OB Chapt. 22 Nursing Management of the Postpartum Woman at Risk

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 of the following is the most likely cause of this postpartum hemorrhage? a) Cervical laceration b) Retained placental fragment c) Disseminated intravascular coagulation d) Uterine atony

Cervical laceration Explanation: Lacerations of the cervix are usually found on the sides of the cervix, near the branches of the uterine artery. If the artery is torn, the blood loss may be so great that blood gushes from the vaginal opening. Because this is arterial bleeding, it is brighter red than the venous blood lost with uterine atony. Fortunately, this bleeding ordinarily occurs immediately after detachment of the placenta, when the primary care provider is still in attendance. Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, but there is no evidence for this in the scenario.

After teaching a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful? a) "Postpartum psychosis usually appears soon after the woman comes home." b) "Postpartum depression develops gradually, appearing within the first 6 weeks." c) "Postpartum psychosis usually involves psychotropic drugs but not hospitalization." d) "Postpartum blues usually resolves by the 4th or 5th postpartum day."

"Postpartum depression develops gradually, appearing within the first 6 weeks." Correct Explanation: Postpartum depression usually has a more gradual onset, becoming evident within the first 6 weeks postpartum. Postpartum blues usually peaks on the 4th to 5th postpartum day and resolves by the 10th day. Postpartum psychosis generally surfaces within 3 weeks of giving birth. Treatment typically involves hospitalization for up to several months. Psychotropic drugs are almost always a part of treatment, along with individual psychotherapy and support group therapy.

A nurse is assigned to care for a client with deep vein thrombosis who has to undergo anticoagulation therapy. Which of the following instructions should the nurse offer the client as a caution when the client receives anticoagulation therapy? a) Refrain from performing any leg exercises b) Avoid products containing aspirin c) Avoid prolonged straining during defecation d) Sit with legs crossed over each other

Avoid products containing aspirin Correct Explanation: The nurse should caution the client to avoid products containing aspirin, which inhibits the synthesis of clotting factors and can further prolong clotting time and precipitate bleeding. The nurse should instruct the client to avoid crossing the legs as a preventive measure. The nurse should not instruct the client to refrain from performing any leg exercises; instead the nurse should instruct the client to perform leg exercises such as flexion and extension of the feet and pushing the back of the knees into the mattress and then flexing slightly to promote venous return. The nurse should instruct the client to avoid prolonged straining during defecation and to avoid heavy lifting and exercises when caring for a client with cystocele and rectocele

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

Check for bladder distention, while encouraging the client to void Explanation: 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 should place the client in a semi-Fowler's position to encourage uterine drainage in the client with postpartum endometritis. The nurse should offer analgesics as prescribed by the primary care provider to minimize perineal discomfort in clients experiencing postpartum lacerations.

Two weeks after their baby is born, Tom calls to report that his wife Sylvia is behaving strangely. She is extremely talkative and energetic and he has not observed her sleeping for more than an hour or two at a time. She is also forgetting to eat and neglecting her appearance, but worse, she seems to barely be aware of the baby's needs and appears surprised when Tom asks her about the child, "As if," Tom says, "she's forgotten that we even have a baby!" You tell him to bring her in right away, because you suspect Sylvia is suffering from what condition? a) Maladjustment b) Postpartum psychosis c) Postpartum blues d) Postpartum depression

Postpartum psychosis Explanation: Postpartum psychosis can present with a patient in extreme mood changes and odd behavior. Her sudden change in behavior from normal and lack of self care and care for the infant are a sign of psychosis and need to be assessed by a provider as soon as possible. Postpartum depression affects the woman's ability to function; however, her perception of reality remains intact. Postpartum blues is a transitory phase of sadness and crying common among postpartum women. Maladjustment is a distracter for this question

A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which of the following conditions? a) Postpartum depression b) Postpartum blues c) Postpartum panic disorder d) Postpartum psychosis

Postpartum psychosis Explanation: The client's signs and symptoms suggest that the the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the infant, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that her life is rapidly tumbling out of control. The client thinks of herself as an incompetent parent. Emotional swings, crying easily--often for no reason, and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristics of postpartum blues.

