The nurse is assigned to care for the postpartum client during her shift.
The nurse knows one of the most common risk factors for early (PPH) postpartum hemorrhage is uterine atony. When providing care, the nurse would plan to:.

Have the client void frequently.

Massage the uterus.

Have the client in a side-lying position for comfort.

Keep the patient on strict bed rest for 24 hours to avoid stress on the uterus.

Answer and Explanation

The Correct Answer is B

Massaging the uterus helps it contract and prevent excessive bleeding after delivery. Uterine atony is a condition where the uterus does not contract enough to clamp the blood vessels that supply the placenta, leading to postpartum hemorrhage. Uterine massage is one of the interventions to treat uterine atony and restore uterine tone.

Choice A is wrong because having the client void frequently does not directly affect the uterine contraction. However, a full bladder can interfere with uterine contraction and cause displacement of the uterus, so it is important to monitor the bladder status and empty it as needed.

Choice C is wrong because having the client in a side-lying position for comfort does not help with uterine contraction. However, this position may be beneficial for other reasons, such as reducing edema and pain in the perineal area.

Choice D is wrong because keeping the patient on strict bed rest for 24 hours to avoid stress on the uterus does not help with uterine contraction. In fact, early ambulation after delivery can help prevent thromboembolic complications and promote recovery.

Normal ranges for postpartum blood loss are less than 500 mL for vaginal delivery and less than 1000 mL for cesarean delivery. Postpartum hemorrhage is defined as blood loss greater than or equal to 1000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after birth.

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Correct Answer is C

Explanation

A nonstress test (NST) is a test in pregnancy that measures fetal heart rate and reaction to movement.Your pregnancy care provider performs a nonstress test to make sure the fetus is healthy and getting enough oxygen.It’s safe and painless, and gets its name because it puts no stress (nonstress) on you or the fetus.

Choice A is wrong because a nonstress test does not measure the mother’s ability to tolerate the discomfort of labor.A stress test is a different procedure that involves stimulating contractions and monitoring how the fetus responds.

Choice B is wrong because a nonstress test does not measure fetal lie, which is the position of the fetus in the uterus.

Fetal lie is usually determined by ultrasound or physical examination.

Choice D is wrong because a nonstress test does not measure maternal readiness for labor.A nonstress test typically happens after 28 weeks of pregnancy, when fetal heart rate starts reacting to movements.

Maternal readiness for labor is assessed by other factors, such as cervical dilation and effacement.

A. Have her do Kegel exercises once an hour. B. Apply ice to her perineal area. C. Keep her hips slightly elevated. D. Observe her perineal area for signs of infection.

Correct Answer is B

Explanation

The correct answer is choice B. Apply ice to her perineal area.This is because ice can help reduce swelling and pain in the episiotomy wound, which is a cut made in the tissue between the vagina and anus during childbirth.Ice should be applied for the first 24 to 48 hours after delivery.

Choice A is wrong because Kegel exercises, which involve contracting and relaxing the pelvic floor muscles, are not recommended for the first 12 hours after an episiotomy.They can increase blood flow and inflammation in the area, and may interfere with healing.

Choice C is wrong because keeping her hips slightly elevated can cause pressure on the episiotomy wound and increase discomfort.It can also affect blood circulation and drainage in the area.

Choice D is wrong because observing her perineal area for signs of infection is not a nursing action that should be included in her plan of care for the first 12 hours.Infection is rare in episiotomy wounds, and signs of infection usually appear after 24 hours or later.However, the nurse should teach the patient how to keep the area clean and dry, and when to report any signs of infection, such as fever, pus, or foul-smelling discharge.

Normal ranges for episiotomy healing are:

• Stitches dissolve within 2 to 4 weeks

• Pain and swelling subside within a few days to a week

• Wound heals completely within 4 to 6 weeks

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The nurse is assigned to care for the postpartum client during her shift. The nurse knows one of the most common risk factors for early (PPH) postpartum hemorrhage is uterine atony. When providing care, the nurse would plan to:.

Nursing Test Bank

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Correct Answer is C

Explanation

A patient had an episiotomy during her delivery. Which nursing action should be included in her plan of care for the first 12 hours?

Correct Answer is B

Explanation

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The nurse is assigned to care for the postpartum client during her shift.
The nurse knows one of the most common risk factors for early (PPH) postpartum hemorrhage is uterine atony. When providing care, the nurse would plan to:.