Exam 4 OB
The nurse is performing an assessment for a client in the immediate postpartum period. Which assessment finding should the nurse prioritize? *Infection *Dehydration *Hemorrhage *Bladder distention
Hemorrhage
The LPN has reported that uterine massage is ineffective on a client. The nurse anticipates the health care provider will prescribe which medication to address this issue? Ibuprofen Oxytocin Penicillin Digoxin
Oxytocin
The nurse is preparing to assess a client who is 1 day postpartum. The nurse predicts the client's fundus will be at which location on assessment? *At level of umbilicus *1 cm above the umbilicus *1 cm below the umbilicus *At the symphysis pubis
1 cm below the umbilicus
When completing the morning postpartum data collection, the nurse notices the client's perineal pad is completely saturated. Which action should be the nurse's first response? *Vigorously massage the fundus *Immediately call the primary care provider *Have the charge nurse review the assessment *Ask the client when she last changed her perineal pad
Ask the client when she last changed her perineal pad
Why are postpartal women prone to urinary retention? *Catheterization at the time of delivery reduces bladder tonicity. *Decreased bladder sensation results from edema because of pressure of birth. *Frequent partial voidings never relieve the bladder pressure. *Mild dehydration causes a concentrated urine volume in the bladder.
Decreased bladder sensation results from edema because of pressure of birth
A nurse is performing an assessment on a female client who gave birth 24 hours ago. On assessment, the nurse finds that the fundus is 2 cm above the umbilicus and boggy. Which intervention is a priority? *Notify the primary care provider, and document the findings. *Have the client void, and then massage the fundus until it is firm. *Assess a full set of vital signs. *Check and inspect the lochia, and document all findings.
Have the client void, and then massage the fundus until it is firm
The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? *postpartum blues *postpartum depression *postpartum psychosis *anxiety disorders
Postpartum depression
Which recommendation should be given to a client with mastitis who is concerned about breast-feeding her neonate? She should stop breast-feeding until completing the antibiotic. She should supplement feeding with formula until the infection resolves. She should not use analgesics because they are not compatible with breast-feeding. She should continue to breast-feed; mastitis will not infect the neonate.
She should continue to breast-feed; mastitis will not infect the neonate
A woman who delivered her infant by cesarean section 1 week ago called her physician's office to report chills, fever of 101.6℉ (38.7℃) and a poor appetite. She also tells the nurse that she is having strong afterbirth pains and her lochia has increased in volume and has an odor. Labwork shows an elevated WBC count. Which of these reported findings is the most significant finding related to the suspected diagnosis of endometritis? Fever Lochia odor Strong afterpains Elevated WBC count
Fever
When assessing a client's uterine fundus during the fourth stage of labor, the nurse palpates a soft, uncontracted fundus. Which of the following would the nurse do next? *Instruct the client to exercise *Gently massage the boggy fundus *Suggest complete bed rest *Suggest avoiding lifting weight
Gently massage the boggy fundus
A nurse is caring for a client who has had a cesarean birth and has developed a wound infection. What precautions should be taken by the nurse as a primary prevention measure? *Apply ice packs every 12 to 24 hours *Keep the incisions clean and dry *Use a sitz bath once every 24 hours *Apply ice and heat alternatively
Keep the incisions clean and dry
During a home visit, a postpartum patient is complaining of a painful area on one breast. The nurse notes a local area on one breast to be red and warm to touch. For which health problem should the nurse plan care for this patient? Mastitis Breast cancer Engorgement Plugged milk duct
Mastitis
The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? *lochia serosa *edematous vagina *uterus 1 cm below umbilicus *diaphoresis
Uterus 1 cm below umbilicus
A nurse is assigned to care for a client with lacerations. The nurse knows that which factor would be the most likely cause of lacerations of the genital tract? *history of hypertension *birth of a large newborn *excessive traction on umbilical cord *development of endometritis
birth of a large newborn
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? hematoma laceration uterine inversion uterine atony
laceration
Which assessment finding 1 hour after birth should be reported to the health care provider? *Fundus of uterus is palpable at the level of the umbilicus. *Fundus is displaced to the right, and bladder is hard. *Large, bruised hemorrhoids are protruding from the anal opening. *Lochia rubra is saturating a pad every 45 to 60 minutes.
