Match Procedure with Complications

Procedure	Complications
A. D&E	I. PPH
B. Atonic uterus	II. Wound dehiscence
C. Oxytocin administration	III. Uterine perforation
D. Episiotomy	IV. Water intoxication

1. A

   A-III, B-I, C-IV, D-II

2. B

   A-I, B-III, C-II, D-IV

3. C

   A-I, B-II, C-IV, D-III

4. D

   A-III, B-IV, C-I, D-II

Appeared in: MNS 2024

Explanation

• The correct option correctly pairs each procedure or condition with its most recognized and direct complication.
• D&E (A) is an invasive uterine procedure, making Uterine Perforation (III) a primary mechanical risk.
• Atonic Uterus (B) is the failure of the uterus to contract after birth, which is the leading cause of Postpartum Hemorrhage (PPH) (I).
• Oxytocin Administration (C) has an antidiuretic effect due to its similarity to ADH, which can lead to fluid retention and Water Intoxication (IV), especially with prolonged high-dose infusions.
• Episiotomy (D) is a surgical incision of the perineum, and like any surgical wound, it is at risk for Wound Dehiscence (II) or infection.

Why Other Options Were Wrong

• Option B: This option incorrectly matches A-I, B-III, C-II, and D-IV. For example, atonic uterus (B) causes PPH, not uterine perforation (III). Episiotomy (D) is associated with wound dehiscence, not water intoxication (IV).
• Option C: This option incorrectly matches A-I, B-II, C-IV, and D-III. For example, D&E (A) is directly associated with uterine perforation, not primarily PPH (I). Atonic uterus (B) does not cause wound dehiscence (II).
• Option D: This option incorrectly matches A-III, B-IV, C-I, and D-II. While A-III and D-II are correct, it wrongly pairs atonic uterus (B) with water intoxication (IV) and oxytocin administration (C) with PPH (I). While oxytocin is used to prevent PPH, its overdose complication is water intoxication, and atonic uterus directly causes PPH.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Matching common obstetric and gynecological procedures and conditions with their potential complications helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses play a critical role in monitoring for these complications.
• For D&E, the nurse must monitor for signs of perforation, such as severe abdominal pain, tenderness, and signs of shock (hypotension, tachycardia).
• Postpartum, the nurse's primary responsibility is to assess uterine tone by palpating the fundus. A boggy uterus indicates atony and requires immediate fundal massage and notification of the provider to prevent PPH.

How to Approach the Question

• This is a 'Match the Following' question. The goal is to correctly pair items from two columns.
• First, analyze each item in the 'Procedure' column individually.
• For each procedure, recall or deduce its most common or severe complication from the 'Complications' column.
• A. D&E: This is an instrumental procedure inside the uterus. The most direct mechanical complication is uterine perforation (III).
• B. Atonic uterus: This means the uterus is not contracting. This leads to uncontrolled bleeding from the placental site, which is PPH (I).
• C. Oxytocin: This drug can cause water retention. The complication is water intoxication (IV).

Concept Tested & Keywords

• Concept Tested: Matching common obstetric and gynecological procedures and conditions with their potential complications.
• Stem keywords: D&E, Atonic uterus, Oxytocin administration, Episiotomy, Complications, PPH, Uterine perforation, Wound dehiscence
• Lead-in keywords: Match

Question ID

QbIKhRzgfe46kFotC1aqnE

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 15-23, 65-81

E6 Obstetrics Williams p. 40-58