PPD/postpartum

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

"I can't wait for these stretch marks to disappear after delivery." Correct Explanation: Stretch marks gradually fade to silvery lines but do not disappear completely. As estrogen and progesterone levels decrease, the darkened pigmentation on the abdomen, face, and nipples gradually fades

A new mother is concerned because it is 24 hours after childbirth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? a) "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in." b) "You may have developed mastitis. I'll ask the physician to examine you." c) "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs." d) "It takes about 3 days after birth for milk to begin forming."

"It takes about 3 days after birth for milk to begin forming." Correct Explanation: The formation of breast milk (lactation) begins in a postpartal woman regardless of her plans for feeding. For the first 2 days after birth, an average woman notices little change in her breasts from the way they were during pregnancy as, since midway through pregnancy, she has been secreting colostrum, a thin, watery, prelactation secretion. On the third day post birth, her breasts become full and feel tense or tender as milk forms within breast ducts and replaces colostrum. There is no need to recommend formula feeding to the mother. Mastitis is inflammation of the lactiferous (milk-producing) glands of the breast; there is no indication that the client has this condition. Lactational amenorrhea is the absence of menstrual flow that occurs in many women during the lactation period.

A woman who gave birth to a healthy newborn 2 months ago comes to the clinic and reports discomfort during sexual intercourse. Which suggestion by the nurse would be most appropriate? a) "You might try using a water-soluble lubricant to ease the discomfort." b) "This is entirely normal, and many women go through it. It just takes time." c) "It takes a while to get your body back to its normal function after having a baby." d) "Try doing Kegel exercises to get your pelvic muscles back in shape."

"You might try using a water-soluble lubricant to ease the discomfort." Correct Explanation: Coital discomfort and localized dryness usually plague most postpartum women until menstruation returns. Water-soluble lubricants can reduce discomfort during intercourse. Although it may take some time for the woman's body to return to its prepregnant state, telling the woman this does not address her concern. Telling her that dyspareunia is normal and that it takes time to resolve also ignores her concern. Kegel exercises are helpful for improving pelvic floor tone but would have no effect on vaginal dryness.

When working with parents who have some form of sensory impairment, nurses should consider which information when writing a plan of care? A) One of the major difficulties visually impaired parents experience is the skepticism of health care professionals B) Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact C) The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities D) Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information E) Childbirth education and other materials are available in Braille.

*A) One of the major difficulties visually impaired parents experience is the skepticism of health care professionals* *C) The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities* *D) Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information* *E) Childbirth education and other materials are available in Braille.* Rationale: The skepticism, open or hidden, of health care professionals throws up an additional and unneeded hurdle for the parents. Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. After the parents' capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a child's cry. Sign language is acquired readily by young children. Childbirth education and other materials are available in Braille.

Parents can facilitate the adjustment of their other children to a new baby by: A) having the children choose or make a gift to give to the new baby on its arrival home. B) emphasizing activities that keep the new baby and other children together. C) having the mother carry the new baby into the home so she can show him or her to the other children. D) reducing stress on other children by limiting their involvement in the care of the new baby.

*A) having the children choose or make a gift to give to the new baby on its arrival home.* Rationale: Having the sibling make or choose a gift for the new baby helps to make the child feel a part of the process. Special time should be set aside just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability without overwhelming them.

When helping a woman cope with postpartum blues, the nurse should offer what appropriate suggestions? (Select all that apply.) A) The father should take over care of the baby, because postpartum blues are exclusively a female problem. B) Get plenty of rest. C) Plan to get out of the house occasionally. D) Asking for help will not foster independence. E) Use La Leche League or community mental health centers.

*B) Get plenty of rest.* *C) Plan to get out of the house occasionally.* *E) Use La Leche League or community mental health centers.* Rationale: Suggestions for coping with postpartum blues include: · Remember that the "blues" are normal and that both the mother and the father or partner may experience them. · Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not "Supermom.") · Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques). · Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk. · Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers' Morning Out. · Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics). · If you are breastfeeding, give yourself and your baby time to learn. · Seek out and use community resources such as La Leche League or community mental health centers.

The maternity nurse promoting parental-infant attachment should incorporate which appropriate cultural beliefs into the plan of care? (Select all that apply.) A) Asian mothers are encouraged to return to work as soon as possible. B) Jordanian mothers have a 40-day lying-in after birth. C) Japanese mothers rest for the first 2 months after childbirth. D) Encourage Hispanics to eat plenty of fish and pork to increase vitamin intake. E) Encourage Vietnamese mothers to cuddle with the newborn.

