Which client is at greatest risk for early postpartum hemorrhage (PPH)?

Primigravida in spontaneous labor with preterm twins

Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress

Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor

Woman with severe preeclampsia on magnesium sulfate whose labor is being induced

Answer and Explanation

The Correct Answer is C

Choice A reason: Primigravida in spontaneous labor with preterm twins is not at the greatest risk for early postpartum hemorrhage, as preterm births are associated with lower blood loss and smaller placentas. However, this client may have other complications, such as preterm labor, premature rupture of membranes, or fetal growth restriction.

Choice B reason: Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress is not at the greatest risk for early postpartum hemorrhage, as cesarean births are associated with higher blood loss and larger incisions. However, this client may have other complications, such as infection, wound dehiscence, or thromboembolism.

Choice C reason: Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor is at the greatest risk for early postpartum hemorrhage, as multiparity and rapid labor are both risk factors for uterine atony, which is the most common cause of early postpartum hemorrhage. Uterine atony is a condition where the uterus fails to contract and retract after delivery, and can cause excessive bleeding and hypovolemic shock.

Choice D reason: Woman with severe preeclampsia on magnesium sulfate whose labor is being induced is not at the greatest risk for early postpartum hemorrhage, as preeclampsia and magnesium sulfate are both risk factors for late postpartum hemorrhage, which occurs after 24 hours of delivery. However, this client may have other complications, such as eclampsia, HELLP syndrome, or placental abruption.

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Correct Answer is A

Explanation

Choice A reason: She is exhibiting hypertonic uterine dysfunction, because she has frequent and painful contractions that are ineffective in dilating the cervix. Hypertonic uterine dysfunction occurs when the uterus contracts too often and too forcefully, resulting in poor oxygenation and fetal distress. The woman may need tocolytic therapy, pain relief, and hydration.

Choice B reason: She is not experiencing a normal latent stage, because her contractions are too frequent and too painful for this phase of labor. The normal latent stage is characterized by irregular and mild contractions that gradually increase in frequency and intensity, and cervical dilation from 0 to 3 cm.

Choice C reason: She is not experiencing precipitous labor, because her labor is not progressing rapidly. Precipitous labor is defined as labor that lasts less than 3 hours from the onset of contractions to the delivery of the baby. It is associated with cervical dilation of more than 5 cm per hour.

Choice D reason: She is not exhibiting hypotonic uterine dysfunction, because her contractions are not weak or infrequent. Hypotonic uterine dysfunction occurs when the uterus contracts too weakly or too rarely, resulting in prolonged labor and increased risk of infection. The woman may need oxytocin augmentation, amniotomy, or cesarean section.

A. Prostaglandin E2 B. Methylergonovine C. Terbutaline D. Oxytocin

Correct Answer is C

Explanation

Choice A reason: Prostaglandin E2 is not an appropriate medication for the client, because it is a uterotonic agent that stimulates uterine contractions and cervical ripening. Prostaglandin E2 is used to induce labor, not to stop it.

Choice B reason: Methylergonovine is not an appropriate medication for the client, because it is a uterotonic agent that causes sustained uterine contractions and vasoconstriction. Methylergonovine is used to prevent or treat postpartum hemorrhage, not to stop preterm labor.

Choice C reason: Terbutaline is an appropriate medication for the client, because it is a tocolytic agent that relaxes the uterine smooth muscle and inhibits contractions. Terbutaline is used to delay preterm labor and prolong pregnancy.

Choice D reason: Oxytocin is not an appropriate medication for the client, because it is a uterotonic agent that stimulates uterine contractions and milk ejection. Oxytocin is used to augment labor, not to stop it.

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Which client is at greatest risk for early postpartum hemorrhage (PPH)?

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Naxlex Comprehensive Predictor Exams

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor?

Correct Answer is A

Explanation

A nurse is admitting a client who has a diagnosis of preterm labor. The nurse anticipates an order by the provider for which of the following medications?

Correct Answer is C

Explanation

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