A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin.
She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of afterbirth hemorrhage in this woman is:

Retained placental fragments.

Unrepaired vaginal lacerations.

Uterine atony

Puerperal infection

Answer and Explanation

The Correct Answer is C

Uterine atony.

This is when the uterus does not contract enough to stop the bleeding from the placental site after delivery. It is the most common cause of postpartum hemorrhage, accounting for up to 80% of cases. Uterine atony can be caused by factors such as prolonged or augmented labor, large baby, multiple pregnancies, infection, or retained placenta.

The woman in question has some risk factors for uterine atony, such as a large baby and augmentation of labor with Pitocin.

The other choices are wrong because:

A . Retained placental fragments: This is when parts of the placenta remain attached to the uterine wall and prevent it from contracting properly. It is the second most common cause of postpartum hemorrhage.

However, there is no indication in the question that the woman had any difficulty with the delivery of the placenta or that it was incomplete

B. Unrepaired vaginal lacerations: This is when there are tears or cuts in the vagina or cervix that cause bleeding. It is a less common cause of postpartum hemorrhage.

However, there is no indication in the question that the woman had any trauma during delivery or that she was examined for lacerations

D. Puerperal infection: This is when there is an infection in the uterus or other parts of the reproductive tract after delivery.

It can cause fever, pain, and bleeding. It is a rare cause of postpartum hemorrhage.

However, there is no indication in the question that the woman had any signs or symptoms of infection, such as fever, chills, or foul-smelling discharge.

Normal ranges for blood loss after delivery are less than 500 mL for vaginal birth and less than 1000 mL for C-section.

Any amount above these thresholds can be considered postpartum hemorrhage and requires prompt evaluation and treatment.

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Correct Answer is D

Explanation

Diabetes insipidus is a disorder of the posterior pituitary gland that causes a deficiency of antidiuretic hormone (ADH). This leads to excessive urination (polyuria) and excessive thirst (polydipsia) as the body tries to balance the fluid loss. These symptoms may be so severe that the child does little other than drink and urinate.

Choice A is wrong because oliguria means decreased urine production and is not associated with diabetes insipidus.

Choice B is wrong because glycosuria means glucose in the urine and is associated with diabetes mellitus, not diabetes insipidus.

Choice C is wrong because nausea and vomiting are associated with inappropriate ADH secretion (SIADH), which causes fluid retention and hyponatremia, not diabetes insipidus.

A. Pouring water from a squeeze bottle over the woman’s perineum. B. Placing oil of peppermint in a bedpan under the woman. C. Asking the physician to prescribe analgesics. D. Inserting a sterile catheter.

Correct Answer is B

Explanation

This is because oil peppermint can stimulate the micturition reflex and help the woman to void.

Some possible explanations for the other choices are:

Choice A is wrong because pouring water over the perineum may not be enough to trigger the micturition reflex and may cause discomfort or infection.

Choice C is wrong because analgesics may not address the underlying cause of urinary retention and may have side effects such as drowsiness or nausea.

Choice D is wrong because inserting a sterile catheter is an invasive procedure that carries risks such as trauma, infection, or bladder spasms. It should be used only as a last resort after other methods have failed.

Normal ranges for postpartum bladder function are:

Urine output: 3000 to 5000 mL/day for the first 2 to 3 days after delivery.
Urine specific gravity: 1.005 to 1.030.
Urine pH: 4.6 to 8.0.

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A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of afterbirth hemorrhage in this woman is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would be observable?

Correct Answer is D

Explanation

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse could try is:

Correct Answer is B

Explanation

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A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin.
She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of afterbirth hemorrhage in this woman is: