A nurse is caring for a client who is 5 hours postpartum following a vaginal birth of a newborn weighing 9 lb 6 oz (4252 g). The nurse should recognize that this client is at risk for which of the following postpartum complications?
Uterine atony
Thrombophlebitis
Puerperal infection
Retained placental fragments
The Correct Answer is A
A. Uterine atony is the most common cause of postpartum hemorrhage and is more likely to occur after a delivery of a large infant or in cases of rapid or prolonged labor.
B. Thrombophlebitis is a risk after childbirth, especially in clients who have undergone cesarean delivery or who have other risk factors such as prolonged immobility, but it is not directly related to the size of the newborn.
C. Puerperal infection is a risk following childbirth, but it is not directly related to the size of the newborn.
D. Retained placental fragments can lead to postpartum hemorrhage, but the size of the newborn is not a direct risk factor for this complication.
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Related Questions
Correct Answer is D
Explanation
A. Molding refers to the shaping of the fetal head during labor and delivery to facilitate passage through the birth canal. It typically resolves within a few days and does not involve bruising.
B. Caput succedaneum is localized swelling or edema of the scalp that crosses suture lines and typically resolves within a few days. It is not associated with bruising.
C. Pilonidal dimple refers to a small pit or depression in the skin, typically at the base of the spine, and is not related to the finding described.
D. Cephalhematoma is a collection of blood between the skull bone and its periosteum. It is
confined by suture lines and may take weeks to resolve. It does not cross suture lines and may be associated with bruising due to birth trauma.
Correct Answer is B
Explanation
A. An apical heart rate of 130/min is within the normal range for a newborn and does not require further assessment by the provider.
B. Documenting this as an expected finding is appropriate as the normal range for a newborn's heart rate is typically between 120-160 beats per minute.
C. Asking another nurse to verify the heart rate may delay care unnecessarily, as the rate is within the expected range.
D. There is no indication to prepare the newborn for transport to the NICU based solely on an apical heart rate of 130/min, as this is within the normal range.
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