Ch 22 Nursing Management of the Postpartum Woman

A) Delirium

14. A nurse suspects that a postpartum client is experiencing postpartum psychosis. Which of the following would most likely lead the nurse to suspect this condition? A) Delirium B) Feelings of anxiety C) Sadness D) Insomnia

C) Thrombophlebitis

1. Review of a primiparous womans labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which of the following? A) Retained placental fragments B) Hypertension C) Thrombophlebitis D) Uterine subinvolution

D) Sharp stabbing chest pain with shortness of breath

10. A nurse is assessing a postpartum woman. Which finding would cause the nurse to be most concerned? A) Leg pain on ambulation with mild ankle edema B) Calf pain with dorsiflexion of the foot. C) Perineal pain with swelling along the episiotomy D) Sharp stabbing chest pain with shortness of breath

D) Terbutaline

11 A woman experiencing postpartum hemorrhage is ordered to receive a uterotonic agent. Which of the following would the nurse least expect to administer? A) Oxytocin B) Methylergonovine C) Carboprost D) Terbutaline

C) Wait until the uterus is firm to express clots.

12. Which of the following would be most appropriate when massaging a womans fundus? A) Place the hands on the sides of the abdomen to grasp the uterus. B) Use an up-and-down motion to massage the uterus. C) Wait until the uterus is firm to express clots. D) Continue massaging the uterus for at least 5 minutes.

B) When I put on a new pad, Ill start at the back and go forward.

13. After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? A) I need to call my doctor if my temperature goes above 100.4 F. B) When I put on a new pad, Il start at the back and go forward. C) If I have chills or my discharge has a strange odor, Ill call my doctor. D) Ill point the spray of the peribottle so the water flows front to back.

A) Endometrium B) Decidua C) Myometrium

15. A postpartum woman is diagnosed with metritis. The nurse interprets this as an infection involving which of the following? (Select all that apply.) A) Endometrium B) Decidua C) Myometrium D) Broad ligament E) Ovaries F) Fallopian tubes

B) S. Aureus

16. A group of nursing students are reviewing information about mastitis and its causes. The students demonstrate understanding of the information when they identify which of the following as the most common cause? A) E. Coli B) S. Aureus C) Proteus D) Klebsiella

A) Lower abdominal tenderness E) Anorexia

17. A home health care nurse is assessing a postpartum woman who was discharged 2 days ago. The woman tells the nurse that she has a low-grade fever and feels lousy. Which of the following findings would lead the nurse to suspect metritis? (Select all that apply.) A) Lower abdominal tenderness B) Urgency C) Flank pain D) Breast tenderness E) Anorexia

B) Moderate lochia serosa

18. A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which of the following? A) Nonpalpable fundus B) Moderate lochia serosa C) Bruising on arms and legs D) Fever

A) Hematoma

19. Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which of the following? A) Hematoma B) Laceration C) Bladder distention D) Uterine atony

D) Blues

2. As part of an inservice program, a nurse is describing a transient, self-limiting mood disorder that affects mothers after childbirth The nurse correctly identifies this as postpartum: A) Depression B) Psychosis C) Bipolar disorder D) Blues

C) Piggyback the IV infusion into a primary line.

20. A postpartum woman is ordered to receive oxytocin to stimulate the uterus to contract. Which of the following would be most important for the nurse to do? A) Administer the drug as an IV bolus injection. B) Give as a vaginal or rectal suppository. C) Piggyback the IV infusion into a primary line. D) Withhold the druq if the woman is hypertensive.

A) Diaphoresis D) Cool extremities

21. Assessment of a postpartum woman experiencing postpartum hemorrhage reveals mild shock. Which of the following would the nurse expect to assess? (Select all that apply.) A) Diaphoresis B) Tachycardia C) Oliguria D) Cool extremities E) Confusion

A) Rapid labor C) Hydramnios

22. A group of students are reviewing risk factors associated with postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as associated with uterine tone? (Select all that apply.) A) Rapid labor B) Retained blood clots C) Hydramnios D) Operative birth E) Fetal malpostion

B) Helps support the lower uterine segment

23. A nurse is massaging a postpartum clients fundus and places the nondominant hand on the area above the symphysis pubis based on the understanding that this action A) Determines that the procedure is effective B) Helps support the lower uterine segment C) aids in expressing accumulated clots D) Prevents uterine muscle fatigue

C) Early ambulation

24. A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which of the following would the nurse include as the most cost-effective method for prevention? A) Prophylactic heparin administration B) Compression stocking C) Early ambulation D) Warm compresses

B) I can take ibuprofen if I have any pain.

25. 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 states which of the following? A) I will use a soft toothbrush to brush my teeth. B) I can take ibuprofen if I have any pain. C) I need to avoid drinking any alcohol. D) I will call my health care provider if my stools

A) Taking the prescribed antibiotic until it is finished C) Washing hands before and after perineal care D) Handling perineal pads by the edges

26, The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which of the following would the nurse most likely include in this teaching plan? (Select all that apply.) A) Taking the prescribed antibiotic until it is finished B) Checking temperature once a week C) Washing hands before and after perineal care D) Handling perineal pads by the edges E) Directing peribottle to flow from back to front

B) Im feeling so guilty and worthless lately.

27. A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression? A) I just feel so overwhelmed and tired. B) Im feeling so guilty and worthless lately. C) Its strange, one minute Im happy, the next Im sad, D) keep hearing voices telling me to take my baby to the river.

D) Hardening of an area in the affected breast.

3. 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 assess for which of the following? A) An inverted nipple on the affected breast B) No breast milk in the affected breast C) An ecchymotic area on the affected breast D) Hardening of an area in the affected breast.

B) Uterine atony

4. A group of students are reviewing the causes of postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as the most common cause? A) Labor augmentation B) Uterine atony C) Cervical or vaginal lacerations D) Uterine inversion

B) Inspecting the placenta after delivery for intactness

5. After presenting a class on measures to prevent postpartum hemorrhage, the presenter determines that the teaching was successful when the class states which of the following as an important measure to prevent postpartum hemorrhage due to retained placental fragments? A) Administering broad-spectrum antibiotics B) Inspecting the placenta after delivery for intactness C) Manually removing the placenta at delivery D) Applying pressure to the umbilical cord to remove the placenta

A) Dyspnea, diaphoresis, hypotension, and chest pain

6. A multipara client develops thrombophlebitis after delivery. Which of the following would alert the nurse to the need for immediate intervention? A) Dyspnea, diaphoresis, hypotension, and chest pain B) Dyspnea, bradycardia, hypertension, and confusion C) Weakness, anorexia, change in level of consciousness, and coma D) Pallor, tachycardia, seizures, and jaundice

A) Infection

7. A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which of the following in the mother and the newborn? A) Infection B) Hemorrhage C) Trauma D) Hypovolemia

A) These measurements may not change until after the blood loss is large

8 When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage based on the knowledge that: A) These measurements may not change until after the blood loss is large B) The bodys compensatory mechanisms activate and prevent any changes C) They relate more to change in condition than to the amount of blood lost D) Maternal anxiety adversely affects these vital signs

C) Appearance of petechiae

9. The nurse is assessing a woman with abruption placentae who has just given birth. The nurse would be alert for which of the following? A) Severe uterine pain B) Board-like abdomen C) Appearance of petechiae D) Inversion of the uterus