Postpartum Review

The most common causes of late postpartum hemorrhage (>24 hours) include (select all that apply). 1. Subinvolution 2. Uterine atony 3. Retained placental fragments 4. Cesarean birth

1. Subinvolution 3. Retained placental fragments

On completing a fundal assessment, the nurse notes the fundus is situated on the client's left abdomen. Which of the following actions is appropriate? 1. Ask the client to empty her bladder 2. Call the client's health provider for direction 3. Straight catheterize the client immediately 4. Straight catheterize the client for half of her uterine volume

1. Ask the client to empty her bladder

A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following? 1. Ask the mother to urinate and empty her bladder 2. Massage the fundus gently before determining the level of the fundus 3. Ask the client to lie flat on her back with the knees and legs flat and straight 4. Ask the client to turn on her side

1. Ask the mother to urinate and empty her bladder

A nurse performs an assessment on a client who is 4 hours PP. The nurse notes that the client has cool, clammy skin and is restless and excessively thirsty. The nurse prepares immediately to: 1. Assess for hypovolemia and notify the health care provider 2. Begin hourly pad counts and reassure the client 3. Begin fundal massage and start oxygen by mask 4. Elevate the head of the bed and assess vital signs

1. Assess for hypovolemia and notify the health care provider

When performing a postpartum check, the nurse should: 1. Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum 2. Assist the woman into a supine position with her arms above her head and her legs extended for the examination of her abdomen 3. Instruct the woman to avoid urinating just before the examination since a full bladder will facilitate fundal palpation 4. Wash hands and put on sterile gloves before beginning the check

1. Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum

On which of the postpartum days can the client expect lochia serosa? 1. Days 3 to 10 PP 2. Days 3 and 4 PP 3. Days 14 to 42 PP 4. Days 10-14 PP

1. Days 3 to 10 PP

Select all of the physiological maternal changes that occur during the PP period. 1. Fundus begins to descend into the pelvis after 24 hours 2. Vaginal distention decreases slowly 3. Cervical involution ceases immediately 4. Digestive processes slow immediately 5. Cardiac output decreases with resultant tachycardia in the first 24 hours

1. Fundus begins to descend into the pelvis after 24 hours 3. Cervical involution ceases immediately (weird wording)

A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.2*F. Which of the following actions would be most appropriate? 1. Increase hydration by encouraging oral fluids 2. Document the findings 3. Retake the temperature in 15 minutes 4. Notify the physician

1. Increase hydration by encouraging oral fluids

The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is: 1. Indicates the presence of infection 2. Indicates the need for increasing oral fluids 3. Indicates the need for increasing ambulation 4. Normal

1. Indicates the presence of infection

The nurse examines a woman one hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: 1. Massage her fundus 2. Place her on a bedpan to empty her bladder 3. Call the physician 4. Administer Methergine 0.2 mg IM which has been ordered prn

1. Massage her fundus

After expulsion of the placenta in a client who has six living children, an infusion of lactated ringer's solution with 10 units of Pitocin is ordered. The nurse understands that this is indicated for this client because: 1. Multigravidas are at increased risk for uterine atony 2. Retained placental fragments must be expelled 3. This was an extramural birth 4. She had a precipitate birth

1. Multigravidas are at increased risk for uterine atony

A nurse is assessing a client in the 4th stage if labor and notes that the fundus is firm but that bleeding is excessive. The initial nursing action would be which of the following? 1. Notify the physician 2. Record the findings 3. Massage the fundus 4. Place the mother in the Trendelenburg's position

1. Notify the physician

Which of the following behaviors characterizes the PP mother in the taking in phase? 1. Passive and dependent 2. Curious and interested in care of the baby 3. Striving for independence and autonomy 4. Exhibiting maximum readiness for new learning

1. Passive and dependent

Which of the following factors might result in a decreased supply of breastmilk in a PP mother? 1. Maternal diet high in vitamin C 2. Frequent feedings 3. Supplemental feedings with formula 4. An alcoholic drink

3. Supplemental feedings with formula

A new mother received epidural anesthesia during labor and had a forceps delivery after pushing 2 hours. At 6 hours PP, her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse immediately plans to: 1. Prepare the client for surgery 2. Monitor fundal height 3. Apply perineal pressure 4. Reassure the client

1. Prepare the client for surgery

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing the needs of women during this stage, should: 1. Provide time for the mother to reflect on the events of and her behavior during childbirth 2. Foster an active role in the baby's care 3. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs 4. Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now

1. Provide time for the mother to reflect on the events of and her behavior during childbirth

The characteristics of postpartum blues includes (select all that apply). 1. Self-limiting 2. Moderate depression 3. Lasts up to 2 weeks 4. Lasts up to 4 weeks 5. Responds to therapeutic touch 6. Insomnia, fatigue, and tearfulness 7. Suicidal thoughts

1. Self-limiting 3. Lasts up to 2 weeks (past two weeks it becomes depressions, there is a difference) 5. Responds to therapeutic touch 6. Insomnia, fatigue, and tearfulness

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is one day postpartum. An expected finding would be: 1. Soft, non-tender; colostrum is present 2. A few blisters and a bruise on each areola 3. Swollen, warm, and tender upon palpation 4. Leakage of milk at let down

1. Soft, non-tender; colostrum is present

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: 1. Uses the peribottle to rinse upward into her vagina 2. Washes from symphysis pubis back to episiotomy 3. Changes her perineal pad every 2 - 3 hours 4. Uses soap and warm water to wash the vulva and perineum

1. Uses the peribottle to rinse upward into her vagina

A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse instructs the mother that she should expect normal bowel elimination to return: 1. 7 days PP 2. 3 days PP 3. within 2 weeks PP 4. One the day of the delivery

2. 3 days PP

A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss? 1. An increase in the respiratory rate from 18 to 22 breaths per minute 2. An increase in the pulse from 88 to 102 BPM 3. A temperature of 100.4*F 4. A blood pressure change from 130/88 to 124/80 mm Hg

2. An increase in the pulse from 88 to 102 BPM

On the first PP night, a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases? 1. Letting-go phase 2. Depression phase 3. Taking-in phase 4. Taking-hold phase

3. Taking-in phase

Which of the following interventions would be helpful to a breastfeeding mother who is experiencing engorged breasts? 1. Applying ice 2. Applying a breast binder 3. Teaching how to express her breasts in a warm shower 4. Administering bromocriptine (Parlodel)

3. Teaching how to express her breasts in a warm shower

A PP nurse is assessing a mother who delivered a healthy newborn infant by C-section. The nurse is assessing for signs and symptoms of superficial venous thrombosis. Which of the following signs or symptoms would the nurse note if superficial venous thrombosis were present? 1. Palpable dorsalis pedis pulses 2. Enlarged, hardened veins 3. Coolness of the calf area 4. Paleness of the calf area

2. Enlarged, hardened veins

A postpartum nurse is preparing to care for a woman who has just delivered a healthy newborn infant. In the immediate postpartum period the nurse plans to take the woman's vital signs: 1. Every 5 minutes for the first 30 minutes and then every hour for the next 4 hours 2. Every 15 minutes during the first hour and then every 30 minutes for the next two hours 3. Every hour for the first 2 hours and then every 4 hours 4. Every 30 minutes during the first hour and then every hour for the next two hours

2. Every 15 minutes during the first hour and then every 30 minutes for the next two hours

A PP client is being treated for DVT. The nurse understands that the client's response to treatment will be evaluated by regularly assessing the client for: 1. Dysuria, ecchymosis, and vertigo 2. Hematuria, ecchymosis, and epistaxis 3. Epistaxis, hematuria, and dysuria 4. Hematuria, ecchymosis, and vertigo

2. Hematuria, ecchymosis, and epistaxis

Which measure would be least effective in preventing postpartum hemorrhage? 1. Encourage the woman to void every 2 hours 2. Massage the fundus every hour for the first 24 hours following birth 3. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered 4. Teach the woman the importance of rest and nutrition to enhance healing

2. Massage the fundus every hour for the first 24 hours following birth

A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which of the following nursing interventions would be most appropriate initially? 1. Push on the uterus to assist in expressing clots 2. Massage the fundus until it is firm 3. Elevate the mothers legs 4. Encourage the mother to void

2. Massage the fundus until it is firm

A client is complaining of painful contractions, or afterpains, on postpartum day 2. Which of the following conditions could increase the severity of afterpains? 1. Primiparity 2. Multiple gestation 3. Diabetes 4. Bottle-feeding

2. Multiple gestation

Which of the following findings would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum? 1. Bradycardia — pulse rate of 55 BPM 2. Pain in left calf with dorsiflexion of left foot 3. Postural hypotension 4. Temperature of 100.4°F

