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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?

A.

Massage her fundus until firm and ensure IV access.

B.

Orders for methylergonovine (Methergine) 0.2 mg IM and an oxytocin bolus.

C.

Orders for carboprost tromethamine (Hemabate) 250 mcg IM. .

D.

Orders for carboprost tromethamine (Hemabate) 250 mcg IM. .

Question Solution

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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View Related questions

Correct Answer is B

Explanation

Choice A rationale

Administering oxytocin during shoulder dystocia can exacerbate the problem by increasing uterine contractions, making it harder to deliver the baby's shoulder.

Choice B rationale

Flexing the client's thighs sharply toward her abdomen, known as the McRoberts maneuver, helps to widen the pelvis and can often resolve shoulder dystocia by changing the angle of the pelvic bones.

Choice C rationale

While applying oxygen is a standard practice to improve maternal and fetal oxygenation, it does not specifically address shoulder dystocia and is not a primary intervention.

Choice D rationale

Applying downward pressure on the fundus is contraindicated as it can worsen shoulder dystocia by further impacting the shoulder against the pelvic bone.

Correct Answer is D

Explanation

Choice A rationale

A low transverse uterine scar is considered the safest type of uterine incision for a VBAC because it is less likely to rupture compared to other types of scars. Therefore, a low transverse uterine scar would not disqualify the patient for VBAC.

Choice B rationale

Patient asking multiple questions does not disqualify her for VBAC. Patient education and ensuring the patient’s understanding and agreement with the procedure is an essential part of the process.

Choice C rationale

Induction of labor in the first pregnancy does not automatically disqualify a patient from attempting VBAC. The success of VBAC depends on multiple factors including the reason for the initial cesarean section.

Choice D rationale

A cesarean due to pelvic abnormalities would disqualify the patient for VBAC because the underlying pelvic condition that necessitated the initial cesarean section is likely still present and would increase the risk of complications during vaginal birth.

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