A perinatal nurse is caring for a woman in the immediate postbirth period.
Assessment reveals that the client is experiencing profuse bleeding.
What is the most likely cause for this bleeding?
Uterine atony.
Uterine inversion.
Vaginal laceration.
Vaginal hematoma.
Retained placental fragments.
The Correct Answer is A
Choice A rationale
Uterine atony, defined as the failure of the myometrial muscle fibers to contract effectively after placental separation, is the most common cause of postpartum hemorrhage (PPH), accounting for approximately 70 to 80 percent of cases. This lack of contraction prevents the mechanical compression of blood vessels at the placental site, leading to rapid and profuse blood loss into the uterine cavity.
Choice B rationale
Uterine inversion is the rare turning inside out of the uterus. While it causes profuse bleeding and is a life-threatening emergency, its incidence is very low (around 1 in 3000 to 20,000 deliveries), making it statistically less likely than uterine atony to be the cause of profuse bleeding in an unspecified client in the immediate postbirth period.
Choice C rationale
Vaginal lacerations are a common cause of postpartum bleeding, but typically the bleeding is described as a steady trickle of bright red blood, often despite a firm uterus. While it can be profuse, uterine atony typically results in a rapid gush or steady flow of blood associated with a boggy fundus, making it the more likely primary cause for generalized "profuse bleeding.”.
Choice D rationale
A vaginal hematoma involves a collection of blood in the connective tissue spaces and usually presents with pain and a mass, with the amount of external bleeding often being minimal or absent. The blood is concealed within the tissue space. Therefore, a hematoma is an unlikely cause of externally visible, profuse, hemorrhage.
Choice E rationale
Retained placental fragments also cause PPH, often through preventing the uterus from fully contracting (secondary atony). While a significant cause, fragments are often associated with bleeding that is intermittent or delayed, or bleeding that begins after the first hour. Primary uterine atony remains the most frequent etiology of profuse bleeding immediately postbirth.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale
Body tremors are a common neurobehavioral sign of Neonatal Abstinence Syndrome (NAS), reflecting generalized central nervous system (CNS) hyperirritability due to the absence of the maternally supplied opioid. These tremors often manifest as rhythmic, involuntary muscle contractions, exacerbated by external stimuli, and are indicative of the heightened state of arousal and dysregulated autonomic nervous system functioning characteristic of withdrawal.
Choice D rationale
Excessive sneezing is a manifestation of autonomic nervous system dysfunction and hyperreflexia characteristic of NAS. The withdrawal state often causes overreaction to normal environmental stimuli, including tactile and olfactory inputs. This hypersensitivity leads to symptoms like frequent sneezing, yawning, and nasal stuffiness (rhinorrhea), which are non-specific indicators of neurobehavioral stress and autonomic instability.
Choice E rationale
Hyperirritability, defined as an excessive response to stimuli or an inability to be comforted, is a cardinal sign of NAS. It reflects a state of CNS hypersensitivity where the neonate's threshold for stimulation is significantly lowered. The infant exhibits frantic, high-pitched crying, increased wakefulness, and an exaggerated Moro reflex, demonstrating the profound disruption in neurological regulation caused by drug withdrawal.
Choice B rationale
Drowsiness or lethargy is not a typical manifestation of the hyper-excitable state seen in opioid-related NAS; rather, the infant usually exhibits wakefulness and difficulty sleeping. Drowsiness or CNS depression would be more characteristic of maternal overdose, the immediate acute drug effect on the newborn before withdrawal begins, or withdrawal from CNS depressants like barbiturates or alcohol, but not the hyperactivity seen in classic NAS.
Choice C rationale
Excessive appetite is not a characteristic finding in NAS. Paradoxically, infants undergoing withdrawal often exhibit poor feeding and an uncoordinated sucking reflex, sometimes accompanied by vomiting and diarrhea (gastrointestinal hypermotility). This combination leads to failure to thrive and significant weight loss, necessitating supportive and pharmacological management to ensure adequate nutrition and hydration during the withdrawal period.
Correct Answer is ["1000"]
Explanation
Step 1 is: Convert the child's weight from pounds to kilograms. The conversion factor is 1 kg ≈ 2.2 lbs. 44 lbs÷ 2.2 lbs/kg = 20 kg.
Step 2 is: Calculate the minimum safe daily dosage using the recommended range (25 mg/kg/24 h). 25 mg/kg/24 h× 20 kg = 500 mg/24 h.
Step 3 is: Calculate the maximum safe daily dosage using the recommended range (50 mg/kg/24 h). 50 mg/kg/24 h× 20 kg = 1000 mg/24 h.
Step 4 is: State the minimum and maximum safe daily dosage range. The safe daily dosage range is 500 𝐦𝐠/24 𝐡 to 1000 𝐦𝐠/24 𝐡.
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