action for managing uterine atony and postpartum hemorrhage. Vaginal examinations may be necessary to assess the degree of cervical dilation and to identify potential causes of bleeding.

B. Anticipating a prescription for misoprostol is appropriate for managing uterine atony and postpartum hemorrhage. Misoprostol is a prostaglandin analog that helps to promote uterine contractions and control bleeding.

C. Obtaining a specimen for a Kleihauer-Betke test is not the priority action in this situation. The Kleihauer-Betke test is used to estimate the amount of fetal-maternal hemorrhage in Rh-negative mothers.

D. Administering betamethasone IM is not indicated for the management of uterine atony and postpartum hemorrhage. Betamethasone is a corticosteroid used to promote fetal lung maturity when preterm birth is anticipated.

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Correct Answer is C,A,B,D,E

Explanation

C. Instruct the client to empty their bladder.

A. Position the client supine with knees flexed and place a small rolled towel under one of their hips.
B. Palpate the fetal part positioned in the fundus.

D. Palpate the fetal parts along both sides of the uterus.

E. Palpate the fetal part positioned above the symphysis pubis.

A. "The car seat should be positioned in the car at a 45-degree angle." B. "My baby will need a car seat challenge test before discharge." C. "When my baby is 1 year old, I can turn their car seat facing forward." D. "I can use a sleep sack to keep my baby warm in the car seat."

Correct Answer is A

Explanation

A. Positioning the car seat at a 45-degree angle helps to ensure that the baby's airway remains open and reduces the risk of slumping, which can lead to suffocation. This positioning is essential for newborns who may have limited head and neck control.

B. A car seat challenge test is typically performed for preterm infants or those with specific health concerns, not for all newborns. Newborns delivered at 38 weeks generally do not require this test unless there are other complications.

C. Car seat safety guidelines recommend that infants remain in a rear-facing position until at least 2 years of age, not just until they turn 1 year old. This statement does not demonstrate an understanding of current safety recommendations.

D. While sleep sacks can help keep a baby warm, they should not be used in a way that compromises the harness system of the car seat. It’s crucial to ensure that the baby is snugly secured in the car seat without any additional bulky clothing or blankets that could interfere with the safety harness.

In summary, the correct understanding is that the car seat should be positioned at a 45-degree angle for optimal safety.

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A nurse is caring for a client who is 1 hr postpartum and has uterine atony. The client is exhibiting a large amount of vaginal bleeding. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

31. A nurse is preparing to perform Leopold maneuvers on a client who is at 36 weeks of gestation. Identify the sequence of actions the nurse should take. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps)

Correct Answer is C,A,B,D,E

Explanation

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Correct Answer is A

Explanation

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