Which nursing action is essential to performing a pelvic ultrasound?

A 33-year-old woman, P6/G6, is admitted to the ED on a stretcher. She arrived by ambulance approximately 1 hour after an extramural delivery of a healthy, 61b, 5oz (2.9-kg) girl at home. While assisting with transferring the patient from the ambulance stretcher to the ED stretcher, the ED nurse notes that the sheets under the patient are saturated with bright-red blood. The patient is pale and restless. Her blood pressure is 90/60 mmHg, pulse rate 108 beats/minute, respiratory rate 28 breaths/minute, and temperature 99.6 F (37.5 C). The fundus is firm at the umbilical level. The patient’s perineal pad is completely saturated with lochia rubra. Blood loss is estimated at greater than 500 mL. After examining the patient, the physician diagnoses postpartum hemorrhage caused by a vaginal laceration. The priority nursing action at this time would be to assess the patient’s:

Of the following, which assessment finding indicates that the patient is at risk for postpartum hemorrhage?

Postpartum hemorrhage can occur after either vaginal or Csection deliveries and can be seen anytime from immediately after delivery to several weeks postpartum. What is the most common cause of early postpartum hemorrhage?

Approximately 1 hour prior to arrival at the ED, a 29-yearold has given birth to a normal, healthy girl. Since arriving in the ED, the patient has completely saturated five perineal pads. Her blood pressure is 100/70 mmHg, pulse rate 82 beats/minute and regular; and respiratory rate, 18 breaths/minute. She has no sign of syncope or light-headedness and has not lost consciousness. Blood specimens are sent to the laboratory for a complete blood count (CBC) with differential, electrolyte levels, and type and cross match. Two units of packed red blood cells are available, if necessary. The nurse palpates the fundus and determines that it is soft. Which nursing intervention would be most appropriate at this time?

Which finding suggests postpartum hemorrhage related to a vaginal laceration?

Two hours later, the bleeding decreases but continues to be heavier than normal. The fundus is soft and located above and to the right of the umbilicus. The most appropriate initial nursing intervention would be to:

A patient has delivered a baby, 1 hour afterwards. A blood pressure of 90/60 mmHg, pulse rate 92 beats/minute, and respiratory rate 16 breaths/minute is noted. She complains of light-headedness and appears restless. The fundus is firm with a moderate amount of lochia rubra. The appropriate nursing action would be to stay with the patient, alert other staff, and:

The nurse knows that a slow rate of continuous postpartum vaginal bleeding usually indicates:

A patient, post deliver in the ED of a healthy baby boy has had excessive bleeding, with stable vital signs and asymptomatic. No transfusion was necessary, however, blood is available should it be needed. After palpating the fundus, and discovering it is soft, the patient is to be admitted to the medical-surgical unit for further observation. The nurse explains to the patient the reason for the admission. Which of the following best indicates that the patient has understood the explanation:

A client presents to the ER bleeding profusely from a gunshot wound. The client is in hypovolemic shock and needs a rapid transfusion. What does the nurse anticipate to replace blood volume after starting the IV?

A nurse who is going home at the end of the shift is giving report to the oncoming nurse. The report is on a 53-year-old client who is being treated for hypovolemic shock secondary to chronic vomiting and diarrhea. Which information should the nurse present first during this client handoff?

A nurse is caring for a 35-year-old client who has been diagnosed with hypovolemic shock as a result of severe hemorrhage. In which position should the nurse place this client to promote optimal circulation?

A nurse is measuring systemic vascular resistance for a client with hypovolemic shock. The client has a central catheter and his mean arterial pressure (MAP) is 100 mmHg. His central venous pressure is 0 mmHg and his cardiac output is 8.0 L/min. Calculate this client’s systemic vascular resistance (SVR).

A client who has been injured in a construction accident is bleeding profusely from a femoral artery laceration. The nurse estimates that the client has lost 700 mL of blood. The client has the following vital signs: HR 98 bpm, BP 100/70 mmHg, RR 20/min. In which class of hypovolemic shock would this client be classified?

The nurse is caring for a client with a history of asthma who has just delivered a healthy, ten-pound baby. The mother notifies the nurse that she has had some gushing of blood. On assessment she has heavy bleeding and a boggy uterus so the nurse notifies the provider. Which of the following orders given by the provider should the nurse question?

The nurse is caring for a client who just delivered the placenta. Which of the following does the nurse anticipate will be the next order?

The nurse is planning care for a client with postpartum hemorrhage. Which of the following interventions is appropriate for a client with this condition? Select all that apply.

Methylergonovine is ordered for a client with postpartum hemorrhage. The nurse is reviewing the client’s history and should notify the provider of which of the following conditions?

A client who is recovering from a vaginal delivery of an infant has developed postpartum hemorrhage. Which of the following medications would most likely be administered for management of this condition?

A high-risk pregnant client has had a complicated delivery and is in the recovery room with active bleeding. The physician has ordered the IV infusion hetastarch in sodium chloride (Hespan). Which best describes the indications for this fluid?

A client is given oxytocin after delivery. The nurse knows the medication is successful when which of the following assessments are made? Select all that apply.

The nurse is caring for a hypertensive client who is assessed and noted to have a boggy uterus. The nurse gives oxytocin IV and fundal massage but the bleeding is still heavy. The nurse reviews the client’s orders. Which of the following orders is best for this client?

The nurse is caring for a client on the labor and delivery unit who is prescribed methylergonovine. The nurse knows this medication is given for which of the following reasons? Select all that apply.