2. Pain in left calf with dorsiflexion of left foot

All of the following are important in the immediate care of the premature neonate. Which nursing activity should have the greatest priority? 1. Instillation of antibiotic in the eyes 2. Placement in a warm environment 3. Neurological assessment to determine gestational age 4. Identification by bracelet and foot prints

2. Placement in a warm environment

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: 1. Recognize this as a behavior of the taking-hold stage 2. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time 3. Tell the woman she can rest after she feeds her baby 4. Record the behavior as ineffective maternal-newborn attachment

2. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

Which of the following complications is most likely responsible for a delayed postpartum hemorrhage? 1. Clotting deficiency 2. Uterine subinvolution 3. Cervical laceration 4. Perineal laceration

2. Uterine subinvolution

A nurse is providing instructions to a mother who has been diagnosed with mastitis. Which of the following statements if made by the mother indicates a need for further teaching? 1. "I need to take antibiotics, and I should begin to feel better in 24-48 hours." 2. "I need to wear a supportive bra to relieve the discomfort." 3. "I need to stop breastfeeding until this condition resolves." 4. "I can use analgesics to assist in alleviating some of the discomfort."

3. "I need to stop breastfeeding until this condition resolves."

A nurse is caring for a PP client with a diagnosis of DVT who is receiving a continuous intravenous infusion of heparin sodium. Which of the following laboratory results will the nurse specifically review to determine if an effective and appropriate dose of the heparin is being delivered? 1. International normalized ratio 2. Platelet count 3. Activated partial thromboplastin time 4. Prothrombin time

3. Activated partial thromboplastin time

Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? 1. Retained placental fragments 2. UTI 3. Cervical laceration 4. Uterine atony

3. Cervical laceration

Parents can facilitate the adjustment of their other children to a new baby by: 1. Reducing stress on other children by limiting their involvement in the care of the new baby 2. Having the mother carry the new baby into the home so she can show the other children the new baby 3. Having the children choose or make a gift to give to the new baby upon its arrival home 4. Emphasizing activities that keep the new baby and other children together

3. Having the children choose or make a gift to give to the new baby upon its arrival home

The nurse is assessing a client who is 6 hours PP after delivering a full-term healthy infant. The client complains to the nurse of feelings of faintness and dizziness. Which of the following nursing actions would be most appropriate? 1. Elevate the mother's legs 2. Obtain hemoglobin and hematocrit levels 3. Instruct the mother to request help when getting out of bed 4. Inform the nursery room nurse to avoid bringing the newborn infant to the mother until the feelings of lightheadedness and dizziness have subsided

3. Instruct the mother to request help when getting out of bed

Which type of lochia should the nurse expect to find in a client 2 days PP? 1. Foul-smelling 2. Lochia serosa 3. Lochia rubra 4. Lochia alba

3. Lochia rubra

The nurse is about the give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum? 1. Lower than during her pregnancy 2. Higher than before she became pregnant 3. Lower than before she became pregnant 4. Higher than during her pregnancy

3. Lower than before she became pregnant

Which of the following responses is most appropriate for a mother with diabetes who wants to breastfeed her infant but is concerned about the effects of breastfeeding on her health? 1. Mothers with diabetes shouldn't breastfeed because of potential complications 2. Mothers with diabetes shouldn't breastfeed; insulin requirements are doubled 3. Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding 4. Mothers with diabetes who breastfeed have a hard time controlling their insulin needs

3. Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding

When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which of the following nursing actions is most appropriate? 1. Document the findings 2. Encourage increased intake of fluids 3. Notify the physician 4. Reassess the client in 2 hours

3. Notify the physician

A nurse is developing a plan of care for a PP woman with a small vulvar hematoma. The nurse includes which specific intervention in the plan during the first 12 hours following the delivery of this client? 1. Assess vital signs every 4 hours 2. Measure fundal height every 4 hours 3. Prepare an ice pack for application to the area 4. Inform health care provider of assessment findings

3. Prepare an ice pack for application to the area

During the 3rd PP day, which of the following observations about the client would the nurse be most likely to make? 1. The client sleeps whenever the neonate isn't present 2. The client requests help in choosing a name for the neonate 3. The client appears interested in learning about neonatal care 4. The client talks a lot about her birth experience

