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Maternity Exam 1 Detailed Questions And Expert Answers
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Maternity Exam 1 Detailed Questions And Expert Answers
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Maternity Exam 1 Detailed Questions AndExpert Answers
How can a mother prevent engorgement? - ANS Wear a tight sports bra 24/7 for
the first 2 weeks
You assess that fundus is firm, bladder is empty, and lochia is bright red flowing
briskly from the vagina. What do you think is happening? - ANS Fundus is
firm→the uterus has to contract down (called involution), it's not empty, the
muscle contraction of the uterus (feels like menstrual cramps for most women) &
it has to contract down to make sure the BVs are cut off. So firm is the word we
use to describe the uterus after childbirth & cantaloupe is the analogy→so around
the time of birth we usually feel the fundus (top of uterus) at around the umbilicus
& it feels like a cantaloupe. If it's NOT firm, we refer to it as boggy (soft,
indentible). We want it firm so the uterus is contracting, so it's shutting off those
BVs so the Mom doesn't bleed to death
This pt is firm, her bladder is empty, & the lochia is bright red flowing briskly from
the vagina. What are we describing here?
Her uterus being firm is good/normal & her bladder being empty is also good BUT
briskly is not an okay word & flowing is also not an okay word here. So, she's
hemorrhaging from somewhere
Our 1st priority assessment is the fundus & in this situation it's firm, thankfully. But
if it wasn't firm, we'd massage the fundus as the 1st nursing intervention if we
have an unfirm or an atonic or a boggy uterus/fundus. If she calls us & says "I feel
like I'm gushing" then the 1st thing we do when we run into the room is feel the
,fundus & if it's not hard like a cantaloupe, we're going to massage it. You
WILL/CAN feel it firming up. When it's firm, you stop massaging it b/c it could
affect the muscle fibers & cause the uterus to go back to being boggy. So the
answer is always massaging the fundus if it's boggy or if she's bleeding. BUT in this
scenario, the fundus is firm so there are some other things that can cause it
A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce
boy after augmentation of labor with Pitocin. She puts on her call light and asks for
her nurse right away, stating, "I'm bleeding a lot." The most likely cause of
postpartum hemorrhage in this woman is:
A. Retained placental fragments
B. Unrepaired vaginal lacerations
C. Uterine atony
D. Puerperal infection - ANS C. Uterine atony
A. Incorrect: Although retained placental fragments may cause postpartum
hemorrhage, this typically would be detected in the first hour after delivery of the
placenta and is not the most likely cause of hemorrhage in this woman
B. Incorrect: Although unrepaired vaginal lacerations may cause bleeding, they
typically would occur in the period immediately after birth
C. Correct: This woman gave birth to a macrosomic boy after Pitocin
augmentation. The most likely cause of bleeding 4 hours after delivery, combined
with these risk factors, is uterine atony
D. Incorrect: Puerperal infection can cause subinvolution and subsequent bleeding,
but it typically would be detected after 24 hours postpartum.
,On examining a woman who gave birth 5 hours ago, the nurse finds that the
woman has completely saturated a perineal pad within 15 minutes. The nurse's
first action is to:
A. Begin an intravenous (IV) infusion of Ringer's lactate solution
B. Assess the woman's vital signs
C. Call the woman's primary health care provider
D. Massage the woman's fundus - ANS D. Massage the woman's fundus
A. Incorrect: The nurse may begin an IV infusion to restore circulatory volume, but
this would not be the first action
B. Incorrect: Blood pressure is not a reliable indicator of impending shock from
impending hemorrhage; assessing vital signs should not be the nurse's first action
C. Incorrect: The physician would be notified after the nurse completes the
assessment of the woman
D. Correct: The nurse should assess the uterus for atony. Uterine tone must be
established to prevent excessive blood loss.
A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary
health care provider has written orders for perineal ice packs, use of a sitz bath tid,
and a stool softener. What information is most closely correlated with these
orders?
A. The woman is a gravida 2, para 2
B. The woman had a vacuum-assisted birth
C. The woman received epidural anesthesia
D. The woman has an episiotomy - ANS D. The woman has an episiotomy
, A. Incorrect: A multiparous classification is not an indication for these orders
B. Incorrect: A vacuum-assisted birth may be used in conjunction with an
episiotomy, which would indicate these interventions
C. Incorrect: Use of epidural anesthesia has no correlation with these orders
D. Correct: These orders are typical interventions for a woman who has had an
episiotomy, lacerations, and hemorrhoids.
The laboratory results for a postpartum woman are as follows: blood type, A; Rh
status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse
best interpret these data?
A. Rubella vaccine should be given
B. A blood transfusion is necessary
C. Rh immune globulin is necessary within 72 hours of birth
D. A Kleihauer-Betke test should be performed - ANS A. Rubella vaccine should be
given
A. Correct: This client's rubella titer indicates that she is not immune and that she
needs to receive a vaccine
B. Incorrect: These data do not indicate that the client needs a blood transfusion
C. Incorrect: Rh immune globulin is indicated only if the client has a negative Rh
status and the infant has a positive Rh status
D. Incorrect: A Kleihauer-Betke test should be performed if a large fetomaternal
transfusion is suspected, especially if the mother is Rh negative. The data do not
provide any indication for performing this test
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