Postpartum

The nurse is teaching a client about oral contraceptive therapy. The client reports missing three doses of the scheduled medication. Which statement made by the client indicates understanding of the teaching regarding oral contraceptives?

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

A primigravida client experiences a normal vaginal birth. The next day, the nurse monitors the client's lochia for color, amount, and the presence of clots. Which finding best describes lochia on the first postpartum day?

dark red, moderate amount, with a few small clots

The nurse is caring for a postpartum client after giving birth to a healthy neonate. When checking the client's fundus, which finding would the nurse most likely note?

fundus 1 cm above the umbilicus 1 hour postpartum

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.

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

Dehydration

One day after a client gives birth, the nurse performs a postpartum assessment. The nurse finds a moderate amount of lochia rubra on the client's perineal pad. Which action should the nurse?

Document this as a normal finding

The nurse is caring for a postpartum client had an uncomplicated vaginal birth of an 8-lb, 2-oz (3.7-kg) neonate 24 hours ago. The client has no episiotomy and is bottle-feeding her baby. The nurse implements the plan of care, focusing on achievement of which outcome within the next 8 hours?

The client will demonstrate the ability to bottle-feed the neonate appropriately.

A new mother is discharged 16 hours after a vaginal birth. After reviewing the client's discharge instructions, the nurse determines that the teaching was successful when the client states that she will contact her health care provider if she develops which symptom?

increased flow of bright red lochia

The nurse is reviewing the medical record of a client who is 6 weeks postpartum and came for a follow up appointment with her health care provider. The client's uterus is enlarged and soft, and she is experiencing vaginal bleeding. Based on the findings, which condition would the nurse most likely suspect?

uterine subinvolution

A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. Based on this finding, the nurse would anticipate which test as the priority?

venous duplex ultrasound of the right leg

A postpartum client has been ordered 500 mg of ampicillin oral suspension. The label reads ampicillin 125 mg/5 mL. How many milliliters should the client receive? Record your answer using a whole number.

20

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 nurse caring for a client during the first 24 hours following delivery notes normal lochia. Which of the following should the nurse include in the care of this client?

Encourage the client to increase fluid intake.

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

Hemorrhage

When monitoring a postpartum client 2 hours after birth of her newborn, the nurse notices heavy bleeding with large clots. Which action would the nurse perform first?

Massage the fundus firmly.

The nurse is participating in the care of a client who has given birth to a 7 pound, 4 ounce baby. The nurse observes bleeding saturating the pad. What is the priority intervention at this time to control the bleeding?

Massage the fundus.

A nurse is caring for a client who gave birth yesterday and had a right mediolateral episotomy performed. The client asks the nurse, "What can I do to get pain relief from my episiotomy?" Which response by the nurse would be most appropriate?

"Apply a cold pack to your perineum."

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."

A postpartum client has given birth to a healthy newborn by cesarean. Which information would the nurse most likely reinforce?

coughing and deep-breathing exercises

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

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.

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.

A client is diagnosed with disseminated intravascular coagulation (DIC) postpartum. The nurse recognizes that DIC may be related to which antepartum complication?

increased flow of bright red lochia

A nurse is providing care to a postpartum client on her second day. What appearance does the nurse anticipate the lochia will have on the second postpartum day?

red with moderate flow

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."

A client is 2 days postpartum and is experiencing bleeding. She asks the nurse, "Will it always be like this?" Which statement by the nurse would be the most accurate?

"This is lochia rubra and will last 3 to 4 days."

A client who had an emergency cesarean birth for fetal distress 3 days ago is preparing for discharge. When reviewing the home care instructions with the nurse, the client reveals she is saddened about her cesarean and feels let down that she wasn't able to have a vaginal birth. When questioned further, the client states she feels "weepy about everything" and can't stop crying. Which action would be the priority?

Ask the client to elaborate on her feelings.

The nurse is caring for a breastfeeding client on her second postpartum day. The breast is enlarged, firm, and warm to touch. Which action is the nurse expected to take?

Encourage the client to breast feed the baby more frequently and regularly.

The nurse is providing care to a postpartum client with mastitis. As part of the client's teaching plan, the nurse is reinforcing information about the condition. Which information should the nurse emphasize?

Symptoms include fever, chills, malaise, and localized breast tenderness.

The nurse is assisting with the development of a care plan for a postpartum client who had an uncomplicated vaginal birth of an 8-lb, 2-oz (3,693-g) neonate over an intact perineum 24 hours ago. While planning care for this client, the registered nurse collaborates with the licensed practical nurse to achieve which priority outcome in the next 8 hours?

encouraging the client to demonstrate an ability to breast-feed the neonate

A client is diagnosed with disseminated intravascular coagulation (DIC) postpartum. The nurse recognizes that DIC may be related to which antepartum complication?

severe pre-eclampsia

A client who is 9 days postpartum and breastfeeding her baby reports pain, redness, swelling of her left breast and is diagnosed with mastitis. The nurse is reviewing information with the client about how to care for her infected breast. Which information should the nurse most likely reinforce?

"Use a warm, moist compress over the painful area."

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

Which assessment finding indicates that the infant latch during breast-feeding needs further intervention?

The baby's lips smack.

The nurse is caring for a client on the fourth postpartum day. The nurse is expecting to observe which behavior in the client on the fourth postpartum day?

The client asks many questions about the baby's care.

A client experienced a perinatal loss 3 days ago. The nurse is concerned that the client may be experiencing dysfunctional grieving based on which finding?

denial of the death

A nurse is assisting a postpartum client to breast-feed her newborn. The client is having difficulty in establishing an adequate supply of breast milk. The nurse understands that which factor might play a role?

supplemental formula feedings

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."

