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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A fetus in the left sacroanterior (LSA) position has its sacrum, or buttocks, pointing toward the mother's left side and toward the front of her pelvis. The fetal heart is typically located in the fetal chest, and with a breech presentation (sacrum first), the fetal heart is located higher in the uterus, often above the umbilicus, which explains why the nurse hears the fetal heart rate in that location.
Choice B rationale
A fetus in the left occipitoanterior (LOA) position has its occiput, or back of the head, pointing toward the mother's left side and toward the front of her pelvis. In this vertex presentation, the fetal head is typically in the lower uterine segment, and the fetal heart would be heard below the mother's umbilicus, not above it.
Choice C rationale
A fetus in the right occipitoanterior (ROA) position has its occiput, or back of the head, pointing toward the mother's right side and toward the front of her pelvis. Similar to LOA, this is a vertex presentation. The fetal heart is typically heard below the mother's umbilicus and on her right side, not above it and on her left side.
Choice D rationale
A fetus in the right occipitoposterior (ROP) position has its occiput, or back of the head, pointing toward the mother's right side and toward the back of her pelvis. This is also a vertex presentation. The fetal heart would be heard below the mother's umbilicus and on her right side, not above it and on her left side.
Correct Answer is D
Explanation
Choice A rationale
Prostaglandin gels, like Prepidil, primarily function by modifying the cervical tissue, not by directly stimulating the amniotic membranes to rupture. Amniotomy, the artificial rupture of membranes, is a separate procedure often performed once the cervix is favorable, but it is not the direct effect of prostaglandin administration. This medication's mechanism is focused on tissue changes to prepare the cervix.
Choice B rationale
Prostaglandin gels do not have a direct mechanism of action to increase amniotic fluid volume. Amniotic fluid volume is primarily regulated by fetal renal function, swallowing, and placental exchange. The purpose of this medication is to facilitate cervical ripening, which is a prerequisite for labor induction, not to alter the fluid environment surrounding the fetus.
Choice C rationale
Prostaglandins do not enhance uteroplacental perfusion. This medication's primary pharmacological effect is localized to the cervix, where it causes cervical softening and effacement by breaking down collagen fibers and increasing water content. Uteroplacental perfusion is a complex circulatory process that ensures adequate oxygen and nutrient exchange, and it's not the target of this drug.
Choice D rationale
Prepidil, which contains dinoprostone, is a prostaglandin E2 analog. Its primary action is to promote cervical ripening by stimulating the breakdown of collagen and increasing the water content of the cervix. This leads to cervical softening, effacement, and dilation, making the cervix more favorable for subsequent induction with oxytocin. The goal is to prepare the cervix for the mechanical forces of labor.
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