A fundal massage is sometimes performed on a postpartum woman. Which of the following is a reason for performing a fundal massage? a) Uterine subinvolution b) Uterine contraction c) Uterine prolapse d) Uterine atony

Uterine atony Explanation: Fundal massage is performed for uterine atony, which is failure of the uterus to contract and retract after birth. The nurse would place the gloved dominant hand on the fundus and the gloved nondominant hand on the area just above the symphysis pubis. Using a circular motion, the nurse massages the fundus with the dominant hand. Then the nurse checks for firmness and, if firm, applies gentle downward pressure to express clots that may have accumulated. Finally the nurse assists the woman with perineal care and applying a new perineal pad.

Jerry, who is hypertensive and who received corticosteroids during pregnancy, delivered by cesarean and subsequently developed endometritis. Her incision is red, warm, and very sensitive to touch, and she remains febrile despite antibiotic therapy. What is the most important aspect of post hospital care to teach her? a) Wound care and hand washing b) Use of warm compresses and sitz baths c) Proper perineal care d) Strict adherence to antibiotic therapy

Wound care and hand washing Correct Explanation: The use of systemic corticosteroids prior to delivery has increased her risk for development of an infection. She has been treated for endometritis and is now at greater risk for infection. Hand washing is the best defense again transmission of any infection. While adherence to antibiotic therapy, proper perineal care, and use of warm compresses and sitz baths may be indicated, they would not be a higher priority than wound care and hand-washing.

On the third day postpartum, which temperature is internationally defined as a postpartal infection? a) 104.2°F (40.1°C) b) 99.6°F (37.5°C) c) 102.4°F (39.1°C) d) 100.4°F (38°C)

100.4°F (38°C) Explanation: A temperature over 100.4°F (38°C) past the first day postpartum is suggestive of infection

A client has had a cesarean birth. Which of the following amounts of blood loss would the nurse document as a postpartum hemorrhage in this client? a) 500 ml. b) 250 ml. c) 750 ml. d) 1000 ml.

1000 ml. Explanation: Postpartum hemorrhage is defined as blood loss of 500 ml or more after a vaginal birth and 1000 ml or more after a cesarean birth.

Which of the following behaviors exhibited by a 4-hour postpartum woman requires further interventions by the nurse? a) Returns her son to the nursery because of fatigue. b) Absent verbalization about the birthing process. c) Cuddles her son close to her while feeding. d) Tells visitors about her son and the labor.

Absent verbalization about the birthing process. Correct Explanation: After delivery the woman would be excited and interested in the delivery and the infant. A woman may be tired and to ask for sleep is also expected, unexpected is the absent verbalization of the activities and birth. Therefore options A, C, and D are incorrect answers.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? a) Begin an IV infusion of Ringer's lactate solution. b) Assess the woman's vital signs. c) Assess the woman's fundus. d) Call the woman's health care provider.

Assess the woman's fundus. Correct Explanation: To have a suggested idea of the location of the bleeding, the nurse would need to assess the fundus of the patient first.

Which of the following assessments would lead you to believe a postpartal woman is developing a urinary complication? a) Her perineum is obviously edematous on inspection. b) She tells you she is extremely thirsty. c) At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. d) She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart.

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. Correct Explanation: Postpartal women who void in small amounts may be experiencing bladder overflow from retention.

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

Client's temperature remains below 100.4° F or 38° C orally Explanation: As fever would accompany a puerperal infection, a likely expected outcome would be to reduce the client's temperature and keep it in a normal range. The other expected outcomes do not pertain as directly to puerperal infection as does the reduced temperature.

A postpartal woman is developing a thrombophlebitis in her right leg. Which of the following assessments would you make to detect this? a) Bend her knee and palpate her calf for pain. b) Ask her to raise her foot and draw a circle. c) Blanch a toe and count the seconds it takes to color again. d) Dorsiflex her right foot and ask if she has pain in her calf.