*B) Jordanian mothers have a 40-day lying-in after birth.* *C) Japanese mothers rest for the first 2 months after childbirth.* Rationale: Asian mothers must remain at home with the baby up to 30 days after birth and are not supposed to engage in household chores, including care of the baby. Jordanian mothers have a 40-day lying-in after birth, during which their mothers or sisters care for the baby. Japanese mothers rest for the first 2 months after childbirth. Hispanic practice involves many food restrictions after childbirth, such as avoiding fish, pork, and citrus foods. Vietnamese mothers may give minimal care to their babies and refuse to cuddle or further interact with the baby to ward off "evil" spirits.

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? A) Talks and coos to her son B) Seldom makes eye contact with her son C) Cuddles her son close to her D) Tells visitors how well her son is feeding

*B) Seldom makes eye contact with her son* Rationale: The woman should be encouraged to hold her infant in the en face position and make eye contact with him. Talking and cooing to her son is a normal infant-parent interaction. Cuddling is a normal infant-parent interaction. Sharing her son's success at feeding is a normal infant-parent interaction.

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior? A) The parents have difficulty naming the infant. B) The parents hover around the infant, directing attention to and pointing at the infant. C) The parents make no effort to interpret the actions or needs of the infant. D) The parents do not move from fingertip touch to palmar contact and holding.

*B) The parents hover around the infant, directing attention to and pointing at the infant.* Rationale: Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior. Reluctance to name the baby is an inhibiting behavior. Failure to interpret the actions and needs of the infant is an inhibiting behavior. Lack of fingertip, palmar touch, and holding represents an inhibiting behavior.

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: A) foster an active role in the baby's care. B) provide time for the mother to reflect on the events of and her behavior during childbirth. C) recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. D) promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

*B) provide time for the mother to reflect on the events of and her behavior during childbirth.* Rationale: Once the mother's needs are met, she would be more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach. *The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.*

Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care? A) PPD symptoms are consistently severe. B) This syndrome affects only new mothers. C) PPD can easily go undetected. D) Only mental health professionals should teach new parents about this condition.

*C) PPD can easily go undetected.* Rationale: PPD symptoms range from mild to severe, with women having good days and bad days. Screening should be done for mothers and fathers. PPD may also occur in new fathers. PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: A) Express a strong need to review events and her behavior during the process of labor and birth. B) Exhibit a reduced attention span, limiting readiness to learn. C) Shifts between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. D) Have reestablished her role as a spouse/partner.

*C) Shifts between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn.* Rationale: *One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth.* Reviewing events and behavior during labor/birth and exhibiting reduced attention span/limited readiness to learn are characteristic of the taking-in stage, which lasts for the first few days after birth. Re-establishing role as spouse/partner reflects the letting-go stage, which indicates that psychosocial recovery is complete.

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: A) express a strong need to review events and her behavior during the process of labor and birth. B) exhibit a reduced attention span, limiting readiness to learn. C) vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. D) have reestablished her role as a spouse/partner.

*C) vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn.* Rationale: *One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth.* Reviewing events and behavior during labor/birth and exhibiting reduced attention span/limited readiness to learn are characteristic of the taking-in stage, which lasts for the first few days after birth. Re-establishing role as spouse/partner reflects the letting-go stage, which indicates that psychosocial recovery is complete.

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: A) tell the woman she can rest after she feeds her baby. B) recognize this as a behavior of the taking-hold stage. C) record the behavior as ineffective maternal-newborn attachment. D) take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.

*D) take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.* Rationale: The woman should not be told what to do and needs to care for her own well-being. *The taking-hold stage occurs about 1 week after birth.* Because the woman needs to rest does not indicate ineffective maternal-newborn attachment. The behavior described is typical of this stage and not a reflection of ineffective attachment unless it persists. Mothers need to reestablish their own well-being to effectively care for their baby.

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: A) Tell the woman she can rest after she feeds her baby. B) Recognize this as a behavior of the taking-hold stage. C) Record the behavior as ineffective maternal-newborn attachment. D) Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.

*D)Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.* Rationale: The woman should not be told what to do and needs to care for her own well-being. *The taking-hold stage occurs about 1 week after birth.* Because the woman needs to rest does not indicate ineffective maternal-newborn attachment. The behavior described is typical of this stage and not a reflection of ineffective attachment unless it persists. Mothers need to reestablish their own well-being to effectively care for their baby.

