Lesson 6: Maternity Client - Postpartum Care

A nurse provides instructions to a breastfeeding mother about measures that will provide relief from breast engorgement. Which statement by the mother indicates an understanding of the instructions? "I should switch to formula to feed my baby for 1 week." "I need to stop breastfeeding until the engorgement resolves." "I should apply warm packs to my breasts before each feeding." "I need to apply ice packs to my breasts 20 minutes before a feeding."

"I should apply warm packs to my breasts before each feeding."

The lactation consultant nurse visits Annie to discuss breastfeeding and to observe as Annie breastfeeds her baby. The nurse discusses mastitis, its signs and symptoms, how to prevent it, and what to do if it occurs. Which statements by Annie reflect understanding of the information that is being presented? Select all that apply. "It won't hurt to miss a few feedings if I'm too tired." "I'll wash my nipples carefully before and after feedings." "I should expect to have sore, cracked nipples when starting to breastfeed." "If I get mastitis, I'll have to stop breastfeeding from that side until it is healed." "If my nipples are sore, I should apply warm water compresses before breastfeeding." "If I get mastitis, I can continue to breastfeed and will make sure to empty the breast every 2 to 4 hours."

"I'll wash my nipples carefully before and after feedings." "If my nipples are sore, I should apply warm water compresses before breastfeeding." "If I get mastitis, I can continue to breastfeed and will make sure to empty the breast every 2 to 4 hours."

The next day, the newborn's blood type comes back as A-positive. Annie is type B-negative. The obstetrician prescribes an intramuscular dose of Rho(D) immunoglobulin (RhoGAM) for Annie. The nurse explains the purpose of the RhoGAM, and prepares the injection. Which statement by Annie reflects a need for further education? "My baby will need a dose of this medication, too." "My husband doesn't need to have a dose of this medication." "This shot will prevent a reaction in my body from the blood of my baby." "This shot will make it safer for my future babies if they have a positive blood type."

"My baby will need a dose of this medication, too."

A nurse monitoring lochial flow in a woman who delivered 2 hours earlier notes that the client's perineal pad shows drainage measuring less than 1 inch in a 1-hour period. How should the nurse report the lochial flow? Scant Light Heavy Excessive

Scant

That evening, during an assessment, the nurse finds that Annie's uterine fundus is above the umbilicus and to the left of the midline of the abdomen. What action by the nurse is a priority? Performing fundal massage Performing a sterile urinary catheterization Assessing the lochia on Annie's perineal pad Assisting Annie to the bathroom to help her void

Assisting Annie to the bathroom to help her void

Three weeks after the birth of her baby, Sara, Annie calls her obstetrician's office and speaks to the nurse. She tells the nurse that she has been feeling "hot" and very fatigued, even though she has been resting and has had her husband at home to help with the baby. The nurse asks Annie to come to the office for a checkup, and notes the assessment findings in Annie's record. Based on these assessment findings (refer "Chart" below), what problem does the nurse suspect? Vital SignsTemperature: 100.9° F (oral)Pulse: 110 beats/minRespiratory rate: 14 breaths/minBlood pressure: 118/64 mm Hg Subjective Information"I've been breastfeeding Sara every 4 to 6 hours with no problems, and she seems to be fine.""I've been so tired for the past few days, even though I'm getting sleep, but I haven't been hungry.""My lower belly is very sore. I also noticed that my vaginal discharge has increased and changed back to a brownish color. It's smellier now, too."I've had no problem passing urine. Objective InformationSmall amount of lochia, brownish with a strong foul odor, on padComplains of pain on palpation of lower abdomenNo bladder distention notedUterine fundus nonpalpableLung sounds clearUrine clearUrinalysis findings normalWhite blood cell count: 12,000 cells/mm3 Mastitis Influenza Endometritis Bladder infection

Endometritis

A woman who has just delivered a baby asks the nurse when she may resume sexual intercourse. Which response should the nurse give to the client? Intercourse may be resumed at any time after delivery. Intercourse may not be resumed until menstruation returns. Intercourse may not be resumed until after the 6-week checkup with the obstetrician. Intercourse may be resumed 2 to 4 weeks after delivery, once bleeding has stopped and the episiotomy has healed.

Intercourse may be resumed 2 to 4 weeks after delivery, once bleeding has stopped and the episiotomy has healed.

A nurse taking the vital signs of a client who delivered a healthy newborn infant 4 hours ago notes that the client's oral temperature is 101.2° F (38.4° C). Which action would be appropriate? Documenting the findings Notifying the primary health care provider Retaking the temperature rectally Telling the client that the temperature at this level is expected at this time

Notifying the primary health care provider

One hour after delivery, the nurse checks Annie for postpartum bleeding. Which procedure is best for this purpose? Assessing Annie's blood pressure Visually assessing bleeding by checking Annie's perineal pad Asking Annie how much bleeding she has had since the last check Visually assessing bleeding by checking the linens under Annie's buttocks and the perineal pad

Visually assessing bleeding by checking the linens under Annie's buttocks and the perineal pad