Dorsiflex her right foot and ask if she has pain in her calf. Explanation: A Homans' sign (pain in the calf on dorsiflexion of the foot) is a common assessment for thrombophlebitis in conjunction with assessing for edema and calf redness. Having her raise her foot and draw a circle would not be an assessment for thrombophlebitis in her leg, nor would assessing capillary refill in a toe

Which clinical manifestation in a woman with DVT should you report immediately? a) Edema b) Homan's sign c) Pyrexia d) Dyspnea

Dyspnea Explanation: Dyspnea in any patient with a DVT may be an indicator the clot has moved from the original site to the lungs. This is an emergency. A patient who has a DVT would be expected to have a positive Homan's sign, pyrexia, and edema.

A woman is two weeks postpartum when she calls the clinic and tells the nurse that she has a fever of 101°F. She complains of abdominal pain and a "bad smell" to her lochia. The nurse recognizes that these symptoms are associated with which condition? a) Mastitis b) Endometritis c) Episiotomy infection d) Subinvolution

Endometritis Explanation: The woman with endometritis typically looks ill and commonly develops a fever of 100.4°F (38°C) or higher (more commonly 101°F [38.4°C], possibly as high as 104°F [40°C]) on the third to fourth postpartum day. The rise in temperature at this specific time is the most significant finding. The woman exhibits tachycardia, typically a rise in pulse rate of 10 beats per minute for each rise in temperature of one degree. In addition, the woman may report chills, anorexia, and general malaise. She also may report abdominal cramping and pain, including strong afterpains. Fundal assessment reveals uterine subinvolution and tenderness. Lochia typically increases in amount and is dark, purulent, and foul-smelling. However, with certain microorganisms, her lochia may be scant or absent.

You administer methylergonovine (Methergine) 0.2 mg to a postpartal woman with uterine subinvolution. Which of the following assessments should you make prior to administering the medication? a) She can walk without experiencing dizziness. b) Her blood pressure is below 140/90. c) Her hematocrit level is over 45%. d) Her urine output is over 50 mL/h.

Her blood pressure is below 140/90. Explanation: Methylergonovine elevates blood pressure. It is important to assess that it is not already elevated before administration.

Which assessment on the third postpartal day would make you evaluate a woman as having uterine subinvolution? a) Her uterus is three finger widths under the umbilicus. b) She experiences "pulling" pain while breastfeeding. c) Her uterus is at the level of the umbilicus. d) Her uterus is 2 cm above the symphysis pubis.

Her uterus is at the level of the umbilicus. Explanation: A uterus involutes at a rate of one finger width daily. On the third postpartal day, it is normally three finger widths below the umbilicus

An Rh-positive client vaginally delivers a 6-lb, 10-oz neonate after 17 hours of labor. Which condition puts this client at risk for infection? a) Length of labor b) Size of the neonate c) Method of delivery d) Maternal Rh status

Length of labor Correct Explanation: A prolonged length of labor places the mother at increased risk for developing an infection. The average size of the neonate, vaginal delivery, and Rh status of the client don't place the mother at increased risk

A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? a) Administer amoxicillin, as prescribed b) Obtain a clean-catch urine specimen c) Encourage her to drink large amounts of fluid d) Suggest that she take an oral analgesic

Obtain a clean-catch urine specimen Explanation: The client in this scenario shows classic signs of a urinary tract infection. The priority nursing action at this point is to obtain a clean-catch urine specimen to confirm the infection. The other answers are therapeutic management interventions that would take place after confirmation of the infection via the clean-catch urine specimen.

When assessing the patient for postpartum hemorrhage the nurse monitors which of the following every hour? a) Pad count b) Urine volume excreted c) Complete blood count d) Vital signs

Pad count Correct Explanation: The way to monitor for bleeding every hour is to assess pads and percent of pad saturated by blood in the previous hour. It would not be necessary to do a complete blood count every hour, nor hourly urines. Vital signs are not typically taken every hour.