Screen all postpartum women, because

*Many believe symptoms are normal *Unable to recognize she is depressed *feels she is going crazy & someone will take the baby *fears being labeled as a "bad mother"

Nursing interventions for PPD

*educate woman & support system of dx *screen each new mom for PPD *refer PRN to doctor or hospitalization *follow-up with the patient (risk period is up to 3 months)

Risk factors for PPD

*prenatal depression *low self-esteem *stress of child care *prenatal anxiety *life stress *hx of depression *unplanned/unwanted pregnancy *lack of social support *marital relationship problems *"difficult" infant temperament *single mom *postpartum blues *low socio-economic status

Nursing diagnoses for PPD

*risk for self-directed/other-directed harm *situational low self-esteem r/t role change *disabled family coping r/t incr. care needs *risk for impaired parenting r/t detachment *risk for injury r/t mother's depression

The nurse is monitoring a postpartum client who says she's concerned because she feels mildly depressed. The nurse recognizes that she's most likely experiencing "postpartum blues," and reassures the client that this symptom is experienced by approximately what percentage of women? a) 25% b) 100% c) 75% d) 40%

75% Explanation: Postpartum blues, or mild depression during the first 10 days after giving birth, affects 75% to 80% of women who give birth. More intense depression during this period is referred to as postpartum depression, which affects approximately 10% to 15% of postpartum clients. Postpartum depression can be severe with negative implications for maternal and neonatal well-being.

Bonding between a mother and her infant can be defined how? a) An ongoing process in the year after delivery b) The skin to skin contact that occurs in the delivery room c) A process of developing an attachment and becoming acquainted with each other d) Family growing closer together after the birth of a new baby

A process of developing an attachment and becoming acquainted with each other Correct Explanation: Bonding in the maternal-newborn world is the attachment process that occurs between a mother and her newborn infant. This is how the mother and infant become engaged with each other and is the foundation for the relationship. Because bonding is a process and not a single event, option B is incorrect. The process of bonding is not a year-long process, so option C is incorrect. The family growing closer together after the birth of a new baby is not bonding, so option D is incorrect.

A nurse is caring for a client who gave birth about 10 hours earlier. The nurse observes perineal edema in the client. What intervention should the nurse perform to decrease the swelling caused due to perineal edema? a) Apply moist heat b) Use a warm sitz bath or tub bath c) Apply ice d) Use ointments locally

Apply ice Correct Explanation: Ice is applied to perineal edema within 24 hours after delivery. Use of ointments is not advised for perineal edema. Moist heat and a sitz or tub bath are encouraged if edema continues 24 hours after delivery.

Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? a) Administering bromocriptine (Parlodel) b) Applying warm compresses c) Restricting fluids d) Applying ice

Applying ice Correct Explanation: Ice promotes comfort by decreasing blood flow (vasoconstriction), numbing the area, and discouraging further letdown of milk. Restricting fluids doesn't reduce engorgement and shouldn't be encouraged. Warm compresses will promote blood flow and hence, milk production, worsening the problem of engorgement. Bromocriptine has been removed from the market for lactation suppression.

A client gave birth to a healthy boy 2 days ago. Both mother and baby have had a smooth recovery. The nurse enters the room and tells the client that she and her baby will be discharged home today. The client states, "I do not want to go home." Which of the following is the nurse's most appropriate response? a) Tell the client that she must go home as per hospital policy. b) Ask the client if she has any support in the home. c) Inform the physician that the client does not want to go home. d) Ask the client why she does not want to go home.

Ask the client why she does not want to go home. Correct Explanation: It is important for the nurse to identify the client's concerns and reasons for wanting to stay in the hospital. Open-ended questioning facilitates both effective and therapeutic communication and allows the nurse to address concerns appropriately. Asking about supports at home implies that the nurse has made assumptions about why the client may not want to go home. Informing the physician or telling the client that discharge is hospital policy is not appropriate at this time, because the nurse has not addressed the underlying reason for the client's comment. The client may have safety-related concerns, undisclosed fears, or a need for increased support before discharge. It is imperative that the nurse not make assumptions but further explore concerns.

