Kaplan NCLEX Practice Question of the Day

The nurse reviews the care needs for a group of postpartum clients. Which client does the nurse identify as being most at risk for developing postpartum hemorrhage?

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Client who delivered a 9 lb, 8 oz (4.3 kg) newborn. (Correct Answer)
Delivery of a large birthweight infant (greater than 9 lb [4.1 kg]) leads to increased uterine stretching, which can cause uterine fatigue and poor tone.
Client with an episiotomy.
An episiotomy can cause discomfort but is not a risk factor for postpartum hemorrhage.
Client with engorged breasts.
Engorged breasts are filled with milk. This is not a risk factor for a postpartum hemorrhage.
Client requesting assistance with fundal massage.
Fundal massage expels blood clots and helps uterine blood vessels to contract. This is not a risk factor for postpartum hemorrhage.

Decision Tree:

This walk-through provides test-taking strategies to determine the correct answer for the different types of questions you will encounter on the NCLEX-RN exam. These strategies are based on the Kaplan Decision Tree (DT) algorithm, a technique that provides a process to determine the correct answer for NCLEX-style questions.

This is a Priority Question.

Priority questions use words such as most, best, first, immediate, etc.

STEP 1: Can you identify the topic of the question?

Most at risk for postpartum hemorrhage.

STEP 2: Are the answer choices assessment or implementation?

Assessment vs. Implementation

Client who delivered a 9 lb, 8 oz (4.3 kg) newborn. Assessment
Client with an episiotomy. Assessment
Client with engorged breasts. Assessment
Client requesting assistance with fundal massage. Assessment

Because a mix of assessment and implementation answer choices does not exist, answer choices cannot be eliminated at this step. Move to Step 3.

STEP 3: Apply Maslow: Are the answer choices physical or psychosocial?

Maslow

Client who delivered a 9 lb, 8 oz (4.3 kg) newborn. Physical
Client with an episiotomy. Physical
Client with engorged breasts. Physical
Client requesting assistance with fundal massage. Physical

Because a mix of physical and psychosocial answer choices does not exist, answer choices cannot be eliminated at this step. Move to Step 4.

STEP 4:Are the answer choices related to ABCs?

ABCs

Client who delivered a 9 lb, 8 oz (4.3 kg) newborn. Circulation (large birthweight increases uterine stretching and decreases tone)
Client with an episiotomy. N/A
Client with engorged breasts. N/A
Client requesting assistance with fundal massage. Circulation (fundal massage contracts uterus, which decreases bleeding)

ABC answer options take priority over non-ABC answer options if they make sense with the topic. Eliminate #2 and 3. Move to Step 5.

STEP 5: What is the outcome of each of the remaining answer choices?

Evaluate the outcome(s)

1. Client who delivered a 9 lb, 8 oz (4.3 kg) newborn. At significant risk for postpartum bleeding.

4. Client requesting assistance with fundal massage. Helps to prevent postpartum bleeding, not a risk factor. Eliminate.

Select the best choice

Is #1 the correct answer? Yes, large birthweight babies can stretch the uterus, which reduces the tone, increasing the risk of bleeding.

Does #1 make sense? Yes, the client who delivered a large birthweight infant is most at risk for postpartum bleeding. The client requires frequent assessment.

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