Chapter 23: Conditions Occurring after Delivery

Which complication is most likely responsible for a late postpartum hemorrhage? 1 cervical laceration 2 clotting deficiency 3 perineal laceration 4 uterine subinvolution

4

A postpartum client is showing signs and symptoms of a pulmonary embolism. What should the nurse do? 1 Start oxygen at 2 to 3 liters per minute via nasal cannula. 2 Raise the head of the bed to at least 45 degrees. 3 Lay the client flat and start oxygen. 4 Sit the client up 90 degrees and call the RN.

2 Immediate action is crucial for the woman who develops a pulmonary embolism. Immediately raise the head of the bed to at least 45 degrees to facilitate breathing. Begin oxygen therapy at 8 to 10 liters per minute via facemask and notify the health care provider

The nurse is caring for a client within the first four hours after her cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis? 1 Roll a bath blanket or towel and place it firmly behind the knees. 2 Limit oral intake of fluids for the first 24 hours to prevent nausea. 3 Assist client in performing leg exercises every two hours. 4 Ambulate the client as soon as her vital signs are stable.

4

When developing the plan of care for a client with postpartum endometritis, which intervention would the nurse most likely include? 1 Performing vigorous but gentle fundal massage 2 Using semi-Fowler's position to encourage uterine drainage 3 Inserting a indwelling urinary catheter to keep the bladder empty 4 Performing bimanual compression of the uterine structure

2

Which measurement best describes delayed postpartum hemorrhage? 1. blood loss in excess of 300 ml, occurring 24 hours to 6 weeks after birth 2. blood loss in excess of 500 ml, occurring 24 hours to 6 weeks after birth 3. blood loss in excess of 800 ml, occurring 24 hours to 6 weeks after birth 4. blood loss in excess of 1,000 ml, occurring 24 hours to 6 weeks after birth

2

A postpartal woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this? 1 Bend her knee, and palpate her calf for pain. 2 Ask her to raise her foot and draw a circle. 3 Blanch a toe, and count the seconds it takes to color again. 4 Assess for pedal edema.

4 Calf swelling, erythema, warmth, tenderness, and pedal edema may be noted and are caused by an inflammatory process and obstruction of venous return.

While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect? 1 hematoma 2 laceration 3 uterine inversion 4 uterine atony

2 Lacerations typically present with a firm contracted uterus and a steady stream of unclotted bright red blood. Hematoma would present as a localized bluish bulging area just under the skin surface in the perineal area, accompanied by perineal or pelvic pain and difficulty voiding. Uterine inversion would present with the uterine fundus at or through the cervix. Uterine atony would be manifested by a noncontracted uterus.

The nurse notes that a client's uterus, which was firm after the fundal massage, has become boggy again. Which intervention would the nurse do next? 1 Perform vigorous fundal massage for the client. 2 Check for bladder distention, while encouraging the client to void. 3 Use semi-Fowler's position to encourage uterine drainage. 4 Offer analgesics prescribed by health care provider.

2 If the nurse finds a previously firm fundus to be relaxed, displaced, and boggy, the nurse should assess for bladder distension and encourage the woman to void or initiate catheterization as indicated. Emptying a full bladder facilitates uterine contraction and decreased bleeding. The nurse should not perform a vigorous fundal massage. Excessive massage leads to overstimulation of uterine muscle, resulting in excessive bleeding

The nurse is reviewing the medical record of a postpartum client. The nurse determines that the client is at risk for thromboembolism based on which factors from her history? Select all that apply. 1 previous oral contraceptive use 2 first pregnancy 3 age 30 years 4 severe varicose veins 5 preeclampsia

1, 4, 5

The nurse receives a report on a client with type 1 diabetes mellitus whose delivery was complicated by polyhydramnios and macrosomia. The nurse is aware of these complications and knows to monitor the client closely for which of the following? 1 Postpartum mastitis 2 Increased insulin needs 3 Postpartum hemorrhage 4 Gestational hypertension

3

Which of the following would lead the nurse to suspect that a postpartum client is experiencing hypovolemic shock? 1 Lightheadedness 2 Severe localized pain 3 Cyanosis and oliguria 4 Increased rectal pressure

3

A client with a perineal hematoma undergoes an incision and drainage. Which of the following would be most appropriate after this procedure? 1 Administer prescribed magnesium sulfate 2 Monitor the client's fluid status 3 Check client's clotting study results 4 Pack the area to promote hemostasis and drainage

4

A nurse teaches a postpartum woman about her risk for thromboembolism. The nurse determines that additional teaching is required when the woman identifies which as a factor that increases her risk? 1 increase in clotting factors 2 vessel damage 3 immobility 4 increase in red blood cell production

4

The nurse is caring for a client who has been diagnosed with a deep vein thrombosis. Which assessment finding should the nurse prioritize and report immediately? 1 Calf pain 2 Pyrexia 3 Edema 4 Dyspnea

4

The nurse notes that a client's uterus, which was firm after the fundal massage, has become boggy again. Which intervention would the nurse do next? 1 Perform vigorous fundal massage for the client. 2 Check for bladder distention, while encouraging the client to void. 3 Use semi-Fowler's position to encourage uterine drainage. 4 Offer analgesics prescribed by health care provider.

2

A woman is 2 weeks postpartum when she calls the clinic and tells the nurse that she has a fever of 101°F (38.3°C). She reports abdominal pain and a "bad smell" to her lochia. The nurse recognizes that these symptoms are associated with which condition? 1 Mastitis 2 Endometritis 3 Subinvolution 4 Episiotomy infection

2

The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady gush of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider? 1 Uterine atony 2 Laceration 3 Perineal hematoma 4 Infection of the uterus

2

The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? 1 Attachment, lochia color, complete blood cell count 2 Blood pressure, pulse, reports of dizziness 3 Degree of responsiveness, respiratory rate, fundus location 4 Height, level of orientation, support systems

2

The nurse is teaching a client with newly diagnosed mastitis about her condition. The nurse would inform the client that she most likely contracted the disorder from which organism? 1 Escherichia coli 2 group beta-hemolytic streptococci (GBS) 3 Staphylococcus aureus 4 Streptococcus pyogenes

3

A client arrives in the emergency department accompanied by her husband and new 10-week-old infant, crying, confused, and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear approximately when? 1 within 3 months of giving birth 2 within 4 months of giving birth 3 within 2 months of giving birth 4 within 5 months of giving birth

1

A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? 1 dyspnea, diaphoresis, hypotension, and chest pain 2 dyspnea, bradycardia, hypertension, and confusion 3 weakness, anorexia, change in level of consciousness, and coma 4 pallor, tachycardia, seizures, and jaundice

1

A postpartal patient is receiving heparin as treatment for thrombophlebitis. What should the nurse instruct the patient about breast-feeding during this time? 1 Breast-feeding can continue. 2 The baby will need weekly blood work. 3 The effect of anticoagulants is counteracted by infant gastric juices. 4 All anticoagulants pass in breast milk so breastfeeding will have to stop.

1

Eight days after birth the woman notices a return to red lochia. What condition does the nurse anticipate this patient is experiencing? 1 Retained placental fragments 2 Perineal hematoma rupture 3 Genital tract infection 4 Disseminate intravascular coagulopathy

1

It is discovered that a new mother has developed a puerperal infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition? 1 Client's temperature remains below 100.4° F or 38° C orally. 2 Fundus remains firm and midline with progressive descent. 3 Client maintains a urinary output greater than 30 mL per hour. 4 Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour.

1