Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a postpartum client following a vaginal birth of a newborn weighing 4252 g (9 lb 6 oz). The nurse should identify that this client is at risk for which of the following postpartum complications?
A. Uterine atony
Uterine atony is the failure of the uterus to contract and retract after delivery, which can lead to excessive bleeding and hemorrhage. It is the most common cause of postpartum hemorrhage, accounting for up to 80 percent of cases. Risk factors for uterine atony include large or multiple babies, prolonged or rapid labor, overdistended uterus, use of oxytocin or magnesium sulfate during labor, and previous history of uterine atony.
B. Puerperal infection
Puerperal infection is an infection of the reproductive tract that occurs within six weeks after delivery. It can affect the uterus (endometritis), the bladder (cystitis), the kidneys (pyelonephritis), the breast (mastitis), or the wound (cesarean section or episiotomy). Symptoms include fever, chills, malaise, foul-smelling lochia, pelvic pain, and wound redness or drainage. Risk factors for puerperal infection include cesarean delivery, prolonged rupture of membranes, prolonged labor, multiple vaginal examinations, retained placental fragments, and poor hygiene.
C. Retained placental fragments
Retained placental fragments are pieces of the placenta that remain in the uterus after delivery. They can cause postpartum hemorrhage, infection, or delayed involution of the uterus. Symptoms include heavy or prolonged bleeding, fever, abdominal pain, and an enlarged uterus. Risk factors for retained placental fragments include placenta previa, placenta accrete, manual removal of the placenta, and incomplete examination of the placenta after delivery.
D. Thrombophlebitis.
Thrombophlebitis is the inflammation and clotting of a vein, usually in the legs or pelvis. It can cause pain, swelling, redness, and warmth in the affected area. It can also lead to pulmonary embolism if the clot breaks off and travels to the lungs. Risk factors for thrombophlebitis include pregnancy and the postpartum period, cesarean delivery, obesity, smoking, dehydration, immobility, varicose veins, and inherited or acquired clotting disorders.
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Full Explanation
Choice A reason:
Uterine atony is the failure of the uterus to contract and retract after delivery, which can lead to excessive bleeding and hemorrhage. It is the most common cause of postpartum hemorrhage, accounting for up to 80 percent of cases. Risk factors for uterine atony include large or multiple babies, prolonged or rapid labor, overdistended uterus, use of oxytocin or magnesium sulfate during labor, and previous history of uterine atony.
Choice B reason:
Puerperal infection is an infection of the reproductive tract that occurs within six weeks after delivery. It can affect the uterus (endometritis), the bladder (cystitis), the kidneys (pyelonephritis), the breast (mastitis), or the wound (cesarean section or episiotomy).
Symptoms include fever, chills, malaise, foul-smelling lochia, pelvic pain, and wound redness or drainage. Risk factors for puerperal infection include cesarean delivery, prolonged rupture of membranes, prolonged labor, multiple vaginal examinations, retained placental fragments, and poor hygiene.
Choice C reason:
Retained placental fragments are pieces of the placenta that remain in the uterus after delivery. They can cause postpartum hemorrhage, infection, or delayed involution of the uterus. Symptoms include heavy or prolonged bleeding, fever, abdominal pain, and an enlarged uterus. Risk factors for retained placental fragments include placenta previa, placenta accrete, manual removal of the placenta, and incomplete examination of the placenta after delivery.
Choice D reason:
Thrombophlebitis is the inflammation and clotting of a vein, usually in the legs or pelvis. It can cause pain, swelling, redness, and warmth in the affected area. It can also lead to pulmonary embolism if the clot breaks off and travels to the lungs. Risk factors for thrombophlebitis include pregnancy and the postpartum period, cesarean delivery, obesity, smoking, dehydration, immobility, varicose veins, and inherited or acquired clotting disorders.
Similar Questions
What are the risk factors for neonatal sepsis? Select all that apply. (Select All that Apply.).
A. Preterm birth
Preterm birth is a major risk factor for neonatal sepsis, especially early-onset sepsis. Preterm babies have immature immune systems and lack antibodies to protect them against certain bacteria.
B. Cesarean birth
Cesarean birth is not a risk factor for neonatal sepsis by itself, unless it is associated with other factors such as prolonged rupture of membranes, maternal infection or chorioamnionitis.
C. Precipitous delivery
Precipitous delivery is a risk factor for neonatal sepsis, especially early-onset sepsis. Precipitous delivery can cause fetal distress, hypoxia, acidosis and increased susceptibility to infection.
D. Frequent vaginal exams
Frequent vaginal exams are a risk factor for neonatal sepsis, especially early-onset sepsis. Frequent vaginal exams can introduce bacteria into the amniotic fluid and increase the risk of ascending infection.
E. Mother has GBS infection
Mother has GBS infection is a risk factor for neonatal sepsis, especially early-onset sepsis. GBS (group B streptococcus) is the most common cause of early-onset neonatal sepsis and can be transmitted from the mother to the baby during labor and delivery.
Full Explanation
Choice A reason:
Preterm birth is a major risk factor for neonatal sepsis, especially early-onset sepsis. Preterm babies have immature immune systems and lack antibodies to protect them against certain bacteria.
Choice B reason:
Cesarean birth is not a risk factor for neonatal sepsis by itself, unless it is associated with other factors such as prolonged rupture of membranes, maternal infection or chorioamnionitis.
