N1022 Postpartum

The nurse encourages a postpartum client to discuss the childbirth experience. Which client outcome is most appropriate for this client?

"The client demonstrates the ability to integrate the childbirth experience and progress to the task of maternal role attainment."

postpartum diuresis of 2-3 L output in first 12-25 hours accounts for this amount of weight loss

5 pound weight loss

encourage lactating mothers to add this many more calories to diet

500Kcal/day

The perineum during involution

Mild to moderate pain depending on severity Edematous and bruised Lacerations take 4-6 months to heal

how should mother hold baby who was delivered via cesarean to avoid pressure on incision

football hold or side lying

pain in calf upon dorsiflexion of foot and may indicated thrombophlebitis

homans sign

discharge of blood and debris after delivery

lochia

A client is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by:

3 days of elevated basal body temperature and clear, thin cervical mucus.

A client delivers a neonate prematurely at 28 weeks' gestation. The neonate is placed in the neonatal intensive care unit (NICU). Three days later, the client's husband seems withdrawn and barely speaks to the staff when visiting his child in the NICU. His behavior indicates that he's in which stage of grief?

Depression

Which assessment finding indicates that the infant isn't latching on properly during breast-feeding.

The baby's lips smack.

Factors that enhance uterine involution

Uncomplicated labor Complete expulsion of placenta Breastfeeding (increases oxytocin) Early ambulation

what happens to GFR during diuresis

increased GFR

afterpains are caused by these following delivery

intermittent uterine contractions

this hormone level decreases vaginal lubrication for 6-10 weeks post delivery and cause painful intercourse

low estrogen levels

promote rest and gradual activity, nothing strenuous, if increased lochia is shown it is due to this

over exertion

cardiovascular status returns within 2 weeks and 40% of blood volume is decreased due to this

diuresis

After 2 days of breast-feeding, a postpartum client reports nipple soreness. To relieve her discomfort, the nurse should suggest that she:

lubricate her nipples with expressed milk before feedings.

when is engorgement presented postpartum

second or thrid day

assess for orthostatic hypotension monitor more closely if pt. is postpartum from this labor problem

preeclamsia

REEDA

Redness Edema Ecchymosis Discharge Approximation

soft interrupted contracted uterus causing hemorrhage

boggy uterus

what happens to os (opening to uterus) after delivery from round dimple like opening to

slit opening

A 24-year-old multigravida client who had an uncomplicated, spontaneous vaginal delivery 7 hours ago is uninterested in her baby and wants to sleep. The student nurse assigned to care for the client is concerned and tells the licensed practical nurse (LPN) who's also assigned to her care. Which response by the LPN is most effective in educating the student nurse?

"Extreme fatigue from the delivery is common, and new mothers initially focus on recovery and taking in the birth experience."

The nurse is teaching a breast-feeding client how to care for her engorged breasts. Which statement by the client indicates the need for further teaching?

"If my breasts are uncomfortable, I'll limit the time I spend breast-feeding."

The nurse is teaching a client how to use a diaphragm. Which instruction should the nurse provide?

"Leave the diaphragm in place for at least 6 hours after intercourse."

After receiving methylergonovine (Methergine) I.M. for postpartum hemorrhage, a client is prescribed methylergonovine 0.4 mg by mouth every 6 hours. The pharmacy sends 0.2 mg tablets. How many tablets must the nurse administer with each dose?

2

how often should perineum be iced during first 24 hours

20 minutes on 10 minutes of in first 24 hours

The uterus returns to the pelvic cavity in which of the following time frames?

7 to 9 days postpartum

when does menstruation resume

7-9 weeks

A postpartum client tells the nurse she isn't having regular bowel movements. The nurse should recommend that the client do what to combat constipation?

Add high-fiber foods to her diet.

Endometrial Regeneration

Begins soon after childbirth Outer portion is expelled with the placenta in 2-3 days postpartum, separates into two layers. First layer shed with lochia, second layer remains to become new endometrial lining Primary complication is METRITIS: infection of endometrial tissue

A clinical pathway is guiding care for a postpartum client who had an uncomplicated vaginal delivery of an 8-lb, 2-oz (3,686-g) baby 24 hours ago. The client has no episiotomy and is bottle-feeding her baby. Which outcome should be achieved within the next 8 hours?

Client will demonstrate ability to bottle-feed the neonate.