When providing care for a postpartum patient at a 6 week check-up, which behavior would alert the nurse the patient may have postpartum psychosis? a) Tearful during appointment b) Talkative and asking questions c) Restless and agitated, concerned with self d) States being tired and happy at same time

Restless and agitated, concerned with self Explanation: When a woman has postpartum psychosis the signs may vary but a woman presenting with restlessness, irritability and concerned only for self needs further evaluation. Therefore options A, B, and D are incorrect...

Which recommendation should be given to a client with mastitis who's concerned about breast-feeding her neonate? a) She should stop breast-feeding until completing the antibiotic b) She should continue to breast-feed; mastitis won't infect the neonate c) She should supplement feeding with formula until the infection resolves d) She shouldn't use analgesics because they aren't compatible with breastfeeding

She should continue to breast-feed; mastitis won't infect the neonate Explanation: The client with mastitis should be encouraged to continue breast-feeding while taking antibiotics for the infection. No supplemental feedings are necessary because breastfeeding doesn't need to be altered and actually encourages resolution of the infection. Analgesics are safe and should be administered as needed

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? a) A breast abscess is a common complication of mastitis b) The most common pathogen is group A beta-hemolytic streptococci c) Symptoms include fever, chills, malaise, and localized breast tenderness d) Mastitis usually develops in both breasts of a breast-feeding client

Symptoms include fever, chills, malaise, and localized breast tenderness Correct Explanation: Mastitis is an infection of the breast characterized by flulike symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? a) Hemoglobin level of 12 g/dl b) Moderate amount of lochia rubra c) Thrombophlebitis d) Uterine atony

Uterine atony Explanation: Multiparous women typically experience a loss of uterine tone due to frequent distentions of the uterus from previous pregnancies. As a result, this client is also at higher risk for hemorrhage. Thrombophlebitis doesn't increase the risk of hemorrhage during the postpartum period. The hemoglobin level and lochia flow are within acceptable limits.

A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? a) Uterine bleeding present b) Pain in the lower abdomen c) Foul smelling lochia d) Uterine protrusion into the vagina

Uterine protrusion into the vagina Explanation: To determine if the uterine prolapse in the client is mild or severe, the nurse should assess for uterine protrusion of the cervix and uterus into the vagina. As more of the uterus descends, the vagina becomes inverted. Uterine bleeding, foul-smelling lochia, and pain or tenderness in the lower abdomen are all characteristic manifestations of late postpartum hemorrhage

A nurse discovers a perineal hematoma in a woman who has recently given birth. Which of the following interventions should the nurse make in this case? (Select all that apply.) a) Administer methotrexate b) Apply an ice pack to the site c) Administer a mild analgesic as prescribed d) Administer an antibiotic e) Estimate the size of the hematoma and report it f) Perform fundal massage

• Estimate the size of the hematoma and report it • Administer a mild analgesic as prescribed • Apply an ice pack to the site Explanation: Report the presence of a perineal hematoma, its estimated size, and the degree of the woman's discomfort to her primary care provider. Administer a mild analgesic as prescribed for pain relief. Applying an ice pack (covered with a towel to prevent thermal injury to the skin) may prevent further bleeding. Usually a hematoma is absorbed over the next 3 or 4 days. An antibiotic is not required, as there is no indication of infection. Fundal massage is indicated for uterine atony, and methotrexate is used to destroy retained placental fragments when removal is not possible.

A client who gave birth vaginally 16 hours ago states she doesn't need to void at this time. The nurse reviews the documentation and finds that the client hasn't voided for 7 hours. Which response by the nurse is indicated? a) "I'll contact your physician." b) "If you don't attempt to void, I'll need to catheterize you." c) "It's not uncommon after delivery for you to have a full bladder even though you can't sense the fullness." d) "I'll check on you in a few hours."

