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Exhibits

The nurse is reviewing the clients' chart.

Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage.

36-year-old client who is gravida 5, para 5, transferred to the postpartum unit 1 hour after delivery of a 9 lb 1 oz (4.1 kg) female. She was in labor for 25 hours and forceps were used to assist with the delivery. She was given an epidural for anesthesia that was effective. The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale. Her vital signs were stable, and she was catheterized for 500 mL of light yellow urine just prior to delivery. Her spouse was at the bedside for delivery and appeared supportive. Blood type A+. Estimated blood loss was 600 mL after delivery.

client who is gravida 5, para 5

delivery of a 9 lb 1 oz (4.1 kg) female

She was in labor for 25 hours and forceps were used to assist with the delivery

She was given an epidural for anesthesia that was effective

The labor and delivery nurse reported that the client had a 4th degree laceration

Her vital signs were stable

Estimated blood loss was 600 mL after delivery

Answer and Explanation

The Correct Answer is ["A","B","C","E","G"]

Rationale for Correct Choices:

36-year-old client who is gravida 5, para 5 (G5P5): The client is a multipara, which increases the risk of uterine atony due to difficulty with uterine contractions or postpartum hemorrhage as a result of overstretched uterine muscles.
Transferred to the postpartum unit 1 hour after delivery of a 9 lb. 1 oz (4.1 kg) female: Macrosomia increases the likelihood of trauma during delivery, including lacerations and uterine atony increasing the risk for postpartum hemorrhage.
In labor for 25 hours: Prolonged labor increases the risk of uterine atony, where the uterus struggles to contract after delivery. This can lead to an increased risk of postpartum hemorrhage as the uterus fails to close off blood vessels effectively.
Forceps were used to assist with the delivery: Forceps-assisted deliveries can cause trauma to the birth canal, cervix, or perineum, leading to increased bleeding. This traumatic delivery can also contribute to uterine atony, raising the risk of postpartum hemorrhage.
4th degree laceration: A 4th degree laceration involves extensive damage to the perineum and anal sphincter, increasing bleeding risk. This severe injury requires surgical repair and is a known risk factor for postpartum hemorrhage due to the size and depth of the tear.
Estimated blood loss was 600 mL after delivery: Blood loss of 600 mL after delivery, although within the normal range for some vaginal deliveries, is considered a moderate risk factor. It may indicate ongoing bleeding or inadequate uterine contraction, both contributing to postpartum hemorrhage risk.
Macrosomic baby (9 lb 1 oz): A larger-than-normal baby (macrosomia) increases the likelihood of a difficult delivery, trauma to the birth canal, and uterine atony. These factors, combined with a prolonged labor, raise the risk of postpartum hemorrhage.

Rationale for Incorrect Choices:

Epidural anesthesia: The use of epidural anesthesia provides pain relief but does not directly increase the risk of postpartum hemorrhage. While epidurals may delay mobilization, they do not interfere with uterine tone or bleeding.
Vital signs were stable: Stable vital signs, including normal blood pressure, respiratory rate, and heart rate, indicate that the client is not in acute distress or hemorrhaging severely at this time.

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Correct Answer is C

Explanation

A. Maternal apical heart rate: While monitoring the maternal heart rate is important, the primary concern in this scenario is the timing of the oxytocin infusion in relation to the onset of bleeding. The time of the infusion helps determine if there is a correlation with the excessive bleeding.

B. Maternal blood pressure: Blood pressure is important for assessing hemodynamic stability, especially in cases of hemorrhage, but the most important immediate information would be related to the timing of the oxytocin infusion, as this could help determine if it is a contributing factor to the bleeding.

C. Time oxytocin infusion completed: The timing of the oxytocin infusion is the most important piece of information to provide. If the bleeding began after the infusion, the healthcare provider can consider oxytocin as a potential cause of uterine atony or other complications.

D. Total amount of oxytocin infused: While the total amount of oxytocin administered is important, the timing of the infusion is more critical in understanding the connection between the oxytocin administration and the onset of bleeding.

Correct Answer is []

Explanation

Rationale
Potential Condition: Menorrhagia is defined as abnormally heavy or prolonged menstrual bleeding. The client's report of heavier-than-usual bleeding, longer periods, and associated fatigue and increased pain are hallmark signs. Menorrhagia can lead to iron-deficiency anemia and may be caused by hormonal imbalance, uterine fibroids, or bleeding disorders.

Actions to Take

Test for anemia: Heavy menstrual bleeding increases the risk for anemia, especially with symptoms of fatigue. A CBC will help assess hemoglobin and hematocrit levels.
Ask the client about contraceptive use: Hormonal contraceptives can influence menstrual bleeding patterns and may also be used as part of the management plan for menorrhagia.

Parameters to Monitor

Frequency and duration of menstrual cycle: Tracking these helps evaluate the severity of bleeding and response to treatment.
Hemoglobin and hematocrit: These labs monitor for blood loss–related anemia and help guide treatment such as iron supplementation or further investigation.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client delivers a viable infant but begins to have excessive uncontrolled vaginal bleeding after the IV oxytocin is infused. When notifying the healthcare provider of the client's condition, which information is most important for the nurse to provide?

Correct Answer is C

Explanation

Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Correct Answer is []

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