Ch. 23 Conditions Occurring After Delivery

True or False: If a nurse suspects that a patient is experiencing hypovolemic shock, the initial step taken should be to call for help.

True

True or False: Individuals receiving anticoagulant therapy need to avoid use of any over-the-counter products containing aspirin or aspirin-like derivatives such as NSAIDs (ibuprofen) to reduce the risk for bleeding.

True

Which of the following is a common mechanism for postpartum hemorrhage? a. Singleton Gestation b. Maternal Lupus c. Retained Placenta d. Maternal hypertension e. Placental Insufficiency f. Post-dates pregnancy

c. Retained Placenta

Which best describes a risk factor for postpartum infection? a. Maternal Phenylketonuria b. Maternal Depression c. Vaginal Trauma d. Bimanual exam e. Maternal hypertension f. Advanced Maternal Age

c. Vaginal Trauma

Uncontrolled postpartum hemorrhage can lead to ______________________ shock.

hypovolemic

The risk for ____________________ complications increase when the client is older than 35, is obese, and has a history of diabetes or a pre-existing cardiovascular disease

thromboembolic

Which best describes a risk factor for postpartum infection? a. Retained Placental Fragments b. Advanced Maternal Age c. Maternal Antiphospholipid Syndrome d. Fetal Macrosomia e. Hydrops Fetalis f. Fetal arrhythmias

a. Retained Placental Fragments

Which of the following clinical findings is most likely to be seen in postpartum hemorrhage? a. Positive psoas sign b. Decreased PaO2 c. Hypotension d. Homan's Sign e. Irregular Respirations f. Joint Pain

c. Hypotension

Which best describes a risk factor for postpartum infection? a. Fetal Macrosomia b. Caused by Twin Gestation c. Multiple Vaginal Examinations d. Maternal hypertension e. Maternal ibuprofen use f. Transverse Fetal Position

c. Multiple Vaginal Examinations

The most common cause of postpartum hemorrhage is....

uterine atony.

Which complication is most likely responsible for a late postpartum hemorrhage? cervical laceration clotting deficiency perineal laceration uterine subinvolution

uterine subinvolution

The typical signs of hemorrhage do not appear in the postpartum woman until as much as _______ to ________ ml of blood has been lost.

1,800 - 2,100

______________ causes a decrease in the number of circulating oxygenated blood cells. This leads to a potential decrease in tissue oxygenation. When severe, it can decrease the body's natural defense mechanisms in fighting infections.

Anemia

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

Check for bladder distention, while encouraging the client to void.

Which of the following is a common mechanism for postpartum hemorrhage? a. Maternal Lupus b. Maternal hypertension c. Post-dates pregnancy d. Placental Insufficiency e. Singleton Gestation f. Lacerations

f. Lacerations

After the first 24 hours any fever greater than ______________ on ___ or more successive days within the first ____ days postpartum is diagnostic in the USA. A rise in temperature is a response the body uses to combat infection.

100.4F (38C) 2 10

The nurse is teaching a postpartum woman and her spouse about postpartum blues. The nurse would instruct the couple to seek further care if the client's symptoms persist beyond which time frame? 1 week 2 weeks 3 weeks 4 weeks

2 weeks

It is discovered that a new mother has developed a postpartum infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition? Client's temperature remains below 100.4°F (38.8°C) orally. Fundus remains firm and midline with progressive descent. Client maintains a urinary output greater than 30 ml per hour. Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour.

Client's temperature remains below 100.4°F (38.8°C) orally.

True or False: Methylergonovine is one medication that can safely be administered to a hypertensive patient affected by postpartum hemorrhage.

False

A nurse is caring for a client who has had a cesarean birth and has developed a wound infection. What precautions should be taken by the nurse as a primary prevention measure? Apply ice packs every 12 to 24 hours. Keep the incisions clean and dry. Use a sitz bath once every 24 hours. Apply ice and heat alternatively.

Keep the incisions clean and dry.

Which of the following interventions is most likely indicated in postpartum hemorrhage? Excision & Grafting Labor Induction Oxytocin Erythropoietin Terbutaline Amnioreduction

Oxytocin

________________ ___________ is a phase of emotional lability characterized by crying episodes, irritability, anxiety, confusion, and sleep disorders. Symptoms usually arise within the first few days after childbirth, reaching a peak at 3 to 5 days and spontaneously disappearing within 10 days.

