Assessment of a newborn reveals uneven gluteal (buttocks) skin creases and a 'click' when Ortolani's maneuver is performed.
Which of the following would the nurse suspect?
Slipping of the periosteal joint.
Overriding of the pelvic bone.
Normal newborn variation.
Developmental (congenital) hip dysplasia.
The Correct Answer is D
Choice A rationale
Slipping of the periosteal joint is not a recognized term or common pathology in this context. Developmental (congenital) hip dysplasia (DDH) is the condition associated with the described findings, which relate to the instability or dislocation of the femoral head within the acetabulum and not merely a periosteal issue which is the tough, fibrous sheath covering the bone.
Choice B rationale
Overriding of the pelvic bone is not typically the cause of a positive Ortolani sign or uneven gluteal creases. The physical findings of a 'click' during Ortolani's maneuver indicate dislocation of the hip, where the femoral head is reduced into the acetabulum, and uneven gluteal creases reflect femoral shortening caused by the displacement of the joint.
Choice C rationale
These findings are pathognomonic (highly characteristic) of instability or dislocation of the hip joint, which is Developmental (congenital) hip dysplasia (DDH), and are not considered normal variations in a newborn assessment. Normal findings would include symmetrical skin folds and a negative Ortolani and Barlow maneuver (no clicks or clunks indicating instability).
Choice D rationale
Uneven gluteal creases (a sign of limb shortening) and a positive Ortolani sign (the 'click' representing the reduction of a dislocated hip into the acetabulum) are the classic clinical signs suggestive of Developmental (congenital) hip dysplasia (DDH), indicating a potentially unstable or dislocated hip joint. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A hemorrhoid is a swollen, inflamed vein in the rectum or anus, which can cause pain and pressure, especially after the strenuous process of childbirth and pushing. While possible, the combination of increasing perineal pain, rectal pressure, and inability to void following a forceps delivery and a third-degree laceration is more indicative of a deeper tissue injury or collection of blood than an external or internal hemorrhoid alone.
Choice B rationale
A bladder infection, or cystitis, typically presents with symptoms such as dysuria (painful urination), urgency, frequency, and sometimes hematuria, often appearing later in the postpartum course. While urinary retention is a risk after birth trauma, an infection is less likely to be the immediate cause of acute, rapidly increasing rectal pressure and severe perineal pain just three hours after delivery.
Choice C rationale
Uterine atony is the failure of the uterus to contract sufficiently after childbirth, which is the most common cause of postpartum hemorrhage. The assessment states the fundus is firm and the lochia is moderate without clots, which rules out significant uterine atony as the primary issue causing the localized, intense perineal and rectal discomfort.
Choice D rationale
A vaginal or vulvar hematoma is a collection of blood in the connective tissue, often resulting from trauma during delivery, especially with forceps, episiotomy, and deep lacerations. Its rapid expansion causes severe, unremitting, localized pain, rectal pressure (from mass effect), and can lead to urinary retention by distorting the urethra, which perfectly aligns with the patient's acute symptoms. —.
Correct Answer is A
Explanation
Choice A rationale
Uterine atony, the lack of uterine muscle tone, is the most common cause of immediate postpartum hemorrhage (PPH). The boggy (soft, not firm) and displaced fundus (to the right) strongly suggest the uterus is not contracting effectively, which allows blood vessels at the placental site to bleed freely. Furthermore, a distended bladder due to incomplete or infrequent voiding (last void 4 hours ago) can physically displace the uterus, impairing its ability to contract and leading to atony, heavy bleeding, and clot formation.
Choice B rationale
While a bleeding disorder can cause PPH, it is less likely to be the primary cause when classic signs of uterine atony are present. A bleeding disorder would typically be associated with generalized bleeding from all sites and possibly abnormal coagulation lab values (e.g., prolonged PT/INR, PTT, low platelet count-normal: 150,000-450,000/μ L). The physical assessment findings of a boggy, displaced fundus are more indicative of a mechanical issue with uterine contraction.
Choice C rationale
A 4th-degree laceration extends through the anal sphincter and rectal mucosa, causing pain and a risk for infection or dehiscence. While it contributes to overall blood loss, it typically causes steady, bright red bleeding despite a firm fundus. The fundal displacement and boggy consistency with large clots are the hallmark signs pointing away from the laceration as the primary source of the current heavy bleeding.
Choice D rationale
A hematoma is a collection of blood in the connective tissue, often in the vagina or perineum, characterized by severe pain, pressure, and possibly a tense, firm, bulging mass. While the patient is sore, the main concern here is the heavy vaginal bleeding accompanied by the boggy and displaced fundus. A hematoma generally does not cause the profuse, clot-filled bleeding that results from uterine atony. —.
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