Certain drugs used during the postpartum period may affect blood pressure. Which drug would decrease a postpartum client's blood pressure?

Codeine phosphate

When assessing a client who gave birth 12 hours ago, the nurse measures an oral temperature of 99.6° F (37.5° C), a heart rate of 82 beats/minute, a respiratory rate of 18 breaths/minute, and a blood pressure of 116/70 mm Hg. Which nursing action is appropriate?

Encouraging increased fluid intake

The nurse is preparing to perform a physical examination on a postpartum client. Which statement best explains why the nurse must wear gloves during this examination?

Gloves are required for standard precautions.

What happens to the uterus during involution?

Happens through contractions, regeneration of epithelial cells, and the shrinking of existing cells back to normal size and function

The vagina during involution

Heals over a period of 3 weeks, but needs 6 weeks for involution to occur After birth it is edematous and has small lacerations Kegel exercises to improve muscle tone and contractibility Mild to moderate pain will come with involution check for REEDA

Prolactin

Hormone released by ANTERIOR PITUITARY that increases production of breast tissue and stimulates milk production

Following a precipitous delivery, examination of the client's vagina reveals a fourth-degree laceration. Which of the following steps would be contraindicated when caring for this client?

Instructing the client to use two or more peripads to cushion the area

Episiotomy

Laceration to get the baby out during childbirth. Surgical incision to enlarge vaginal opening.

Subinvolution

Reproductive organs are not returning to pre pregnancy state correctly

Endocrine system during involution

Resumption of ovulation and menses occurs -meses within 7-9 weeks without ovulation -breast feeding delays return of both (can go 12 weeks-18months without menses)

How would you know, based on your assessment, that the mother could have a cervical laceration?

The fundus will be firm and midline, and in the correct spot but she is still losing a good amount of blood.

high risk of this __postpartum due to decreased peristalsis, use of opioid analgesics, dehydration, decreased motility

constipation

is it normal for increase in the amount or reappearance of lochia rubra?

abnormal

Hgb levels drop due to blood loss from delivery and but if Hct decreases this is a sign of

abnormal blood loss

what temperature may indicate infection postpartum,

above 100.4*

what type of analgesics are possible pain meds to be given to postpartum

acetaminophen, NSAIDS, narcs and PCA pump

After Pains

alternating relaxation and contraction of uterine muscles after childbirth

what happens to amount of lochia if exertion or breastfeeding

amount increases

process parents form emotional relationship with infant

bonding

this pulse rate is common 6-10 days after delivery

bradycardia

what should be reported for signs of DVT postpartum

calf pain, tender, red or swelling

Postpartum assessment- vital signs

compare BP with pre-delivery BP Bradycardia/Tachycardia may occur Resp should be WNL

what is the mother to do postpartum for better oxygenation and increased perfusion

cough and deep breath postpartum

fathers absorption proccupation and interest in infant shortly after birth

engrossment

how often should mother nurse baby and awaken infant and allow sleep at night

every 2 -4 hours

high risk of this __ due to pressure from pushing during second stage of labor

hemorrhoids

if mom is Rh negative and byb is Rh positive which lab result would determine if candidate for Rhogam

indirect coombs test

promote bowel elimination postpartum by early frequent ambulation, increased fluids and fiber, stool softeners, avoid straining will increase this __

peristalsis

6 week period after delivery

puerperium

The nurse is caring for a client on her second postpartum day. The nurse should expect the client's lochia to be:

red and moderate.

what should breast signs should be reported postpartum

reddened warm breast

what are the 5 targets to assess if tubal ligation, cesarean, abdomnial incisions

redness, edema, eccymosis, discharge, app skin edge

encourage this type of bath warm or cool within first 24 hours

sitz three times a day

first 3 days postpartum, needs to discuss labor and delivery, own needs, dependent and touches and explores baby

taking in phase

The nurse should tell new mothers who are breast-feeding that breast milk is produced when:

the placenta is delivered, causing the secretion of prolactin.

what is a palpable indicator of involution

top portion of the fundus

A client is experiencing an early postpartum hemorrhage. Which action by the nurse is most appropriate?

Performing fundal massage

(SELECT ALL THAT APPLY) The nurse is assisting in developing a care plan for a client with an episiotomy. Which interventions would be included for the nursing diagnosis Acute pain related to perineal sutures?

(3) Administer sitz baths three to four times per day., (4) Encourage the client to do Kegel exercises.

