The nurse is reviewing the client’s chart.

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

Client was middle aged and married.

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.

Choice A rationale
Type 1 diabetes is not the most common type of diabetes. Type 1 diabetes is a condition where the pancreas produces little or no insulin, which is a hormone that regulates the blood glucose level. Type 1 diabetes usually develops in childhood or adolescence and requires lifelong insulin therapy. Type 1 diabetes accounts for about 5% to 10% of all cases of diabetes.

Choice B rationale
Type 2 diabetes often goes undiagnosed. Type 2 diabetes is a condition where the body becomes resistant to the action of insulin or the pancreas produces insufficient insulin. Type 2 diabetes usually develops in adulthood and is associated with obesity, physical inactivity, and family history. Type 2 diabetes can be managed with diet, exercise, oral medications, or insulin. Type 2 diabetes accounts for about 90% to 95% of all cases of diabetes. However, many people with type 2 diabetes do not have any symptoms or are unaware of their condition, which can lead to delayed diagnosis and complications.

Choice C rationale
Type 1 diabetes cannot become type 2 during pregnancy. Type 1 and type 2 diabetes are different conditions with different causes and treatments. Type 1 diabetes is an autoimmune disorder that destroys the insulin-producing cells in the pancreas, while type 2 diabetes is a metabolic disorder that impairs the insulin sensitivity or secretion. Type 1 diabetes cannot be reversed or prevented, while type 2 diabetes can be prevented or delayed with lifestyle changes.

Choice D rationale
Gestational diabetes mellitus (GDM) does not mean that the woman will be receiving insulin treatment until 6 weeks after birth. GDM is a condition where the blood glucose level becomes elevated during pregnancy, usually after 24 weeks of gestation. GDM can cause complications for the mother and the fetus, such as preeclampsia, macrosomia, and neonatal hypoglycemia. GDM can be managed with diet, exercise, oral medications, or insulin. GDM usually resolves after delivery, but the woman should be tested for diabetes 6 to 12 weeks postpartum, as she has a higher risk of developing type 2 diabetes later in life.

Choice A rationale
This is correct because blood pressure 80/56 mm Hg is the nurse's priority finding. It indicates hypotension, which is a common and serious complication of epidural analgesia. Hypotension can compromise the maternal and fetal perfusion and oxygenation, leading to fetal distress and acidosis. The nurse should immediately administer oxygen, fluids, and vasopressors as prescribed, and monitor the fetal heart rate and variability.

Choice B rationale
This is incorrect because temperature 38.2°C (100.8°F) is not the nurse's priority finding. It indicates a fever, which could be a sign of infection or dehydration. The nurse should assess the client for other signs of infection, such as chills, malaise, or foul-smelling discharge, and administer antipyretics and antibiotics as prescribed. The nurse should also ensure adequate hydration and cooling measures for the client.

Choice C rationale
This is incorrect because the client reports weakness of the lower extremities is not the nurse's priority finding. It indicates a side effect of epidural analgesia, which blocks the nerve impulses from the lower spinal segments. The nurse should assess the client's motor and sensory function, and adjust the epidural infusion rate as prescribed. The nurse should also assist the client with positioning and mobility, and prevent pressure ulcers and nerve injuries.

Choice D rationale
This is incorrect because the client reports profuse itching is not the nurse's priority finding. It indicates a side effect of opioid epidural analgesia, which stimulates the histamine receptors in the skin. The nurse should assess the client's skin condition, and administer antihistamines as prescribed. The nurse should also provide comfort measures, such as cool compresses, lotion, or massage, for the client.