A nurse is caring for a client who is 6 hours postpartum following a vaginal birth.
The client has saturated a perineal pad within 15 minutes.
Which of the following actions should the nurse take first?

Assess the client's blood pressure.

Assess the bladder for distention.

Massage the client's fundus.

Prepare to administer a prescription.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Assessing the client's blood pressure can help determine if there is a significant loss of blood and consequent hypotension. However, it is not the immediate first action to manage heavy bleeding postpartum.

Choice B rationale

Assessing the bladder for distention is crucial as a full bladder can interfere with uterine contraction, potentially leading to increased bleeding. But, it isn't the first priority compared to addressing the immediate bleeding.

Choice C rationale

Massaging the client's fundus is the priority action in this case. It helps to contract the uterus, thereby reducing bleeding. Uterine atony is the most common cause of postpartum hemorrhage, and fundal massage is the first intervention to manage it.

Choice D rationale

Preparing to administer a prescription may be necessary, especially if uterotonics are required. However, this is a subsequent step after attempting to control the bleeding through fundal massage.

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Correct Answer is C

Explanation

Choice A rationale

Dexamethasone is a corticosteroid and is not used for treating ectopic pregnancy.

Choice B rationale

Clomid (clomiphene citrate) is used to stimulate ovulation, not to treat ectopic pregnancy.

Choice C rationale

Methotrexate is a chemotherapeutic agent that effectively stops the growth of ectopic pregnancy cells, allowing the pregnancy tissue to be reabsorbed by the body.

Choice D rationale

Progesterone supports pregnancy and is not used to treat ectopic pregnancy.

A. G4T1 P1 A1 L2. B. G5T2 P0 A2 L2. C. G5T1 P1 A2 L2. D. G5T1 P1 A1 L3. .

Correct Answer is C

Explanation

Choice A rationale

G4T1 P1 A1 L2 implies the client has been pregnant 4 times, with 1 term birth, 1 preterm birth, 1 abortion, and 2 living children. This does not include the correct number of pregnancies or abortions for this client.

Choice B rationale

G5T2 P0 A2 L2 indicates 5 pregnancies, 2 term births, no preterm births, 2 abortions, and 2 living children. This does not correctly account for the preterm birth and abortion history provided.

Choice C rationale

G5T1 P1 A2 L2 is the correct answer, as it denotes 5 pregnancies (including the current one), 1 term birth, 1 preterm birth, 2 abortions, and 2 living children, aligning with the client's history.

Choice D rationale

G5T1 P1 A1 L3 indicates 5 pregnancies, 1 term birth, 1 preterm birth, 1 abortion, and 3 living children. The client has only 2 living children, so this is incorrect.

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A nurse is caring for a client who is 6 hours postpartum following a vaginal birth.The client has saturated a perineal pad within 15 minutes.Which of the following actions should the nurse take first?

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A nurse is caring for a client who is 6 hours postpartum following a vaginal birth.
The client has saturated a perineal pad within 15 minutes.
Which of the following actions should the nurse take first?