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A nurse massages the uterus of a postpartum woman after making a hypothesis of uterine atony.
Which of the following outcomes would indicate that the client's condition had improved?

A.

Decreased pain level.

B.

Stable blood pressure.

C.

Fundus firm at or below the umbilicus.

D.

Reduced lochial flow.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Decreased pain level can be an effect of addressing the cause of pain, but it doesn't indicate improved uterine tone or resolution of atony.

 

Choice B rationale

Stable blood pressure is important, but it is not the direct outcome of improved uterine tone or the resolution of uterine atony.

 

Choice C rationale

A firm fundus at or below the umbilicus indicates successful contraction of the uterus, resolving uterine atony and reducing bleeding.

 

Choice D rationale

Reduced lochial flow can indicate decreased bleeding, but it does not directly indicate improved uterine tone or resolution of uterine atony.


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Correct Answer is B

Explanation

Choice A rationale

Retained tissue can cause postpartum hemorrhage, but with a firm uterus and no other signs of retained placenta, this is less likely the cause here.

Choice B rationale

Trauma is the most likely cause of increased bleeding in this scenario. The prolonged oxytocin induction and macrosomic infant suggest a higher risk of lacerations or uterine atony

despite the firm uterus.

Choice C rationale

Thrombin disorders cause bleeding due to clotting issues. However, this patient shows signs of active bleeding and clotting, making this less likely.

Choice D rationale

Uterine atony, indicated by a soft, boggy uterus, is a common cause of postpartum hemorrhage, but in this case, the uterus is firm, so it's less likely to be the cause.

Correct Answer is B

Explanation

Choice A rationale

Prior amniotic fluid leakage is not a required criterion for amniotomy. The main concern is cervical readiness and fetal head position, not previous leakage.

Choice B rationale

The fetal head engaged in the maternal pelvis ensures proper pressure and position for safe amniotomy. Engagement reduces the risk of umbilical cord prolapse and injury.

Choice C rationale

Certification of the nurse for amniotomy is not a standard criterion. The procedure is performed by qualified professionals, but certification isn't a prerequisite for the procedure to be scheduled.

Choice D rationale

Ultrasound to check the umbilical cord's position isn't a standard pre-amniotomy criterion. While it can be useful, the primary concern is the fetal head engagement and cervical readiness.

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