A nurse is caring for a client who delivered vaginally 4 hours ago and has a boggy uterus that is displaced to the right of midline.
Which of the following actions should the nurse take first?
Apply ice packs to the perineum
Assist the client to empty her bladder
Increase the rate of IV fluids
Administer carboprost as prescribed
The Correct Answer is B
This is because a boggy uterus that is displaced to the right of midline indicates that the bladder is full and pushing the uterus out of place. A full bladder can prevent the uterus from contracting effectively after delivery, leading to excessive bleeding and postpartum hemorrhage (PPH) .
Emptying the bladder can help the uterus return to its normal position and tone.
Choice A is wrong because applying ice packs to the perineum may help reduce swelling and pain, but it will not address the underlying cause of the boggy uterus.
Choice C is wrong because increasing the rate of IV fluids may worsen the bleeding by diluting the blood and reducing its clotting ability.
Choice D is wrong because administering carboprost, a medication that stimulates uterine contractions, may be indicated if other measures fail to restore uterine tone, but it is not the first action to take. Carboprost also has side effects such as fever, nausea, vomiting, and diarrhea .
Normal ranges for uterine size and position after delivery are:
• Immediately after delivery: at or slightly below the level of the umbilicus (navel)
• 6 hours after delivery: 1 fingerbreadth above the umbilicus
• 12 hours
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Urine output of 40 mL/hr indicates an improvement in the client’s condition.According to the MSF Medical Guidelines, the objective of resuscitation in postpartum hemorrhage is to maintain a urine output of at least 30 mL/hour.
A urine output of 40 mL/hr suggests that the client has adequate fluid replacement and blood transfusion therapy.
Choice B is wrong because a pulse rate of 110 beats/min is still high and indicates tachycardia.
Tachycardia is a sign of hypovolemia and shock due to blood loss.The normal pulse rate for an adult is 60 to 100 beats/min.
Choice C is wrong because a hematocrit level of 32% is low and indicates anemia.
Anemia is a complication of postpartum hemorrhage due to reduced red blood cell count.The normal hematocrit level for women is 36% to 48%.
Choice D is wrong because a blood pressure of 90/60 mm Hg is low and indicates hypotension.
Hypotension is a sign of hypovolemia and shock due to blood loss.The normal blood pressure for an adult is 120/80 mm Hg.
Correct Answer is ["A","C","D","E"]
Explanation
The correct answer is choice A, C, D and E. These medications are all uterotonic agents that can stimulate uterine contractions and reduce bleeding.
They act on different receptors in the uterus and have different side effects and contraindications.
Choice B is wrong because magnesium sulfate is a tocolytic agent that can relax uterine muscles and prevent preterm labor.
It is not indicated for postpartum hemorrhage and can worsen uterine atony.
Normal ranges for postpartum blood loss are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery.
Uterine atony is the most common cause of postpartum hemorrhage and occurs when the uterus fails to contract adequately after delivery.
Risk factors include prolonged or rapid labor, overdistension of the uterus, multiparity, retained placenta, infection and anesthesia.
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