A nurse receives a call from a parent concerned their toddler ingested half of a bottle of ferrous sulfate vitamins.  What should the nurse instruct the parent to do? 

Choice A rationale

A saturated perineal pad within 15 minutes suggests a significant hemorrhage. The most common cause of postpartum hemorrhage is uterine atony, a lack of uterine muscle tone. Assessing the fundus first allows the nurse to determine if the uterus is firm or boggy, a key indicator of atony, and to perform a fundal massage if needed to stimulate contractions and reduce bleeding.

Choice B rationale

While an IV infusion may be necessary to restore blood volume, initiating it is not the first action. The nurse must first determine the cause of the bleeding. The fundus assessment provides critical diagnostic information and an immediate opportunity for intervention (massage) that could resolve the bleeding before initiating a fluid resuscitation.

Choice C rationale

Assessing vital signs is important but should not be the first action. In a situation of heavy bleeding, the priority is to identify and address the source of the hemorrhage. A fundal assessment provides this information immediately. Vital signs will change in response to blood loss, but the fundal assessment provides the most direct and immediate action to stop the bleeding.

Choice D rationale

The health care provider must be notified, but this action is not the first step. The nurse must first gather essential assessment data, such as the condition of the fundus, and initiate immediate interventions like a fundal massage if indicated. Notifying the provider without this information will delay appropriate care.

Choice A rationale

Increasing weight loss is an incorrect characteristic. Nephrotic syndrome is marked by massive proteinuria, which leads to a decrease in plasma oncotic pressure. This fluid shift from the intravascular space to the interstitial space results in significant fluid retention, causing weight gain and edema, not weight loss. The body holds onto fluid, masking any potential muscle or fat wasting.

Choice B rationale

Increased urinary output is not a characteristic of nephrotic syndrome. The condition is associated with severe fluid retention and decreased plasma volume, leading to oliguria, or a decreased urinary output. The kidneys are not effectively filtering protein and fluid is being retained in the body, which directly reduces the amount of fluid that can be excreted as urine.

Choice C rationale

Generalized edema is the most common and striking characteristic of nephrotic syndrome. The massive loss of protein, particularly albumin, in the urine leads to a significant decrease in serum albumin levels. Albumin is crucial for maintaining plasma oncotic pressure. The resulting decrease in oncotic pressure causes fluid to shift from the bloodstream into the interstitial spaces, resulting in widespread or anasarca edema.

Choice D rationale

While hypertension can occur, it is not the most common characteristic associated with nephrotic syndrome. The primary physiological change is the massive proteinuria leading to hypoproteinemia and subsequent edema. Hypertension may develop as a result of volume overload, but it is not a hallmark sign. The most prominent and defining symptom is the severe edema.