Postpartum at Risk
A primigravid client at 41 weeks' gestation is admitted to the hospital's labor and birth unit in active labor. After 25 hours of labor with membranes ruptured for 24 hours, the client gives birth to a healthy neonate vaginally with a midline episiotomy. Which problem should the nurse identify as the priority for the client?
risk of infection
A client gave birth to a healthy full-term girl 2 hours ago by cesarean birth. When assessing this client which finding requires immediate nursing action?
tachycardia and hypotension
A multiparous client whose fundus is firm and midline at the umbilicus 8 hours after a vaginal birth tells the nurse that when she ambulated to the bathroom after sleeping for 4 hours, her dark red lochia seemed heavier. Which information would the nurse include when explaining to the client about the increased lochia on ambulation?
The increased lochia occurs from lochia pooling in the vaginal vault.
After instructing a primiparous client about episiotomy care, which client statement indicates successful teaching?
"I wipe front to back in a blotting motion"
In developing a plan of care for the client who has just given birth to a 7-lb (3,175-g) baby, the nurse reviews her prenatal, labor, and birth records. Which data in the client's record would alert the nurse to the possibility of a problem?
perineal laceration
In the fourth stage of labor, a full bladder increases the risk of what postpartum complication?
hemorrhage
The nurse is caring for a client with a diagnosis of early postpartum hemorrhage. Which would not be a priority action at this time?
Assess the number of perineal pads used during the past shift.
The nurse is caring for a client who is 2-hours post-partum and experienced a fourth-degree vaginal laceration. Which intervention should the nurse teach the client is contraindicated at this time?
Frequent Kegel exercises
The nurse assesses a client during the third stage of labor. Which assessment findings indicate that the client is experiencing postpartum hemorrhage?
Heart rate 120 beats/minute, respiratory rate 28 breaths/minute, blood pressure 80/40 mm Hg
s part of the postpartum follow-up, a 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 assessment would the nurse make?
This is expected behavior for a client 3 to 7 days postpartum.
A client is 9 days postpartum and breast-feeding her neonate. The client experiences pain, redness, and swelling of her left breast and 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.
The nurse plans care for four mothers and their newborns. After reviewing the clients' medical records, the nurse should make rounds on which client first?
a 35-year-old G4 P4 with an uncomplicated vaginal birth 4 hours ago; the nurse's notes indicated she soaked two peripads over the last 2 hours; fundus is firm
The nurse is caring for a primipara who gave birth 12 hours ago. The client says, "Look at all of the beautiful things my family brought for the new baby." The nurse should become concerned if the client has received which gift?
a pillow in the neonates crib
A client is recovering in the labor and delivery area after giving birth to a 6-lb, 3-oz (2,813 g) newborn. On assessment, the nurse finds that the client's fundus is firm and located two fingerbreadths below the umbilicus. Although she didn't have an episiotomy, her perineal pad reveals a steady trickle of blood. What is the probable cause of these assessment findings?
a vaginal laceration
A primigravid client has just completed a difficult, forceps-assisted birth of a 9-lb (4.08-Kg) neonate. Her labor was unusually long and required oxytocin augmentation. The nurse who's caring for her should stay alert for uterine
atony
While caring for a postpartum client who is receiving treatment with bed rest and intravenous heparin therapy for a deep vein thrombosis, the nurse should contact the client's health care provider (HCP) immediately if the client exhibits which symptom?
dysnea
Two hours after a vaginal birth under epidural anesthesia, a client with a midline episiotomy ambulates to the bathroom to void. After voiding, the nurse assesses the client's bladder, finding it distended. The nurse interprets this finding based on the understanding that the client's bladder distention is most likely caused by which factor?
edema in the lower urinary tract area
A postpartum client's husband calls the nurse and says, "My wife feels funny." The nurse enters the room and notes blood gushing from the client's vagina, pallor, and a rapid, thready pulse. What should be the nurse's first intervention?
massage the fundus
A primiparous client who was diagnosed with hydramnios and breech presentation while in early labor is diagnosed with early postpartum hemorrhage at 1 hour after a cesarean birth. The client asks, "Why am I bleeding so much?" The nurse responds based on the understanding that the most likely cause of uterine atony in this client is which factor?
overdistention of the uterus from hydramnios
Following a cesarean birth, what should the nurse do first?
palpate the fundus
Three hours postpartum, a primiparous client's fundus is firm and midline. On perineal inspection, the nurse observes a small, constant trickle of blood. Which condition should the nurse assess further?
perineal lacerations
A nurse is providing care for a postpartum client. Which condition increases this client's risk for a postpartum hemorrhage?
placenta previa
A client at 4 weeks postpartum tells the nurse that she cannot cope any longer and is overwhelmed by her newborn. The baby has old formula on her clothes and under her neck. The mother does not remember when she last bathed the baby and states she does not want to care for the infant. The nurse should encourage the client and her husband to call their health care provider (HCP) because the mother should be evaluated further for which complication?
postpartum depression
The nurse makes a home visit to a primigravid client on the fourth postpartum day after birth of a term neonate. When the nurse enters the house, the nurse finds the client sitting in a chair, crying inconsolably, while the neonate is crying in another room. The client tells the nurse that she has not been sleeping well and has been hearing voices. The nurse determines that the client is most likely experiencing which condition?
postpartum psychosis
A 34-year-old primigravid client at 39 weeks' gestation admitted to the hospital in active labor has type B Rh-negative blood. The nurse should instruct the client that if the neonate is Rh positive, the client will receive an Rh immune globulin injection for what reason?
to prevent Rh-positive sensitization with the next pregnancy
The physician orders docusate sodium 100 mg at bedtime for a primiparous client after vaginal delivery of a term neonate after a midline episiotomy. The nurse instructs the client to expect which of the following results from taking the medication?
softening of the stool
A client with a past history of varicose veins has just given birth to her first neonate. The nurse suspects that the client has developed a pulmonary embolus. Which findings support the nurse's suspicion? Select all that apply.
sudden dyspnea diaphoresis confusion
The nurse is caring for a 22-year-old G2, P2 client who has disseminated intravascular coagulation after delivering a dead fetus. Which finding is the highest priority to report to the health care provider (HCP)?
urinary output of 25 mL in the past hour
A client with gestational diabetes had a cesarean birth because the fetus was determined to be large for gestational age. The nurse should assess for which postsurgical complications? Select all that apply.
wound-edge separation fever after the first 24 hours postpartum lochia odor purulent drainage from incision
