1. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the woman is experiencing profuse bleeding. The most likely etiology for the
bleeding is:
a.
uterine atony.
b.
uterine inversion.
c.
vaginal hematoma.
d.
vaginal laceration.
ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of after birth
hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of
this patient’s bleeding. Furthermore, if the woman is experiencing a uterine inversion, it
would be evidenced by the presence of a large, red, rounded mass protruding from the
introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely
clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may
cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony.
A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a
firm, contracted uterine fundus.
2. A primary nursing responsibility when caring for a woman experiencing an obstetric
hemorrhage associated with uterine atony is to:
a.
establish venous access.
b.
perform fundal massage.
c.
prepare the woman for surgical intervention.
d.
catheterize the bladder.
ANS: B
The initial management of excessive after birth bleeding is firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention, the initial
intervention would be fundal massage. The woman may need surgical intervention to treat her
after birth hemorrhage, but the initial nursing intervention would be to assess the uterus. After
uterine massage the nurse may want to catheterize the patient to eliminate any bladder
distention that may be preventing the uterus from contracting properly.
3. The perinatal nurse caring for the after birth woman understands that late postpartum
hemorrhage (PPH) is most likely caused by:
a.
subinvolution of the placental site.
b.
defective vascularity of the decidua.
c.
cervical lacerations.
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