1. A n u rse is caring for a client w h o h as uterine a t o n y a n d is

experiencing po stp art u m hemor rha ge. W h i c h of th e following

action s is the nurse’s priority?

• M a s s a g e the client’s f u n d u s

Uterine ato ny a n d p ostpart um h morrhag e indicate that thisclient is at the

greatest risk for hy povolemi c shock. This can compromi s e the client’s vital

organs, which c an lead todeath. Therefo re, the nurse’s priority is to ma s s a g e

the client’s fundus to minimize blo o d loss.

2. A n u rse is caring for a client w h o is to receive oxytocin to

a u gme n t h er labor. W h i c h of th e following findings

contraindicates the initiation of th e oxytocin infusion a n d

s h o u ld b e rep ort ed to the provid er?

• Late decelerat ions

Late decelerations are indicative of uteroplacental insufficiency. Therefore,

this is a contraindication for theadministration of oxytocin a n d should be

repo rted to theprovider.

3. A n u rse is assessing a client w h o h as severe preec lamp sia. W h i c h

of th e follow ing man if est a ti o n s s h o u ld t h e n u r s e e xp e c t ?

• Blurred vision

The nur se should identify that a client w h o has severe pr e ec l amp s i a c a n

h a v e arterio lar v a s o sp a sm s a n d decreased bl oo d flow to the retina whi ch

can lead to visualdisturbances, such as blurred vision, doub le vision, or dark

sp o t s in t h e visual field.

4. A n u rse is assessing a client w h o is 1 d a y -p o st p a rt u m a n d h a s a

vaginal h e m a t o m a . W h i c h of th e followin g man ifestat ion

sh ou ld t h e n u rse exp ect ?

• Vaginal p ressu re

• T h e n u rse sh ou ld exp ect a client who h a s a vaginal

h e m a t oma t o report p ressure in the vagin a due t o th e

b lood that leaked into th e tissues.

5. A n u rse is caring for a client w h o is at 36 w e e k s of gestation a n d

h as a positive contraction stress test. T h e n u rse shou ld plan to

p rep are th e client for w h i c h of the followin g diagnostic tests?