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? a) Ask if she wants a breast pump to empty her breasts b) Assist the woman in placing ice packs on her breasts c) Assist the woman into the shower and have her run cold water over her breasts d) Explain to the woman that she should breastfeed because she is producing so much milk

Assist the woman in placing ice packs on her breasts Correct Explanation: If the breasts are engorged and the woman is bottle-feeding her newborn, instruct her to keep a support bra on 24 hours per day. Cool compresses or an ice pack wrapped in a towel will usually be soothing and help to suppress milk production.

A new mother, who is an adolescent, was cautious at first when holding and touching her newborn. She seemed almost afraid to make contact with baby and only touched it lightly and briefly. However, 48 hours after the birth, the nurse now notices that the new mother is pressing the newborn's cheek against her own and kissing her on the forehead. The nurse recognizes these actions as which of the following? a) Engorgement b) Engrossment c) Involution d) Attachment

Attachment Correct Explanation: When a woman has successfully linked with her newborn it is termed attachment or bonding. Although a woman carried the child inside her for 9 months, she often approaches her newborn not as someone she loves but more as she would approach a stranger. The first time she holds the infant, she may touch only the blanket. Gradually, as a woman holds her child more, she begins to express more warmth, touching the child with the palm of her hand rather than with her fingertips. She smoothes the baby's hair, brushes a cheek, plays with toes, and lets the baby's fingers clasp hers. Soon, she feels comfortable enough to press her cheek against the baby's or kiss the infant's nose; she has successfully bonded or become a mother tending to her child. Engrossment describes the action of new fathers when they stare at their newborn for long intervals. Involution is the process whereby the reproductive organs return to their nonpregnant state. Engorgement is the tension in the breasts as they begin to fill with milk.

A woman has just delivered a baby. Her prelabor vital signs were T - 98.8 B/P-P-R 120/70, 80, 20. Which combination of findings during the early postpartum period are the most concerning? a) Shaking chills with a fever of 100.3 b) B/P-P-R 90/50, 120, 24 c) Bradycardia and excessive, soaking diaphoresis d) Blood loss of 250 mL and WBC 25,000 cells/mL

B/P-P-R 90/50, 120, 24 Correct 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 delivery and need to be reported ASAP. Shaking chills with a temperature of 100.3ºF can occur due to stress on the body and is considered a normal finding. A fever of 100.4ºF should be reported. Options C and D are considered to be within normal limits after delivering a baby.

On assessment of a 2-day postpartum patient the nurses finds the fundus is boggy, at U and slightly to the right. What is the most likely cause of this assessment finding? a) Full bowel b) Uteruine atony c) Bladder distention d) Poor bladder tone

Bladder distention Correct Explanation: The most often cause of a displaced uterus is a distended bladder. Ask the patient to void and then reassess the uterus. According to the scenario described, the most likely cause of the uterine findings would not be uterine atony. A full bowel or poor bladder tone would not cause a boggy and displaced fundus.

A nurse is monitoring the vital signs of a client 24 hours after childbirth. She notes that the client's blood pressure is 100/60 mm Hg. Which of the following postpartum complications should the nurse most suspect in this client, based on this finding? a) Postpartal gestational hypertension b) Bleeding c) Diabetes d) Infection

Bleeding Correct Explanation: Blood pressure should also be monitored carefully during the postpartal period, because a decrease in this can also indicate bleeding. In contrast, an elevation above 140 mm Hg systolic or 90 mm Hg diastolic may indicate the development of postpartal gestational hypertension, an unusual but serious complication of the puerperium. An infection would best be indicated by an elevated oral temperature. Diabetes would be indicated by an elevated blood glucose level.

When caring for a postpartum client who has given birth vaginally, the nurse assesses the client's respiratory status, noting that it has quickly returned to normal. The nurse understands that which of the following is responsible for this change? a) Decreased bladder pressure b) Increased progesterone levels c) Decreased intra-abdominal pressure d) Use of anesthesia during delivery

Decreased intra-abdominal pressure Correct Explanation: The nurse should identify decreased intra-abdominal pressure as the cause of the respiratory system functioning normally. Progesterone levels do not influence the respiratory system. Decreased bladder pressure does not affect breathing. Anesthesia used during delivery causes the respiratory system to take a longer time to return to normal.

