A nurse is caring for a patient who is 1 hour postpartum and has uterine atony. The patient is exhibiting a large amount of vaginal bleeding.What action should the nurse take?
Obtain a specimen for a Kleihauer-Betke test.
Anticipate a prescription for misoprostol.
Administer betamethasone IM.
Avoid performing sterile vaginal examinations.
The Correct Answer is B
Choice A rationale
Obtaining a specimen for a Kleihauer-Betke test is not the immediate action to take when a patient is experiencing a large amount of vaginal bleeding due to uterine atony.
Choice B rationale
Misoprostol is a medication that can be used to treat uterine atony. It helps to contract the uterus and reduce bleeding.
Choice C rationale
Administering betamethasone IM is not the appropriate action. Betamethasone is a steroid medication often used to mature the lungs of a fetus at risk of premature birth, not to treat uterine atony.
Choice D rationale
Avoiding sterile vaginal examinations is not the immediate action to take when a patient is experiencing a large amount of vaginal bleeding due to uterine atony.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Applying firm pressure on the client’s suprapubic area is not part of the McRoberts maneuver. This action is more associated with the suprapubic pressure technique, which is another method used to manage shoulder dystocia.
Choice B rationale
The McRoberts maneuver involves having the client flex her hips against her abdomen. This is achieved by assisting the client in pulling her knees toward her abdomen.
Choice C rationale
Applying pressure to the client’s fundus is not part of the McRoberts maneuver and can be contraindicated as it may cause additional complications.
Choice D rationale
Moving the client onto their hands and knees is not part of the McRoberts maneuver. This position is more associated with the all-fours maneuver, also known as the Gaskin maneuver.
Correct Answer is A
Explanation
Choice A rationale
The nurse should close the newborn’s eyes before applying eyepatches. This is because the intense light used in phototherapy can harm the newborn’s eyes. Therefore, protective eye patches are used to shield the newborn’s eyes from the light while allowing the rest of the body to be exposed to the light. This helps to convert the bilirubin in the skin into a form that can be easily eliminated from the body.
Choice B rationale
Turning the newborn every 4 hours is not specifically related to phototherapy. While turning is important for preventing pressure ulcers, it does not directly impact the effectiveness of phototherapy. The primary goal of phototherapy is to expose as much of the newborn’s skin as possible to the light, which helps to reduce the level of bilirubin.
Choice C rationale
Applying hydrating lotion to the newborn’s skin prior to treatment is not recommended. The use of lotions or creams can block the light and reduce the effectiveness of phototherapy. The skin should be clean and free of any barriers to light penetration.
Choice D rationale
Providing the newborn with 15 mL glucose water after each feeding is not directly related to phototherapy. While maintaining hydration is important for all newborns, it does not specifically enhance the effectiveness of phototherapy for jaundice.
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