A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
Infection of the uterus.
Uterine atony.
Perineal hematoma.
Lacerations of the genital tract.
The Correct Answer is D
Choice A rationale
Infection of the uterus typically presents with fever, foul-smelling lochia, and uterine tenderness, not bright red vaginal bleeding with a firm fundus. Firm fundus decreases the likelihood of retained products causing infection.
Choice B rationale
Uterine atony causes excessive vaginal bleeding due to the uterus's inability to contract effectively, but it doesn't apply here since the fundus is firm, indicating adequate uterine tone.
Choice C rationale
Perineal hematoma results from blood vessel damage during delivery. It causes a tense, painful mass and vaginal or perineal swelling, not steady, bright red bleeding with a firm fundus.
Choice D rationale
Lacerations of the genital tract result in bright red bleeding despite a firm fundus, as the bleeding originates from tears in the vaginal or perineal tissues rather than uterine atony.
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Naxlex Comprehensive Predictor Exams
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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