Lochia rubra is saturating a pad every 45 to 60 minutes.
Eight days after birth the woman notices a return to red lochia. What condition does the nurse anticipate this patient is experiencing? Retained placental fragments Perineal hematoma rupture Genital tract infection Disseminate intravascular coagulopathy
Retained placental fragments
The LVN/LPN will be assessing a postpartum client for danger signs after a vaginal birth. What assessment finding would the nurse assess as a danger sign for this client? *presence of lochia rubra *fever more than 100.4° F (38° C) *fundus is above the umbilicus *fundus is firm
fever more than 100.4F
Which body system is most vulnerable to infection during the postpartum period? *Gastrointestinal *Urinary *Breasts *Respiratory
Urinary
A nurse is caring for a client who is nursing her baby boy. The client reports afterpains. Secretion of which substance would the nurse identify as the cause of afterpains? *prolactin *progesterone *oxytocin *estrogen
Oxytocin
The nurse is preparing discharge instructions for a postpartum woman who has developed DVT after a long and difficult birthing process. The nurse will include instruction on which medication for this client? NSAIDS Anticoagulants Narcotic analgesics Beta blockers
Anticoagulants *prescribed to prevent DVT
A postpartum client's care provider has prescribed a stool softener. When providing health education to the client, the nurse should teach the client to: *drink plenty of fluids while taking the medication. *limit intake of high-fiber foods. *consider herbal alternatives. *take the medication on empty stomach.
drink plenty of fluids while taking the medication
The nursing instructor is leading a discussion exploring the various conditions that can result in postpartum hemorrhage. The instructor determines the session is successful when the students correctly choose which condition is most frequently the cause of postpartum hemorrhage? Hematoma Uterine atony Perineal lacerations Disseminated intravascular coagulation
Uterine atony
A nurse is caring for a postpartum client with urinary tract infection. Which instruction would the nurse include in the teaching plan for the client to help prevent future infections? "Empty your bladder frequently" "Wear your elastic compression stockings" "Avoid foods that are salty" "Apply ice to infected area"
"Empty your bladder frequently"
After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, the nurse understands there is a need for additional teaching when one of the women makes which statement? *"I can't wait for these stretch marks to disappear after I give birth." *"I might lose some hair, but it will grow back." *"This line on my belly will go away over time." *"My nipples won't be so dark after I give birth."
"I can't wait for these stretch marks to disappear after I give birth."
The nurse provides discharge instructions to a postpartum patient. Which patient statement indicates that teaching has been effective? *"I should limit stair climbing to four times a day." *"I can have coitus at any time after returning home." *"I should plan to return to my full-time job after 6 weeks." *"I should notify the physician if my discharge decreases in amount."
"I should return to my full-time job after 6 weeks"
An 20-year-old primipara is getting ready to go home. She had a second-degree episiotomy with repair. She confides in the nurse that she is afraid to go to her postpartum checkup because she is afraid to have the stitches removed. Which reply by the nurse is best? *"It doesn't hurt when the midwife takes out the stitches. You will only feel a little tugging and pulling sensation." *"It is very important for you to go to your checkup visit. Besides, the stitches do not have to be removed." *"Many women have that fear after having an episiotomy. The stitches do not need to be removed because the suture will be gradually absorbed." *"Oh, you must not miss your follow-up appointment. Don't worry. Your midwife will be very gentle."
"Many women have that fear after having an episiotomy. The stitches do not need to be removed because the suture will be gradually absorbed"
A woman who delivered her infant 2 days ago asks the nurse why she wakes up at night drenched in sweat. She is concerned that this is a problem. The nurse's best reply would be: *"Many women sweat after delivery but you seem to be perspiring far more than normal. I'll call the doctor." *"Often, when a postpartum woman perspires like you are reporting, it means that they have an infection." *"I need to get your vital signs and check your fundus to be sure you are not going into shock." *"Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy."
"Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy."
The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambuate until the next day. What response by the nurse is most appropriate? *"If you do not get up to walk you will not recover." *"Walking is the best way to prevent complications such as blood clots." *"As long as you walk more tomorrow to make up for the delay in walking today you should be fine." *"Maybe you will feel better after you take pain medication."