"It's not uncommon after delivery for you to have a full bladder even though you can't sense the fullness." Correct Explanation: After a vaginal delivery, the client should be encouraged to void every 4 to 6 hours. As a result of anesthesia and trauma, the client may be unable to sense the filling bladder. It's premature to catheterize the client without allowing her to attempt to void first. There's no need to contact the physician at this time as the client is demonstrating common adaptations in the early postpartum period. Allowing the client's bladder to fill for another 2 to 3 hours might cause overdistention.

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? a) 300 mL b) 250 mL c) 500 mL d) 100 mL

500 mL Explanation: Postpartum hemorrhage is defined as a blood loss of greater than 500 mL after a vaginal birth or more than 1,000 mL after a cesarean birth.

When diagnosed with a deep vein thrombosis, the nurse knows the patient will be treated with which medication? a) Non-steroidal inflammatory b) Anticoagulants c) Narcotic analgesics d) Beta blockers

Anticoagulants Correct Explanation: Anticoagulant therapy is used as the primary treatment option for DVT. This makes options A, C, and D incorrect.

Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? a) Restricting fluids b) Applying ice c) Applying warm compresses d) Administering bromocriptine (Parlodel)

Applying ice Correct Explanation: Ice promotes comfort by decreasing blood flow (vasoconstriction), numbing the area, and discouraging further letdown of milk. Restricting fluids doesn't reduce engorgement and shouldn't be encouraged. Warm compresses will promote blood flow and hence, milk production, worsening the problem of engorgement. Bromocriptine has been removed from the market for lactation suppression.

Which measurement best describes delayed postpartum hemorrhage? a) Blood loss in excess of 500 ml, occurring 24 hours to 6 weeks after delivery b) Blood loss in excess of 300 ml, occurring 24 hours to 6 weeks after delivery c) Blood loss in excess of 1,000 ml, occurring 24 hours to 6 weeks after delivery d) Blood loss in excess of 800 ml, occurring 24 hours to 6 weeks after delivery

Blood loss in excess of 500 ml, occurring 24 hours to 6 weeks after delivery Correct Explanation: Postpartum hemorrhage involves blood loss in excess of 500 ml. Most delayed postpartum hemorrhages occur between the fourth and ninth days postpartum. The most common causes of a delayed postpartum hemorrhage include retained placental fragments, intrauterine infection, and fibroids.

You are caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would you need to assess before the woman ambulates? a) Attachment, lochia color, complete blood cell count b) Blood pressure, pulse, complaints of dizziness c) Height, level of orientation, support systems d) Degree of responsiveness, respiratory rate, fundus location

Blood pressure, pulse, complaints of dizziness Correct Explanation: Continue to monitor the woman's vital signs for changes. If she reports dizziness or light-headedness when getting up, obtain her blood pressure while lying, sitting, and standing, noting any change of 10 mm Hg or more.

The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse most likely expect the culture to reveal? a) Klebsiella pneumoniae b) Gardenerella vaginalis c) Escherichia coli d) Staphylococcus aureus

Escherichia coli Explanation: E. coli is the most common causative organism for urinary tract infections. S. aureus is the most common causative organism for mastitis. G. vaginalis is a common cause of metritis. K. pneumoniae is a common cause of metritis, but some species of Klebsiella may cause urinary tract infections.

The majority of women who experience postpartal psychosis had no symptoms of mental illness before pregnancy. a) True b) False

False

Over 75% of women who give birth experience postpartum depression. a) True b) False

False Explanation: Although almost every woman notices some immediate (1 to 10 days postpartum) feelings of sadness (postpartal "blues") after childbirth, these feelings develop into postpartum depression in about 20%

A nurse is assessing vital signs for a postpartum patient 48 hours after delivery. The vital signs are: Temp 101.2F; HR 82; RR 18; BP 125/78. How will the nurse interpret the vital signs? a) Normal vital signs b) Dehydration c) Infection d) Shock

Infection Explanation: Temperatures elevated above 100.4F 24 hours after delivery are indicative of possible infection. All but the temperature for this patient are within normal limits, so they are not indicative of shock or dehydration

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 of the following would the nurse suspect? a) Laceration b) Hematoma c) Uterine atony d) Uterine inversion

Laceration Correct Explanation: 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.

