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Patient Data

Exhibits

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

gravida 5, para 5,

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

labor for 25 hours

epidural for anesthesia

4th degree laceration

Estimated blood loss was 600 mL after delivery

forceps were used to assist with the delivery

catheterized for 500 mL of light-yellow urine

spouse was at the bedside for delivery

pain was currently at a 4 on a 0 to 10 pain scale

Answer and Explanation

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

Correct choices;

Gravida 5, para 5 (G5P5)

This means the client has been pregnant 5 times and has given birth 5 times. Multiparity (having had multiple pregnancies and deliveries) is a risk factor for PPH due to uterine overdistension, which can lead to poor uterine tone and difficulty in contracting effectively after delivery.

Delivery of a 9 lb 1 oz (4.1 kg) baby

Larger babies are associated with an increased risk of PPH. The weight of the baby suggests a potentially larger placental surface area and increased uterine distension during pregnancy, which can contribute to uterine atony post-delivery.

Labor for 25 hours

Prolonged labor can lead to uterine exhaustion, where the uterus may not contract effectively after delivery, predisposing the client to PPH.

Forceps-assisted delivery

Instrumental deliveries, including forceps, can cause trauma to the birth canal, including the cervix, vagina, and perineum, increasing the risk of lacerations and bleeding.

Epidural anesthesia

Epidurals can mask the pain associated with uterine atony, which may delay the diagnosis of PPH. It's important to closely monitor uterine tone and blood loss in clients who have had epidurals.

4th degree laceration

Explanation: A 4th degree laceration involves the perineum and extends through the anal sphincter complex. Such extensive trauma increases the risk of significant bleeding postpartum.

Estimated blood loss of 600 mL

Although this is within the normal range of blood loss immediately after delivery, it still signifies that the client has experienced significant hemorrhage, putting her at higher risk for ongoing bleeding.

Nursing Test Bank

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Correct Answer is A

Explanation

Rationale

A. Informing the information services department allows them to be aware of the issue promptly. They can then investigate the cause of the system failure and initiate appropriate measures to restore the system. It's important to involve IT professionals who are responsible for maintaining and troubleshooting the computer system.

B. While having access to patient information is crucial, printing from a backup server might not be immediately feasible or necessary if the primary system is expected to be restored soon. The nurse should first notify IT services to resolve the issue. If access to patient records is urgently needed and cannot be delayed, then printing from a backup server could be considered after notifying IT services.

C Waiting passively without taking action may delay the resolution of the issue. It's important for the nurse to proactively notify the information services department so they can begin troubleshooting and rebooting the system if necessary.

D. Labeling information as a late entry should only be considered once the system is back online and accessible. It should be done according to facility policies and procedures regarding late entries in medical records. However, this should not be the first action because the primary concern is to restore the functionality of the computer documentation system.

Correct Answer is ["1.3"]

Explanation

Convert pounds to kilograms.

1 pound = 0.453592 kilograms
132 pounds * 0.453592 kg/pound = 59.87 kilograms

Step 2: Calculate the total dose in micrograms.

44 micrograms/kilogram * 59.87 kilograms = 2635.08 micrograms

Step 3: Convert micrograms to milligrams.

1 milligram = 1000 micrograms
2635.08 micrograms / 1000 micrograms/milligram = 2.63508 milligrams

Step 4: Calculate the volume to be administered.

Concentration of lorazepam = 2 milligrams/milliliter
Volume = Dose / Concentration
Volume = 2.63508 milligrams / 2 milligrams/milliliter = 1.31754 milliliters

Therefore, the nurse should administer approximately 1.3milliliters of the lorazepam solution.

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Correct choices;

Gravida 5, para 5 (G5P5)

Delivery of a 9 lb 1 oz (4.1 kg) baby

Labor for 25 hours

Forceps-assisted delivery

Epidural anesthesia

4th degree laceration

Estimated blood loss of 600 mL

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After a scheduled downtime, the computer documentation system fails to restart. Which action should the nurse take first?

Correct Answer is A

Explanation

Correct Answer is ["1.3"]

Explanation

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