"walking is the best way to prevent complications such as blood clots"
On postpartum day 4, a client has a temperature of 101.4°F (38.6°C). Which findings would be consistent with a diagnosis of endometritis? Select all that apply. foul-smelling lochia tender uterus strong afterpains fluctuant, perineal mass swollen, warm breast
foul smelling lochia tender uterus
When doing a health assessment, at which location would the nurse expect to palpate the fundus in a woman on the second postpartal day and how should it feel? *fundus height 4 cm below umbilicus and midline *fundus two fingerbreadths above symphysis pubis and hard *fundus 4 cm above symphysis pubis and firm *fundus two fingerbreadths below umbilicus and firm
fundus two fingerbreadths below umbilicus and firm
The nurse is caring for a client is who 24-hours post delivery of an infant. Which assessment does the nurse predict the health care provider will prioritize for the mother at this time? *blood type *folic acid level *hemoglobin and hematocrit *iron level
hemoglobin and hematocrit
A nurse is assessing uterine involution of a postpartum woman. When reviewing the woman's labor and birth record, which factor would the nurse identify as potentially delaying involution? Select all that apply. *hydramnios *birth of triplets *labor of 4 hours *grand multiparity *limited use of analgesia
hydramnios birth of triplets grand multiparity
The nurse assesses a postpartum woman's perineum and notices that her lochial discharge is moderate in amount and red. The nurse would record this as what type of lochia? *lochia rubra *lochia serosa *lochia normalia *lochia alba
lochia rubra
A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? fetal demise placenta accreta preeclampsia multiparity
multiparity
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? Postpartum mastitis Increased insulin needs Postpartum hemorrhage Gestational hypertension
postpartum hemorrhage
The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? Flat in bed On her left side Trendelenburg Semi-Fowler
semi-fowler
A client who gave birth several hours ago is experiencing postpartum hemorrhage. She had a cesarean birth and received deep, general anesthesia. She has a history of postpartum hemorrhage with her previous births. The blood is a dark red. Which cause of the hemorrhage is most likely in this client? uterine atony cervical laceration retained placental fragment disseminated intravascular coagulation
uterine atony
A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? uterine atony uterine prolapse uterine subinvolution uterine contraction
uterine atony
When assessing a postpartum client who was diagnosed with a cervical laceration that has been repaired, what sign should the nurse report as a possible development of hypovolemic shock? *warm and flushed skin *weak and rapid pulse *elevated blood pressure *decreased respiratory rate
weak and rapid pulse
Which postpartum client will the nurse assess first? *an 18-year-old who wants to sleep until 10:00 before the nurse brings the infant for a visit *a 35-year-old who had estimated blood loss of 700 mL and has a supine BP of 130/80 mm Hg and BP of 100/65 mm Hg when head of the bed is elevated *a 22-year-old who has been up, showered, and packing for discharge later today *a 30-year-old postpartum client who had a cesarean birth and is sleeping following pain medication administration
A 35 y/o who had estimated blood loss of 700 mL and has a supine BP of 130/80 mmHg and a BP of 100/65 mmHg when head of the bed is elevated
The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly, bright red blood gushes from the vagina. The nurse recognizes that which occurrence is the most likely cause of this postpartum hemorrhage? A cervical laceration Uterine atony Retained placental fragments Disseminated intravascular coagulation
A cervical laceration
The nurse is caring for several postpartum clients and notes various warning signs that are concerning. Which client should the nurse suspect is developing endometritis? A woman with diabetes, vaginal birth, HR 110, temperature 101.7° F (38.7° C) on the third postpartum day. The next day, appears ill; temperature now 102.9° F (39.3° C); WBC 31,500 cells; negative blood cultures. A woman with a history of infection and smoking, temperature 101° F (38.3° C) on the fourth postpartum day; reports severe perineal pain; edges of the episiotomy have separated. An obese woman with temperature 100.4° F (38° C) at 12 hours after birth; lochia is moderate; negative vaginal cultures. A woman with PROM before birth; reports severe burning with urination, malaise and severe temperature spikes on the 7th postpartum day. WBC is 21,850 cells; temperature 101° F (38.3° C); skin pale and clammy.