One day after having a cesarean birth, a client reports 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.

The nurse is observing a new mother interact with her baby for the first time approximately 1 hour after the baby's birth. Upon receiving the baby, 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.

A nurse is preparing to evaluate a client who gave birth 6 hours ago. Which statement best explains the use of gloves during the postpartum evaluation?

Gloves are an essential part of standard precautions.

A licensed practical nurse (LPN) who typically works in the nursery is being cross-trained to work with postpartum clients. The charge nurse is busy with a delivery and assigns her to complete hourly rounds on the unit. 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 experiencing an early postpartum hemorrhage. Which action by the nurse is most appropriate?

Performing fundal massage

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?

"It's common for you to have a full bladder even though you can't sense it."

A nurse enters a postpartum client's room to collect data and observes the perineal pad is completely saturated with lochia rubra. Which action by the nurse is the priority?

Ask the client when she last changed her perineal pad.

The nurse receives a report on a client who delivered a healthy neonate 1 hour ago. What should the nurse monitor during the immediate postpartum period of this client?

Height of fundus

The nurse is performing a postpartum check on a client. Which nursing action is appropriate?

Instruct the client to empty her bladder before the examination.

The nurse is planning to discharge a 24-year-old gravida 1, para 1, non-English-speaking Hispanic client. Which nursing intervention takes priority?

Locating a staff member who can interpret the discharge instructions.

The night nurse reports that a postpartum client is homeless, has poor hygiene, and has tested positive for the human immunodeficiency virus (HIV). The nurse assigned to care for the client requests that the assignment be changed because she's pregnant and doesn't want to risk exposure. Which response by the charge nurse indicates an understanding of the ethical responsibilities of a professional nurse?

"It's inappropriate to refuse this assignment; all clients should be treated equally."

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

A postpartum client with diabetes wants to breast-feed but is concerned about the effects of breast-feeding on her health. Which response would be most appropriate?

Mothers with diabetes may breast-feed; insulin requirements may decrease from breast-feeding.

While preparing a client for a postpartum tubal ligation, a 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 would be best?

Review the client's understanding of the procedure in private.

Lochia normally progresses in which of the following patterns?

Rubra, serosa, alba

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. Which client outcome takes priority for this client?

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

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

breast-feed every 1½ to 3 hours.

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."

A 15-year-old primigravida client gave birth 2 days ago. She tells the nurse that having her own little baby will be wonderful. The nurse gathers additional information from the client to determine the accuracy of the client's expectations. Which statement would be most appropriate?

"Tell me what your day will be like after you take your baby home."

A nurse observes a client's vaginal discharge on the first postpartum day and describes it in the progress note (shown). Which terms best identifies the discharge?

Lochia rubra.

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

Obtain a vaginal swab for culture

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

Tachycardia and hypotension

A postpartum client recovering from spinal anesthesia with morphine reports that her nose itches. Which would the nurse suspect as the cause?

The client is experiencing a common effect due to a morphine-based anesthetic.

A postpartum client is experiencing breast engorgement. When providing care to the client, which action would the nurse anticipate as being most helpful?

informing the client on how to express her breasts while in a warm shower

The nurse is caring for a postpartum client with diabetes who has developed an infection. The nurse would monitor this client for which complication?

ketoacidosis

A nurse is caring for a 1-day postpartum client. The progress note above informs the nurse that the client is in which phase of the postpartum period?

taking in

A multiparous client has given birth vaginally to a healthy neonate. It is now her first postpartum day. Which factor would the nurse identify as putting this client at risk for developing hemorrhage?

uterine atony

A nurse is collecting data on a client who gave birth yesterday. Where would the nurse expect to find the top of the client's fundus?

one fingerbreadth below the umbilicus

A nurse is caring for a client in the fourth stage of labor. Based on the nurse's note, which postpartum complication has the client developed?

postpartum hemorrhage

A new mother who's breast-feeding asks how she can quickly lose the 40 lb she gained during pregnancy. Which response by the nurse is best?

"It's important to avoid dieting while your milk supply is being established; a well-balanced diet with gradual weight loss is recommended."

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."

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. Which of the following nursing action should the nurse take?

Ask the father if he would want to talk about his feelings regarding the newborn and being in the intensive care.

Which of the following correctly defines puerperium?

The 6 weeks following birth

A postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. After assisting with the discharge teaching plan, the nurse determines that the client has understood the information when what statement is made?

"I should not take any over-the-counter (OTC) salicylates."

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

A postpartum client who has developed mastitis is being discharged. What recommendation would be most appropriate when the client voices concern about breast-feeding her neonate with this condition?

Continue to breast-feed; mastitis won't infect the neonate.

During the postpartum period, the nurse anticipates normal involution. Which action taken by the nurse promotes involution?

Encourage the mother to breast feed.

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

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 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

A nurse is reviewing a postpartum client's medical record and plan of care before discharge. Which factor if noted in the client's history would the nurse identify as most likely to interfere with this client's parental attachment?

recent loss of a parent

A postpartum client is scheduled for discharge tomorrow. The nurse is reinforcing discharge instructions with the client. The nurse determines that the client understands the information when stating that she will report which finding to her health care provider?

redness, warmth, and pain in a breast

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

A nurse is reinforcing the teaching plan for a postpartum client diagnosed with mastitis. The nurse determines that the client has understood the information when she states which organism as most likely responsible?

staphylococcus aureus