For several hours after delivery, Norah, a multigravida who experienced a much more difficult labor this time than any time previously, wants to talk about why the birthing process was so hard for her this time. In fact, she's focusing on this aspect to the point that she seems relatively indifferent to her newborn. How should you handle this situation? a) Redirect her attention to the baby by reminding her of the details of newborn care b) Encourage her to discuss her experience of the birth and answer any questions or concerns she may have c) Point out positive features of her baby and encourage her to hold and cuddle the baby d) Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings

Encourage her to discuss her experience of the birth and answer any questions or concerns she may have Explanation: The patient needs to explore her birth experience and clarify her questions. The nurse should allow her to ask questions, be supportive and encourage her to express her feelings. Redirecting her attention to the baby, asking her to describe how she plans to integrate the new baby into the family, or pointing out positive features of the new baby do not meet the needs of the patient at this time, and are therefore incorrect answers.

The patient under your care is complaining she has not had a bowel moment since her infant was born 2 days ago. She asks the nurse what she can do to help her have a bowel movement. What intervention is appropriate to encourage having a bowel movement? 1. Add dairy products to her diet 2. Give a stimulant laxative 3. Encourage fiber rich foods 4. Holding the feces until there is a strong urge to defecate.

Encourage the patient to eat more fiber rich foods Correct Explanation: Encouraging fiber rich foods will help with prevention of constipation. The patient needs plenty of water, to ambulate, and take stool softeners if ordered by the provider. Offering a stimulant laxative is not appropriate. Adding dairy products to the diet may be a good thing, but will not generally produce a bowel movement. Holding the feces until there is a strong urge to defecate will only increase the risk of constipation as well as possible resultant complications.

A woman who has just given birth seems to be bonding with her newborn, despite the fact that earlier in labor she had expressed an intent to give the baby up for adoption. In this case, the nurse should encourage the mother to keep her baby. a) True b) False

False Correct Explanation: Do not attempt to change a woman's mind about keeping her child or placing the child for adoption during the postpartal period as she is extremely vulnerable to suggestion at this time, and such decisions are too long range and too important to be made at such an emotional time. Her earlier conclusion may be the sound one. Instead, offer nonjudgmental support. Be especially aware of your own feelings about this issue, to avoid influencing a woman's decision making unnecessarily.

A nurse is caring for a breastfeeding client who complains of engorgement. The nurse identifies that the client's condition is due to not fully emptying her breasts at each feeding. Which of the following should the nurse suggest to help her prevent engorgement? a) Feed the baby at least every two or three hours b) Apply cold compresses to the breasts c) Dry the nipples following feedings d) Provide the infant oral nystatin

Feed the baby at least every two or three hours Correct Explanation: The nurse should suggest the client feed the baby every two or three hours to help her reduce and prevent further engorgement. Application of cold compresses to the breasts is suggested to reduce engorgement for non-breastfeeding clients. If the mother has developed a candidal infection on the nipples, the treatment involves application of an antifungal cream to the nipples following feedings and providing the infant with oral nystatin. The nurse can suggest drying the nipples following feedings if the client experiences nipple pain.

A client in her sixth week postpartum complains of general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which of the following? 1. Hypertension 2. Hypovolemia 3. Hyperglycemia 4. Hyperthyroidism

Hypovolemia Correct 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.

When assessing a postpartum woman, which finding would be most significant in identifying possible postpartum hemorrhage? a) Increased cardiac output b) Increase heart rate c) Increased hematocrit level d) Increased blood pressure

Increase heart rate Correct Explanation: Tachycardia in the postpartum woman warrants further investigation. Typically the postpartum woman is bradycardic for the first 2 weeks. In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of a compensatory increase in heart rate. Red blood cell production ceases early in the puerperium, causing hemoglobin and hematocrit levels to decrease slightly in the first 24 hours and then rise slowly. Hematocrit would be unreliable as an indicator of hemorrhage.

The process by which the reproductive organs return to the nonpregnant size and function is termed what? a) Evolution b) Involution c) Decrement d) Progression

Involution Correct Explanation: Involution is the term used to describe the process of the return to nonpregnancy size and function of reproductive organs. Evolution is change in the genetic material of a population of organisms from one generation to the next. Decrement is the act or process of decreasing . Progression is defined as movement through stages such as the progression of labor. Options A, C, and D are distracters for this question.

Healthy bonding behaviors are important to note when you are assessing the new family. What would you consider a warning sign that the mother and infant were not attaching as they should? a) Mother wants you in the room while she breastfeeds as she is afraid she isn't doing it right. b) Mother states she is concerned about one of her other children not liking the new baby. c) Mother cries and says "I have no family nearby and my mother-in-law doesn't like me." d) Mother states she wanted a boy this time, not another girl.

