OB-GYN

Which of the following is a priority nursing diagnosis for a woman, G10 P6, w from a spontaneous vaginal delivery with a significant postpartum hemorrhage?

• Alteration in comfort related to afterbirth pains.

• Risk for altered parenting related to grand multiparity.

• Fluid volume deficit related to blood loss.

• Risk for sleep deprivation related to mothering role.

A woman who has given birth to a healthy neonate is being discharged. As part of discharge teaching, the nurse should instruct the client to observe vaginal discharge for postpartum hemorrhage and notify the health care provider about:

• Bleeding that becomes lighter each day

• Clots the size of golf balls

• Saturating a pad in an hour

• Lochia that lasts longer than 1 week

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:

• Establish venous access

• Perform fundal massage

• Prepare the woman for surgical intervention

• Catheterize the bladder

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:

• uterine atony

• uterine inversion

• vaginal hematoma

• vaginal laceration

What woman is at greatest risk for early postpartum hemorrhage?

• A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress

• A woman with severe preeclampsia on magnesium sulfate whose labor is being induced

• A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor

• A primigravida in spontaneous labor with preterm twins

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:

• Call the woman's primary health care provider

• Administer the standing order for an oxytocic

• Palpate the uterus and massage it if it is boggy

• Assess maternal blood pressure and pulse for signs of hypovolemic shock

When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is:

• Absence of cyanosis in the buccal mucosa

• Cool, dry skin

• Diminished restlessness

• Urinary output of at least 30 ml/hr

A nurse is preparing to care for a woman who had just delivered a healthy newborn infant. In the immediate postpartum period, the nurse plans to take the woman's vital signs:

• every 15 mins for the first 2H then every 30 mins for the next hour

• every 30 mins during the first hour then every hour for the next 2H

• every hour for the first 2H then every 4H

• every 5 mins for the 1st 30 minutes

A nurse is assessing a client in the 4th stage of labor and notes that the fundus is firm and bleeding is excessive. The initial nursing action would be:

• Massage the fundus

• Place the mother in a trendelenburg's position

• Notify the physician

• Record the findings

Methergine is prescribed for a woman diagnosed with PPH. Before administration, the priority nursing assessment is to check the:

• amount of lochia

• blood pressure

• deep tendon reflex

• uterine tone