A client who gave birth 24 hours ago continues to experience urine retention after several catheterizations. The physician prescribes bethanechol (Urecholine), 10 mg by mouth three times per day. The client asks, "How does bethanechol act on the bladder?" How should the nurse respond?

"It stimulates the smooth muscle of the bladder."

(SELECT ALL THAT APPLY) The nurse is collecting data on client who is 1 day postpartum. The nurse expects which normal findings?

(1) Lochia Rubra, (4) Heart rate of 50 to 70 beats/minute

After receiving the shift report, the nurse realizes that she should monitor her postpartum client closely for puerperal infection. Which factor alerted the nurse to the client's risk for this complication?

Cesarean birth

The nurse determines that a postpartum client's perineal pad weighs 100 g. The nurse should document this client's blood loss as:

100 ml

encourage fluids this amount postpartum

2000 ml/day

Which client care assignment is the most appropriate assignment for a newly graduated licensed practical nurse (LPN)?

A 24-year-old primigravida who delivered a 6-lb, 4-oz (2,835-g) baby vaginally 4 hours ago and is unable to void

The nurse brings a new mother her baby for the first time approximately 1 hour after the baby's birth. After checking the identification, the nurse hands the baby to the mother. Within a few minutes, the mother begins to undress her baby. Which of the following should the nurse do?

Anticipate and support the behavior as a normal part of bonding.

The nurse is caring for a client during the first postpartum day. The client asks the nurse how to relieve pain from her episiotomy. What should the nurse instruct the woman to do?

Apply an ice pack to her perineum.

Focused assessment BUBBLE-HE

B- Breasts U- Uterus B- Bowels B- Bladder L- Lochia E- Episiotomy/ Laceration/ C-section incision HE-Homan's sign and emotions

During an annual checkup, a client tells the nurse that she and her husband have decided to start a family. Ideally, when should the nurse plan for childbirth education to begin and end?

It should begin before conception and end 3 months after delivery.

A client with a first-degree tear and swollen perineum is 28 hours postpartum when she requests assistance with her first sitz bath. Which intervention by the nurse is necessary at this time?

Requesting that the client call for assistance to walk back to bed when she's finished with the sitz bath

Lochia Ruba

Deep red, bloody discharge postpartum 1-3 days. It hold mucous, endometrial lining increases with breast feeding

What is the most likely reason for a temperature of 99.8° F (37.7° C) during the first 24 hours postpartum?

Dehydration

The nurse is preparing to provide contraceptive counseling for a young client. What should the nurse plan to do first?

Explore her own personal beliefs and feelings about contraception.

Degrees of lacerations to the vagina during childbirth

First degree: affected areas are the superficial vaginal mucosa. Perineal skin is torn or cut Second degree: affected areas are: the superficial vaginal mucosa, perineal skin, deep tissue, and muscles of the perineum (maybe) Third degree: Affected areas are: same as 2nd, adding the anal sphincter Fourth Degree: Same as 3rd, also involves rectal mucosa

Three hours after birth, a client becomes weak and dizzy as she attempts to ambulate for the first time. The client's hemoglobin level at the end of pregnancy was 10.4 g/dl. Two hours later she asks to use the bathroom. Which nursing intervention is the top priority?

Obtaining the assistance of a second nurse before attempting to assist the client with ambulation

As a postpartum client adapts to her maternal role, she progresses through several phases. During which phase does she begin to accept the neonate as a separate individual?

Letting-go phase

On her 3rd postpartum day, a client complains of chills and aches. Her chart shows that she has had a temperature of 100.6° F (38.1° C) for the past 2 days. The nurse assesses foul-smelling, yellow lochia. What do these findings suggest?

Localized infection

if mother is to recieve both of these drugs than the second is not given for 3 months due to drug interaction

Rhogam and rubella vaccine

Lactation

Secretion of milk

Decidua

The endometrial lining of the uterus during pregnancy. Postpartum, all lining but the innermost is shed

During the postpartum period, the nurse should assess for signs of normal involution. Which of the following would indicate that the client is progressing normally?

The uterus is descending at the rate of one fingerbreadth per day.

As part of the postpartum follow-up, the nurse calls a new mother at home a few days after discharge. The client answers the telephone, begins to cry, and tells the nurse that she has feelings of inadequacy and isn't coping with the demands of motherhood. Based on this information, which of the following assessments would the nurse make?