Mother states she wanted a boy this time, not another girl. Correct Explanation: It is important to differentiate between a new parent who is nervous and anxious about her new role and one who is rejecting her parenting role. Warning signals of poor attachment include turning away from the newborn, refusing or neglecting to provide care, and disengagement from the newborn.

PPD Diagnosis Criteria

Must have 5 or > symptoms lasting > 2 wks: *little interest in usual activities/hobbies *feeling tired all the time *changes in amount of food eaten *gaining or losing weight *having trouble sleeping or eating too much *having trouble concentrating or decisions *thinking about suicide or death

A nurse is caring for a client who is nursing her baby boy. The client complains of afterpains. Secretion of which of the following should the nurse identify as the cause of afterpains? a) Oxytocin b) Prolactin c) Estrogen d) Progesterone

Oxytocin Correct 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

A postpartum client complains of stress incontinence. What information should the nurse suggest to the client to overcome stress incontinence? a) Perform aerobic exercises b) Frequently empty the bladder c) Reduce fluid intake d) Perform Kegel's exercises

Perform Kegel's exercises Correct Explanation: The nurse should ask the client to perform the Kegel's exercises in which the client needs to alternately contract and relax the perineal muscles. Aerobic exercises will not help to strengthen perineal muscles. Reduced fluid intake and frequent emptying of the bladder will not help the client overcome stress incontinence.

You are used to working on the postpartum floor taking care of women who have had normal vaginal deliveries. Today, however, you have been assigned to help care for woman who are less than 24 hours post cesarean delivery. You know that in making your assessments you will have to change some things that you would not normally assess. What would you leave out of your patient assessments? a) Respiratory status b) Lower extremities c) Perineum d) Breasts

Perineum Correct Explanation: Usually a woman who experiences cesarean birth does not have an episiotomy, although rarely this may be the case.

Causes of PPD

Physical - hormonal fluctuations, changes in blood volume & metabolism Emotional - sleep deprivation, feeling overwhelmed, anxiety, loss of control Lifestyle influences - other demanding children, breastfeeding difficulties, financial problems, lack of emotional support

During a postpartum exam on the day of delivery, the woman complains that she is still so sore that she can't sit comfortably. You examine her perineum and find the edges of the episiotomy approximated without signs of a hematoma. Which intervention will be most beneficial at this point? a) Notify a physician b) Apply a warm washcloth c) Place an ice pack d) Put on a witch hazel pad.

Place an ice pack Correct Explanation: The labia and perineum may be edematous after delivery and bruised, the use of ice would assist in decreasing the pain and swelling. Applying a warm washcloth would bring more blood as well as fluid to the sore area, thereby increasing the edema and the soreness. Applying a witch hazel pad needs the order of the physician. Notifying a physician is not necessary at this time as this is considered a normal finding.

A woman who delivered a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which of the following factors/conditions does the nurse believe is causing this experience? a) Postpartum depression. b) Postpartum reaction. c) Postpartum anxiety. d) Postpartum baby blues.

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.

A nurse is caring for a client on the second day postpartum. The client informs the nurse that she is voiding a large volume of urine frequently. Which of the following should the nurse identify as a potential cause for urinary frequency? a) Urinary overflow b) Postpartum diuresis c) Trauma to pelvic muscles d) Urinary tract infection

Postpartum diuresis Correct Explanation: The nurse should identify postpartum diuresis as the potential cause for urinary frequency. Urinary overflow occurs if the bladder is not completely emptied. Urinary tract infection may be accompanied by fever and a burning sensation. Trauma to pelvic muscles does not affect urinary frequency.

What is the primary function of uterine contractions after delivery of the infant and placenta? a) Return the uterus to normal size b) Seal off the blood vessels at the site of the placenta c) Stop the flow of blood d) Close the cervix

Seal off the blood vessels at the site of the placenta Correct Explanation: The contractions of the uterus help to constrict the vessels where the placenta was located. This does decrease the flow of blood, but is secondary in occurrence to the constriction of the blood vessels. Uterine contraction also leads to uterine involution, which normally occurs at a predictable rate. Uterine involution assists in closing the cervix. Again, options A, C, and D are secondary to the constriction of blood vessels at the placental site.

