Nursing Elites

1. The healthcare provider is providing postpartum care to a client who had a vaginal delivery. Which finding would require further assessment?

• A. Perineal swelling
• B. Moderate lochia serosa
• C. Headache unrelieved by analgesics
• D. Breast engorgement

Correct answer: C

Rationale: A headache unrelieved by analgesics can be a sign of a serious condition such as preeclampsia, which is a life-threatening condition characterized by high blood pressure and often protein in the urine. Prompt assessment and intervention are crucial to prevent complications for both the mother and baby.

2. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn?

• A. Assess the newborn's skin condition and color.
• B. Initiate positive-pressure ventilations.
• C. Start chest compressions and contact medical control.
• D. Provide blow-by oxygen with oxygen tubing.

Correct answer: B

Rationale: In a newborn with a heart rate below 100 beats/min, the most appropriate initial management is to initiate positive-pressure ventilations. This helps support the newborn's respiratory effort and oxygenation in the setting of a low heart rate, ensuring adequate oxygen supply to vital organs. Assessing the skin condition and color, starting chest compressions, or providing blow-by oxygen are not the priority in this scenario where respiratory support is crucial.

3. Beta-adrenergic agonists such as albuterol are given to Reggie, a child with asthma, to primarily do which of the following?

• A. Dilate the bronchioles
• B. Reduce secondary infections
• C. Decrease postnasal drip
• D. Reduce airway inflammation

Correct answer: A

Rationale: Beta-adrenergic agonists like albuterol are bronchodilators that primarily work by relaxing and dilating the bronchioles, which helps to alleviate bronchoconstriction, a characteristic feature of asthma. This action leads to improved airflow and easier breathing for individuals experiencing asthma symptoms.

4. Following delivery of a newborn and placenta, you note that the mother has moderate vaginal bleeding. The mother is conscious and alert, and her vital signs are stable. Treatment for her should include:

• A. carefully packing the vagina with sterile dressings.
• B. massaging the uterus if signs of shock develop.
• C. treating her for shock and providing rapid transport.
• D. administering oxygen and massaging the uterus.

Correct answer: D

Rationale: Administering oxygen and massaging the uterus are appropriate interventions to manage postpartum bleeding. Oxygen helps support tissue perfusion, and uterine massage can aid in uterine contraction, controlling bleeding. These actions are indicated when the mother experiences moderate vaginal bleeding post-delivery, as described in the scenario. Careful monitoring for signs of shock should continue while these interventions are implemented to ensure the mother's condition remains stable. Choices A and B are incorrect because packing the vagina with sterile dressings is not recommended for postpartum bleeding unless it is severe and immediate action is needed, while massaging the uterus is a proactive approach and should not be delayed until signs of shock develop. Choice C is also incorrect as rapid transport is not the primary intervention in this scenario where the mother is conscious, alert, and stable, and the focus should be on immediate management of the bleeding.

5. Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. In addition to administering high-flow oxygen, treatment should include:

• A. treating for shock and uterine massage during transport.
• B. uterine massage and transport.
• C. placing her on her left side and transport.
• D. internal vaginal pads and treating for shock during transport.

Correct answer: A

Rationale: In this scenario, the mother is showing signs of postpartum hemorrhage with increased heart rate, diaphoresis, and mild vaginal bleeding. The correct approach involves treating for shock by addressing hypovolemia and providing uterine massage to help control bleeding. Administering high-flow oxygen is essential. Therefore, the most appropriate option is to treat for shock and perform uterine massage during transport to manage the postpartum hemorrhage effectively.

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