This is expected behavior for a client 3 to 7 days postpartum.

Which finding would lead the nurse to suspect that a client has developed hypovolemic shock caused by postpartum hemorrhage?

Urine output less than 25 ml/hour

what are 4 tactics to suppress lactation and promote bottle feeding

breast binder, avoid heat, apply ice packs for 20 minutes x 4/day, demand feedings q 3-4 hrs

what are the 9 assessment targets postpartum mother

breast, utterus, bladder, bowel, lochia, episiotomy, homans sign, emotion, bonding

A postpartum client requires teaching about breast-feeding. To prevent breast engorgement, the nurse should instruct her to:

breast-feed every 1½ to 3 hours.

what type of bleeding is reported to report to health care

bright red blood one pad and hour or large clots

Normal lochial findings during the first 24 hours following delivery include:

bright red blood. (lochia rubra)

separation of rectus muscles of abdomen may improve with exercise or physical condition

diastasis recti

what are several factors that slow involution

difficult labor, anesthesia, grand multiparity, full urinary bladder, infection, uterus distention

Engorgement

edema of breast tissue do to milk increase

Oxytocin

hormone released by POSTERIOR PITUITARY. causes an increase in uterine contractions and causes milk ducts to release milk

what amount of lochia is expected for cesaerean

less lochia than vaginal birth

ten days to 6 weeks postpartum mothering established and sees infant as a unique person

letting go phase

yellow white discharge with stale odor 11-21 days or upto 6 weeks if lactacting

lochia alba

dark red bloody fleshy musty stale with nickel size clots occur within 1-3 days post delivery

lochia rubra

One day after a client gives birth, the nurse performs a postpartum assessment. At this time, the nurse expects to find:

lochia rubra.

pink brownish watery odorless discharge 4-10 days post delivery

lochia serosa

when should a couple resume sex postpartum

lochia stopped, episiotomy healed, usually 3 weeks postpartum

what is avoided on nipples for breast care of lactating or breastfeeding mother

no soap

normal pulse postpartum may be 50-80 bpm. if pulse is greater than 100 what should be done

report to health care provider

what are 5 side effects of morphine epidural

respiratory depression, NV, itching, urinary retention, somnolence(drowsiness)

increased bladder size and decreased tone causes this risk postpartum

retention and infection

give this vaccine to mother to avoid fetal malformations if disease is contracted during future pregnancy

rubella vaccine

Lochia Alba

scant, yellow or white in color discharge that is seen from days 11-21 postpartum and contains mostly leukocytes

perineal care after every eliminations of postpartum to avoid infection

squirt warm water and blot front to back, perineal pad

During the first formula feeding, a client has difficulty getting her neonate to take the artificial nipple into his mouth. To resolve this problem, the nurse should suggest that the mother:

stroke the neonate's lips gently with the nipple.

what is contraindicated for postpartum if has a 3rd or 4th degree perineal laceration involving rectum

suppositories

third to tenth day postpartum, obsessed with body functions, mood swings, anticpates

taking hold phase

what to teach client if boggy uterus

teach self massage of uterus

what are the 4 factors that enhance involution

uncomplicated labor, breastfeeding, early ambulation, complete expulsion of placenta and membranes

what type of urinary signs should be reported

urinary retention, burning, urgency or frequency

continue prenatal vitamins with iron as ordered and iron is best absorbed in the presence of this vitamin

vitamin C

A postpartum client decides to bottle-feed her neonate. To prevent breast engorgement, the nurse should recommend that she:

wear a supportive, well-fitting brassiere.

when should mother void postpartum

within 6-8 hours postpartum

if mother Rh negetive and baby Rh positive then Rhogam is given 300 mcg IM within this time frame postpartum

within 72 hours of delivery

The physician prescribes phytonadione (AquaMEPHYTON), 0.5 mg I.M., for a neonate born 30 minutes ago. The nurse has a solution containing 2 mg/ml. How many milliliters of solution should the nurse administer to achieve this dose?

0.25

Lochia normally progresses in which of the following patterns?

1.Rubra (first 3-4 days small to moderate amount contains mostly blood fleshy odor), 2. Serosa (occurs days 4-10 decreases to small amount brownish or pinkish in color) 3.Alba (occurs after day 10 becomes white or pale yellow, bleeding has stopped and discharge is composed of mostly WBCs

A client has just begun taking an oral contraceptive that contains estrogen and progestin. The nurse should explain that full contraceptive benefits won't occur until the client has taken the drug for at least:

10 days.

