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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Related Questions
Correct Answer is C
Explanation
Choice A rationale
Stating the bleeding is normal and linking it to stitches being loosened downplays the severity. Postpartum bleeding that saturates one pad in 30 minutes requires urgent evaluation to prevent complications like hypovolemic shock.
Choice B rationale
Menstruation typically resumes several weeks to months postpartum, depending on lactation. Heavy bleeding in this scenario is unlikely to be menstrual and requires medical attention to rule out hemorrhage or uterine atony.
Choice C rationale
Significant postpartum bleeding exceeding normal lochia patterns suggests a possible hemorrhage or retained products of conception, warranting immediate emergency department evaluation for prompt treatment and stabilization.
Choice D rationale
Bed rest is not appropriate in this case, as the heavy bleeding could indicate a life-threatening condition that demands immediate medical intervention rather than conservative management like rest.
Correct Answer is A
Explanation
Choice A rationale
Narcan (naloxone) is contraindicated as it can precipitate acute withdrawal symptoms in neonates exposed to opioids in utero, leading to seizures and severe distress due to sudden opioid receptor blockade.
Choice B rationale
Phenobarbital is used to manage neonatal abstinence syndrome by reducing central nervous system hyperexcitability and seizures. It is not contraindicated as it provides symptomatic relief for withdrawal symptoms.
Choice C rationale
Methadone is used to treat neonatal abstinence syndrome by stabilizing opioid levels and preventing withdrawal symptoms. It is not contraindicated and helps manage symptoms effectively in opioid-exposed neonates.
Choice D rationale
Morphine is a first-line treatment for neonatal abstinence syndrome, reducing withdrawal symptoms by mimicking the effects of opioids. It is not contraindicated and is commonly used in neonatal care.
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