(OB) Ch 33: Multiple Choice
A (puerperal infections are infections of the genital tract after birth; pulse will increase, not decrease, in response to fever; choices B and C will also occur but are not the first signs exhibited.)
The nurse responsible for the care of postpartum women recognizes that the first sign of puerperal infection most likely is: A. Temperature elevation to 38°C or higher on 2 successive days of the first 10 postpartum days, excluding the first 24 hours after birth B. Increased white blood cell count C. Foul-smelling profuse lochia D. Bradycardia
C,F (heparin and warfarin are safe for use by breastfeeding women; heparin, usually administered intravenously for the first 3 to 5 days, is the anticoagulant of choice during the acute stage of DVT; after acute phase, warfarin (Coumadin) is begun orally while the patient is still receiving heparin; woman should be fitted for elastic stockings after the acute stage has passed when edema subsides; the woman should be encouraged to change her position when on bed rest.)
A breastfeeding woman's cesarean birth occurred 2 days ago. Investigation of the pain, tenderness, and swelling in her left leg led to a medical diagnosis of deep vein thrombosis (DVT). Care management for this woman during the acute stage of the DVT involves: (Circle all that apply.) A. Explaining that she will need to stop breastfeeding until anticoagulation therapy is completed B. Administering warfarin (Coumadin) orally C. Placing the woman on bed rest with her left leg elevated D. Fitting the woman with an elastic stocking so that she can exercise her legs E. Telling her to avoid changing her position for the first 24 hours F. Administering heparin intravenously for 3 to 5 days
A (Prior to administering Methergine, the nurse must check the client's BP. If the BP is greater than 140/90 mm Hg, the medication should not be given. In either case, the nurse must continue careful monitoring of vaginal bleeding and uterine tone.)
A physician orders methylergonovine (Methergine) 0.2 mg IM for a postpartum client. Which intervention should the nurse take prior to administering this medication? a. Obtain the client's blood pressure (BP) b. Determine the client's blood glucose level c. Take the client's pulse d. Have the client empty her bladder
D (15-methylprostaglandin F2a (Hemabate) is a powerful prostaglandin that is given to treat excessive uterine blood loss or hemorrhage related to uterine atony)
A postpartum woman in the fourth stage of labor received prostaglandin F2α (Hemabate) 0.25 mg intramuscularly. The expected outcome of care for the administration of this medication is: A. Relief from the pain of uterine cramping B. Prevention of intrauterine infection C. Reduction in the blood's ability to clot D. Limitation of excessive blood loss that is occurring after birth
B (although BP should be taken before and after administration of methylergonovine (Methergine), the woman's hypertensive status would be a contraindicating factor for its use... a more appropriate choice would be oxytocin)
Methylergonovine (Methergine) 0.2 mg is ordered for a woman who gave birth vaginally 1 hour ago; it is to be administered intramuscularly to treat a profuse lochial flow with clots. Her fundus is boggy and does not respond well to massage. She is still being treated for preeclampsia with IV magnesium sulfate at 1 g/hour. Her blood pressure (BP), measured 5 minutes ago, was 155/98 mm Hg. In fulfilling this order, the nurse should: A. Measure the woman's blood pressure again 5 minutes after administering the medication B. Question the order, based on the woman's hypertensive status C. Administer the methylergonovine because it is the best choice to counteract the possible uterine relaxation effects of the magnesium sulfate infusion the woman is receiving D. Tell the woman that the medication will lead to uterine cramping