At her follow-up examination, a client who's 6 weeks postpartum tells the nurse that she's exhausted and sore from breast-feeding and wants to formula-feed her baby. She also mentions that she feels like a failure and finds it increasingly difficult "just to get out of bed in the morning." Which intervention should the nurse attempt before notifying the physician?

Acknowledging the client's feelings, asking about other life stressors, and identifying the client's support system

One day after having a cesarean birth, a client complains of incisional pain that she rates as a 3 on a 1-to-10 scale, with 10 representing the most severe pain. The physician prescribed ibuprofen (Motrin), 400 mg by mouth every 4 to 6 hours, as needed. Which intervention should the nurse take when administering this drug?

Administer the drug with meals or milk.

A breast-feeding client is diagnosed with mastitis. Which nursing intervention would be most helpful to her?

Advising her to massage the affected area gently while breast-feeding

Breasts and nipple assessment

Look for reddness, cracked, bruising, blistering, bleeding, inverted nipples, palpable masses physiologic breast engorgement: just engorged Pathologic engorgement: swollen, red, painful, warm or hot to touch Mastitis: pathological engorgement, infection of breast tissue Cholostrum: first milk out of breast, contains ImG and imA to prevent infection of baby

On a client's first postpartum day, nursing assessment reveals vital signs within normal limits, a boggy uterus, and saturation of the perineal pad with lochia rubra. Which nursing intervention takes highest priority?

Massaging the uterus gently

Integumentary system during involution

Melasma, Chloasma (mask of pregnancy)- discoloration of the face due to increase in pigmentation (melanocyte production increased) Linea Negra- Dark brown line down middle of abdomen Spider nevi- Bursted blood vessels Palmar Erythema- Red, swollen palms Striae Gravidarum (stretch marks)- red during pregnancy, fade to white/silver Hair Loss

Postpartum assessment- immune system

Mild increase in temperature, however if temp is 100.4 or greater two days in a row, concern of postpartal infection Elevate need for RhoGAM and Rubella -if mother is Rh-negative, give IM injection within 72 hours of birth -if not immune to Rubella (no rubella antibodies), give IM injection after childbirth

When caring for a client who has had a cesarean section, which of the following actions is appropriate?

Monitoring pain status and providing necessary relief

what three meds are given postpartum as oxytocic medications which will increase uterine contractions for involution

Pitocin, methergine, ergotrate

Renal system during involution

Takes 4-6 weeks for kidneys to return to pre-pregnancy state Inabilty to void is common, bladder tone and sensation is dereased Diuresis causes mom to void 3000ml a day Make sure patient voids before checking funds. Full bladder causes displacement. Distended bladder causes it to be displaced up and to the R Distended bladder can cause cystitis (UTI) Hemorrhage can occur due to distended bladder: uterine ligaments that were attatched during pregnancy allow the uterus to be displaced upward and laterally, causing atony of uterus and blood will pool.

puerperium

The 4th trimester. Occurs from the end of childbirth until involution is complete

Which of the following correctly defines puerperium?

The 6 weeks following birth

The nurse is collecting data on a neonate. Which finding indicates that the neonate's fontanels are normal?

They're soft to touch.

teach client to avoid pregnancy for this time frame postpartum after vaccination, rubella vaccine contains live virus and adversly affect fetus

avoid pregnancy for three months

The nurse is teaching a client about oral contraceptive therapy. If a client misses three or more pills in a row, the nurse should instruct her to:

discard the pack, use an alternative contraceptive method until her menses begins, and start a new pack on the regular schedule.

keep the bladder full or empty postpartum?

empty bladder

what hormones drop postpartum rapidly from delivery of placenta

estrogen and progesterone drop

how often should postpartum pt. urinate even if no feeling to

every 2-3 hours

what temperature should be reported postpartum

greater than 100.4 or chills

what position should the maternal head be postpartum assessment

head flat for most accurate findings

A client who delivered her first child 6 weeks ago seems overwhelmed by her new role as a mother. She tells the nurse, "I can't keep up with my housework any more because I spend so much time caring for the baby." The nurse should:

help the client break down large tasks into smaller ones.

