When assessing a multiparous patient who has just given birth to an 8-pound boy, the nurse notes that the patient's fundus is firm and has become globular in shape.
A gush of dark red blood comes from her vagina. What does the nurse conclude?

The placenta has separated.

Clots have formed in the upper uterine segment.

The patient is beginning to hemorrhage.

A cervical tear occurred during the birth.

Answer and Explanation

The Correct Answer is A

Choice A rationale

This assessment finding indicates the normal physiological process of placental separation. The globular shape of the uterus signifies that the placenta has detached from the uterine wall, while the gush of blood represents the blood loss from the placental site. The fundus is firm because the uterine muscle is contracting to prevent excessive bleeding from the now-exposed blood vessels. This is a critical stage of labor.

Choice B rationale

While clots can form, a gush of dark red blood and a globular, firm fundus are not characteristic signs of clotting within the uterine segment. Clots are more likely to be expelled with the placenta or form after its delivery. These specific findings are classic indicators of placental separation, which is a distinct physiological event.

Choice C rationale

The described signs do not indicate a hemorrhage. A postpartum hemorrhage is characterized by excessive and uncontrolled bleeding, often bright red, with a soft or boggy uterus that cannot contract effectively. The firm fundus noted in this scenario is a protective mechanism against hemorrhage, indicating effective uterine contraction.

Choice D rationale

A cervical tear typically presents with a steady trickle or bright red bleeding, even when the fundus is firm. It is not associated with the sudden gush of blood and the characteristic globular, firm fundus that signals placental separation. The cervical examination would be needed to confirm a tear.

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Correct Answer is D

Explanation

Choice A rationale

Ritodrine is a beta-mimetic tocolytic that can cause maternal and fetal tachycardia. Betamethasone does not reduce this side effect. The primary purpose of betamethasone is to enhance fetal lung maturity. Tachycardia from ritodrine is a known side effect that is managed by monitoring and dosage adjustment, not by administering corticosteroids.

Choice B rationale

The purpose of betamethasone is not to suppress uterine contractions. Betamethasone is a corticosteroid that enhances the production of surfactant in the fetal lungs. Tocolytic medications like nifedipine or magnesium sulfate are used to suppress uterine contractions in preterm labor, allowing time for the betamethasone to take effect.

Choice C rationale

Magnesium sulfate therapy can cause respiratory depression as a side effect. Betamethasone does not maintain maternal respiratory effort or ventilation during this treatment. Calcium gluconate is the antidote for magnesium toxicity. The role of betamethasone is specific to fetal lung maturity, not maternal respiratory support during magnesium sulfate administration.

Choice D rationale

Betamethasone is a corticosteroid that stimulates the production and release of surfactant in the fetal lungs. Surfactant is a substance that reduces surface tension in the alveoli, preventing them from collapsing and improving gas exchange. Administering this medication to the mother improves fetal lung maturity and reduces the risk of respiratory distress syndrome in preterm infants.

Correct Answer is ["2.5"]

Explanation

Step 1: The total units available are 100 U in a 10 mL vial.

Step 2: Calculate the concentration of the medication: 100 U ÷ 10 mL = 10 U/mL.

Step 3: The ordered dose is 25 U.

Step 4: Calculate the volume to administer: 25 U ÷ (10 U/mL) = 2.5 mL. Final calculated answer: 2.5.

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When assessing a multiparous patient who has just given birth to an 8-pound boy, the nurse notes that the patient's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. What does the nurse conclude?

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Naxlex Comprehensive Predictor Exams

A patient in preterm labor at 30 weeks gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacological treatment is to:

Correct Answer is D

Explanation

Order: Pitocin 25 U IM now. Available: Pitocin 100 U in a 10 ml vial. How much will you draw up for one dose? (Provide the number only, no units of measurement.)

Correct Answer is ["2.5"]

Explanation

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When assessing a multiparous patient who has just given birth to an 8-pound boy, the nurse notes that the patient's fundus is firm and has become globular in shape.
A gush of dark red blood comes from her vagina. What does the nurse conclude?