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Patient Data

Exhibits

Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage.

36-year-old client who is gravida 5, para 5, 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

gravida 5, para 5,

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

labor for 25 hours

epidural for anesthesia

4th degree laceration

Estimated blood loss was 600 mL after delivery

forceps were used to assist with the delivery

catheterized for 500 mL of light-yellow urine

spouse was at the bedside for delivery

pain was currently at a 4 on a 0 to 10 pain scale

Answer and Explanation

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

Correct choices;

Gravida 5, para 5 (G5P5)

This means the client has been pregnant 5 times and has given birth 5 times. Multiparity (having had multiple pregnancies and deliveries) is a risk factor for PPH due to uterine overdistension, which can lead to poor uterine tone and difficulty in contracting effectively after delivery.

Delivery of a 9 lb 1 oz (4.1 kg) baby

Larger babies are associated with an increased risk of PPH. The weight of the baby suggests a potentially larger placental surface area and increased uterine distension during pregnancy, which can contribute to uterine atony post-delivery.

Labor for 25 hours

Prolonged labor can lead to uterine exhaustion, where the uterus may not contract effectively after delivery, predisposing the client to PPH.

Forceps-assisted delivery

Instrumental deliveries, including forceps, can cause trauma to the birth canal, including the cervix, vagina, and perineum, increasing the risk of lacerations and bleeding.

Epidural anesthesia

Epidurals can mask the pain associated with uterine atony, which may delay the diagnosis of PPH. It's important to closely monitor uterine tone and blood loss in clients who have had epidurals.

4th degree laceration

Explanation: A 4th degree laceration involves the perineum and extends through the anal sphincter complex. Such extensive trauma increases the risk of significant bleeding postpartum.

Estimated blood loss of 600 mL

Although this is within the normal range of blood loss immediately after delivery, it still signifies that the client has experienced significant hemorrhage, putting her at higher risk for ongoing bleeding.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is ["21"]

Explanation

To calculate the flow rate in gtt/min, you can use the formula: (Volume in mL * Drop factor) / Time in
minutes.

For 1 L of lactated Ringer's IV, which is 1000 mL, to be infused over 12 hours, with an IV administration set that delivers 15 gtt/mL, the calculation would be: (1000 mL * 15 gtt/mL) / (12 hours * 60 minutes/hour).

This simplifies to (15000 gtt) / (720 minutes), which equals approximately 20.83 gtt/min.

Therefore, the nurse should regulate the infusion to 21 gtt/min, rounding to the nearest whole
number.

A. Neutrophil count. B. Hematocrit. C. Platelet count. D. Serum sodium level.

Correct Answer is A

Explanation

Rationale

A. An elevated neutrophil count suggests an active immune response to infection, supporting the clinical findings of purulent drainage. This information is crucial for the healthcare provider to assess the severity of the infection and guide treatment.

B. Hematocrit changes are more related to blood volume, fluid shifts, or bleeding rather than infection. While it may be monitored postoperatively, it does not provide specific information about infection.

C. Platelet count is important for assessing clotting function but does not directly indicate infection or purulent drainage.

D. Serum sodium levels are part of electrolyte balance and hydration status monitoring but do not directly relate to the presence of infection.

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Correct choices;

Gravida 5, para 5 (G5P5)

Delivery of a 9 lb 1 oz (4.1 kg) baby

Labor for 25 hours

Forceps-assisted delivery

Epidural anesthesia

4th degree laceration

Estimated blood loss of 600 mL

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receives a prescription for 1 L of lactated Ringer's IV to be infused over 12 hours. The IV administration set delivers 15 gtt/mL. How many gtt/min should the nurse regulate the infusion? (Enter numerical value only. If rounding is required, round to the nearest whole number.)

Correct Answer is ["21"]

Explanation

While changing a client's postoperative dressing, the nurse observes purulent drainage at the site. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

Correct Answer is A

Explanation

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