Postpartum blues

Which of the following is a common mechanism for postpartum hemorrhage? a. Placental Insufficiency b. Advanced Maternal Age c. Post-dates pregnancy d. Uterine Atony e. Maternal Lupus f. Singleton Gestation

d. Uterine Atony

Which postpartum finding is most concerning for a postpartum infection? a. Fever > 100.4F After 6 Hours (38 C) b. Fever > 100.4F After 24 Hours (38 C) c. Fever > 100.4F After 48 Hours (38 C) d. Fever > 100.4F After 36 Hours (38 C) e. Fever > 100.4F After 12 Hours (38 C) f. Fever > 100.4F After 1 Hour (38 C)

b. Fever > 100.4F After 24 Hours (38 C)

Which measurement best describes delayed postpartum hemorrhage? blood loss in excess of 3000 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 300 ml, occurring within the first 24 hours after birth blood loss in excess of 1,000 ml, occurring within 24 hours after birth

blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth

Which best describes a risk factor for postpartum infection? a. Maternal Antiphospholipid Syndrome b. Fetal Hemolytic Disease c. Anemia of Pregnancy d. Advanced Maternal Age e. Maternal hypertension f. Maternal Phenylketonuria

c. Anemia of Pregnancy

Which best describes a risk factor for postpartum infection? a. Hydrops Fetalis b. Maternal ibuprofen use c. Cesarean Birth d. Maternal Phenylketonuria e. Fetal arrhythmias f. Fetal Macrosomia

c. Cesarean Birth

Which of the following clinical findings is most likely to be seen in postpartum hemorrhage? a. Joint Pain b. Bruising c. Heartburn (Pyrosis) d. Boggy Uterus e. Irregular Contractions f. Positive psoas sign

d. Boggy Uterus Rationale: The uterus is not contracting, which means that is not properly coagulating.

A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would question the woman about which symptom? an inverted nipple on the affected breast no breast milk in the affected breast an ecchymotic area on the affected breast hardening of an area in the affected breast

hardening of an area in the affected breast

A nurse teaches a postpartum woman about her risk for thromboembolism. The nurse determines that additional teaching is required when the woman identifies which as a factor that increases her risk? increase in clotting factors vessel damage immobility increase in red blood cell production

increase in red blood cell production

A first-degree uterine __________________ occurs when the uterine fundus prolapses into the uterine cavity.

inversion

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 condition would the nurse suspect? hematoma laceration uterine inversion uterine atony

laceration

A postpartum woman presenting with a red, swollen, painful breast accompanied by flu-like symptoms is most likely experiencing _______________________.

mastitis

The nurse receives a report on a client with type 1 diabetes whose delivery was complicated by polyhydramnios and macrosomia. The nurse is aware of these complications and knows to monitor the client closely for which of the following? postpartum mastitis increased insulin needs postpartum hemorrhage gestational hypertension

postpartum hemorrhage

Late postpartum bleeding is usually the result of ________________________ of the uterus. This is commonly caused by retained products of conception or infection.

subinvolution

Which best describes a risk factor for postpartum infection? a. Fetal Hemolytic Disease b. Maternal hypertension c. Advanced Maternal Age d. Transverse Fetal Position e. Poor Health Status f. Maternal ibuprofen use

e. Poor Health Status

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement? "I will use a soft toothbrush to brush my teeth." "I can take ibuprofen if I have any pain." "I need to avoid drinking any alcohol." "I will call my health care provider if my stools are black and tarry."

"I can take ibuprofen if I have any pain."

After teaching a postpartum client about postpartum blues, the nurse determines that the teaching was effective when the client makes which statement? "If the symptoms last more than a few days, I need to call my doctor." "I might feel like laughing one minute and crying the next." "I'll need to take medication to treat the anxiety and sadness." "I should call this support line only if I hear voices."

"I might feel like laughing one minute and crying the next."

A nurse is caring for a client in the labor and delivery unit. Immediately after fetal birth, a large amount of blood gushes from the client's vagina. The uterus is not palpable in the abdomen. The client's blood pressure drops significantly and the client becomes very pale. Which nursing action is completed next? Discontinue the oxytocin. Place the uterus back into the birth canal. Administer oxygen by mask. Obtain vital signs.

Administer oxygen by mask. Rationale: When uterine inversion occurs, a large amount of blood suddenly gushes from the vagina. The first nursing action is to apply oxygen. Then, the nurse will discontinue the oxytocin, because it makes the uterus more tense and difficult to replace. Next, the uterus will be replaced by the health care provider, typically while the client is under general anesthesia. The nurse should not attempt to replace the uterus. Vital signs will be obtained as often as every 15 minutes.

