Chapter 25 - Postpartum Period Practice Questions
The nurse is assessing a client who is 6 hours postpartum after delivering a full-term health new newborn. The client complains to the nurse of feelings of faintness and dizziness. Which nursing action is most appropriate? A. Raise the head of the client's bed B. Obtain a hemoglobin and hematocrit levels C. Instruct the client to request help when getting out of bed D. inform the nursery room nurse to avoid bringing the newborn to the client until the client's symptoms have subsided
C Rationale: orthostatic hypotension may be evident in first 8 hours PP
The nurse is caring four 1-day postpartum clients. Which client assessment requires the need for follow-up? A. The client with mild afterpains B. The client with a pulse rate of 60 bpm C. the client with colostrum discharge from both breasts D. The client with lochia that is red and ahas a foul-smelling odor
D
The postpartum nurse is taking the vital signs of a client who delivered a healthy newborn 4 hours ago. the nurse notes that the client's temperature is 100.2 F. What is the priority nursing action? A. document the findings B. notify the obstetrician C. Retake the temperature in 15 mintues D. Increase hydration by encouraging oral fluids
D Rationale: Temperatures up to 100.4 in first 24 hours PP are usually related to dehydrating effects of labor
The nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has saturated a perineal pad in 15 minutes. How should the nurse respond to this finding initially? A. Document the finding B. Encourage the client to ambulate C. Encourage the client to increase fluid intake D. Contact the obstetrician and inform him or her of these findings
D
The nurse has provided discharge instructions to a client who delivered a healthy newborn by cesarean delivery. Which statement made by the client indicates a need fo further instruction? A. I will begin abdominal exercises immediately B. I will notify my obstetrician if I develop a fever C. I will turn on my side and push up with my arms to get out of bed D. I will lift nothing heavier than my newborn baby for at least 2 weeks
A
The nurse is teaching a postpartum client about breastfeeding. Which instruction should the nurse include? A. the diet should include additional fluids B. prenatal vitamins should be discontinued C. soap should be used to cleanse the breast D. Birth control measures are unnecessary while breastfeeding
A
The nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client required an episiotomy and has several hemorrhoids. What is the priority nursing consideration for this client? A. client pain level B. Inadequate urinary output C. Client perception of body changes D. Potential for imbalanced body fluid volume
A Rationale no data to suggest B,C,D are correct
The postpartum nurse is providing instruction to a client after birth of a healthy newborn. Which time frame should the nurse relay to the client regarding the return of bowel function? A. 3 days postpartum B. 7 days postpartum C. On the day of birth D. within 2 weeks postpartum
A Rationale: normally bowel elimination returns 2-3 days PP
After a precipitous delivery, the nurse notes that the new mother is passive and only touches her newborn infant only briefly with her fingertips. What should the nurse do to help the woman process the delivery? A. Encourage the mother to breastfeed after birth B. Support the mother in her reaction to the newborn infant C. Tell the mother that it is important to hold the newborn infant D. Document a complete account of the mother's reaction of the birth record.
B
The nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. After locating the fundus, the nurse notes that the uterus feels soft and boggy. Which nursing intervention is appropriate? A. elevate the client's legs B. massage the fundus until it is firm C. Ask the client to turn on her left side D. Push on the uterus to assist in expressing clots
B
The nurse is providing postpartum instructions to a client who will be breast-feeding her newborn. The nurse determines that the client has understood the instructions if she makes which statements? (select ALL that apply) A. I should wear a bra that provides support B. Drinking alcohol can affect my milk supply C. The use of caffeine can decrease my milk supply D. I will start my estrogen birth control pills again as soon as I get home E. I know if my breasts get engorged, I will limit my breastfeeding and supplement the baby F. I plan on having bottled water available in the refrigerator so I can get additional fluids easily
A B C F
When performing a postpartum 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 1cm. Which nursing action is most appropriate? A. Document the findings B. Notify the obstetrician C. Reassess the client in 2 hours D. Encourage increased oral intakes of fluids
B Rationale: normally a few clots may be noted in the lochia in the first 1-2 days, clots larger than 1cm are considered abnormal. The cause needs to be determined