A woman with diabetes, vaginal birth, HR 110, temp 101.7 F, on the third postpartum day. The next day, appears ill, temp now 102.9 WBC 31,500, neg blood cultures.
When completing the morning postpartum data collection, the nurse notices the client's perineal pad is completely saturated. Which action should be the nurse's first response? *Vigorously massage the fundus. *Immediately call the primary care provider. *Have the charge nurse review the assessment. *Ask the client when she last changed her perineal pad.
Ask the client when she last changed her perineal pad
A postpartal woman has a history of thrombophlebitis. Which action would help the nurse determine if she is developing this postpartally? *Ask her if she feels any warmth in her legs. *Assess for calf redness and edema. *Take her temperature every 4 hours. *Palpate her feet for tingling or numbness.
Assess for calf redness and edema
The nurse notes uterine atony in the postpartum client. Which assessment is completed next? Assessment of bowel function Assessment of the lung fields Assessment of the perineal pad Assessment of laboratory data
Assessment of the perineal pad
During the assessment, the nurse observes a separation of the rectus muscle that is more than two fingerbreadths wide. Which instruction should the nurse offer the client? *Perform regular exercises *Avoid lifting heavy objects *Sleep on a firm mattress *Avoid sleeping on back
Avoid lifting heavy objects
The nurse suspects that a postpartum mother is experiencing uterine atony. What physical findings would the nurse note in this client that would validate the suspicion? Select all that apply. Boggy fundus Urinary output of 50 mL over the last hour Fundus located above the umbilicus Heavy lochia Deep pelvic pain unrelieved by comfort measures
Boggy fundus fundus located above the umbilicus heavy lochia
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? *Client's temperature remains below 100.4° F or 38° C orally. *Fundus remains firm and midline with progressive descent. *Client maintains a urinary output greater than 30 mL per hour. *Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour.
Client's temperature remains below 100.4 orally
A client presents to the clinic with her 3-week-old infant complaining of general flu-like symptoms and a painful right breast. Assessment reveals temperature 101o8F (38.8oC) and the right breast nipple with a hard area that is red and warm. Which instruction should the nurse prioritize for this client? *Complete the 10-day antibiotic prescription even if she begins to feel better. *Use NSAIDs, warm showers, and warm compresses to relieve discomfort. *Breast-feed or otherwise empty her breasts at least every 3 hours. *Increase her fluid intake to ensure that she will continue to produce adequate milk.
Complete the 10-day antibiotic prescription even if she begins to feel better
In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status? *"What time did you last change your pad?" *"How much blood was on the two pads?" *"Are you in any pain with your bleeding?" *"When did you last void?"
How much blood was on the two pads?
A nurse is developing a program to help reduce the risk of late postpartum hemorrhage in clients in the labor and birth unit. Which measure would the nurse emphasize as part of this program? *administering broad-spectrum antibiotics *inspecting the placenta after delivery for intactness *manually removing the placenta at birth applying pressure to the umbilical cord *to remove the placenta
Inspecting the placenta after delivery for intactness
The nursing instructor is leading a discussion on the physical changes to a woman's body after delivery of the baby. The instructor determines the session is successful after the students correctly point out which process results in the return of nonpregnant size and function of the female organs? *Evolution *Involution *Decrement *Progression
Involution
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? Uterine atony Laceration Perineal hematoma Infection of the uterus
Laceration
A postpartum patient is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? *Assess ambulation. *Measure urine output. *Measure blood pressure. *Evaluate current hematocrit level.
Measure BP
When assessing a postpartum mother, the nurse asks the client how many peripads she has used over the last 4 hours. The mother responds that she has changed her pad 2 to 3 times per hour when they were saturated. What action should the nurse take? *Notify the MD of the finding. *Bring the mother more peripads to her bedside. *Record the number of peripads on the client's chart. *Encourage the mother to start massaging her fundus every hour.
