Postpartum

Nurse is caring for a client 12 hours after giving birth. The client had an episiotomy during the second stage of labor. What education would the nurse provide to promote comfort and healing and to reduce risks of complications? What client would the nurse be on alert for after pains?

Change pad Q 3-4 hours, peri pad, tucks pads, tighten gluteal muscles, NSAIDS, ice 24 hours, then heat via sitz

Which postpartum client will the nurse assess first? A.a 35-year-old who delivered her 4th baby, complains of palpations, and bright red bleeding with large clots B.a 18-year-old who had estimated blood loss of 500 mL and has a supine BP of 130/80 mm Hg and BP of 100/65 mm Hg when head of the bed is elevated C.a 22-year-old who has been up, showered, and packing for discharge later today D.a 30-year-old postpartum client who had a cesarean birth and is sleeping following pain medication administration

A

A client who gave birth by cesarean birth 3 days ago is bottle-feeding her neonate. While collecting data the nurse notes that vital signs are stable, the fundus is four fingerbreadths below the umbilicus, lochia are small and red, and the client reports discomfort in her breasts, which are hard and warm to touch. What is the best nursing intervention? A.Encourage the client to apply ice bilaterally. B.Have the client stand facing in a warm shower. C.Notify the primary care provider that the client is showing early signs of a breast infection. D.Promote use of a breast pump to facilitate removal of stagnant breast milk.

A. Problem: Engorgement

When assessing the episiotomy site of a postpartum client that delivered 3-hours ago, the nurse would document which findings as expected? Select all that apply. a.Edema b.Redness c.Slight bruising d.Discharge e.Bleeding

ABC

A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply. a.uterine infection b.prolonged labor c.hydramnios d.breastfeeding e.early ambulation f.empty bladder

AC

A nurse finds their 8-hour postpartum (vaginal delivery) client in the bed, pale, shaking, and complaining of palpitations. She experienced a 48-hour induction of labor with oxytocin and delivered a macrosomic newborn. The client currently has a heplock in place. She has a history of 2 previous term vaginal deliveries, and chronic hypertension. The client is holding the infant. What would be the nurse's priority assessment? A.Blood Pressure B.Fundal Tone and position C.Check the history of bleeding D.Check hematocrit and hemoglobin

B

Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which of the following is present? a.Boggy fundus b.Heart rate 120 beats/minute c.Respiratory rate 22 breaths/minute d.Blood pressure 145/89

Contraindicated in patients with hypertension or toxemia. Monitor and record BP, pulse rate, and uterine response; report sudden change in vital signs, frequent periods of uterine relaxation, and character and amount of vaginal bleeding. Not safe in breastfeeding Don't routinely use IV route because of increased risk of severe hypertension and stroke.

What assessment findings would indicate to the nurse a postpartum client is exhibiting effective breastfeeding? SATA a.Utilizes the right breast for each feeding b.Nurses for 20-30 per feeding c.Initiates breastfeeding on demand d.Alternates positions with each feeding e.Manually expresses milk to erect the nipple

What are normal findings for breastfeeding client on day 5? B, c, d, e

Which interventions would the nurse take to reduce the incidence of infection in a postpartum woman? Select all that apply. a.Teach proper positioning of the infant for breast-feeding. b.Recommend that the mother change her peri pads every 12 hours. c.Encourage intake of fluids following delivery and after discharge. d.Wash her hands before and after caring for the client. e.Have the mother maintain a low activity level to allow the perineum to heal.

A, C, D,

While assessing a postpartum client who gave birth about 12 hours ago, the nurse evaluates the client's bladder and voiding. The nurse determines that the client may be experiencing bladder distention based on which finding? Select all that apply. a.moderate lochia rubra b.rounded mass over symphysis pubis c.dullness on percussion over symphysis pubis d.fundus boggy to the right of the umbilicus e.elevated oral temperature

BCD

The nurse finds this client's uterus to be boggy, up 2 finger breaths above the umbilicus, and to the right. Large amounts of bright red vaginal bleeding and clots are noted on the choux below the client. In what order, would the nurse implement the the follow interventions? • A.Remove the infant from the mother's arms. B.Perform continuous fundal massage. C.Administer oxygen at 10 L/min via face mask. D.Place a Foley catheter to empty the bladder. E.Place the client in a supine position

A, E, B, C, D

During the early postpartum period, a new mother is displaying dependent behaviors. What behaviors would the nurse recognize as normal for this period? Select all that apply. a.Needing assistance with changing her peripad b.Desiring to hold her infant c.Telling the nurse about her delivery experience. d.Asking the nurse to take the newborn away so she can rest. e.Changing her newborn's diaper with guidance from the nurse. •

ACD

A client who has just given birth to a baby girl demonstrates behavior not indicative of bonding when she performs which action? a.Holds and smiles at the infant b.Kisses the infant on her cheek c.Points out common features and expresses pride in infant d.Frequently asks for the baby to be kept in the nursery •

D

A postpartum nurse has been assigned 4 clients. Which client would the nurse anticipate having the worst complaints of after pains? a.G2P2, who is bottle feeding her infant b.G1P1, breastfeeding client c.G4P3, who is bottle feeding her infant d.G4P4, who is pumping Q2 hours for her infant in the NICU

D

A nurse is assessing a woman during the first 24 hours after birth. Which assessment findings require intervention? Select all that apply. a.Pain and redness in left calf b.Fundus firm, 2 above umbilicus, tilted to the right c.Hypotonic bowel sounds in only one quadrant d.Urination of 800 mL every 4 hours e.Moderate saturation of peripad every 3 hours What are your next actions for each correct choice?