reduction in uterine size after delivery caused by uterine contractions to constrict placental site

involution

ovulation and menstruation return is prolonged due to these to factors

lactating and breastfeeders

oral contraceptives containing estrogen may interfere with this postpartum process

lactation

prolactin is released which causes this effect of release of milk by alveoli contractions in the breast

let-down reflex

maternal adjustment reaction of transient depression on 2nd or third day postpartum, related to hormone changes and stress

postpartum blues

colostrum is first milk secreted and is rich in these two nutrients

protein and immunoglobulins

A client is taking a progestin-only oral contraceptive, or minipill. Progestin use may increase the client's risk of:

tubal or ectopic pregnancy.

this should be placed if cesarean delivery for 12-24 hours pospartum

urinary catheter

Neurological system during involution

Anesthesia and analgesia temporary cause dizziness, disorientation, decreased sensation, headache, nausea. *frontal headache is normal, severe headaches are not common-caused by a puncture of the spine Postpartal chills- freezing, shaking, normal response of CNS Pain- drug of choice is percicet and tramadol

What happens to the cervix during involution

Cervix is permanently changed after childbirth. it will now look slit-like rather than oval or circular. if there are cervical lacerations, the cervix will appear lopsided

A 28-year-old woman gave birth 1 hour ago to a full-term baby boy. Which finding should the nurse expect when palpating the client's fundus?

Firm, at the level of the umbilicus

The nurse explains to new parents the importance of maintaining their infant's safety during hospitalization. Which action best ensures the infant's safety?

Instructing the mother to notify staff when she showers to avoid leaving the infant unattended

Musculoskeletal system during involution

Muscle fatigue and aches Hip and joint pain Abdominal skin and musculature are loose and flabby diastasis recti abdominis Striae will fade but will never go away

Involution

Process of postpartum body going back to its original pre pregnancy state. Retrogressive changes that return reproductive organs to nonpregnant size and condition

Fundus

Top of the uterus where the fetus developed

Atony

When the uterus is not contracting (absence)

After delivering her second baby, the client tells the nurse that she wants to breast-feed this baby. She indicates that she was unsuccessful at breast-feeding her first child and that she bottle-fed after 3 days of trying to nurse. Which of the following responses would best support this client's breast-feeding efforts?

"It's important to room-in with your newborn so that you can respond to her nursing cues."

(SELECT ALL THAT APPLY) The nurse observes several interactions between a mother and her new son. Which of the following behaviors by the mother would the nurse identify as evidence of mother-neonate attachment?

(1) Talks and coos to her son, (2) Cuddles her son close to her

advise mother to nurse for this amount of time on first breast and until infant lets go of second

10-15 minutes

The nurse is assessing the psychosocial status of a postpartum client. Which finding is most likely to promote parent-neonate attachment?

Sustained parent-neonate contact immediately after delivery

A client who has received a new prescription for oral contraceptives asks the nurse how to take them. Which of the following would the nurse instruct the client to report to her primary health care provider?

Blurred vision and headache

GI system during involution

Bowel tone is sluggish due to progesterone. First stool within 2-3 days Perineal trauma, episiotomy and hemorrhoids cause discomfort and pain ambulate and give stool softeners and laxatives

The cardiovascular system during involution

Cardiac output increases for 48 hours postpartum but gradually decreases and returns to normal 6-12 weeks after childbirth Plasma volume causes the body to get rid of extra fluid. Causes diuresis (urinary output) and diaphoresis (sweating) Coagulation factors are increased during pregnancy and immediately postpartum, causing an increased risk of thromboembolisms. Takes 3-4 weeks to return to normal WBC increased to prevent infection, and due to imflammation and pain (14-16,000 but can go up to 30,000) should return to normal within 4-7 days Hemoglobin and Hematocrit are low but should return to normal within 4-8 days average blood loss in vaginal birth is 200-500ml, and ~1000ml for cesarian

A client delivered a healthy full-term baby girl 2 hours ago by cesarean section. When assessing this client, which finding requires immediate nursing action?

Tachycardia and hypotension

Lochia serosa

Pink, brown, scant discharge that has fleshy odor and is seen 4-10 days postpartum. Increases during activity. contains serous exudate, blood, and leukocytes

While preparing a client for a postpartum tubal ligation, the nurse overhears the client tell her husband that they can always have reversal surgery if they decide they want more children in the future. Which intervention by the nurse is best?

