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TEST BANK FOR MATERNAL AND PEDIATRIC NURSING – MIDTERM SOLVED -6
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TEST BANK FOR MATERNAL AND PEDIATRIC NURSING – MIDTERM SOLVED -6
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TEST BANK FOR MATERNAL AND PEDIATRIC NURSING –MIDTERM SOLVED #6
The perinatal nurse's assessment while caring for a woman in the immediate post birth
period reveals that the woman is experiencing profuse bleeding. What is the most likely
etiology for her bleeding?
A. Uterine atony
B. Uterine inversion
C. Vaginal hematoma
D. Vaginal laceration - correct answer ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum
hemorrhage. Uterine inversion may lead to hemorrhage but it is not the most likely
source of this woman's bleeding. Furthermore if the woman were experiencing a uterine
inversion it would be evidenced by the presence of a large red rounded mass protruding
from the introitus. A vaginal hematoma may be associated with hemorrhage. However
the most likely clinical finding would be pain not the presence of profuse bleeding. A
vaginal laceration may cause hemorrhage but it is more likely that profuse bleeding
would result from uterine atony. A vaginal laceration should be suspected if vaginal
bleeding continues in the presence of a firm contracted uterine fundus.
Which is a primary nursing responsibility when caring for a woman experiencing an
obstetrical hemorrhage associated with uterine atony?
A. Establish venous access.
B. Perform fundal massage.
C. Prepare the woman for surgical intervention.
D. Catheterize the bladder. - correct answer ANS: B
The initial management of excessive postpartum bleeding is firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention the initial
intervention would be fundal massage. The woman may need surgical intervention to
treat her postpartum hemorrhage but the initial nursing intervention would be to assess
the uterus. After uterine massage the nurse may want to catheterize the patient to
eliminate any bladder distension that may be preventing the uterus from contracting
properly.
Which is the most likely cause of late postpartum hemorrhage (PPH)?
A. Subinvolution of the placental site
B. Defective vascularity of the decidua
C. Cervical lacerations
D. Coagulation disorders - correct answer ANS: A
Late PPH may be the result of subinvolution of the uterus pelvic infection or retained
placental fragments. Late PPH is not typically a result of defective vascularity of the
decidua cervical lacerations or coagulation disorders.
What woman is at greatest risk for early postpartum hemorrhage (PPH)?
A. A primiparous woman being prepared for an emergency Caesarean birth for fetal
distress
,B. A woman with severe pre-eclampsia on magnesium sulphate whose labour is being
induced
C. A multiparous woman with an 8-hour labour
D. A primigravida in spontaneous labour with preterm twins - correct answer ANS: B
Magnesium sulphate administration during labour poses a risk for PPH. Magnesium
acts as a smooth muscle relaxant thereby contributing to uterine relaxation and atony.
Although many causes and risk factors are associated with PPH the primiparous
woman being prepared for an emergency Caesarian birth the multiparous woman with
8-hour labour and the primigravida in spontaneous labour are not at risk for early PPH.
What is the initial priority nursing intervention when a nurse observes profuse
postpartum bleeding?
A. Call the woman's primary health care provider.
B. Administer the standing order for an oxytocic.
C. Palpate the uterus and massage it if it is boggy.
D. Assess maternal blood pressure (BP) and pulse for signs of hypovolemic shock. -
correct answer ANS: C
The initial management of excessive postpartum bleeding is firm massage of the uterine
fundus. Although calling the health care provider administering an oxytocic and
assessing maternal BP are appropriate interventions the primary intervention should be
to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage.
What is the most objective and least invasive assessment of adequate organ perfusion
and oxygenation when caring for a postpartum woman experiencing hemorrhagic
shock?
A. Absence of cyanosis in the buccal mucosa
B. Cool dry skin
C. Diminished restlessness
D. Urinary output of at least 30 ml/hr - correct answer ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in
which the perfusion of body organs may become severely compromised and death may
occur. The presence of adequate urinary output indicates adequate tissue perfusion.
The assessment of the buccal mucosa for cyanosis can be subjective in nature. The
presence of cool pale clammy skin would be an indicative finding associated with
hemorrhagic shock. Hemorrhagic shock is associated with lethargy not restlessness.
Which is one of the first symptoms of puerperal infection to assess for in the postpartum
woman?
A. Fatigue continuing for longer than 1 week
B. Pain with voiding
C. Profuse vaginal bleeding with ambulation
D. Temperature of 38.6° C - correct answer ANS: D
Postpartum or puerperal infection is any clinical infection of the genital canal that occurs
within 28 days after miscarriage induced abortion or childbirth. A temperature greater
than 38° C warrants further investigation for a puerperal infection. Fatigue would be a
late finding associated with infection. Pain with voiding may indicate a urinary tract
,infection but it is not typically one of the earlier symptoms of infection. Profuse lochia
may be associated with endometritis but it is not the first symptom associated with
infection.