Notify the MD of the finding
Which postpartum clients would require the nurse to intervene? Select all that apply. Primipara with vital signs including temperature 100.2, blood pressure 140/ 86, pulse 124, respiratory rate 12. Multipara with vital signs including temperature 99, blood pressure 136/84, pulse 96, respiratory rate 32. Postpartum client with urine output of 30 ml/hour for 2 hours. First day postpartum client with blood pressure 84/48, pulse 128, respiratory rate 16. Postpartum client requesting newborn stay in nursery so that she can nap. Primipara with vital signs including temperature 100.2, respiratory rate 28, oxygen saturation 94%.
Primipara with vital signs including temp. 100.2, BP 140/86, pulse 124, RR: 12 Multipara with temp: 99, BP: 136/84, pulse 96, rr: 32 Postpartum client with urine output of 30 ml/hour for 2 hours first day postpartum client with BP 84/48, pulse 128, rr:16 Primipara with vital signs including temp: 100.2, rr: 28, o2 sat: 94%
The nurse is assessing a postpartum client's vital signs 24 hours after the birth of her infant and notes: respirations 18, pulse 110 bpm, temperature 100.1, and blood pressure 128/88. Which assessment finding should the nurse prioritize for further attention? temperature blood pressure respiration pulse
Pulse
A nurse helps a postpartum woman out of bed for the first time postpartally and notices that she has a very heavy lochia flow. Which assessment finding would best help the nurse decide that the flow is within normal limits? *The flow contains large clots. *The flow is over 500 mL. *Her uterus is soft to your touch. *The color of the flow is red.
The color of the flow is red
The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action? *The client is having a moderate amount of rubra lochia. *The client requires assistance to ambulate in the hallway. *The fundus is located 2 fingerbreadths above the umbilicus. *The client is afibrile. *Bowel sounds are active.
The fundus is located 2 fingerbreadths above the umbilicus
In recording a postpartum mother's urinary output, the nurse notes that she is voiding between 100 to 200 mL with each void. How would the nurse interpret this finding? *The urinary output is inadequate and the mother needs to drinks more fluids. *The urinary output is inadequate suggestive of urinary retention. *The urinary output is normal. *The urinary output is above expected levels.
The urinary output is normal
Which reason explains why women should be encouraged to perform Kegel exercises after birth? *They assist with lochia removal. *They promote the return of normal bowel function. *They promote blood flow, enabling healing and muscle strengthening. *They assist the woman in burning calories for rapid postpartum weight loss.
They promote blood flow, enabling healing and muscle strengthening.
Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis? *"Stop breastfeeding until the pain and swelling subside." *"You'll need to take this medication to stop the milk from being produced." "Try applying warm compresses to your breasts to encourage the milk to be released." "Limit the amount of fluid you drink so your breasts don't get much fuller."
Try applying warm compresses to your breasts to encourage the milk to be released
During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After birth, during the early postpartum period, the woman eliminates the additional fluid volume she has been carrying. What is one way she does this? *Urinary elimination *elimination of solid wastes *being too tired to eat *breathing off fluid vapor
Urinary elimination
A postpartum client reports urinary frequency and burning. What cause would the nurse suspect? *uterine atony *urinary tract infection *subinvolution *stress incontinence
Urinary tract infection
Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? hemoglobin level of 12 g/dL uterine atony thrombophlebitis moderate amount of lochia rubra
Uterine atony
A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply. *uterine infection *prolonged labor *hydramnios *breastfeeding *early ambulation *empty bladder
Uterine infection prolonged labor hydramnios
Which instruction would the nurse include in the teaching plan for a postpartal client with a history of thromboembolism to reduce the risk of a recurrence? *Refrain from performing leg exercises. *Wear support hose or antiembolic stockings. *Flex the muscles at the groin. *Avoid pressure on the thigh muscles.
Wear support hose or antiembolic stockings
A nurse is caring for a client who gave birth about 10 hours earlier. The nurse observes perineal edema in the client. What intervention should the nurse perform to decrease the swelling caused by perineal edema? *Apply ice. *Use ointments locally. *Apply moist heat. *Use a warm sitz bath or tub bath.
apply ice
A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus. Which finding would the nurse identify as expected? *two fingerbreadths above the umbilicus *at the level of the umbilicus *two fingerbreadths below the umbilicus *four fingerbreadths below the umbilicus
at the level of the umbilicus
