Practice Question
A nurse is assessing a client following a vaginal delivery and notes heavy lochia and a boggy fundus. Which of the following medications should the nurse expect to administer?
Answer Choices:
Correct Answer:
Oxytocin
Rationale:
🔷 A boggy fundus and heavy lochia indicate uterine atony, the most common cause of postpartum hemorrhage.
🔷 Oxytocin is a uterotonic medication that stimulates uterine contractions, helping the uterus to firm up and constrict blood vessels.
🔷 Strong uterine contractions reduce uterine bleeding, making oxytocin the first-line medication in this scenario.
🔷 It is often administered IV or IM immediately postpartum when atony or hemorrhage is suspected.
🔷 Therefore, the nurse should expect to administer oxytocin to treat uterine atony with heavy bleeding.
Nalbuphine
🔷 Nalbuphine is an opioid analgesic used to treat moderate to severe pain, not postpartum hemorrhage.
🔷 It acts on opioid receptors to provide pain relief but has no uterotonic action to improve uterine tone.
🔷 Giving nalbuphine would not address the underlying problem of uterine atony and heavy lochia.
🔷 Pain control may be important postpartum, but it is not the priority in the presence of active heavy bleeding.
🔷 Thus, nalbuphine is not appropriate for treating a boggy uterus with hemorrhage.
Terbutaline
🔷 Terbutaline is a beta-adrenergic agonist that acts as a tocolytic, meaning it relaxes uterine muscle.
🔷 It is used to stop preterm labor by decreasing uterine contractions, which is the opposite of what is needed for postpartum hemorrhage.
🔷 Administering terbutaline in a client with a boggy uterus would worsen atony and increase bleeding.
🔷 In the postpartum setting, the goal is to enhance uterine contractions, not suppress them.
🔷 Therefore, terbutaline is contraindicated in uterine atony and postpartum hemorrhage.
Magnesium sulfate
🔷 Magnesium sulfate is commonly used as an anticonvulsant in clients with preeclampsia/eclampsia and as a tocolytic in preterm labor.
🔷 It causes smooth muscle relaxation, including the uterus, which can increase the risk of uterine atony postpartum.
🔷 Giving magnesium sulfate in this situation would not treat hemorrhage and might worsen the boggy fundus.
🔷 It is not indicated for postpartum hemorrhage management.
🔷 Thus, magnesium sulfate is not appropriate for a client with heavy lochia and a boggy uterus.
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This question is from RN ATI VATI comprehensive practice 2025 which contains 120 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI EXIT Exam(s)
- Domain: RN ATI Comprehensive Predictor Exam(s)~2025
- Answer Choices: 4