Which maternal reaction is the most concerning? a) She is tearful for several days and has difficulty eating and sleeping b) She hesitates to take her newborn when offered and expresses disappointment with the way the baby looks c) She expresses doubt about her ability to care for the baby as well as the nurse can d) She neglects to engage with or provide care for the baby and shows little interest in it

She neglects to engage with or provide care for the baby and shows little interest in it Correct Explanation: A mother not bonding with the infant or showing disinterest is a cause for concern and requires a referral or notification of the primary health care provider. Some mothers hesitate to take their newborn, and express disappointment in the way the baby looks, especially if they want a child of one sex and have a child of the opposite sex. Expressing doubt about the ability to care for the baby is not unusual, and being tearful for several days with difficulty eating and sleeping is common with "postpartum blues".

A nurse is caring for a client in the postpartum period. The nurse observes that distention of the abdominal muscles during pregnancy has resulted in separation of the rectus muscles. What intervention should the nurse perform to assist in healing the distended abdominal muscles? a) Applying warm compresses b) Massaging the muscles c) Applying moist heat d) Suggesting proper exercise

Suggesting proper exercise Correct Explanation: The nurse should suggest proper exercise to the client to heal the distended abdominal muscles. Application of warm compresses, application of moist heat, and massaging the muscles gently are not suggested for distended abdominal muscles.

A new mother gave birth to her baby 24 hours ago and today has been content to rest in her hospital bed, hold her baby, allow the nurse to care for her, and to discuss her labor and birth experience with visitors. Which phase of the puerperium is this client in? a) Taking-hold phase b) Taking-in phase c) Letting-go phase d) Rooming-in phase

Taking-in phase Correct Explanation: The taking-in phase is largely a time of reflection. During this 1- to 3-day period, a woman is largely passive. She prefers having a nurse attend to her needs and make decisions for her, rather than do these things herself. As a part of thinking and pondering about her new role, the woman usually wants to talk about her pregnancy, especially about her labor and birth. After a time of passive dependence, a woman enters the taking-hold phase and begins to initiate action. She prefers to get her own washcloth or to make her own decisions. In the letting-go phase, a woman finally redefines her new role. She gives up the fantasized image of her child and accepts the real one; she gives up her old role of being childless or the mother of only one or two (or however many children she had before this birth). Rooming-in is a feature offered by hospitals in which the infant is allowed to stay in the same hospital room as the mother following birth; it is not a phase of the puerperium.

Rubin identified a series of changes that a new mother makes during the postpartum period. The correct sequence of these changes is a) Taking-in, taking-hold, letting-go b) Taking, holding-on, letting-go c) Taking-in, holding-on, letting-go d) Taking-in, taking-on, letting-go

Taking-in, taking-hold, letting-go Correct Explanation: The new mother makes progressive changes to know her infant, review the pregnancy and labor, validate her safe passage through these phases, learn the initial tasks of mothering, and let go of her former life to incorporate this new child.

While educating a class of postpartum patients before discharge home after delivery, one woman asks when "will I stop bleeding?" How should the nurse respond? a) Bleeding may occur on and off for the next 2 to 3 weeks b) You should stop bleeding and have no discharge in the next 1 to 2 weeks c) The bleeding may slowly decrease over the next 1 to 3 weeks, changing color to a white discharge, which may continue for up to 6 weeks d) The bleeding may continue for 6 weeks

The bleeding may slowly decrease over the next 1 to 3 weeks, changing color to a white discharge, which may continue for up to 6 weeks Correct Explanation: The lochia changes color in the first few weeks postpartum; the active bleeding stops in the first week but a white discharge may continue for up to 6 weeks after delivery. Option A is incorrect because it is an incomplete answer. Option B is incorrect because bleeding does not occur "off and on"; the bleeding stops during the first week but a discharge continues to occur. Option C is incorrect because the discharge may continue for up to six weeks

Which reason explains why women should be encouraged to perform Kegel exercises after delivery? a) They promote blood flow, enabling healing and muscle strengthening. b) They promote the return of normal bowel function. c) They assist the woman in burning calories for rapid postpartum weight loss. d) They assist with lochia removal.

They promote blood flow, enabling healing and muscle strengthening. Correct Explanation: Exercising the pubococcygeal muscle increases blood flow to the area. The increased blood flow brings oxygen and other nutrients to the perineal area to aid in healing. Additionally, these exercises help strengthen the musculature, thereby decreasing the risk of future complications, such as incontinence and uterine prolapse. Performing Kegel exercises may assist with lochia removal, but that isn't their main purpose. Bowel function isn't influenced by Kegel exercises. Kegel exercises don't generate sufficient energy expenditure to burn many calories.

