A nurse is caring for a client who has postpartum hemorrhage and is receiving IV fluids and blood products.

Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

Monitor intake and output

Elevate the head of the bed

Apply oxygen via nasal cannula

Insert a nasogastric tube E

Administer pain medication as needed

Answer and Explanation

Correct Answer : A,B,C

The correct answer is choice A, B and C. The nurse should monitor intake and output to assess the client’s fluid status and blood loss.

The nurse should elevate the head of the bed to reduce the risk of hypovolemic shock and improve tissue perfusion.

The nurse should apply oxygen via nasal cannula to increase oxygen delivery to the vital organs and prevent hypoxia.

Choice D is wrong because inserting a nasogastric tube is not indicated for a client who has postpartum hemorrhage.

A nasogastric tube is used to decompress the stomach or administer medications or feedings in some conditions.

Choice E is wrong because administering pain medication as needed is not a priority intervention for a client who has postpartum hemorrhage.

Pain medication can mask the signs of shock and lower the blood pressure further.

The nurse should focus on restoring the blood volume and preventing complications.

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Correct Answer is A

Explanation

All of these conditions are risk factors for postpartum hemorrhage (PPH), which is severe bleeding after childbirth.

Choice A) Prolonged labor is a risk factor for PPH because it can cause uterine fatigue and atony, which is the inability of the uterus to contract and compress the blood vessels.

Choice B) Oligohydramnios is a risk factor for PPH because it can cause placental abruption, which is the premature separation of the

A. Urine output 200 mL for the past 8 hours B. Weight decrease of 2 pounds since delivery C. Hemoglobin, which is an indicator of the number of RBCs and decreases during hypovolemia and hemorrhage D. Hematocrit, which is the percent of RBCs in the total blood volume, and decreases during hypovolemia.

Correct Answer is C

Explanation

Hemoglobin, which is an indicator of the number of RBCs and decreases during hypovolemia and hemorrhage.

Hemoglobin is a protein that carries oxygen in the blood and is measured in grams per deciliter (g/dL).

A normal range for hemoglobin is 12 to 16 g/dL for women.

A low hemoglobin level indicates anemia, which can be caused by blood loss or other factors.

A postpartum hemorrhage is a loss of more than 500 mL of blood after delivery, which can lead to hypovolemia (low blood volume) and shock.

Choice A is wrong because urine output 200 mL for the past 8 hours is within the normal range for a postpartum woman.

The kidneys may retain fluid during pregnancy and release it after delivery, resulting in increased urine output.

A normal urine output is 30 to 50 mL per hour.

Choice B is wrong because weight decrease of 2 pounds since delivery is expected for a postpartum woman.

The weight loss reflects the loss of fluid, blood, and placental tissue during delivery.

A normal weight loss after delivery is 10 to 12 pounds.

Choice D is wrong because hematocrit, which is the percent of RBCs in the total blood volume, and decreases during hypovolemia, may not reflect the true extent of blood loss in a postpartum hemorrhage.

Hematocrit is measured as a percentage and a normal range for hematocrit is 37 to 47% for women.

However, hematocrit may be falsely elevated due to hemoconcentration (increased concentration of blood cells) caused by fluid loss.

Hematocrit may take several days to reflect the actual blood loss.

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A nurse is caring for a client who has postpartum hemorrhage and is receiving IV fluids and blood products. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

Which of the following is a risk factor for postpartum hemorrhage?

Correct Answer is A

Explanation

Which of the following laboratory tests should the nurse report to the obstetrician when monitoring a client who is one day postpartum and has experienced significant postpartum hemorrhage?

Correct Answer is C

Explanation

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A nurse is caring for a client who has postpartum hemorrhage and is receiving IV fluids and blood products.

Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)