Choice C reason:
Precipitous delivery is a risk factor for neonatal sepsis, especially early-onset sepsis. Precipitous delivery can cause fetal distress, hypoxia, acidosis and increased susceptibility to infection.
Choice D reason:
Frequent vaginal exams are a risk factor for neonatal sepsis, especially early-onset sepsis. Frequent vaginal exams can introduce bacteria into the amniotic fluid and increase the risk of ascending infection.
Choice E reason:
Mother has GBS infection is a risk factor for neonatal sepsis, especially early-onset sepsis. GBS (group B streptococcus) is the most common cause of early-onset neonatal sepsis and can be transmitted from the mother to the baby during labor and delivery.
Which of the following are contraindications for VBAC? (Select All that Apply.).
A. A prior vaginal delivery.
A prior vaginal delivery is not a contraindication for VBAC. In fact, it is a positive predictor of success for VBAC, as it indicates that the woman has a proven pelvis and can tolerate labor.
B. Gestation of 42 weeks.
The gestation of 42 weeks is not a contraindication for VBAC. However, it is associated with an increased risk of stillbirth while awaiting spontaneous labor, which should be balanced against the risks of induction of labor or elective repeat cesarean.
C. Maternal obesity.
Maternal obesity is a relative contraindication for VBAC. It is associated with a lower success rate of VBAC, a higher risk of uterine rupture, and a higher risk of maternal and neonatal complications. The decision to attempt VBAC in obese women should be made on a case-by-case basis by a senior obstetrician.
D. One prior cesarean delivery.
One prior cesarean delivery is not a contraindication for VBAC. Most women who have had one prior lower segment cesarean delivery are eligible for VBAC, as the risk of uterine rupture is low (0.5%) and the success rate is high (72-75%).
E. Macrosomic fetus.
A macrosomic fetus is a relative contraindication for VBAC. It is associated with a lower success rate of VBAC, a higher risk of uterine rupture, and a higher risk of shoulder dystocia and birth trauma. The decision to attempt VBAC in women with suspected macrosomia should be made on a case-by-case basis by a senior obstetrician.
Full Explanation
Choice A reason:
A prior vaginal delivery is not a contraindication for VBAC. In fact, it is a positive predictor of success for VBAC, as it indicates that the woman has a proven pelvis and can tolerate labor.
Choice B reason:
The gestation of 42 weeks is not a contraindication for VBAC. However, it is associated with an increased risk of stillbirth while awaiting spontaneous labor, which should be balanced against the risks of induction of labor or elective repeat cesarean.
Choice C reason:
Maternal obesity is a relative contraindication for VBAC. It is associated with a lower success rate of VBAC, a higher risk of uterine rupture, and a higher risk of maternal and neonatal complications. The decision to attempt VBAC in obese women should be made on a case-by-case basis by a senior obstetrician.
Choice D reason:
One prior cesarean delivery is not a contraindication for VBAC. Most women who have had one prior lower segment cesarean delivery are eligible for VBAC, as the risk of uterine rupture is low (0.5%) and the success rate is high (72-75%).
Choice E reason:
A macrosomic fetus is a relative contraindication for VBAC. It is associated with a lower success rate of VBAC, a higher risk of uterine rupture, and a higher risk of shoulder dystocia and birth trauma. The decision to attempt VBAC in women with suspected macrosomia should be made on a case-by-case basis by a senior obstetrician.
A nurse is contributing to the plan of care for a preterm newborn. To help the newborn conserve energy, which of the following actions should the nurse recommend?
A. Allow opportunities for newborn massage.
Allowing opportunities for newborn massage is not recommended for preterm newborns, as it can increase their oxygen consumption and energy expenditure. Massage can also cause stress responses, such as increased heart rate, blood pressure, and cortisol levels.
B. Cluster the newborn's care activities.
Clustering the newborn's care activities is the best way to help the newborn conserve energy, as it minimizes the frequency of handling and stimulation. Clustering care also allows for longer periods of uninterrupted sleep, which is essential for growth and development.
C. Change the newborn's position every 2 hours.
Changing the newborn's position every 2 hours is not necessary for preterm newborns, as it can disrupt their sleep and cause them to lose heat. Preterm newborns have limited ability to regulate their body temperature, and frequent position changes can expose them to cold stress.
D. Place elbow restraints on the newborn.
Placing elbow restraints on the newborn is not indicated for preterm newborns, unless they have a specific condition that requires them, such as a cleft lip or palate repair. Elbow restraints can restrict the newborn's movement and cause skin irritation or injury.
Full Explanation
Choice A reason:
Allowing opportunities for newborn massage is not recommended for preterm newborns, as it can increase their oxygen consumption and energy expenditure. Massage can also cause stress responses, such as increased heart rate, blood pressure, and cortisol levels.
Choice B reason:
Clustering the newborn's care activities is the best way to help the newborn conserve energy, as it minimizes the frequency of handling and stimulation. Clustering care also allows for longer periods of uninterrupted sleep, which is essential for growth and development.
Choice C reason:
Changing the newborn's position every 2 hours is not necessary for preterm newborns, as it can disrupt their sleep and cause them to lose heat. Preterm newborns have limited ability to regulate their body temperature, and frequent position changes can expose them to cold stress.
Choice D reason:
Placing elbow restraints on the newborn is not indicated for preterm newborns, unless they have a specific condition that requires them, such as a cleft lip or palate repair. Elbow restraints can restrict the newborn's movement and cause skin irritation or injury.