A patient, one day postpartum, is being monitored carefully after a significant postpartum hemorrhage. Which of the following should the nurse report to the obstetrician?
Urine output of 40 mL in the last 8 hours.
Drop in hematocrit of 2% since admission.
Weight decrease of 2 lbs since delivery.
Pulse rate of 68 beats per minute.
The Correct Answer is A
Choice A rationale
Urine output of 40 mL in 8 hours indicates oliguria, suggesting inadequate renal perfusion. Normal urine output is 30 mL/hour or greater. This could signify hypovolemia or renal compromise post-hemorrhage.
Choice B rationale
A drop in hematocrit of 2% may be expected postpartum and is not immediately concerning unless accompanied by hemodynamic instability or symptoms of anemia like dizziness or fatigue.
Choice C rationale
A 2 lb weight decrease postpartum is normal due to fluid shifts and diuresis. It does not indicate an emergent condition requiring immediate reporting to the obstetrician.
Choice D rationale
A pulse rate of 68 beats per minute is within the normal adult range of 60 to 100 beats per minute and is not typically concerning post-delivery.
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Correct Answer is D
Explanation
Choice A rationale
A soft uterus indicates uterine atony, a complication rather than a normal finding. Daily fundal palpation ensures involution but should result in a firm, not soft, uterus.
Choice B rationale
Passage of clots is common postpartum, but ongoing monitoring for excessive clotting is crucial as it may indicate retained placental fragments or incomplete uterine involution.
Choice C rationale
Decreased lochia does not indicate complications unless it is completely absent, which may suggest uterine or cervical obstruction and warrants further evaluation.
Choice D rationale
Increased lochia or bright red bleeding signifies secondary postpartum hemorrhage, often caused by retained placental tissue or subinvolution, requiring immediate medical attention.
Correct Answer is B
Explanation
Choice A rationale
A cesarean delivery may increase infection risk due to surgical exposure, but a full-term infant born at 38 weeks has more mature immune defenses compared to preterm or growth-restricted infants.
Choice B rationale
A 36-week infant, small for gestational age, has underdeveloped immune function and possible intrauterine growth restriction, which increases susceptibility to infections. Immaturity in skin and mucosal barriers heightens the risk.
Choice C rationale
Infants born to mothers with gestational diabetes may experience metabolic complications, but infection risk is lower in full-term infants due to relatively mature immune function and adequate birth weight.
Choice D rationale
Caput succedaneum may present a localized risk of infection, but a 38-week infant has a more mature immune system compared to premature or growth-restricted infants, thus reducing overall susceptibility to infections.
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