Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A. Primigravida in spontaneous labor with preterm twins
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.
B. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress
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.
C. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
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.
D. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced
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.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Maternal Newborn Proctored Exam 4. Take the full exam now
Full Explanation
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.
Similar Questions
What is the first line medication for postpartum hemorrhage?
A. Misoprostol
Misoprostol is not the first line medication for postpartum hemorrhage, as it is a prostaglandin E1 analog that causes uterine contractions and cervical ripening. Misoprostol is used for the prevention and treatment of postpartum hemorrhage, but it is less effective and more side effects than oxytocin, which is the first line medication.
B. Pitocin
Pitocin is the first line medication for postpartum hemorrhage, as it is a synthetic form of oxytocin, which is a hormone that stimulates uterine contractions and retraction. Pitocin is used for the induction and augmentation of labor, and the prevention and treatment of postpartum hemorrhage, as it reduces blood loss and enhances hemostasis.
C. Hemabate
Hemabate is not the first line medication for postpartum hemorrhage, as it is a prostaglandin F2 alpha analog that causes uterine contractions and vasoconstriction. Hemabate is used for the treatment of postpartum hemorrhage, but it is contraindicated in clients with asthma, hypertension, or cardiac disease, as it can cause bronchospasm, hypertension, or cardiac arrhythmias.
D. Methergine
Methergine is not the first line medication for postpartum hemorrhage, as it is an ergot alkaloid that causes sustained uterine contractions and vasoconstriction. Methergine is used for the treatment of postpartum hemorrhage, but it is contraindicated in clients with hypertension, preeclampsia, or cardiac disease, as it can cause severe hypertension, cerebrovascular accidents, or myocardial infarction.
Full Explanation
Choice A reason: Misoprostol is not the first line medication for postpartum hemorrhage, as it is a prostaglandin E1 analog that causes uterine contractions and cervical ripening. Misoprostol is used for the prevention and treatment of postpartum hemorrhage, but it is less effective and more side effects than oxytocin, which is the first line medication.
Choice B reason: Pitocin is the first line medication for postpartum hemorrhage, as it is a synthetic form of oxytocin, which is a hormone that stimulates uterine contractions and retraction. Pitocin is used for the induction and augmentation of labor, and the prevention and treatment of postpartum hemorrhage, as it reduces blood loss and enhances hemostasis.
Choice C reason: Hemabate is not the first line medication for postpartum hemorrhage, as it is a prostaglandin F2 alpha analog that causes uterine contractions and vasoconstriction. Hemabate is used for the treatment of postpartum hemorrhage, but it is contraindicated in clients with asthma, hypertension, or cardiac disease, as it can cause bronchospasm, hypertension, or cardiac arrhythmias.
Choice D reason: Methergine is not the first line medication for postpartum hemorrhage, as it is an ergot alkaloid that causes sustained uterine contractions and vasoconstriction. Methergine is used for the treatment of postpartum hemorrhage, but it is contraindicated in clients with hypertension, preeclampsia, or cardiac disease, as it can cause severe hypertension, cerebrovascular accidents, or myocardial infarction.
A nurse in a prenatal clinic is caring for a client who is at 38 weeks of gestation and reports heavy, red vaginal bleeding. The bleeding started spontaneously in the morning and is not accompanied by contractions. The client is not in distress and she states that she can "feel the baby moving". An ultrasound is scheduled stat. The nurse should explain to the client that the purpose of the ultrasound is to determine which of the following?
A. Location of the placenta
This statement is correct, as the ultrasound can help diagnose placenta previa, which is a condition where the placenta covers the cervical opening and can cause painless, bright red bleeding in the third trimester. Placenta previa is a serious complication that can affect the delivery and the fetal oxygenation.
B. The biparietal diameter
This statement is incorrect, as the biparietal diameter is a measurement of the fetal head that is used to estimate the gestational age and the fetal growth. The biparietal diameter is not related to the cause or the severity of the bleeding.
C. Fetal lung maturity
This statement is incorrect, as the fetal lung maturity is an assessment of the surfactant level in the amniotic fluid that is used to predict the risk of respiratory distress syndrome in preterm infants. The fetal lung maturity is not related to the cause or the severity of the bleeding.
D. Viability of the fetus
This statement is incorrect, as the viability of the fetus is an evaluation of the fetal heart rate, movement, and tone that is used to determine the fetal well-being and distress. The viability of the fetus is not related to the cause or the severity of the bleeding, although it can be affected by it.
Full Explanation
Choice A reason: This statement is correct, as the ultrasound can help diagnose placenta previa, which is a condition where the placenta covers the cervical opening and can cause painless, bright red bleeding in the third trimester. Placenta previa is a serious complication that can affect the delivery and the fetal oxygenation.
Choice B reason: This statement is incorrect, as the biparietal diameter is a measurement of the fetal head that is used to estimate the gestational age and the fetal growth. The biparietal diameter is not related to the cause or the severity of the bleeding.
Choice C reason: This statement is incorrect, as the fetal lung maturity is an assessment of the surfactant level in the amniotic fluid that is used to predict the risk of respiratory distress syndrome in preterm infants. The fetal lung maturity is not related to the cause or the severity of the bleeding.
Choice D reason: This statement is incorrect, as the viability of the fetus is an evaluation of the fetal heart rate, movement, and tone that is used to determine the fetal well-being and distress. The viability of the fetus is not related to the cause or the severity of the bleeding, although it can be affected by it.
Which compound would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?
A. Calcium carbonate
Calcium carbonate is not the compound that the nurse should have readily available, as it is an antacid that neutralizes stomach acid and relieves heartburn. Calcium carbonate is not used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
B. Potassium chloride
Potassium chloride is not the compound that the nurse should have readily available, as it is an electrolyte supplement that replenishes potassium levels and prevents hypokalemia. Potassium chloride is not used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
C. Ferrous sulfate
Ferrous sulfate is not the compound that the nurse should have readily available, as it is an iron supplement that prevents or treats iron deficiency anemia. Ferrous sulfate is not used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
D. Calcium gluconate
Calcium gluconate is the compound that the nurse should have readily available, as it is an antidote that reverses the effects of magnesium sulfate and restores calcium levels and neuromuscular function. Calcium gluconate is used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
Full Explanation
Choice A reason: Calcium carbonate is not the compound that the nurse should have readily available, as it is an antacid that neutralizes stomach acid and relieves heartburn. Calcium carbonate is not used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
Choice B reason: Potassium chloride is not the compound that the nurse should have readily available, as it is an electrolyte supplement that replenishes potassium levels and prevents hypokalemia. Potassium chloride is not used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
Choice C reason: Ferrous sulfate is not the compound that the nurse should have readily available, as it is an iron supplement that prevents or treats iron deficiency anemia. Ferrous sulfate is not used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.
Choice D reason: Calcium gluconate is the compound that the nurse should have readily available, as it is an antidote that reverses the effects of magnesium sulfate and restores calcium levels and neuromuscular function. Calcium gluconate is used to treat severe preeclampsia or magnesium sulfate toxicity, which are the conditions that the client may have.