A, B, C

A nurse is to care for a client during the postpartum period. The client reports pain and discomfort in her breasts. What signs should a nurse look for to find out if the client has engorged breasts? Select all that apply. a.Breasts are hard b.Breasts are tender c.Nipples are fissured d.Nipples are cracked e.Breasts are soft

ABD Engorged breasts are hard and tender, and the nurse should assess for these signs. Improper positioning of the infant on the breast, not engorged breasts, results in cracked, blistered, fissured, bruised, or bleeding nipples in the breastfeeding woman.

The nurse assesses the fundus of a client that is 2 days postpartum. What assessment findings would the nurse anticipate? A. Fundus firm at the umbilicus, midline, with lochia rubra, nipples cracked, breasts soft and nontender smooth and dry, some firmness noted on breasts B. fundus firm, 2 cm below the umbilicus, midline, with lochia rubra, nipples smooth and dry, breasts soft with some firmness noted C. fundus boggy, 2 cms below the umbilicus, heavy lochia, nipples smooth and dry, breasts firm and tender D. Fundus firm 6 cm below the umbilicus with lochia alba, nipples bruised, breasts are tender with red lateral streaks

B

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

A woman with mastitis is encouraged to continue breastfeeding her infant, and it is recommended to breastfeed about every 2 hours, while the infant is awake. Application of warm compresses helps reduce the discomfort of the infection and encourage healing. The primary health care provider will prescribe antibiotics and the client should complete the regimen. Mastitis can result when bacteria enters through cracks in the nipples. Rubbing breastmilk on the nipples after feeding helps reduce cracks, therefore decreasing the chance of the client experiencing mastitis again. Acetaminophen is safe to take while breastfeeding. The client can still breastfeed from the affected breast. However, if it is too painful, the client must express milk from the breast manually or with a pump to prevent engorgement (also a cause of mastitis) and promote continued milk production.

During the postpartum period, day 3, a new mother is displaying independent behaviors. What behaviors would the nurse recognize as normal for this period? Select all that apply. a.Ambulating the halls without cuing b.Asking questions and for reassurance about breastfeeding the baby c.Telling the nurse about her delivery experience. d.Asking the nurse to take the newborn away so she can rest. e.Changing her newborn's diaper without guidance from the nurse. •

A, B, E

A nurse is assessing a woman during the first 24 hours after birth. Which assessment finding would the nurse determine as acceptable during this time? Select all that apply. a.Pain and redness in left calf b.Fundus one fingerbreadth below the umbilicus c.Hypotonic bowel sounds d.Urination of 100 mL every 4 hours e.Moderate saturation of peripad every 3 hours

BCE

A nurse has been assigned to the care of a client who has just given birth. Prior to labor, the client's vital signs were as follows: BP 117/72, P 80, R 20, T 36.9.Which vital sign indicates normal adaptation for a postpartum client? a.Blood pressure 144/90 b.Respirations 22 breaths/min c.Temperature 38 Celsius d.Pulse 100 beats/minute

C

The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected? a.Cream-colored lochia with clots; uterus above the umbilicus b.Bright-red lochia with clots; uterus 2 finger-breadths below the umbilicus c.Light pink or brown lochia; uterus 4-5 finger-breadths below the umbilicus d.Yellow, mucousy lochia; uterus at the level of the umbilicus

C

One hour after delivery a client's partner calls the nurse and says, "My wife feels funny." The nurse enters the room and notes blood gushing from the client's vagina and pallor. The nurse finds the client's uterus to be boggy, up 2 finger breaths above the umbilicus. Large amounts of bright red vaginal bleeding and clots are noted on the choux below the client. In what order, would the nurse implement the the follow interventions? • A.Remove the infant from the mother's arms. B.Perform continuous fundal massage. C.Administer Hemobate IM D.Place a Foley catheter to empty the bladder. E.Place the client in a supine position •

A, E, B, C, D,

Which interventions would the nurse take to reduce the incidence of infection in a postpartum woman? Select all that apply. a.Teach proper positioning of the infant for breast-feeding. b.Recommend that the mother change her peripads every 12 hours. c.Encourage intake of fluids following delivery and after discharge. d.Wash their hands before and after caring for the client. e.Have the mother maintain a low activity level to allow the perineum to heal. •

ACD