For the first hour after birth, the height of the fundus is at the umbilicus or even slightly above it. a) True b) False

True

The nurse is caring for a client in the postpartum period. The client has difficulty in voiding and is catheterized. The nurse then would monitor the client for which of the following? a) Loss of pelvic muscle tone b) Stress incontinence c) Urinary tract infection d) Increased urine output

Urinary tract infection Correct Explanation: The nurse would need to monitor the client for signs and symptoms of a urinary tract infection, a risk associated with catheterization. Stress incontinence is caused due to loss of pelvic muscle tone after birth. Increased urinary output is observed in diuresis. Catheterization does not cause loss of pelvic muscle tone, increased urine output, or stress incontinence.

The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? a) Edematous vagina b) Lochia serosa c) Diaphoresis d) Uterus 1 cm below umbilicus

Uterus 1 cm below umbilicus Correct Explanation: By the fourth postpartum day, the uterus should be approximately 4 cm below the umbilicus. Being only at 1 cm indicates that the uterus is not contracting as it should. Lochia serosa is normal from days 3 to 10 postpartum. After birth the vagina is edematous and thin with few rugae. It eventually thickens and rugae return in approximately 3 weeks. Diaphoresis is common during the early postpartum period, especially in the first week. It is a mechanism to reduce fluids retained during pregnancy and restore prepregnant body fluid levels.

The nurse is providing education to a mother who is going to bottle feed her infant. What information will the nurse provide to this mom regarding breast care? a) Wear a tight, supportive bra b) Massage the breast when they are painful c) Express small amounts of milk when they are too full d) Run warm water over the breast in the shower

Wear a tight, supportive bra Explanation: The patient trying to dry up her milk supply should do as little stimulation to the breast as possible. She needs to wear a tight, supportive bra and use ice. Running warm water over the breasts in the shower will only stimulate the secretion, and therefore the production, of milk. Massaging the breasts will stimulate them to expel the milk and therefore produce more milk, as will expressing small amounts of milk when the breasts are full.

A nurse is caring for a non-breastfeeding client in the postpartum period. The client complains of engorgement. What suggestion should the nurse provide to alleviate breast discomfort? a) Express milk frequently b) Apply hydrogel dressing c) Wear a well-fitting bra d) Apply warm compress

Wear a well-fitting bra Correct Explanation: The nurse should suggest the client wear a well-fitting bra to provide support and help alleviate breast discomfort. Application of warm compress and expressing milk frequently is suggested to alleviate breast engorgement in breastfeeding clients. Hydrogel dressings are used prophylactically in treating nipple pain.

Postpartum Depression w/Psychosis

aka postpartum psychosis; rare; can be a medical emergency requiring psychiatric hospitalization; intense & pervasive sadness, severe mood swings, may have odd food cravings, episodes of irritability, may feel guilty about feeling depressed when they should feel happy; confusion & disorientation, hallucinations & delusions, paranoia; 5% suicide, 4% infanticide

Postpartum Depression (PPD)

can be serious and disabling; can begin anytime within 3 months after delivery; threat to mother and child; eventually interferes with mother's ability to provide care for baby and perform daily tasks; often preceded by baby blues; most common complication of women who have just had a baby; commonly treated w/antidepressants

EPDS (Edinburgh Postnatal Depression Scale)

designed for home or outpatient use; consists of 10 questions; can complete in 5 minutes; reviews feelings from past 7 days; scored 0-3 depending on symptom severity

Symptoms of PPD

loss of appetite, insomnia, intense irritability or anger, overwhelming fatigue, loss of interest in sex, lack of joy in life, feelings of shame guilty or inadequacy, severe mood swings, difficulty bonding with baby, withdrawal, thoughts of self-harm or baby

PPD left untreated

may become a chronic depressive disorder; may interfere with mother-baby bonding; cause family distress; incidence of child behavioral problems

Postpartum Blues (Baby Blues)

transient and brief; mild mood swings, irritability*, anxiety, decreased concentration, insomnia, tearfulness, crying spells; occur within 2-3 days pp (peak on 4th or 5th) and resolve within 2 wks; more common and less serious than PPD; do not impair normal daily functioning

Screening for PPD

usually done at OB-GYN appt; Beck's Depression Inventory; EPDS (Edinburgh Postnatal Depression Scale)

PPD increases risk of

woman's future episodes of major depression (even with treatment)