The perinatal nurse assisting with establishing lactation is aware that which action can
minimize acute mastitis?
A. Washing the nipples and breasts with mild soap and water once a day
B. Using proper breastfeeding techniques
C. Wearing a nipple shield for the first few days of breastfeeding
D. Wearing a supportive bra 24 hours a day - correct answer ANS: B
Almost all instances of acute mastitis can be avoided by using proper breastfeeding
technique to prevent cracked nipples. Washing the nipples and breasts daily is no
longer indicated. In fact this can cause tissue dryness and irritation which can lead to
tissue breakdown and infection. Wearing a nipple shield does not prevent mastitis.
Wearing a supportive bra 24 hours a day may contribute to mastitis especially if an
underwire bra is worn because it may put pressure on the upper outer area of the breast
contributing to blocked ducts and mastitis.
Which statement is true with regard to postpartum hemorrhage (PPH)?
A. PPH is easy to recognize early after all the woman is bleeding.
B. Traditionally it takes more than 1000 ml of blood after vaginal birth and 2500 ml after
Caesarean birth to define the condition as PPH.
C. If anything nurses and doctors tend to overestimate the amount of blood loss.
D. Traditionally PPH has been classified as early or late with respect to birth. - correct
answer ANS: D
Early PPH is also known as primary or acute PPH late PPH is known as secondary
PPH. Unfortunately PPH can occur with little warning and often is recognized only after
the mother has profound symptoms. Traditionally a 500-ml blood loss after a vaginal
birth and a 1000-ml blood loss after a Caesarean birth constitute PPH. Health care
personnel tend to underestimate blood loss by 33 to 55% in their subjective
observations.
A woman who has recently given birth complains of pain and tenderness in her leg. On
physical examination the nurse notices warmth and redness over an enlarged hardened
area. What should the nurse suspect and then what should the nurse implement to
confirm the diagnosis?
A. Disseminated intravascular coagulation ask for laboratory tests.
B. Von Willebrand disease note whether bleeding times have been extended.
C. Thrombophlebitis use real-time and colour Doppler ultrasound.
D. Coagulopathies draw blood for laboratory analysis. - correct answer ANS: C
Pain and tenderness in the extremities that show warmth redness and hardness likely
indicate thrombophlebitis. A Doppler ultrasound is a common noninvasive way to
confirm diagnosis.
What postpartum hemorrhage (PPH) conditions are considered medical emergencies
that require immediate treatment?
, A. Inversion of the uterus and hypovolemic shock
B. Hypotonic uterus and coagulopathies
C. Subinvolution of the uterus and idiopathic thrombocytopenic purpura
D. Uterine atony and disseminated intravascular coagulation - correct answer ANS: A
Inversion of the uterus and hypovolemic shock are potentially life-threatening
complications and are considered medical emergencies. Although hypotonic uterus and
coagulopathies subinvolution of the uterus and idiopathic thrombocytopenic purpura and
uterine atony and disseminated intravascular coagulation are serious conditions they
are not necessarily medical emergencies that require immediate treatment.
What infection is contracted mostly by mothers who are breastfeeding and usually
occurs after the first postpartum week?
A. Endometritis
B. Wound infections
C. Mastitis
D. Urinary tract infections - correct answer ANS: C
Mastitis is infection in a breast usually confined to a milk duct. Most women who suffer
this are breastfeeding and symptoms rarely appear before the end of the first
postpartum week.
What medication should the nurse expect to see ordered first for the patient with von
Willebrand disease who experiences a postpartum hemorrhage?
A. Cryoprecipitate
B. Factor VIII and von Willebrand factor (vwf)
C. Desmopressin
D. Hemabate - correct answer ANS: C
Desmopressin is the primary treatment of choice. This hormone can be administered
orally nasally and intravenously. This medication promotes the release of factor VIII and
vwf from storage. Cryoprecipitate may be used however it would not be the first
medication ordered for this patient. Treatment with plasma products such as factor VIII
and vwf are an acceptable option for this patient. Because of the repeated exposure to
donor blood products and possible viruses however this is not the initial treatment of
choice. Although the administration of the prostaglandin Hemabate is known to promote
contraction of the uterus during postpartum hemorrhage it is not effective for the patient
who presents with a bleeding disorder.
The nurse should be aware that a pessary would be most effective in the treatment of
which disorder?
A. Cystocele
B. Uterine prolapse
C. Rectocele
D. Stress urinary incontinence - correct answer ANS: B
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the
correct position. A pessary is not used for a cystocele a rectocele or stress urinary
incontinence.
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