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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

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HESI RN EXIT CASE STUDY - POSTPARTUM
1. 1. Prior to discontinuing the IV oxytocin, which assessment is most
impor- tant for the nurse to obtain
ANS: Uterine firmness.
2. 2. The postpartum client has minimal sensation in her lower extremities,
due to the effects of the epidural anesthesia. What is the priority nursing
concern for this client
ANS: Fall risk.
3. 3. What is the priority nursing action to address the client's needs
related to her repaired 4th degree perineal laceration
ANS: Apply perineal ice packs consis- tently for the first 24 hours.
4. 4. The nurse performs the first assessment upon the client's arrival to
the postpartum unit. Where would the nurse expect to palpate the fundus
ANS: 1 cm above the umbilicus.
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HESI RN EXIT CASE STUDY - POSTPARTUM

    1. Prior to discontinuing the IV oxytocin, which assessment is most impor-tant for the nurse to obtain ANS: Uterine firmness.
    1. The postpartum client has minimal sensation in her lower extremities, due to the effects of the epidural anesthesia. What is the priority nursing concern for this client ANS: Fall risk.
    1. What is the priority nursing action to address the client's needs related to her repaired 4th degree perineal laceration ANS: Apply perineal ice packs consis-tently for the first 24 hours.
    1. The nurse performs the first assessment upon the client's arrival to thepostpartum unit. Where would the nurse expect to palpate the fundus ANS: 1 cmabove the umbilicus.

5. Fifteen minutes after the initial assessment, the nurse finds the client disori-ented and lying on her back in a pool of vaginal blood, with the sheets beneathher saturated with blood.

  1. Which action is most important for the nurse to implement immediately ANS: - Massage the fundus.
    1. What is the best method for the nurse to use to obtain immediate assis-tance ANS: Activate the priority call light from the bedside.
    1. The nurse has requested assistance and personnel are on their way. Whilewaiting for help to arrive, what is the next priority action ANS: Assess for bladder distention.
    1. The charge nurse, two staff nurses, and an unlicensed assistive personnel (UAP) rush in to assist the nurse with the client. Which task is best delegatedto the UAP during this crisis ANS: Obtain the vital signs and O2 saturation.
    1. The HCP is notified that the client is hemorrhaging and has an estimatedblood loss of 1,200 mL since delivery. Her blood pressure is 70/40 mmHg, pulse 120 beats/min, respirations 28 breaths/min, and O saturation 73%. TheHCP's prescription includes stat oxytocin 10 units in
    1. Postpartum hemorrhage is designated as blood loss in excess of 500 mL within the first 24 hours of delivery. Considering the client's history, what etiology is most likely ANS: Uterine atony.
  2. The client is pale, weak, and anxious, but no longer disoriented. Her fundusis firm and is 1 cm above the umbilicus. Her bleeding has slowed considerably.The client tells the nurse that her spouse went home to pick up their other child to bring to the hospital. She states that she doesn't want her child to seeher this way and asks the nurse to tell her spouse what has happened.
  3. What intervention should the nurse implement to communicate the situa-tion to the client's spouse ANS: Call the spouse from the nurses' station to inform himof the client's status and request that the spouse come to the hospital soon, withoutthe other child.
    1. What should the nurse do to prepare for the client's blood transfusion?(Select all that apply. One, some, or all options may be correct.): Start an additional IV using a 16 or 18 gauge angiocath. Prime a new Y-set blood tubing using a new bag of sodium chloride 0.9%.Obtain a baseline set of vital signs prior to starting the infusion.
  5. The nurse is getting ready to administer the first unit of blood when the nursery nurse brings in the client's infant and states that the client needs tofeed the baby 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 the nurse to do ANS: Explain the client's history andrequest that the infant is fed with formula in the nursery.
    1. Prior to the blood transfusion, the nurse records the client's vital signsas T 97.8° F (36.6o C), heart rate 110 beats/min, respirations 22 breaths/min, and BP 78/50 mmHg. The blood requisition form, client identification bracelet,and blood label are checked with another nurse, and then the A negative blood transfusion is started at 75 mL/hr. Fifteen minutes after the transfusionbegins, another set of vital signs is taken; T 98.5° F (36.9o C), heart rate 112 beats/min, respiration 22 breaths/min and B/P 76/48 mmHg. The client reportsbeing cold. Which should the nurse do in response to these assessment findings ANS: Provide a warm blanket and continue to monitor the client.
  3. INTAKE: Oral 720 mL IV 500 mL Blood 300 mL Total Intake 1,520 mLOUTPUT: Urine 500 mL (catheterized 4 hours ago just prior to birth)Bleeding 1,600 mL

and decrease the headache.

  1. While the client is resting, the blood bank calls and tells the nurse that herinfant's blood type is A positive, and the blood drawn from the client after delivery indicates that she is indirect Coombs' negative and non- sensitized.
  2. Based on this information, what is the correct nursing action ANS: Allow theclient to rest and administer the RhoGam as prescribed at a later time.
    1. The client's spouse comes to the nursing station and asks for an updateon her condition. The nurse explains that the client is resting while receivingher second unit of blood and that her fundus is firm, her vital signs are stable,and she was able to use the bedpan to void. She tells the spouse that when theclient sat up to void, she developed a severe migraine and is now being treatedfor PDPH. The nurse explains this disorder and the necessary treatment. Thespouse becomes frustrated and storms off the unit shouting, that he can't believe how incompetent the people are here at this hospital. The spouse states that the staff almost let his wife bleed to death, and the provider who put in the epidural catheter didn't know what he was doing and that someoneis going to pay for this. The spouse goes into the client's room where she is breastfeeding the baby. Ten minutes later, the Infant abduction alarm on the unit is activated, and the nurse sees the spouse walking out the door

carrying the infant. Which priority action should the nurse implement ANS: Notifythe security personnel and direct all staff to report to their assigned exit in the hospital.