Privately discussing with the client her understanding of the procedure

Factors that delay uterine involution

Prolonged labor Anesthesia Difficult delivery Grandmultiparity (more than one baby) Multiple fetuses Retained placenta parts Full bladder/ urinary retention

A client who is breast-feeding her infant is experiencing breast engorgement. The nurse suggests breast pumping to relieve the breast engorgement. Which instruction should the nurse provide?

Pump each breast for at least 10 minutes every 3 to 4 hours; pump at night only if she's awake.

A postpartum client is ready for discharge. During discharge preparation, the nurse should instruct her to report which of the following to her primary health care provider?

Redness, warmth, and pain in the breasts

Diastasis Recti

Seperation of longitidinal abdominal muscles during pregnancy

Breast engorgement occurs on the second or third postpartum day. Which of the following processes causes engorgement?

Vasodilation, which causes the breast to feel full

A client is receiving oxytocin (Pitocin) to treat postpartum hemorrhage. When planning the client's care, the nurse anticipates monitoring for which common adverse reactions?

Hypertension and tachycardia

The nurse is providing teaching to a client who's being discharged after delivering a hydatidiform mole. Which expected outcome takes highest priority for this client?

"Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative."

After a vaginal delivery, a postpartum client complains of perineal discomfort when sitting. To promote comfort, the nurse should provide which instruction?

"Contract your buttocks before sitting or rising."

The nurse demonstrates bathing of a neonate to a primiparous client. Which statement by the client indicates understanding?

"I'm going to bathe the baby in the kitchen because it's nice and warm there."

A postpartum client who is bottle-feeding her neonate asks the nurse when she can expect her menstrual period to return. How should the nurse respond?

"In 7 to 9 weeks"

On the second postpartum day, a client tells the nurse she feels anxious and tearful. Which response by the nurse would be appropriate?

"It isn't unusual to have those feelings after delivery."

The mother of a neonate expresses concern about how she'll continue to breast-feed when she returns to work in 6 weeks. What is the best response by the nurse?

"You can continue breast-feeding after you go back to work. You can pump your breasts and put the milk in a bottle."

(SELECT ALL THAT APPLY) On examining a client who gave birth 3 hours ago, the nurse finds that the client has completely saturated a perineal pad within 15 minutes. Which of the following actions should the nurse take?

(2) Assess the client's vital signs., (3) Palpate the client's fundus.

(SELECT ALL THAT APPLY) The nurse is instructing the client on breast-feeding. Which instructions should she include to help the mother prevent mastitis?

(2) Change the breast pads frequently., (3) Expose your nipples to air part of each day., (4) Wash your hands before handling your breast and breast-feeding., (6) Release the baby's grasp on the nipple before removing him from the breast.

When caring for a client who has recently delivered, the nurse assesses the client for urinary retention with overflow. Which of the following descriptions provides an accurate picture of retention with overflow?

A varying urge to urinate with an average output of 100 ml

The client has just given birth to her first child, a healthy, full-term baby girl. The client is Rho(D)-negative and her baby is Rh-positive. What intervention will be performed to reduce the risk of Rh incompatibility?

Administration of Rho(D) immune globulin I.M. to the mother within 72 hours

The nurse is planning to discharge a 24-year-old gravida 1, para 1, non-English-speaking Hispanic client. The client's English-speaking cousin is acting as a translator for the nurse and client. Which nursing intervention takes priority?

Arranging for a home care nurse to assess the client in her home environment

A client who delivered by cesarean birth 3 days ago is bottle-feeding her neonate. While the nurse collects data, the client complains that her breasts are painful, hard, and warm to the touch. How should the nurse intervene?

Apply an elastic bandage to bind the breasts.

The nurse is caring for a client who just delivered triplets. Which intervention by the nurse is most important?

Assessing fundal tone and lochia flow

The nurse understands that measures are necessary to contain health care costs. Which intervention demonstrates effective resource management?

Assigning the nurse's aide to deliver meal trays and to stock rooms; assigning the licensed practical nurse to collect assessment data

A client is resting comfortably 4 hours after delivering her first child. When measuring her heart rate, the nurse expects which normal finding?

Bradycardia

A client gives birth to a stillborn neonate at 36 weeks' gestation. When caring for this client, which strategy by the nurse would be most helpful?

Encourage the client to see, touch, and hold the dead neonate.

(SELECT ALL THAT APPLY) A client is at risk for which postpartum complication during the fourth stage of labor?

