A nurse is caring for a client who is 1 hr postpartum and has uterine atony. The client is exhibiting a large amount of vaginal bleeding. Which of the following actions should the nurse take?

Avoid performing sterile vaginal examinations.

Anticipate a prescription for misoprostol.

Obtain a specimen for a Kleihauer-Betke test.

Administer betamethasone IM.

Answer and Explanation

The Correct Answer is B

Rationale:

A. Avoiding sterile vaginal examinations is not the appropriate action for managing uterine atony and postpartum hemorrhage. Vaginal examinations may be necessary to assess the degree of cervical dilation and to identify potential causes of bleeding.

B. Anticipating a prescription for misoprostol is appropriate for managing uterine atony and postpartum hemorrhage. Misoprostol is a prostaglandin analog that helps to promote uterine contractions and control bleeding.

C. Obtaining a specimen for a Kleihauer-Betke test is not the priority action in this situation. The Kleihauer-Betke test is used to estimate the amount of fetal-maternal hemorrhage in Rh-negative mothers.

D. Administering betamethasone IM is not indicated for the management of uterine atony and postpartum hemorrhage. Betamethasone is a corticosteroid used to promote fetal lung maturity when preterm birth is anticipated.

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Correct Answer is C

Explanation

Rationale:

A. Administering methylergonovine is not appropriate for a fourth-degree perineal laceration.

Methylergonovine is typically used to prevent or treat postpartum hemorrhage by promoting uterine contractions.

B. Applying povidone-iodine to the client's perineum is not indicated for the management of a perineal laceration. Povidone-iodine is an antiseptic solution used for wound cleansing, but it may be too harsh for the perineal area.

C. Providing the client with a cool sitz bath is appropriate for managing discomfort and promoting healing after a fourth-degree perineal laceration. A sitz bath helps to soothe the perineal area and reduces inflammation.

D. Applying a moist, warm compress to the perineum is not recommended for a fourth-degree perineal laceration, as it may increase the risk of infection and discomfort.

A. To facilitate bonding between the newborn and parent B. To allow manifestations of infection to be identified C. The newborn weighs less than 2.5 kg (5.5 lb) D. The newborn was delivered via cesarean birth

Correct Answer is A

Explanation

A. To facilitate bonding between the newborn and parent. This is correct. Antibiotic ophthalmic ointment, typically used to prevent neonatal conjunctivitis, can temporarily blur the newborn's vision. Delaying its application for a short period allows the newborn to maintain eye contact with the parent during the critical bonding period immediately following birth.

B. To allow manifestations of infection to be identified. This is incorrect. The purpose of the antibiotic ointment is to prevent neonatal conjunctivitis caused by gonorrhea or chlamydia, which may not present with immediate symptoms. Delaying its application to observe for signs of infection would not be appropriate.

C. The newborn's weight is not a determining factor for delaying the instillation of antibiotic ophthalmic ointment.

D. The mode of delivery, whether vaginal or cesarean, does not affect the timing of antibiotic ophthalmic ointment instillation.

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A nurse is caring for a client who is 1 hr postpartum and has uterine atony. The client is exhibiting a large amount of vaginal bleeding. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 12 hr postpartum and has a fourth-degree laceration of the perineum. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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