Exam 2 Review Concepts

Question 1

With vaginal delivery, what is the normal blood loss?

Answer 1

200-500 mL blood loss

Question 2

What c section delivery, what is the normal blood loss?

Answer 2

500-1000 mL blood loss

Question 3

What is the most common cause of post partum hemorrhage?

Answer 3

Uterine atony

Question 4

What is uterine atony?

Answer 4

Failure of the uterine muscle to contract

Question 5

What are the two most important interventions to prevent postpartum hemorrhage?

Answer 5

Maintaining good uterine tone

Preventing bladder distention

Question 6

What is a potential cause of uterine atony?

Answer 6

Retained placental fragments

Question 7

How can a nurse monitor for uterine bleeding?

Answer 7

Monitor lochia - color, consistency, amount

Fundus is firm and midline

Question 8

What should a nurse do if she palpates the fundus postpartum and it is boggy?

Answer 8

Apply gentle massage
Express clots
Assess uterine response

Question 9

What is postpartum hemorrhage described as?

Answer 9

cumulative blood loss ≥1000 mL or bleeding associated with signs/symptoms of hypovolemia within 24 hours of the birth process regardless of type of birth

Question 10

Excessive bleeding that occurs during the period from the separation of the placenta to its expulsion or removal is commonly the result of…

Answer 10

incomplete placental separation, undue manipulation of the fundus, or excessive traction on the umbilical cord.

Question 11

Persistent or excessive blood loss occurring after the expulsion or removal of the placenta is usually the result of…

Answer 11

uterine atony or prolapse of the uterus into the vagina

Question 12

Risk factors for uterine atony

Answer 12

Overdistended uterus
Large fetus
Multiple fetuses
Hydramnios
Distention with clots

Question 13

The greatest risk for early PPH is during the

Answer 13

1st hour of birth

Question 14

What is the first intervention for a woman with a distended bladder?

Answer 14

Assist her to the bathroom or onto a bedpan if she is unable to void

Question 15

What are some ways to stimulate voiding?

Answer 15

Having the woman listen to running water, placing her hands in warm water, or pouring water from a squeeze bottle over her perineum may stimulate voiding.

Question 16

What if the non-pharmacologic methods do not work?

Answer 16

Possibly administer analgesia

In and out Cath

Question 17

What are risk factors for bladder distention during pregnancy?

Answer 17

Epidural anesthesia, episiotomy, extensive vaginal or perineal lacerations, vacuum- or forceps-assisted birth, or prolonged labor.

Question 18

How does a full bladder contribute to uterine atony?

Answer 18

A full bladder causes the uterus to be displaced above the umbilicus and well to one side of midline in the abdomen. It also prevents the uterus from contracting normally.

Question 19

Who gets rhogam post partum?

Answer 19

Rh negative mothers who have not been sensitized, give standard dose within 72 h after birth if neonate is Rh-positive.

Question 20

How is rhogam administered?

Answer 20

1 vial (300 mcg) IM in deltoid or gluteal muscle

Question 21

When do you give microdose of rhogam?

Answer 21

Give microdose for first-trimester miscarriage or abortion, ectopic pregnancy, chorionic villus sampling.

Question 22

What is the process for administering rhogam?

Answer 22

Provide explanation to the woman about the procedure, including the purpose, possible side effects, and effect on future pregnancies. Have the woman sign a consent form if required by agency. Verify correct dosage and confirm lot number and woman’s identity before giving injection (verify with another registered nurse or by other procedure per agency policy); document administration per agency policy. Observe client for at least 20 min after administration for allergic response.

Question 23

What can the nurse give a postpartum patient before discharge?

Answer 23

Providing written materials on postpartum self-management, breastfeeding, and infant care that the woman can consult after discharge is helpful.

Question 24

What is the goal before discharge?

Answer 24

maternal self-management and care of the newborn because the goal is for all women to be capable of providing basic care for themselves and their infants at the time of discharge

Question 25

What is a safety concern to teach patients before discharge?

Answer 25

every woman must be taught to recognize physical and psychological signs and symptoms that might indicate problems and how to obtain advice and assistance quickly if these signs appear.

Question 26

How can a nurse know what to focus on during postpartum discharge teaching?

Answer 26

Giving the woman a list of topics and asking her to indicate her learning needs help the nurse to maximize teaching efforts and can increase retention of information

Question 27

What should you discuss during postpartum teaching?

Answer 27

Fatigue
Nutrition
Family adjustment
Psychological status
Family planning - no intercourse 6 weeks
Approach intercourse slow, vaginal dryness
Home visits/ follow up calls 3-4 days
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