When monitoring a postpartum client 2 hours after delivery, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? a) Performing bimanual compressions b) Massaging the fundus firmly c) Notifying the primary health care provider d) Administering ergonovine (Ergotrate)

Massaging the fundus firmly Correct Explanation: Initial management of excessive postpartum bleeding is firm massage of the fundus and administration of oxytocin (Pitocin). Bimanual compression is performed by a primary health care provider. Ergotrate should be used only if the bleeding doesn't respond to massage and oxytocin. The primary health care provider should be notified if the client doesn't respond to fundal massage, but other measures can be taken in the meantime.

The nurse is assessing the breast of a woman who is 1 month postpartum. The woman is complaining of a painful area on one breast with a red area. The nurse notes a local area on one breast, red and warm to touch. Which of the following should the nurse suspect is the potential diagnosis? a) Plugged milk duct b) Breast yeast c) Mastitis d) Engorgement

Mastitis Correct Explanation: Mastitis usually occurs 2-3 weeks after delivery and is noted to be unilateral. Mastitis needs to be assessed and treated with antibiotic therapy. The scenario described is not indicative of a plugged milk duct or engorgement. Breast yeast is a distracter for this question.

A postpartal woman calls you into her room because she is having a very heavy lochia flow containing large clots. Your first action would be to a) Assess her blood pressure. b) Palpate her fundus. c) Have her turn to her left side. d) Assess her perineum.

Palpate her fundus. Correct Explanation: Palpating the fundus will cause it to contract and reduce bleeding. This makes options A, C, and D incorrect.

Your patient delivered six hours ago. She calls you to her room complaining of pain "deep inside." You medicate her per orders with no relief attained. You check her vital signs and find they are markedly different then when the CNA charted them 30 minutes ago. What would you suspect? a) Uterine laceration b) Late postpartum hemorrhage c) Early postpartum hemorrhage d) Pelvic hematoma

Pelvic hematoma Explanation: A hematoma also can form deep in the pelvis where it is much more difficult to identify. The primary symptom is deep pain unrelieved by comfort measures or medication and accompanied by vital sign instability.

Which of the following instructions should the nurse offer a client as primary preventive measures to prevent mastitis? a) Perform handwashing before breastfeeding b) Avoid massaging the breast area c) Avoid frequent breastfeeding d) Apply cold compresses to the breast

Perform handwashing before breastfeeding Correct Explanation: As a primary preventive measure to prevent mastitis, the nurse should instruct the client to perform good handwashing before breastfeeding. The nurse should instruct the client to frequently breastfeed to prevent engorgement and milk stasis. If the breast is distended before feeding, the nurse should instruct the client to apply cold, not warm, moist heat to the breast. Gently massaging the affected area of the breast also helps.

You are the nurse giving an educational presentation to the local Le Leche league chapter. One woman asks you about mastitis. What would be your best response? a) Risk factors include nipple piercing. b) Risk factors include complete emptying of the breast c) Risk factors include breast pumps. d) Risk factors include frequent feeding.

Risk factors include nipple piercing. Correct Explanation: Certain risk factors contribute to the development of mastitis. These include: inadequate or incomplete breast emptying during feeding or lack of frequent feeding leading to milk stasis; engorgement; clogged milk ducts; cracked or bleeding nipples; nipple piercing; use of plastic-backed breast pads.

Which nursing diagnosis would be most appropriate for a client with a postpartum hematoma? a) Risk for impaired urinary elimination b) Deficient fluid volume c) Ineffective tissue perfusion d) Impaired tissue integrity

Risk for impaired urinary elimination Explanation: In addition to risk for injury and pain, another appropriate nursing diagnosis would be risk for impaired urinary elimination related to pressure from the hematoma on urinary structures. Ineffective tissue perfusion and impaired tissue integrity are nursing diagnoses associated with postpartum lacerations. Deficient fluid volume is a nursing diagnoses associated with postpartum hemorrhage.

