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HESI RN EXIT CASE STUDY - POSTPARTUM, Exams of Study of Commodities

School of Advanced Study, University of LondonStudy of Commodities

HESI RN EXIT CASE STUDY - POSTPARTUM HESI RN EXIT CASE STUDY - POSTPARTUM HESI RN EXIT CASE STUDY - POSTPARTUM

Typology: Exams

2025/2026

Available from 04/05/2026

NurseTakshif
NurseTakshif 🇬🇧

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HESI RN EXIT CASE STUDY - POSTPARTUM
1. Meet the Client: Marie Wilson: Marie Wilson is a 28-year-old client who is
gravida 2, para 2, and is transferred to the postpartum unit 1 hour after
delivery of a 8 lb, 1 oz female. She was in labor for 16 hours and forceps were
used to assist with the delivery. Marie was given an epidural for anesthesia that
was effective. The labor and delivery nurse reported that Marie had a 4th
degree laceration and her pain was currently at a 3 out of 10 scale. Her vital
signs were stable and she was catheterized for 500 mL of light yellow urine just
prior to delivery. Mr. Wilson was at the bedside for delivery and appeared
supportive.
2. Assessment: A 1, 000 mL bag of Lactated Ringer's solution containing 10
units of oxytocin (Pitocin) is infusing via an 18 gauge peripheral IV in the LFA at
125 mL/hr, with 300 mL remaining in the bag. The IV is patent, without redness or
swelling, and can be discontinues when the bag's infusion is complete.
3. Prior to discontinuing the IV oxytocin (Pitocin), which assessment is
most important for the nurse to obtain
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HESI RN EXIT CASE STUDY - POSTPARTUM

  1. Meet the Client: Marie Wilson: Marie Wilson is a 28-year-old client who is gravida 2, para 2, and is transferred to the postpartum unit 1 hour after delivery of a 8 lb, 1 oz female. She was in labor for 16 hours and forceps were used to assist with the delivery. Marie was given an epidural for anesthesia that was effective. Thelabor and delivery nurse reported that Marie had a 4th degree laceration and her pain was currently at a 3 out of 10 scale. Her vital signs were stable and she was catheterized for 500 mL of light yellow urine just prior to delivery. Mr. Wilson was atthe bedside for delivery and appeared supportive.
  2. Assessment: A 1, 000 mL bag of Lactated Ringer's solution containing 10 units of oxytocin (Pitocin) is infusing via an 18 gauge peripheral IV in the LFA at 125 mL/hr,with 300 mL remaining in the bag. The IV is patent, without redness or swelling, andcan be discontinues when the bag's infusion is complete.
  3. Prior to discontinuing the IV oxytocin (Pitocin), which assessment is mostimportant for the nurse to obtain

ANS: uterine firmness

4. Early detection of, and intervention for, postpartum complications promotespositive client outcomes. Postpartum protocol requires that the nurse assessMarie's vital signs, fundus, perineum, vaginal bleeding, pain, leg movement, and IV every 15 mins. for the first hour and then every hour for the next 3 hours.:

  1. Marie has minimal sensation in her lower extremities, due to the effects ofthe epidural anesthesia. What is the priority nursing diagnosis for Marie, whois experiencing residual effects of epidural anesthesia ANS: Risk for injury
  2. The nurse performs the first assessment upon arrival to the postpartumunit. Where would the nurse expect to palpate the fundus ANS: 1 cm above theumbilicus
  3. What is the priority nursing action to address Marie's needs r/t the repair ofher 4th degree perineal laceration ANS: Apply perineal ice packs consistently for thefirst 24 to 48 hours.
  4. Postpartum Crisis: Fifteen minutes after the initial assessment, the nurse finds Marie disoriented and lying on her back in a pool of vaginal blood, with the sheetsbeneath her saturated with blood.
  1. The charge nurse, two staff nurses, and an unlicensed assistive personnel(UAP) rush in to assist the nurse with Marie. Which task is best delegated to the UAP during this crisis ANS: Obtain VS and SpO
  2. The HCP is notified that Marie is hemorrhaging and has an estimated bloodloss of 1,200 mL since delivery. Her blood pressure is 70/40 mm Hg, Pulse 120, RR 28, SpO2 73%. The HCP's prescriptions include stat oxytocin (Pitocin) 10 units in each liter of normal saline to infuse at 40 milliunits/minute. The HCP also prescribes 0.2 mg methylergonovine maleate (Methergine) IM to begiven immediately. The vial of oxytocin (Pitocin) is labeled 20 units/mL. The vial of methylergonovine (Methergine) is labeled 0.8 mg/mL. How many mL ofoxytocin (Pitocin) should the nurse draw up in the syringe to inject into the 1000 mL bag of NS ANS: 0.
  3. How many mL of methylergonovine should the nurse draw up in thesyringe to administer to Marie ANS: 0.
  4. Initial Stabilization: The oxytocin (Pitocin) has been infusing at the prescribedrate for 20 minutes. The nurse reassesses the client.
  1. Which finding is most indicative that the medication is reaching a thera-peutic level ANS: Firm fundus
  2. Postpartum hemorrhage is designated as blood loss in excess of 500 mLwithin the first 24 hours of delivery. Considering the client's history, what etiology is most likely ANS: Uterine atony 18. Marie is pale, weak, and anxious, but no longer disoriented. Her fundus isfirm and is 1 cm above the umbilicus. She is receiving O2 per nasal cannula at 4 L/min and has a SpO2 of 88%. Her VS are BP 74/44, P 116, and RR 26. Herbleeding has slowed considerably. The nurse asks the UAP to bathe Marie andchange the bed linens. Marie tells the nurse that her husband went home to pick up their other childto bring her to the hospital. She states that she doesn't want her children to see her this way and asks the nurse to tell Mr. Wilson what has happened.:
  3. What intervention should the nurse implement to communicate the situa-tion to Marie's husband ANS: Call Mr. Wilson from the nurses' station to inform him of his wife's status and request that he come to the hospital soon, without the otherchild.
  4. Blood Transfusion: The HCP prescribes 2 units of PRBC's to be transfused asap. Marie signs the consent form, and a blood sample for the type and cross-
  • Prime a new Y-set tubing using a new bag of normal saline.
  • Obtain a baseline set of vital signs. 22. Marie's nurse is getting ready to administer the first unit of blood when thenursery nurse brings in Marie's infant daughter and states that Marie needs tofeed her because it has been 4 hours since the infant last nursed. The infant is sleeping soundly in the crib.:
  1. What is the best thing for Marie's nurse to do ANS: Explain Marie's history andrequest that the infant is fed with formula in the nursery.
  2. Prior to the blood transfusion, the nurse records Marie's VS at T 97.8. BP 78/50, P 110, RR 22. The blood requisition form, client identification bracelet,and blood label are checked with another nurse, and then the A negative bloodtransfusion is started at 75 mL/hr. Fifteen minutes after the transfusion begins,another set of VS is taken; T 98.5, BP 76/48, P 112, and RR 22. Marie complainsof being cold. What should the nurse do in response to these assessment findings ANS: Provide a warm blanket and continue to monitor. 25. When the first unit of PRBCs is infused, the nurse performs a targeted assessment. Marie's fundus remains firm and lochial flow has decreased to asmall amount. Her VS are T 98.3, PB 96/58, P 92, and RR 22. Her SaO2 is 92% with 3 L of oxygen per nasal cannula. In preparation for shift change, the nursecalculates the intake and output for the past 4 hours as follows: INTAKE Oral 720 mL IV 500 mL

Blood 300 mL Total Intake 1, mLOUTPUT: Urine 500 mL (catheterized just prior to birth; 4 hrs ago) Bleeding 1,600 mL Total Output 2,120 mL:

  1. What is the difference in Marie's intake and output ANS: 580
  2. The nurse is aware that Marie's condition is stabilizing. Which nursing intervention would be most appropriate at this time ANS: Palpate Marie's bladderfor fullness and catheterize if indicated. 28. Marie tells the nurse that she has sensation in her lower extremities, thatshe can move both her legs, and that she needs to use the bathroom. The nurse offers Marie the use of a bedpan or bedside commode. Marie replies

10 / 6 clock out.

34. The nurse notifies the HCP of Marie's status, including receiving the first unit of blood, current VS, voiding 450 mL, and severe headache. The HCP confirms that since the migraine is postural in nature, Marie has a postdural puncture headache. The HCP request continuation of IV fluids as previously prescribed for adequate hydration and then prescribes strict reclined bed rest, Foley catheter, caffeine and sodium benzoate 0.5 g every 6 hours IV, acetaminophen and codeine (Tylenol with Codeine #3) 1 to 2 tablets PO every 4 - 6 hours as needed for pain, and ondansetron (Zofran) 4 mg PO every 8 hoursas need for nausea. Marie's nurse records the new prescriptions and reports them to the new nurse who is assuming Marie's care. The UAP approaches Marie's new nurseand asks if there is anything that the UAP can do to assist in Marie's care.:

  1. Which task is best for the nurse to delegate to the UAP ANS: Obtain anddocument Marie's VS
  2. Stabilization and Postpartum Care: Marie's new nurse prepares to administer the caffeine and sodium benzoate 0.5 g IV. She introduces herself to Marie and

11 / 6 explains that the reason that Marie is experiencing sever migraines when she gets out of bed is because she has a postdural puncture headache (PDPH) that sometimes occurs after epidural anesthesia. The decrease in intacranial pressure causes severe shifting of fluid, which causes the headache. The nurse explains that the headache and associated symptoms usually last 3 to 5 days. They will spontaneously resolve, but until they do, Marie willbe given pain mediation and placed on strict, reclined bed rest to limit her movement.

  1. Prior to administering the medications to Mari, which information should the nurse include about caffeine and sodium benzoate ANS: Caffeine and sodium benzoate will constrict the cerebral blood vessels and decrease the headache. 38. The nurse starts the second unit of A negative blood, medicates Marie for pain, and encourages her to get some rest while the blood is infusing. Marie's VS are stable, her fundus remains firs, located 1 cm below the umbilicus, andno reaction to the second unit of blood is noted. While Marie is resting, the blood bank calls and tells the nurse that Marie's infants blood type is A positive, and the blood drawn from Marie after deliveryindicates that she is indirect Coomb's negative and non- sensitized.:
  2. Based on this information, what is the correct nursing action ANS: Allow Marie to rest during the blood transfusion and administer the RhoGam as prescribed at alater time.

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  1. Case Outcome: Security finds the husband in the waiting room talking on the phone with his brother. He visibly calms during the conversation. After speaking withsecurity, Marie's husband agrees to speak with the family liaison and hospital risk manager. The nurse stays with Marie and assesses her for the risk of intimate partner violence.Marie says she has never seen her husband like this and that he has never abusedher verbally, physically, or sexually. The nurse gives Marie the number for the National Domestic Violence hotline in case she should ever need it. Four days later, Marie and her newborn are discharged home. Her husband and other children accompany her. Follow-up in 1 week is scheduled with Marie's HCP.