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Exhibits

The nurse is reviewing the clients’ chart. Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage

History and Physical A 36-year-old client who is gravida 5 para 5 (GSP5) transferred to the postpartum unit 1 hour after delivery of a 9 lb 1 oz (4.1 kg) female. She was in labor for 25 hours and forceps were used to assist with the delivery. She was given an epidural for anesthesia that was effective. The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale. Her vital signs were stable, and she was catheterized for 500 mL of light yellow urine just prior to delivery. Her spouse was at the bedside for delivery and appeared supportive. Blood type A+. Estimated blood loss was 600 mL after delivery.

Nurses’ Notes Received GSP5 client 1 hour after delivery of a 9 lb 1 oz (4.1 kg) female. She was assisted to the bathroom where she voided 150 mL clear yellow urine. Lochia rubra moderate with small clots, no foul odor noted. Fundus firm at umbilicus. Episiotomy edges well approximated, no redness, edema, drainage, or ecchymosis. No pain, redness or swelling in calves. A 1,000 mL bag of lactated Ringer’s solution containing 10 units of oxytocin is infusing via an 18 gauge peripheral IV in the left forearm at 125 mL/hr, with 500 mL remaining in the bag. The IV is patent, without redness or swelling, and can be discontinued when this bag’s infusion is complete.

gravida 5 para 5

delivery of a 9 lb 1 oz (4.1 kg) female

labor for 25 hours and forceps were used to assist with the delivery

client had a 4th degree laceration

Estimated blood loss was 600 mL after delivery

Lochia rubra moderate with small clots

Episiotomy edges well approximated

A 1,000 mL bag of lactated Ringer’s solution containing 10 units of oxytocin is infusing

The IV is patent, without redness or swelling

given an epidural for anesthesia that was effective

vital signs were stable

Answer and Explanation

The Correct Answer is ["A","B","C","D","E","F"]

Based on the client’s history and physical, the following areas increase the risk for postpartum hemorrhage:

Gravida 5 Para 5 (G5P5): Multiparity (having given birth 5 times) can increase the risk of postpartum hemorrhage due to uterine atony (lack of muscle tone) resulting from repeated stretching of the uterus.
Delivery of a 9 lb 1 oz (4.1 kg) baby: Macrosomia (large baby) can overstretch the uterus, increasing the risk of uterine atony and postpartum hemorrhage.
Labor for 25 hours and use of forceps for delivery: Prolonged labor and instrumental delivery can lead to uterine fatigue and atony, increasing the risk of postpartum hemorrhage.
4th degree laceration: Severe lacerations can lead to significant blood loss.
Estimated blood loss was 600 mL after delivery: This is a significant amount of blood loss and could indicate a risk for further hemorrhage.
Lochia rubra moderate with small clots: This could indicate ongoing blood loss.

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Free Nursing Study Resources

Correct Answer is ["18"]

Explanation

Step 1 is to calculate the infusion rate. The prescription is for heparin 900 units/hr IV. The IV bag contains heparin 25,000 units in 500 mL of 0.45% normal saline.

So, the calculation would be (900 units ÷ 25,000 units) × 500 mL = 18 mL/hr.

Correct Answer is ["3742"]

Explanation

Step 1 is: Convert the child’s weight from pounds to kilograms. 1 pound is approximately 0.453592 kilograms, so 55 lb × 0.453592 kg/lb = 24.9476 kg.

Step 2 is: Calculate the total daily dosage. 150 mg/kg/day × 24.9476 kg = 3742.14 mg/day. Therefore, the nurse should administer approximately 3742 mg each day when rounded to the nearest whole number.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receives a prescription for heparin 900 units/hr IV. The IV bag contains heparin 25,000 units in 500 mL of 0.45% normal saline. How many mL/hr should the nurse program the infusion pump to deliver?

Correct Answer is ["18"]

Explanation

A child weighing 55 lb has been prescribed cefotaxime at a dosage of 150 mg/kg/day, to be administered in divided doses every 6 hours. How many mg should the nurse administer each day? (Provide a numerical value only.)

Correct Answer is ["3742"]

Explanation

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