Hemorrhage

In the fourth stage of labor, a full bladder increases the risk of which postpartum complication?

Hemorrhage

When assessing a postpartum client, the nurse notes a continuous flow of bright red blood from the vagina. The uterus is firm and no clots can be expressed. Which action should the nurse take?

Notify the physician.

A licensed practical nurse (LPN) who typically works in the neonatal intensive care unit is being cross-trained to work with postpartum clients. The charge nurse is busy with a delivery and assigns her to stock rooms, which is typically the responsibility of a nurse's aid. As she enters a client's room, the LPN notices that a client looks pale and shaky. Which action should she take?

Obtain a set of vital signs, check the client's fundus and flow, and compare the findings to baseline data.

A client is at the end of her 1st postpartum day. When assessing her uterus, the nurse expects to find the top of the fundus at the midline and at which position?

One fingerbreadth below the umbilicus

A 41-year-old multipara client had a spontaneous vaginal delivery of an 8-lb (3,629-g) baby 3 hours ago. The nurse collects the following data: "Fundus firm, three fingerbreadths above the umbilicus and deviated to the right. Perineal pad saturated after 20 minutes." Which nursing intervention by the licensed practical nurse (LPN) is best?

Reminding the client to void and helping her to the bathroom

The nurse is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client?

Risk for deficient fluid volume related to hemorrhage

A breast-feeding baby will turn his head toward the mother's breast in a natural instinct to find food. What is the name of this reflex?

Rooting reflex

The nurse assesses a client who gave birth 24 hours earlier. Which of the following findings reveals the need for further evaluation?

Scant lochia rubra

A multiparous client with pelvic thrombophlebitis is being treated with bed rest and anticoagulant therapy. The nurse should call for assistance immediately if the client experiences which symptom?

Sudden onset of shortness of breath

Which of the following options is the most important aspect of nursing care in the postpartum period?

Supporting the mother's ability to successfully feed and care for her infant

The nurse is reviewing the history of a postpartum client. Which history factor strongly suggests that this client will experience afterpains?

The client is a gravida 6, para 5.

A client, age 22, is a gravida 1, para 0. During the first 24 hours after delivery, she doesn't show consistent interest in her neonate. How should the nurse interpret her behavior?

The client is showing expected behaviors for the taking-in period.

A clinical pathway is guiding care for an Rh-negative postpartum client who vaginally delivered a 9-lb, 1-oz (4,121-g) baby 5 hours ago. During the delivery, a second-degree median episiotomy was necessary. Which client outcome should be achieved during the first 12 hours postpartum?

The client will verbalize and demonstrate appropriate self-perineal care.

The nurse is discharging a 34-year-old multipara client who, after 16 hours of labor, delivered an 8-lb, 14-oz (4,032-g) baby vaginally. The nurse notes that the mother is rubella-immune with Rh-positive blood. Which client outcome takes priority for this client?

The client will verbalize the importance of reporting changes in lochia flow.

The nurse is teaching a postpartum client how to perform Kegel exercises. What is the purpose of these exercises?

To strengthen the perineal muscles

A client who is breast-feeding her baby experiences pain, redness, and swelling of her left breast 9 days postpartum. She is diagnosed with mastitis. The nurse teaching the client how to care for her infected breast should include which information?

Use a warm, moist compress over the painful area.

A client's neonate was delivered by cesarean. Which management strategy should be implemented regarding breast-feeding after this type of delivery?

Use the football hold to avoid incisional discomfort.

The nurse is teaching a client how to perform perineal care to reduce the risk of puerperal infection. Which activity indicates that the client understands proper perineal care?

Using a peri bottle to clean the perineum after each voiding or bowel movement

The nurse visits a client at home on the tenth postpartum day. When assessing the client's uterus, the nurse expects to find:

a nonpalpable fundus in the abdomen.

A client asks the nurse about the rhythm (calendar-basal body temperature) method of family planning. The nurse explains that this method involves:

determination of the fertile period to identify safe times for sexual intercourse.

Which physiologic response should the nurse expect during the early postpartum period?

diuresis

A client says she wants to practice natural family planning. The nurse teaches her how to use the calendar method to determine when she's fertile and advises her to avoid unprotected intercourse. When teaching her how to determine her fertile period, the nurse should instruct her to:

subtract 18 days from her shortest menstrual cycle and 11 days from her longest cycle.