Which of the following interventions is most likely indicated in postpartum hemorrhage? a. Terbutaline b. Bimanual Compression of Uterus c. Amnioreduction d. Erythropoietin e. Labor Induction f. Excision and Grafting

Bimanual Compression of Uterus

Which most obvious complication is commonly seen in postpartum hemorrhage? Placenta Previa Bleeding Distributive Shock Increased ICP Hypertension Septic Shock

Bleeding

True or False: Postpartum depression is an expected condition that begins approximately 2 to 3 days after delivery and resolves within 2 weeks.

False

True or False: Symptoms of a blood loss of 1,000 to 1,500 mL include lightheadedness, palpitations, a normal blood pressure, and minimal increase in heart rate.

False

True or False: The risk for venous thromboembolism is higher during pregnancy than in the postpartum period.

False

_____________________ is the preferred initial medication for treatment of a pulmonary embolism.

Heparin

________________ is characterized by a tender, hot, red, painful area on the affected breast.

Mastitis

A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next? Apply warm soaks to the area. Notify the health care provider. Massage the uterine fundus. Encourage the client to void.

Notify the health care provider. The client is experiencing postpartum hemorrhage secondary to a perineal hematoma. The nurse needs to notify the health care provider about these findings to prevent further hemorrhage.

A nurse is caring for a postpartum client who has been treated for deep vein thrombosis (DVT). Which prescription would the nurse question? Wear compression stockings. Plan long rest periods throughout the day. Take aspirin as needed. Take an oral contraceptive pill daily.

Take an oral contraceptive pill daily. Rationale: Cigarette smoking, use of oral contraceptive pills, sedentary lifestyle, and obesity increase the risk for developing DVT.

The nurse instructs a client on actions to prevent postpartum depression. During a home visit, which observation indicates that instruction has been effective? The client complains of fatigue. The client appears disheveled and listless. The client is chatting on the telephone with a friend. The client is cleaning the kitchen while the baby naps.

The client is chatting on the telephone with a friend.

Postpartum hemorrhage caused by uterine atony is initially treated by firm ___________________ of the fundus.

massage

Which of the following interventions is most likely indicated in postpartum hemorrhage? a. Insert 2 fingers in Vagina b. Erythropoietin c. Balloon Tamponade d. Surgery e. Labor Induction f. Amnioreduction

d. Surgery

When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage because: these measurements may not change until after the blood loss is large. the body's compensatory mechanisms activate and prevent any changes. they relate more to change in condition than to the amount of blood lost. maternal anxiety adversely affects these vital signs.

these measurements may not change until after the blood loss is large. The typical signs of hemorrhage do not appear in the postpartum woman until as much as 1,800 to 2,100 ml of blood has been lost.

The nurse would be alert for which of the following complications when caring for a 38-year-old postpartum client with a history of obesity and diabetes? uterine prolapse thromboembolic complications septic pelvic thrombophlebitis postpartum infections

thromboembolic complications

A client who gave birth several hours ago is experiencing postpartum hemorrhage. She had a cesarean birth and received deep, general anesthesia. She has a history of postpartum hemorrhage with her previous births. The blood is a dark red. Which cause of the hemorrhage is most likely in this client? uterine atony cervical laceration retained placental fragment disseminated intravascular coagulation

uterine atony

The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady trickle of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider? Uterine atony Laceration Perineal hematoma Infection of the uterus

Laceration

______________ typically present with a firm contracted uterus and a steady stream of unclotted bright red blood. _______________ 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. _____________ _____________ would present with the uterine fundus at or through the cervix. _____________ ____________ would be manifested by a noncontracted uterus.

Lacerations Hematoma Uterine inversion Uterine atony

Which best describes a risk factor for postpartum infection? a. Bimanual exam b. Fetal arrhythmias c. Prolonged Rupture of Membranes d. Maternal Depression e. Hydrops Fetalis f. Transverse Fetal Position

c. Prolonged Rupture of Membranes

Which of the following interventions is most likely indicated in postpartum hemorrhage? a. Antimicrobial Prophylaxis b. Insert 2 fingers in Vagina c. Erythropoietin d. Excision and Grafting e. Labor Induction f. Blood Transfusion

f. Blood Transfusion

Conditions that contribute to _____________ __________ include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage

uterine atony