While you are taking Monique's vital signs and performing a postpartum assessment 4 hours after delivery, she tells you she is feeling lightheaded. She has a history of chronic hypertension and obesity.
Her vital signs are blood pressure 85/57 mm Hg, pulse 132, respirations 28, oxygen saturation 94%. Her uterus is boggy at midline, 1 cm above the umbilicus.
What would be your next steps and anticipated orders?
Massage her fundus until firm and ensure IV access.
Orders for methylergonovine (Methergine) 0.2 mg IM and an oxytocin bolus.
Orders for carboprost tromethamine (Hemabate) 250 mcg IM. .
Orders for carboprost tromethamine (Hemabate) 250 mcg IM. .
Correct Answer : A,B,C
Choice A rationale
Massaging the fundus helps to stimulate uterine contractions, reducing bleeding and promoting firmness in the uterus. Ensuring IV access is critical for administering medications and
fluids quickly.
Choice B rationale
Methylergonovine (Methergine) is used to prevent and control postpartum hemorrhage by promoting uterine contractions. Oxytocin bolus also helps stimulate contractions, preventing
further blood loss.
Choice C rationale
Carboprost tromethamine (Hemabate) is another uterotonic agent used to control severe postpartum hemorrhage by causing uterine contractions. Its use depends on the patient's
response to other treatments.
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Correct Answer is B
Explanation
Choice A rationale
Applying ice packs can help reduce pain and swelling, but it is not the best intervention for a breastfeeding mother with mastitis. Ice can constrict blood vessels and may hinder milk
flow, which can exacerbate the condition.
Choice B rationale
Frequent breastfeeding helps to empty the affected breast and prevent milk stasis, reducing the risk of abscess formation and promoting faster healing. The mechanical action of
nursing can help clear the infection and provide relief.
Choice C rationale
Weaning immediately is not advised as it can lead to engorgement and milk stasis, worsening the infection. Continuing to breastfeed ensures the breast is regularly emptied, aiding
in recovery.
Choice D rationale
While notifying the pediatrician may be necessary if the baby is affected, it does not directly address the mother's condition or provide immediate relief. Primary management focuses
on treating the infection and maintaining milk flow.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
Impaired intellectual development in children born to mothers with diabetes can occur due to fluctuating blood glucose levels, which can affect brain development.
Choice B rationale
Development of metabolic syndrome is more likely in children born to mothers with diabetes due to genetic predispositions and prenatal exposure to hyperglycemia.
Choice C rationale
Shoulder injury related to birth size, although a possible immediate complication, is not typically considered a long-term effect of maternal diabetes.
Choice D rationale
Changes in genetic expression can occur due to epigenetic modifications from exposure to maternal diabetes, potentially leading to various health issues later in life.
Choice E rationale
Increased risk for chronic illnesses, such as type 2 diabetes and cardiovascular diseases, is higher in children born to mothers with diabetes, due to genetic and environmental factors.