3. The client appears interested in learning about neonatal care

Before giving a PP client the rubella vaccine, which of the following facts should the nurse include in client teaching? 1. The vaccine is safe in clients with egg allergies 2. Transient arthralgia and rash are common adverse effects (Powerpoint states that rubella may cause transient arthritis, online soucres also say rash is possible https://www.nhs.uk/conditions/vaccinations/mmr-side-effects/ ) 3. The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects 4. Breast-feeding isn't compatible with the vaccine

3. The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects (Book says 28days) (maybe they meant 2)

Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage? 1. Endometritis 2. Hypertension 3. Urine retention 4. Cervical and vaginal tears

3. Urine retention

A nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. Select all instructions that would be included on the list. 1. Avoid decompression of the breasts by breastfeeding or breast pump 2. Take the prescribed antibiotics until the soreness subsides 3. Wear supportive bra 4. Rest during the acute phase 5. Continue to breastfeed if the breasts are not too sore

3. Wear supportive bra 4. Rest during the acute phase 5. Continue to breastfeed if the breasts are not too sore

Methergine or Pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the: 1. Deep tendon reflexes 2. Uterine tone 3. Amount of lochia 4. Blood pressure

4. Blood pressure

Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? 1. Retained placental fragments 2. Urinary tract infection 3. Uterine atony 4. Cervical laceration

4. Cervical laceration

A nurse is caring for a PP woman who has received epidural anesthesia and is monitoring the woman for the presence of a vulva hematoma. Which of the following assessment findings would best indicate the presence of a hematoma? 1. Signs of heavy bruising 2. Complaints of intense pain 3. Complaints of a tearing sensation 4. Changes in vital signs

4. Changes in vital signs

Which of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications? 1. Remain the same as during pregnancy 2. Increase 3. Remain the same as before pregnancy 4. Decrease

4. Decrease

A nurse in a PP unit is instructing a mother regarding lochia and the amount of expected lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but should never exceed the need for: 1. One peripad per day 2. Three peripads per day 3. Two peripads per day 4. Eight peripads per day

4. Eight peripads per day

Which of the following findings would be expected when assessing the postpartum client? 1. Fundus slightly to the right; 2 cm above umbilicus on postpartum day 2 2. Fundus palpable in the abdomen at 2 weeks postpartum 3. Fundus 1 cm above the umbilicus on postpartum day 3 4. Fundus 1 cm above the umbilicus 1 hour postpartum

4. Fundus 1 cm above the umbilicus 1 hour postpartum

A PP nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.2F. Which of the following actions would be most appropriate? 1. Retake the temperature in 15 minutes 2. Notify the physician 3. Document the findings 4. Increase hydration by encouraging oral fluids

4. Increase hydration by encouraging oral fluids The mother's temperature may be taken every 4 hours while she is awake. Temperatures up to 100.4 (38 C) in the first 24 hours after birth are often related to the dehydrating effects of labor. The most appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. Although the nurse would document the findings, the most appropriate action would be to increase the hydration.

Methergine or Pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client's medical history? 1. Hypotension 2. Type 1 diabetes 3. Hypothyroidism 4. Peripheral vascular disease

4. Peripheral vascular disease

Which of the following physiological responses is considered normal in the early postpartum period? 1. Increase motility of the GI system 2. Urinary urgency and dysuria 3. Decrease in blood pressure 4. Rapid diuresis

4. Rapid diuresis

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: 1. Fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3 pound weight loss 2. Lactation will inhibit weight loss since caloric intake must increase to support milk production 3. Return to pre pregnant weight is usually achieved by the end of the postpartum period 4. The expected weight loss immediately after birth averages about 11 to 13 pounds

4. The expected weight loss immediately after birth averages about 11 to 13 pounds

What type of milk is present in the breasts 7 to 10 days PP? 1. Hind milk 2. Colostrum 3. Mature milk 4. Transitional milk

4. Transitional milk

When making a visit to the home of a postpartum woman one week after birth, the nurse should recognize that the woman would characteristically: 1. Have reestablished her role as a spouse/partner 2. Exhibit a reduced attention span, limiting readiness to learn 3. Express a strong need to review events and her behavior during the process of labor and birth 4. Vacillate (alternate or waver between different opinions or actions; be indecisive.) between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn

4. Vacillate (alternate or waver between different opinions or actions; be indecisive.) between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn

True or False: The normal respiratory rate for an infant is 30-80 breaths per minute.

False; 30-60