Which of the following is the most frequent reason for postpartum hemorrhage? a) Endometritis. b) Uterine atony. c) Perineal lacerations. d) Disseminated intravascular coagulation.

Uterine atony. Correct Explanation: When a uterus does not contract well, the denuded placental surface can bleed excessively. Therefore options A, C, and D are incorrect.

When caring for a client with postpartum blues, which intervention would be most appropriate? a) Validate the client's emotions, allowing her to express them freely b) Administer antidepressants as prescribed to lessen postpartum blues c) Recommend the client to a support group or to a mental health professional d) Avoid allowing contact between the newborn and the client

Validate the client's emotions, allowing her to express them freely Explanation: When caring for a client with postpartum blues, the nurse should validate the client's emotions and allow the client to express them freely. The nurse should not administer antidepressants to the client since these drugs are administered only during depression, postpartum or otherwise. Recommending the client to a support group or a mental health professional is not an appropriate intervention when caring for a client with postpartum blues. The nurse need not avoid contact between the mother who is experiencing postpartum blues and her infant

When assessing a postpartum patient who was diagnosed with a cervical laceration which has been repaired, what sign should the nurse report as a possible development of hypovolemic shock? a) Weak and rapid pulse b) Decreased respiratory rate c) Elevated blood pressure d) Warm and flushed skin

Weak and rapid pulse Correct Explanation: The sign of weak and rapid pulse is the body in compensatory mechanism attempting to increase the blood circulation. This finding needs to be reported to the health care provider and RN as soon as possible. The other options are incorrect.

Mrs. M. and her infant are being discharged home after an unplanned cesarean delivery. You explain to her that she is at a higher risk for postpartum infection than most patients. What is the major risk factor for a post-partum infection? a) Labor less than 12 hours long. b) A nonelective cesarean birth. c) A planned cesarean birth. d) Labor more than 12 hours long.

A nonelective cesarean birth. Explanation: The major risk factor for postpartum infection is a nonelective cesarean birth. Antepartum risk factors include history of infection; history of chronic conditions, such as diabetes, anemia, or poor nutrition; infections of the genital tract; smoking; and obesity

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

Ambulate the client as soon as her vital signs are stable Explanation: The best prevention for a thrombophlebitis is ambulation as soon as possible after recovery. Options A, B, and C are incorrect.

The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? a) Perform the examination as quickly as possible b) Instruct the client to empty her bladder before the examination c) Wear sterile gloves when assessing the pad and perineum d) Place the client in a supine position with her arms overhead for the examination of her breasts and fundus

Instruct the client to empty her bladder before the examination Explanation: An empty bladder facilitates the examination of the fundus. The client should be in a supine position with her arms at her sides and her knees bent. The arms-overhead position is unnecessary. Clean gloves should be used when assessing the perineum; sterile gloves aren't necessary. The postpartum examination shouldn't be done quickly. The nurse can take this time to teach the client about the changes in her body after delivery.

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? a) Staphylococcus aureus b) Streptococcus pyogenes c) Group beta-hemolytic streptococci (GBS) d) Escherichia coli

Staphylococcus aureus Correct Explanation: The most common cause of mastitis is S. aureus, transmitted from the neonate's mouth. Mastitis isn't harmful to the neonate. E. coli, GBS, and S. pyogenes aren't associated with mastitis. GBS infection is associated with neonatal sepsis and death.

Which situation should concern the nurse treating a postpartum client within a few days of delivery? a) The client is nervous about taking the baby home b) The client would like the nurse to take her baby to the nursery so she can sleep c) The client feels empty since she delivered the neonate d) The client would like to watch the nurse give the baby her first bath

The client feels empty since she delivered the neonate Explanation: A client experiencing postpartum blues may say she feels empty now that the infant is no longer in her uterus. She may also verbalize that she feels unprotected now. The other options are considered normal and wouldn't be cause for concern. Many first-time mothers are nervous about caring for their neonates by themselves after discharge. New mothers may want a demonstration before doing a task themselves. A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery