postpartum care

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

uterine atony

A new mother tells the nurse at the baby's 3 month check-up, "When she cries, it seems like I am the only one who can calm her down." This is an example of which behavior? bonding attachment being spoiled none of the above

attachment

A nurse finds the uterus of a postpartum woman to be boggy and somewhat relaxed. This a sign of which condition? infection hemorrhage normal involution atony

atony

A client has been discharged from the hospital after a cesarean birth. Which instruction should the nurse include in the discharge teaching? "Followup with your healthcare provider within 3 weeks of being discharged." Notify the healthcare provider if your temperature is greater than 99° F (37.2° C)." "You should be seen by your healthcare provider if you have blurred vision." "Call your healthcare provider if you saturate a peri-pad in less than 4 hours."

"You should be seen by your healthcare provider if you have blurred vision."

A nurse is assessing a postpartum client and notes an elevated temperature. Which temperature protocol should the nurse prioritize? 99.1º F (37.3º C) at 12 hours postbirth and decreases after 18 hours 100.1º F (37.8º C) at 24 hours postbirth and decreases the second postpartum day 100.3º F (37.9º C) at 24 hours postbirth and remains the same for the second postpartum day 100.5º F (38.1º C) at 48 hours postbirth and remains the same the third day postpartum

100.5º F (38.1º C) at 48 hours postbirth and remains the same the third day postpartum

A postpartum client is having difficulty stopping her urine stream. Which should the nurse do next? Determine if the client is emptying her bladder. Ask the client when she last urinated. Perform an in and out catheter on the client. Educate the client on how to perform Kegel exercises.

Educate the client on how to perform Kegel exercises.

Which instruction should the nurse offer a client as primary preventive measures to prevent mastitis? Avoid massaging the breast area. Avoid frequent breast-feeding. Perform handwashing before breast-feeding. Apply cold compresses to the breast.

Perform handwashing before breast-feeding.

The nurse is checking the lochia of a new mother at her 2-week checkup. The mother reports that the lochia is a small amount, pale yellow with occasional tinges of brown. She also reports that it has fleshy odor to it. How would the nurse evaluate these findings? The lochia's odor indicates that an infection may be present and the doctor needs to be notified. The color and amount of the lochia is normal and there are no concerns. The brownish tinges indicate that the mother is regressing on the expected pattern of lochia and this is problematic. Lochia should have stopped by now, so this is definitely concerning for the nurse and should be reported.

The color and amount of the lochia is normal and there are no concerns.

A client who has given birth a week ago reports discomfort when defecating and ambulating. The birth involved an episiotomy. Which suggestions should the nurse provide to the client to provide local comfort? Select all that apply. Maintain correct posture. Use of warm sitz baths. Use of anesthetic sprays. Use of witch hazel pads. Use good body mechanics.

Use of witch hazel pads. Use of anesthetic sprays. Use of warm sitz baths.

A client has come to the office for her first postpartum visit. On evaluating her blood work, the nurse would be concerned if the hematocrit is noted to have: acutely decreased. acutely increased. slightly decreased. slightly increased.

acutely decreased.

Which finding would lead the nurse to suspect that a woman is developing a postpartum complication? an absence of lochia red-colored lochia for the first 24 hours lochia that is the color of menstrual blood lochia appearing pinkish-brown on the fourth day

an absence of lochia

The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? Uteruine atony Full bowel Bladder distention Poor bladder tone

bladder distention

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 loss of confidence manifestations of mania decreased interest in life bizarre behavior

decreased interest in life loss of confidence inability to concentrate

In reviewing the postpartum G3, P3 woman's history the nurse notes it is positive for obesity and smoking. The nurse recognizes this client is at risk for which complication? deep venous thrombosis uterine atony postpartum hemorrhage metritis

deep vein thrombosis

A nurse is instructing a woman that it is important to lose pregnancy weight gain within 6 months of birth because studies show that keeping extra weight longer is a predictor of which condition? diabetes long-term obesity feelings of increased self-esteem increased sex drive

