A nurse is reviewing the medical record of a patient who had a vaginal delivery 3 hours ago. Which findings place the patient at risk for postpartum hemorrhage? (Select all that apply)

Choice A rationale
Vacuum-assisted delivery can increase the risk of postpartum hemorrhage. This is because the use of vacuum can cause trauma to the birth canal and uterus, leading to increased bleeding.
Choice B rationale
A newborn weight of 2.948 kg (6 lb 8 oz) is within the normal range and does not increase the risk of postpartum hemorrhage.
Choice C rationale
Labor induction with oxytocin can increase the risk of postpartum hemorrhage. Oxytocin can cause the uterus to contract too strongly or too frequently, leading to uterine atony (a condition where the uterus fails to contract after delivery), which can result in heavy bleeding.
Choice D rationale
A history of uterine atony places the patient at risk for postpartum hemorrhage. Uterine atony is a condition in which the uterus fails to contract after the delivery of the baby and the placenta, leading to heavy bleeding.
Choice E rationale

A history of human papillomavirus (HPV) does not increase the risk of postpartum hemorrhage. HPV is a sexually transmitted infection that can cause genital warts and cervical cancer, but it does not affect the uterus’s ability to contract after delivery.

Choice A rationale
While assessing the client’s kidney function is important in general, it is not the best way to evaluate medication adherence. Kidney function can affect the metabolism and excretion of medications, but it does not directly indicate whether the client is taking their medication as prescribed.
Choice B rationale

Correct answer. Checking the client’s serum medication level is the most direct and reliable way to evaluate medication adherence. If the client is taking the medication as prescribed, the serum medication level should be within the therapeutic range.
Choice C rationale
Determining the client’s apical pulse rate can provide information about the client’s overall cardiovascular status and can indicate certain drug effects or side effects, but it does not directly measure medication adherence.
Choice D rationale
Asking the client if they are taking the medication as prescribed can provide useful information, but it relies on self-report, which may not be reliable. Some clients might forget doses or not take the medication exactly as prescribed.