When caring for a postpartum client, the nurse notes that the client's perineal pad is saturated with bright red blood.
What is the priority to ask the client?
When was the last time you changed your pad?
Have you passed any clots?
Are you having any cramping?
Do you have to go to the bathroom? .
The Correct Answer is A
Choice A rationale
Determining the time of the last pad change assesses the rate of bleeding, which is crucial for evaluating postpartum hemorrhage. Bright red blood saturation indicates active bleeding, requiring quantification. If pads are saturated within an hour, immediate intervention is needed to prevent hypovolemic shock.
Choice B rationale
Asking about clots identifies uterine atony or retained placental fragments. However, it does not prioritize the bleeding rate assessment, which is critical for immediate hemodynamic stability and guides urgency in management.
Choice C rationale
Cramping indicates uterine contractions aiding involution. While helpful for understanding uterine activity, it does not directly evaluate the severity or rate of blood loss, which poses an immediate risk to the client’s life.
Choice D rationale
Checking for the need to urinate helps assess bladder distension. A full bladder inhibits uterine contraction, worsening atony-related bleeding. Still, this line of questioning is less critical compared to assessing the bleeding's rate and volume.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Determining the time of the last pad change assesses the rate of bleeding, which is crucial for evaluating postpartum hemorrhage. Bright red blood saturation indicates active bleeding, requiring quantification. If pads are saturated within an hour, immediate intervention is needed to prevent hypovolemic shock.
Choice B rationale
Asking about clots identifies uterine atony or retained placental fragments. However, it does not prioritize the bleeding rate assessment, which is critical for immediate hemodynamic stability and guides urgency in management.
Choice C rationale
Cramping indicates uterine contractions aiding involution. While helpful for understanding uterine activity, it does not directly evaluate the severity or rate of blood loss, which poses an immediate risk to the client’s life.
Choice D rationale
Checking for the need to urinate helps assess bladder distension. A full bladder inhibits uterine contraction, worsening atony-related bleeding. Still, this line of questioning is less critical compared to assessing the bleeding's rate and volume.
Correct Answer is D
Explanation
Choice A rationale
Liver function tests, while important for identifying hepatic disorders, are not directly associated with polycystic ovarian syndrome (PCOS). PCOS is primarily an endocrine disorder affecting reproductive hormones, not liver function.
Choice B rationale
Blood urea nitrogen (BUN) is used to assess renal function but is not typically relevant for PCOS. PCOS does not inherently affect kidney function, making this test unnecessary in routine monitoring for this condition.
Choice C rationale
Thyroid-stimulating hormone levels are assessed to rule out thyroid dysfunction, which can present with similar symptoms to PCOS. However, thyroid issues are not caused by PCOS and monitoring TSH is not central to PCOS management.
Choice D rationale
Serum glucose levels are critical in PCOS management due to the increased risk of insulin resistance and type 2 diabetes. Monitoring these levels helps to manage glucose metabolism and prevent complications, making it a key parameter in care for PCOS patients.
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