The 4 P's Flashcards
A nurse is assessing a postpartum patient for uterine tone. Which of the following findings is most likely to indicate uterine atony?
A. A firm, contracted uterus at the midline
B. A soft, boggy uterus with excessive bleeding
C. A distended bladder with minimal uterine bleeding
D. A uterus that is displaced to the right with no bleeding
B. A soft, boggy uterus with excessive bleeding
Rationale: Uterine atony is indicated by a soft, boggy uterus and excessive bleeding, as the uterus cannot contract effectively to stop bleeding.
A nurse is caring for a patient with risk factors for uterine atony. Which of the following factors is most likely to contribute to uterine overdistention?
A. Use of epidural anesthesia
B. Multiple gestation
C. Vaginal birth after cesarean section
D. Prolonged second stage of labor
B. Multiple gestation
Rationale: Multiple gestation is a primary cause of uterine overdistention, which increases the risk of uterine atony.
Which of the following conditions is least likely to contribute to uterine overdistention and subsequent atony?
A. Fetal macrosomia
B. Hydramnios
C. Placenta previa
D. Mild preeclampsia
D. Mild preeclampsia
Rationale: Mild preeclampsia does not contribute to uterine overdistention or atony. Conditions like fetal macrosomia, hydramnios, and placenta previa are risk factors for overdistention and uterine atony.
A nurse is caring for a postpartum patient who received oxytocin during labor. Which of the following interventions is most important to prevent uterine atony and bleeding in this patient?
A. Palpate the uterus for tone every 30 minutes
B. Encourage the patient to void to empty the bladder
C. Increase the dosage of oxytocin after delivery
D. Apply a pressure dressing to the abdomen
B. Encourage the patient to void to empty the bladder
Rationale: A distended bladder can displace the uterus and prevent it from contracting effectively. Encouraging the patient to void helps avoid this complication and promotes uterine contraction.
A nurse is assessing a postpartum patient with suspected uterine atony. Which of the following factors is most likely to contribute to the development of uterine atony?
A. Prolonged labor with use of oxytocin
B. Use of epidural anesthesia during labor
C. A rapid, uncomplicated delivery
D. A history of a low-risk pregnancy
A. Prolonged labor with use of oxytocin
Rationale: Prolonged labor with the use of oxytocin increases the risk of uterine atony, as it can overstimulate the uterus and lead to muscle fatigue and inability to contract effectively.
A nurse is caring for a postpartum patient with uterine atony. Which of the following should the nurse monitor for as a result of this condition?
A. Bradycardia and hypotension
B. Hypovolemic shock due to excessive bleeding
C. High fever and chills
D. Tachypnea and chest pain
B. Hypovolemic shock due to excessive bleeding
Rationale: Uterine atony can lead to excessive bleeding, resulting in hypovolemic shock. The nurse should monitor for signs of shock, including hypotension and tachycardia, in this patient.
A nurse is assessing a postpartum patient and suspects retained placental fragments. Which of the following signs should the nurse expect to find in this patient?
A. A firm, contracted uterus with minimal bleeding
B. A soft, boggy uterus with continuous heavy bleeding
C. A uterus with a slight rise in the pelvis and no bleeding
D. A uterus that is displaced laterally with minimal blood loss
B. A soft, boggy uterus with continuous heavy bleeding
B. A soft, boggy uterus with continuous heavy bleeding
Which of the following is the most important action for the nurse to take when retained placental fragments are suspected in a postpartum patient?
A. Administer intravenous fluids to prevent dehydration
B. Perform a thorough inspection of the placenta after expulsion
C. Administer oxytocin to enhance uterine contraction
D. Monitor vital signs every 15 minutes
B. Perform a thorough inspection of the placenta after expulsion
Rationale: A thorough inspection of the placenta is crucial to confirm its intactness and to detect any retained fragments or abnormalities, which could lead to hemorrhage if not addressed.
A postpartum patient is found to have retained placental fragments. What is the most likely consequence of this condition?
A. Increased uterine tone and contraction
B. Enhanced placental separation and normal bleeding
C. Inability of the uterus to contract fully, leading to hemorrhage
D. Immediate cessation of bleeding due to clot formation
C. Inability of the uterus to contract fully, leading to hemorrhage
Rationale: Retained placental fragments prevent the uterus from contracting fully, which leads to hemorrhage due to the inability of the uterus to clamp down on blood vessels.
A nurse is caring for a postpartum patient with suspected placenta accreta. Which of the following should the nurse be alert for when assessing this patient?
A. Complete detachment of the placenta and minimal bleeding
B. A firm, contracted uterus with no signs of hemorrhage
C. Profuse bleeding and inability of the uterus to contract fully
D. Mild cramping with normal blood loss
C. Profuse bleeding and inability of the uterus to contract fully
Rationale: Placenta accreta results in the placenta adhering abnormally to the uterus, which prevents complete separation and leads to profuse bleeding due to the uterus’ inability to contract fully.
A nurse is assessing a postpartum patient who had a precipitous birth. Which of the following is the nurse’s priority assessment to prevent hemorrhage due to retained placental tissue?
A. Assess for a distended bladder
B. Inspect the placenta for completeness after expulsion
C. Monitor for uterine hyperstimulation
D. Perform a pelvic examination for signs of infection
B. Inspect the placenta for completeness after expulsion
Rationale: After expulsion, the placenta must be thoroughly inspected for completeness to rule out retained placental fragments, which could result in hemorrhage if not addressed.
A nurse is assessing a postpartum patient with uterine rupture. Which of the following is the classic presentation of this complication?
A. Severe abdominal pain, fetal heart rate abnormalities, and vaginal bleeding
B. Sudden cessation of contractions and a firm, contracted uterus
C. Continuous, minimal vaginal bleeding with no fetal distress
D. Profuse bleeding with an absence of abdominal pain
A. Severe abdominal pain, fetal heart rate abnormalities, and vaginal bleeding
Rationale: Uterine rupture is often characterized by severe abdominal pain, fetal heart rate abnormalities, and vaginal bleeding, requiring rapid diagnosis and intervention.
A nurse is caring for a postpartum patient who had a vigorous labor and is at risk for trauma. Which of the following interventions can help prevent trauma during delivery?
A. Administer oxytocin for strong uterine contractions
B. Perform controlled delivery with gentle manipulation
C. Use forceps during delivery to expedite the process
D. Allow the patient to bear down before the cervix is fully dilated
B. Perform controlled delivery with gentle manipulation
Rationale: Controlled delivery with gentle manipulation and appropriate inspection and repair of lacerations or episiotomy can help prevent trauma, such as lacerations and hematomas.
A nurse is caring for a patient who is experiencing vaginal bleeding following a forceps delivery. The uterus is contracted, but the patient continues to have bright red blood trickling from the vagina. Which of the following is the most likely cause of this bleeding?
A. Retained placental tissue
B. Uterine atony
C. Cervical lacerations
D. Endometriosis
C. Cervical lacerations
Rationale: Bright red blood trickling from the vagina with a contracted uterus is most often indicative of cervical lacerations, commonly associated with forceps deliveries.
A nurse is assessing a postpartum patient who has had a previous cesarean section. Which complication is this patient at higher risk for during labor?
A. Placental abruption
B. Uterine rupture
C. Hematoma formation
D. Cervical lacerations
B. Uterine rupture
Rationale: Women with a previous cesarean section are at higher risk for uterine rupture, especially during labor, due to the potential disruption of the uterine wall.
