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A nurse is performing fundal massage for a client who has uterine atony and postpartum hemorrhage.

Which of the following actions should the nurse take when performing this procedure?

Use one hand to stabilize the lower uterine segment while massaging the fundus with the other hand

Apply firm pressure on the fundus with both hands until it becomes firm and contracted

Massage the fundus in a circular motion with one hand while supporting the back with the other hand

Rub the fundus vigorously with one hand until it becomes hard and expels clots

Answer and Explanation

The Correct Answer is A

Use one hand to stabilize the lower uterine segment while massaging the fundus with the other hand.

This action prevents the uterus from inverting and reduces the risk of trauma to the cervix and vagina.

The nurse should also monitor the amount and consistency of lochia.

Choice B is wrong because applying firm pressure on the fundus with both hands can cause uterine inversion, which is a life-threatening complication of postpartum hemorrhage.

The nurse should use gentle pressure and avoid overstimulation of the uterus.

Choice C is wrong because massaging the fundus in a circular motion with one hand while supporting the back with the other hand can cause displacement of the uterus and increase bleeding.

The nurse should massage the fundus in a downward motion from the top of the uterus to the umbilicus.

Choice D is wrong because rubbing the fundus vigorously with one hand until it becomes hard and expels clots can cause uterine rupture, which is another serious complication of postpartum hemorrhage.

The nurse should avoid excessive manipulation of the uterus and allow clots to pass naturally.

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Correct Answer is C

Explanation

Hemoglobin, which is an indicator of the number of RBCs and decreases during hypovolemia and hemorrhage.

Hemoglobin is a protein that carries oxygen in the blood and is measured in grams per deciliter (g/dL).

A normal range for hemoglobin is 12 to 16 g/dL for women.

A low hemoglobin level indicates anemia, which can be caused by blood loss or other factors.

A postpartum hemorrhage is a loss of more than 500 mL of blood after delivery, which can lead to hypovolemia (low blood volume) and shock.

Choice A is wrong because urine output 200 mL for the past 8 hours is within the normal range for a postpartum woman.

The kidneys may retain fluid during pregnancy and release it after delivery, resulting in increased urine output.

A normal urine output is 30 to 50 mL per hour.

Choice B is wrong because weight decrease of 2 pounds since delivery is expected for a postpartum woman.

The weight loss reflects the loss of fluid, blood, and placental tissue during delivery.

A normal weight loss after delivery is 10 to 12 pounds.

Choice D is wrong because hematocrit, which is the percent of RBCs in the total blood volume, and decreases during hypovolemia, may not reflect the true extent of blood loss in a postpartum hemorrhage.

Hematocrit is measured as a percentage and a normal range for hematocrit is 37 to 47% for women.

However, hematocrit may be falsely elevated due to hemoconcentration (increased concentration of blood cells) caused by fluid loss.

Hematocrit may take several days to reflect the actual blood loss.

A. Uterine atony B. Trauma C. Lacerations D. Hematomas

Correct Answer is A

Explanation

Uterine atony is the most common cause of early postpartum hemorrhage, accounting for up to 80% of cases.Uterine atony is when the uterus fails to contract after delivery of the placenta, leading to excessive bleeding from the blood vessels where the placenta was attached.

Choice B is wrong because trauma is not the most common cause of early postpartum hemorrhage.Trauma accounts for about 20% of cases and includes uterine rupture, cervical and vaginal lacerations, and uterine inversion.

Choice C is wrong because lacerations are not the most common cause of early postpartum hemorrhage.Lacerations are a type of trauma that can cause bleeding from the cervix, vagina, or perineum.

Choice D is wrong because hematomas are not the most common cause of early postpartum hemorrhage.Hematomas are a type of trauma that can cause bleeding into the tissues of the vulva, vagina, or perineum.

Normal ranges for blood loss after delivery are less than 500 ml for vaginal delivery and less than 1000 ml for cesarean delivery.Postpartum hemorrhage is defined as blood loss greater than these amounts or when bleeding causes symptoms of hypovolemia (low blood volume) or hemodynamic instability (low blood pressure or high heart rate).

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A nurse is performing fundal massage for a client who has uterine atony and postpartum hemorrhage. Which of the following actions should the nurse take when performing this procedure?

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Correct Answer is A

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A nurse is performing fundal massage for a client who has uterine atony and postpartum hemorrhage.

Which of the following actions should the nurse take when performing this procedure?