long-term obesity

A woman who gave birth to a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which condition does the nurse believe is causing this experience? postpartum baby blues postpartum anxiety postpartum reaction postpartum depression

postpartum baby blues Explanation: Postpartum baby blues is common in women after giving birth. It is a mild depression; however, functioning usually is not impaired. Postpartum blues usually peaks at day 4 or 5 after birth. Postpartum anxiety and postpartum depression do not usually start until at least 3 to 4 weeks and up to 1 year following the birth of a baby. Postpartum reaction is a term to include postpartum depression, anxiety, and psychosis.

During the second day postpartum, a nurse notices that a client is initiating breastfeeding with her infant and changing her infant's diapers with some assistance from her partner. Which phase does the nurse recognize that the woman is experiencing? the taking-in phase the taking-hold phase the binding-in phase the letting-go phase

the taking-hold phase

A nurse is caring for a client who is nursing her baby boy. The client reports afterpains. Secretion of which substance would the nurse identify as the cause of afterpains? prolactin progesterone oxytocin estrogen

oxytocin Explanation: Secretion of oxytocin stimulates uterine contraction and causes the woman to experience afterpains. Decrease in progesterone and estrogen after placental delivery stimulates the anterior pituitary to secrete prolactin which causes lactation.

When assessing a postpartum woman, the nurse would find which factor to be most significant in identifying possible postpartum hemorrhage? pulse rate blood pressure cardiac output hematocrit

pulse rate

Many clients experience a slight fever after birth especially during the first 24 hours. To what should the nurse attribute this elevated temperature? infection dehydration change in the temperature from the birth room fluid volume overload

dehydration

A client is Rh-negative and has given birth to her newborn. What should the nurse do next? Determine the newborn's blood type and rhesus. Determine if this is the client's first baby. Administer Rh immunoglobulins intramuscularly. Ask if the client received rH immunoglobulins during the pregnancy.

Determine the newborn's blood type and rhesus.

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. uterine infection prolonged labor hydramnios breastfeeding early ambulation empty bladder

uterine infection hydramnios prolonged labor

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 750 mL 1000 mL 250 mL

1000 mL

A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition? hyperglycemia hypertension hypovolemia hypothyroidism

hypovolemia Explanation: The nurse should assess the client for hypovolemia as the client must have had hemorrhage during birth and puerperium. Additionally, the client also has discontinued iron supplements. Hyperglycemia can be considered if the client has a history of diabetes. Hypertension and hyperthyroidism are not related to discontinuation of iron supplements.

A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing? hemorrhage infection depression pulmonary emboli

infection

Two days ago, a woman gave birth to her third infant; she is now preparing for discharge home. After the birth of her second child, she developed an endometrial infection. Nursing goals for this discharge include all of the following except: the client will show no signs of infection. discuss methods that the woman will use to prevent infection. list signs of infection that she will report to her health care provider maintain previous household routines to prevent infection.

maintain previous household routines to prevent infection.

A woman who gave birth to her infant 1 week ago calls the clinic to report pain with urination and increased frequency. What response should the nurse prioritize? "This is normal; give it a few days and then call back." "After birth it is easier to develop an infection in the urinary system; we need to see you today." "Are you washing and providing good perineal hygiene? If not, this may be the reason for the irritation." "It is common for women to have yeast problems; try an over the counter cream and let us know if this continues."

"After birth it is easier to develop an infection in the urinary system; we need to see you today."

In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status? "What time did you last change your pad?" "How much blood was on the two pads?" "Are you in any pain with your bleeding?" "When did you last void?"

"How much blood was on the two pads?"

A nurse on the postpartum floor is conducting a class on danger signs for postpartum women after discharge. The nurse recognizes that further teaching is needed when a new mother makes which statement? "I need to let the doctor know if my lochia begins to have a foul smell." "I am breast-feeding so I can anticipate that there will be reddened, painful areas in my breasts when I am engorged." "My episiotomy should begin to heal and feel better over the next few weeks" "If I develop chills or my fever goes above 100.4℉ (38℃), I need to let someone know."

"I am breast-feeding so I can anticipate that there will be reddened, painful areas in my breasts when I am engorged."

The nurse is administering a postpartal 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 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." "When breastfeeding, it is recommended to begin nursing on the infected breast first."

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

After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, the nurse understands there is a need for additional teaching when one of the women makes which statement? "I can't wait for these stretch marks to disappear after I give birth." "I might lose some hair, but it will grow back." "This line on my belly will go away over time." "My nipples won't be so dark after I give birth."

"I can't wait for these stretch marks to disappear after I give birth."

The nurse is providing discharge education for a new mother regarding constipation. Which statement by the mother indicates that she understands what the nurse explained to her? "I will avoid medications for constipation such as psyllium (Metamucil) because it can upset the baby's stomach." "It is all right to suppress the urge to have a stool for a few days to allow my stitches to heal." "I will increase my intake of fruits and vegetables in my diet. I love to eat them anyhow." "A good meal for me is cream of chicken soup, cheese toast and ice cream for dessert."

"I will increase my intake of fruits and vegetables in my diet. I love to eat them anyhow."

A newly delivered mother asks the nurse "What can I do to help my womb to get back to a normal size more quickly?" The nurse's best response would be: "If you are breast-feeding, that will help make your uterus contract and get smaller." "I would recommend that you rest for a few days to allow your body to heal and get back to normal." "Eating a large amount of protein and carbohydrates will help make the uterus contract." "There is really nothing you can do to speed along the progress, so just be patient."

"If you are breast-feeding, that will help make your uterus contract and get smaller."

A woman who is at 31 weeks' gestation comes to the clinic in labor. The health care provider decides to use terbutaline therapy before transferring the woman to the hospital. The client is upset and confused and asks the nurse why she can't just have the baby, that it's only 5 weeks early. An appropriate response by the nurse should be: "This drug will make your delivery in a few days less painful." "The drug that you are being given will prevent and control postpartum bleeding." "The drug provides sufficient time for other medications to be given to improve your baby's outcome." "This drug helps induce uterine contractions and milk ejection for breast-feeding."

"The drug provides sufficient time for other medications to be given to improve your baby's outcome."

The client is preparing to go home after a cesarean birth. The nurse giving discharge instructions stresses to the family that the client should be seen by her primary care provider within what time interval? 2 weeks 3 weeks 4 weeks 5 weeks

2 weeks

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? Begin an IV infusion of Ringer's lactate solution. Assess the woman's vital signs. Call the woman's health care provider. Assess the woman's fundus.

Assess the woman's fundus.

A woman is bottle-feeding her baby. When the nurse comes into the room the woman says that her breasts are painful and engorged. Which nursing intervention is appropriate? Assist the woman into the shower, and have her run cold water over her breasts. Assist the woman in placing ice packs on her breasts. Explain to the woman that she should breastfeed because she is producing so much milk. Ask if she wants a breast pump to empty her breasts.

Assist the woman in placing ice packs on her breasts.

A nurse notes a woman's prelabor vital signs were: temperature 98.8° F (37.1° C); BP 120/70 mm Hg; heart rate 80 bpm. and respirations 20 breaths/min. Which assessment findings during the early postpartum period should the nurse prioritize? shaking chills with a fever of 100.4° F (38° C)' BP 90/50 mm Hg, heart rate 120 bpm, respirations 24 breaths/min . heart rate 70 bpm and excessive, soaking diaphoresis blood loss of 250 mL and WBC 25,000 cells/mL

BP 90/50 mm Hg, heart rate 120 bpm, respirations 24 breaths/min. Explanation: The decrease in BP with an increase in HR and RR indicate a potential significant complication and are out of the range of normals from birth and need to be reported immediately. Shaking chills with a temperature of 100.3° F (37.9° C) can occur due to stress on the body and is considered a normal finding. A fever of 100.4° F (38° C) should be reported. The other options are considered to be within normal limits after giving birth to a baby.

Parents tell the nurse that their 3-year-old son has begun to have "accidents" at home following the arrival of his baby sister and wants to sit in his mother's lap all the time now. What advice would the nurse offer these parents? Select all that apply. Tell the older sibling that he is a big boy and has to share his mommy with the little sister. Set aside time every day for the parents to focus on the big brother exclusively. Buy the older sibling a doll for him to care for, as the mother is caring for the new baby. Scold him whenever he wets his pants and place him back in diapers. Be aware of potential aggressive behaviors from the older sibling.

Be aware of potential aggressive behaviors from the older sibling. Set aside time every day for the parents to focus on the big brother exclusively. Buy the older sibling a doll for him to care for, as the mother is caring for the new baby.

A mother is experiencing postpartum hemorrhage shortly after delivery of her infant. Which nursing interventions would be appropriate for this client? Select all that apply. Encourage the mother to breast-feed her infant if she is breast-feeding. Begin uterine massage with both hands on the fundus of the uterus. Turn the mother on her side and inspect the area under her buttocks for blood. Encourage increased fluid intake. Monitor vital signs every 15 minutes.

Encourage the mother to breast-feed her infant if she is breast-feeding. Turn the mother on her side and inspect the area under her buttocks for blood. Encourage increased fluid intake. Monitor vital signs every 15 minutes.

A nurse is applying ice packs to the perineal area of a client who has had a vaginal birth. Which intervention should the nurse perform to ensure that the client gets the optimum benefits of the procedure? Apply ice packs directly to the perineal area. Apply ice packs for 40 minutes continuously. Ensure ice pack is changed frequently. Use ice packs for a week after birth.

Ensure ice pack is changed frequently.

A client who gave birth about 12 hours ago informs the nurse that she has been voiding small amounts of urine frequently. The nurse examines the client and notes the displacement of the uterus from the midline to the right. What intervention would the nurse perform next? Insert a 20 gauge IV. Administer oxytocin IV. Notify the healthcare provider. Perform urinary catheterization.

Perform urinary catheterization.

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

Risk for fatigue related to chronic bleeding due to subinvolution

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

She should continue to breast-feed; mastitis will not infect the neonate.

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

Teach proper positioning of the infant for breast-feeding. Encourage intake of fluids following delivery and after discharge. Wash her hands before and after caring for the client.

A new mother tells the postpartum nurse that she thinks her baby does not like her since it cries often when she holds it. How should the nurse respond to this statement? Tell the mother that it is natural to have feelings of uncertainty when adjusting to a new baby. Recommend that she talk to the unit social worker to get the mother some counseling prior to discharge. Dismiss the mother's concerns by telling her that you are sure she doesn't really mean it. Recommend rooming-in to foster attachment and confidence by the mother.

Tell the mother that it is natural to have feelings of uncertainty when adjusting to a new baby.

Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? applying ice restricting fluids applying warm compresses administering bromocriptine

applying ice

A new mother has been reluctant to hold her newborn. Which action by the nurse would help promote this mother's attachment to her newborn? talking about how the nurse held her own newborn while on the birthing table. showing a video of parents feeding their babies. allowing the mother to pick the best time to hold her newborn. bringing the newborn into the room.

bringing the newborn into the room.

The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? postpartum blues postpartum depression postpartum psychosis anxiety disorders

postpartum depression

The nurse who is working with parents and their newborn encourages which action to assist the bonding and attachment between them? touching talking looking feeding

touching

During an assessment, the nurse notes that the client has been unable to urinate properly since she gave birth and is still bleeding more than expected. The nurse suspects which condition? uterine atony urinary retention postpartum diaphoresis urinary tract infection

uterine atony

A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first? venous duplex ultrasound of the right leg transthoracic echocardiogram venogram of the right leg noninvasive arterial studies of the right leg

venous duplex ultrasound of the right leg

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

weak and rapid pulse