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[mtouchquiz 716 title=off]
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[mtouchquiz 717 title=off]
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1. Maureen, a primigravida client, age 20, has just completed a difficult, forceps-assisted delivery of twins. Her labor was unusually long and required oxytocin (Pitocin) augmentation. The nurse who’s caring for her should stay alert for:
- Uterine inversion
- Uterine atony
- Uterine involution
- Uterine discomfort
2. When the uterus is firm and contracted after delivery but there is vaginal bleeding, the nurse should suspect
- Laceration of soft tissues of the cervix and vagina
- Uterine atony
- Uterine inversion
- Uterine hypercontractility
3. Which of the following techniques during labor and delivery can lead to uterine inversion?
- Fundal pressure applied to assist the mother in bearing down during delivery of the fetal head
- Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation
- Massaging the fundus to encourage the uterus to contract
- Applying light traction when delivering the placenta that has already detached from the uterine wall
4. While assessing a primipara during the immediate postpartum period, the nurse in charge plans to use both hands to assess the client’s fundus to:
- Prevent uterine inversion
- Promote uterine involution
- Hasten the puerperium period
- Determine the size of the fundus
5.A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following should be included in the discussion? (Select all that apply.)
- Precipitous delivery
- Lacerations
- Inversion of the uterus
- Oligohydramnios
- Retained placental fragments
Answers & Rationales
- B. Uterine atony. Multiple fetuses, extended labor stimulation with oxytocin, and traumatic delivery commonly are associated with uterine atony, which may lead to postpartum hemorrhage. Uterine inversion may precede or follow delivery and commonly results from apparent excessive traction on the umbilical cord and attempts to deliver the placenta manually. Uterine involution and some uterine discomfort are normal after delivery.
- A. Laceration of soft tissues of the cervix and vagina. When uterus is firm and contracted it means that the bleeding is not in the uterus but other parts of the passageway such as the cervix or the vagina.
- B. Strongly tugging on the umbilical cord to deliver the placenta and hasten placental separation. When the placenta is still attached to the uterine wall, tugging on the cord while the uterus is relaxed can lead to inversion of the uterus. Light tugging on the cord when placenta has detached is alright in order to help deliver the placenta that is already detached.
- A. Using both hands to assess the fundus is useful for the prevention of uterine inversion.
- A. CORRECT: A rapid, precipitous delivery is a risk factor for postpartum hemorrhage
B. CORRECT: The presence of lacerations is a risk factor for hemorrhage.
C. CORRECT: Inversion of the uterus in a risk factor for postpartum hemorrhage.
D. INCORRECT: Oligohydramnios does not place a client at risk for postpartum hemorrhage
E. CORRECT: Retained placental fragments is a risk factor for postpartum hemorrhage.