Ch. 22: Nursing Management of the Postpartum Woman at Risk

A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first? STI status HIV status urinalysis results coagulation studies

coagulation studies

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? 500 ml 250 ml 1000 ml 750 ml

1000 ml

Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication? She says she is extremely thirsty. She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. Her perineum is obviously edematous on inspection. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.

The nurse reviews the history of a postpartum woman G3P3 and notes it is positive for obesity and smoking. The nurse would be especially alert for the development of signs and symptoms of which complication in this client? postpartum hemorrhage deep venous thrombosis metritis uterine atony

deep venous thrombosis

Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts? applying ice applying warm compresses restricting fluids administering bromocriptine

applying ice

The nurse is preparing discharge instructions for a postpartum woman who has developed DVT after a long and difficult birthing process. The nurse will include instruction on which medication for this client? Opioid analgesics NSAIDS Anticoagulants Beta-blockers

Anticoagulants

The nurse is providing education to a postpartum woman who has developed a uterine infection. Which statement by the woman indicates that further instruction is needed? "I will take frequent walks around my home to promote drainage." "When I am sleeping or lying in bed, I should lie flat on my back." "If my abdomen becomes firm, or if I don't urinate as much, I need to call the doctor." "I will change my perineal pad regularly to remove the infected drainage."

"When I am sleeping or lying in bed, I should lie flat on my back."

The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly, bright red blood gushes from the vagina. The nurse recognizes that which occurrence is the most likely cause of this postpartum hemorrhage? Retained placental fragments A cervical laceration Uterine atony Disseminated intravascular coagulation

A cervical laceration

The nurse is conducting discharge teaching with a postpartum woman. What would be an important instruction for this client? Call her caregiver if lochia moves from serosa to rubra. Call her caregiver if amount of lochia decreases. Call her caregiver if lochia moves from rubra to serosa. Call her caregiver if lochia moves from serosa to alba.

Call her caregiver if lochia moves from serosa to rubra.

A postpartum client is recovering from the birth and emergent repair of a cervical laceration. Which sign on assessment should the nurse prioritize and report to the health care provider? Warm and flushed skin Decreased respiratory rate Elevated blood pressure Weak and rapid pulse

Weak and rapid pulse

The nurse is administering a postpartum woman an antibiotic for mastitis. Which statement by the mother indicates that she understood the nurse's explanation of care? "I will stop breastfeeding until I finish my antibiotics." "I can continue breastfeeding my infant, but it may be somewhat uncomfortable." "When breastfeeding, it is recommended to begin nursing on the infected breast first." "I am able to pump my breast milk for my baby and throw away the milk."

"I can continue breastfeeding my infant, but it may be somewhat uncomfortable."

A postpartum client with a history of deep vein thrombosis is being discharged on anticoagulant therapy. The nurse teaches the client about the therapy and measures to reduce her risk for bleeding. Which statement by the client indicates the need for additional teaching? "If my lochia increases, I need to call my health care provider." "I should brush my teeth vigorously to stimulate the gums." "If I get a cut, I need to apply direct pressure for about 5 minutes or more." "I need to avoid using any aspirin-containing products."

"I should brush my teeth vigorously to stimulate the gums."

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "I am sad because I am not spending as much time with my toddler now that my newborn is here." "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

"When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

The nurse is assigned to care for a postpartum client with a deep vein thrombosis (DVT) who is prescribed anticoagulation therapy. Which statement will the nurse include when providing education to this client? "You need to avoid medications which contain acetylsalicylic acid." "You can breastfeed your newborn while taking any anticoagulation medication." "It is appropriate for you to sit with your legs crossed over each other." "It is expected for you to have minimal blood in your urine during therapy."

"You need to avoid medications which contain acetylsalicylic acid."

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 was not able to have a vaginal birth. When questioned further, the client states she feels "weepy about everything" and cannot stop crying. What nursing action is indicated first? Document the conversation. Discuss the client's potential depression with her family members. Ask the client to elaborate on her feelings. Contact the primary care provider to report the client's deteriorating mental status.

Ask the client to elaborate on her feelings.

The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? Height, level of orientation, support systems Blood pressure, pulse, reports of dizziness Attachment, lochia color, complete blood cell count Degree of responsiveness, respiratory rate, fundus location

Blood pressure, pulse, reports of dizziness

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. Use semi-Fowler position to encourage uterine drainage. Check for bladder distention, while encouraging the client to void. Offer analgesics prescribed by health care provider.

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

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? Assess the temperature. Assess the fundal height. Check the lochia. Monitor the pain level.

Check the lochia.

