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 C
Explanation
Choice A rationale
While intravenous antibiotics are given during labor to prevent GBS transmission to the baby, it is not administered at home but in the hospital when labor begins.
Choice B rationale
GBS does not significantly increase the risk of intrauterine infection that requires daily temperature checks; it primarily poses a risk of neonatal infection during delivery.
Choice C rationale
GBS bacteria reside in the vagina and can be transmitted to the baby during delivery. Administering antibiotics during labor helps protect the baby from serious GBS-related illnesses.
Choice D rationale
GBS does not cause scarlet fever or the symptoms described; those are caused by different bacteria, namely Streptococcus pyogenes. .
Correct Answer is B
Explanation
Choice A rationale
While massaging the fundus and ensuring IV access are correct initial actions, methylergonovine (Methergine) is typically used for patients without hypertensive history due to its
potential to raise blood pressure.
Choice B rationale
This option correctly identifies initial steps and appropriate medication. Carboprost-tromethamine (Hemabate) is effective in controlling postpartum hemorrhage and can be safely
used in patients with hypertension when oxytocin is insufficient.
Choice C rationale
Quantifying blood loss is essential but it is not an immediate priority when the patient is showing signs of significant bleeding and instability. Immediate intervention to control bleeding
takes precedence.
Choice D rationale
Assisting the patient to the restroom and then massaging the fundus overlooks the immediate need to control bleeding. This approach may delay necessary treatment and increase
the risk of further hemorrhage.
Choice E rationale
Straight catheterization and oxytocin maintenance are part of the management of postpartum hemorrhage but do not address the immediate need to ensure uterine contraction and
control active bleeding as effectively as the initial steps outlined in Choice B. .