A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
Infection of the uterus.
Uterine atony.
Perineal hematoma.
Lacerations of the genital tract.
The Correct Answer is D
Choice A rationale
Infection of the uterus typically presents with fever, foul-smelling lochia, and uterine tenderness, not bright red vaginal bleeding with a firm fundus. Firm fundus decreases the likelihood of retained products causing infection.
Choice B rationale
Uterine atony causes excessive vaginal bleeding due to the uterus's inability to contract effectively, but it doesn't apply here since the fundus is firm, indicating adequate uterine tone.
Choice C rationale
Perineal hematoma results from blood vessel damage during delivery. It causes a tense, painful mass and vaginal or perineal swelling, not steady, bright red bleeding with a firm fundus.
Choice D rationale
Lacerations of the genital tract result in bright red bleeding despite a firm fundus, as the bleeding originates from tears in the vaginal or perineal tissues rather than uterine atony.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Tone refers to uterine atony, the leading cause of postpartum hemorrhage. Tissue refers to retained placental fragments. Trauma includes lacerations or uterine rupture. Thrombin relates to coagulation disorders impacting clotting.
Choice B rationale
TOLAC (Trial of Labor After Cesarean) and thrombosis are unrelated to immediate hemorrhage management. Thrombosis generally involves venous clots, differing from thrombin, which concerns clotting factor deficiencies causing bleeding.
Choice C rationale
Tear and tolerance are non-specific terms lacking relevance to postpartum hemorrhage management. Time to search is impractical and unrelated to immediate intervention for hemorrhage or its causes.
Choice D rationale
"None of the above" is incorrect as the Four Ts (Tone, Tissue, Trauma, Thrombin) specifically address the primary causes of postpartum hemorrhage and are universally accepted in clinical guidelines.
Correct Answer is A
Explanation
Choice A rationale
Urine output of 40 mL in 8 hours indicates oliguria, suggesting inadequate renal perfusion. Normal urine output is 30 mL/hour or greater. This could signify hypovolemia or renal compromise post-hemorrhage.
Choice B rationale
A drop in hematocrit of 2% may be expected postpartum and is not immediately concerning unless accompanied by hemodynamic instability or symptoms of anemia like dizziness or fatigue.
Choice C rationale
A 2 lb weight decrease postpartum is normal due to fluid shifts and diuresis. It does not indicate an emergent condition requiring immediate reporting to the obstetrician.
Choice D rationale
A pulse rate of 68 beats per minute is within the normal adult range of 60 to 100 beats per minute and is not typically concerning post-delivery.
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