One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for? Content, lochia, place Consistency, location, and place Consistency, shape, and location Location, shape, and content

Consistency, shape, and location

The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal? Klebsiella pneumoniae Escherichia coli Staphylococcus aureus Gardnerella vaginalis

Escherichia coli

What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? Calcium gluconate Domperidone Magnesium sulfate Oxytocin

Oxytocin

The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize? Assess her blood pressure. Palpate her fundus. Have her turn to her left side. Assess her perineum.

Palpate her fundus.

The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response? Pierced nipple Complete emptying of the breast Frequent feeding Use of breast pumps

Pierced nipple

A woman arrives at the office for her 4-week postpartum visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client? Ineffective peripheral tissue perfusion related to interference with circulation secondary to development of thrombophlebitis Risk for fatigue related to chronic bleeding due to subinvolution Risk for impaired breastfeeding related to development of mastitis Risk for infection related to microorganism invasion of episiotomy

Risk for fatigue related to chronic bleeding due to subinvolution

Which intervention(s) will the nurse recommend for a breastfeeding mother diagnosed with mastitis? Select all that apply. Rub expressed breast milk on the nipples after each feeding session Take antibiotics as prescribed Apply warm compresses to the affected breast PRN Encourage client to breastfeed the infant every 3 to 4 hours Take acetaminophen as needed for pain Do not breastfeed from the affected breast

Rub expressed breast milk on the nipples after each feeding session Take antibiotics as prescribed Apply warm compresses to the affected breast PRN Take acetaminophen as needed for pain

Which recommendation should be given to a client with mastitis who is concerned about breastfeeding her neonate? She should not use analgesics because they are not compatible with breastfeeding. She should supplement feeding with formula until the infection resolves. She should stop breastfeeding until completing the antibiotic. She should continue to breastfeed; mastitis will not infect the neonate.

She should continue to breastfeed; mastitis will not infect the neonate.

The nurse is teaching a client with newly diagnosed mastitis about her condition. The nurse would inform the client that she most likely contracted the disorder from which organism? Staphylococcus aureus Escherichia coli group B streptococcus (GBS) Streptococcus pyogenes (group A strep)

Staphylococcus aureus

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? Symptoms include fever, chills, malaise, and localized breast tenderness. A breast abscess is a common complication of mastitis. Mastitis usually develops in both breasts of a breastfeeding client. The most common pathogen is group A streptococcus (GAS).

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

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? a primiparous client who had a vaginal birth a client who had a nonelective cesarean birth a client who had an 8-hour labor a client who conceived following fertility treatments

a client who had a nonelective cesarean birth

A nurse is caring for a postpartum client with a platelet count of 15,000/ml and has been diagnosed with idiopathic thrombocytopenic purpura (ITP). Which intervention should the nurse perform first? administration of platelet transfusions as prescribed avoiding administration of oxytocics continual firm massage of the uterus administration of prescribed nonsteroidal anti-inflammatory drugs (NSAIDs)

administration of platelet transfusions as prescribed

Which measurement best describes postpartum hemorrhage? blood loss of 1,000 ml, occurring at least 24 hours after birth blood loss of 600 ml, occurring at least 24 hours after birth blood loss of 400 ml, occurring at least 24 hours after birth blood loss of 800 ml, occurring at least 24 hours after birth

blood loss of 1,000 ml, occurring at least 24 hours after birth

A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. inability to concentrate bizarre behavior loss of confidence manifestations of mania decreased interest in life

inability to concentrate loss of confidence decreased interest in life

A nurse is conducting a class for nurses working in the postpartum unit about ways to reduce the risk of postpartum infections. The nurse determines that the teaching was effective when the group identifies which preventive measure as essential? meticulous handwashing fluid intake limitations use of clean gloves for invasive procedures unlimited visitation from family and friends

meticulous handwashing

A nurse is caring for a client in the clinic. The client reports burning during urination for the past few days. Assessment reveals cloudy urine, with the presence of white blood cells (WBCs). Vital signs: temperature, 101.4°F (38.5°C); heart rate, 101 beats/min; blood pressure, 100/64 mm Hg. Complete the following sentence(s) by choosing from the lists of options. The priority actions of the nurse should be to first _____ followed by _____.

obtain a culture; initiate antibiotics

Manual manipulation is used to reposition the uterus of a client experiencing uterine inversion. After the repositioning, which type of medication would the nurse administer as prescribed to the client? nifedipine oxytocin agent indomethacin magnesium sulfate

oxytocin agent

A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and the client frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition? postpartum psychosis postpartum depression postpartum blues postpartum panic disorder

postpartum psychosis

A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? uterine contraction uterine atony uterine prolapse uterine subinvolution

uterine atony

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? uterine atony moderate amount of lochia rubra thrombophlebitis hemoglobin level of 12 g/dl (120 g/L)

uterine atony