A patient who sustained a difficult, lengthy labor and delivery is conversing with the nurse.
Suddenly, the patient complains of chest pain and appears dyspneic.

She is cyanotic and tachycardic, and her blood pressure has decreased to 78/36. What condition should the nurse suspect is developing?

Choice A rationale

Increased clotting factors in the postpartum period is a physiological adaptation that elevates the risk for thromboembolism. Specifically, levels of fibrinogen, factors VII, VIII, and X are often significantly elevated, initiating hypercoagulability. This protective mechanism limits postpartum hemorrhage but unfortunately also predisposes the client to venous thrombus formation, especially when coupled with vessel damage or stasis.

Choice B rationale

Immobility, particularly extended bed rest or reduced activity following a complicated delivery (e.g., cesarean section), significantly contributes to venous stasis. Stasis impedes blood flow, increasing contact time between coagulation factors and the endothelium, promoting platelet aggregation and thrombus formation, thereby heightening the postpartum client's overall thromboembolic risk.

Choice C rationale

Increased red blood cell production is not a primary factor increasing the risk for thromboembolism in the postpartum period. While the blood volume increases during pregnancy, and iron stores are often utilized, the hypercoagulable state is primarily driven by changes in clotting factors and vessel health, not solely by red blood cell count, which typically returns to normal.

Choice D rationale

Vessel damage (endothelial injury), which commonly occurs during childbirth, particularly to the pelvic veins during vaginal delivery or uterine vessels during cesarean section, is a key component of Virchow's triad. This damage activates the intrinsic coagulation cascade, providing a nidus for platelet adhesion and the subsequent development of a potentially dangerous thrombus or embolus.

Choice A rationale

Premature rupture of membranes (PROM) at 34 weeks significantly increases the risk of chorioamnionitis (intra-amniotic infection), as the protective barrier is breached. Infection is a major complication in this scenario. The cardinal symptom the woman should monitor for is a maternal fever, which is a temperature ≥ 100.4° F (or 38° C), requiring immediate notification of the obstetrician for prompt diagnosis and antibiotic treatment to prevent maternal and fetal sepsis.

Choice B rationale

The modified Trendelenburg position (head slightly down, hips elevated) is sometimes used in an acute setting following a prolapsed umbilical cord to reduce pressure on the cord. It is not a standard, routine recommendation for home care following PROM at 34 weeks, as prolonged bed rest carries risks, and the primary home teaching focuses on infection surveillance and activity restriction.

Choice C rationale

A decrease in fetal activity (less than ten movements in two hours) is the key warning sign of potential fetal compromise (e.g., hypoxia or infection) that the woman should report immediately. An increase in fetal activity is generally considered a normal, positive finding, often in response to maternal stimuli or a change in the fetal sleep cycle.

Choice D rationale

Nipple or breast massage stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterine contractile agent and is used for labor induction and postpartum hemorrhage control. In a woman with PROM, this action could potentially stimulate labor, which is generally not the goal if the pregnancy can be safely prolonged.