Which of the following factors in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

Choice A rationale

Obtaining umbilical cord blood gases provides an objective measure of the acid-base status at birth, reflecting the severity and duration of peri-natal asphyxia; however, an APGAR score of 6 at 5 minutes indicates moderate distress and a need for immediate intervention, not just diagnosis, as the priority. While informative, this step is secondary to stabilization efforts. Normal umbilical arterial pH is 7.25-7.40.

Choice B rationale

An APGAR score of 6 at 5 minutes indicates moderate cardio-respiratory depression, requiring active intervention to prevent further decline and potential injury, thus beginning resuscitative measures is the highest priority. Initial steps often include tactile stimulation and positive pressure ventilation (PPV) if necessary, aiming to rapidly improve vital signs and oxygenation which are the direct parameters affecting the APGAR score.

Choice C rationale

Promoting kangaroo care (skin-to-skin contact) is beneficial for thermoregulation, bonding, and stabilization in stable newborns; however, a score of 6 suggests the infant is not fully stable and requires closer monitoring and potential intervention, making it inappropriate as the initial priority over addressing the compromised respiratory and cardiac status.

Choice D rationale

Initiating IV fluid therapy may be necessary for hypovolemia or to administer medications, but it is not the immediate priority for a newborn with an APGAR score of 6, whose primary needs are establishing effective respiration and circulation. Establishing intravenous access would follow the stabilization of the airway and breathing if necessary. —.

Choice A rationale

Testing the ability to raise legs is not a specific or reliable method for assessing Deep Vein Thrombosis (DVT). DVT assessment primarily involves checking for unilateral leg swelling, warmth, redness, and pain, sometimes elicited by Homan's sign (pain on dorsiflexion of the foot), although this sign is less reliable and discouraged by some guidelines due to the risk of embolization. Venous Doppler ultrasound is the definitive diagnostic tool.

Choice B rationale

Assessing hidden bleeding, particularly postpartum hemorrhage (PPH), involves checking the fundus for firmness and location (normal is firm, near the umbilicus initially), assessing the amount and characteristics of lochia (normal is rubra, scant to moderate), and monitoring vital signs for signs of shock (e.g., tachycardia, hypotension). The leg-raising test is irrelevant to PPH assessment.

Choice C rationale

Discharge eligibility after vaginal delivery is typically based on factors such as stable vital signs, appropriate uterine involution, controlled pain, adequate voiding, successful newborn feeding, and completion of necessary teaching and screenings. The ability to raise legs only relates to motor function post-anesthesia, not the global criteria for discharge.

Choice D rationale

Epidural or spinal anesthesia temporarily blocks nerve impulses, causing sensory and motor paralysis in the lower extremities. The ability to flex or raise the legs is a direct test of motor function return. Full motor function must be regained before a patient can safely ambulate, which is crucial for preventing falls and is part of the recovery room discharge criteria. —.