Risk Conditions Related to Pregnancy NCLEX Questions, Chapter 21: Postpartum Complications NCLEX, Pregnancy, Drug Abuse, Diabetes, Cardiac & STD's NCLEX

The client at 9 weeks gestation has been told that her HIV test was positive. The client is very upset, and tells the nurse, "I didn't know I had HIV! What will this do to my baby?" The nurse knows teaching has been effective when the client makes which statement? 1. I cannot take the medications that control HIV during my pregnancy, because they will harm the baby. 2. My baby can get HIV during the pregnancy and through my breast milk. 3. The pregnancy will increase the progression of my disease and will reduce my CD4 counts. 4. The HIV won't affect my baby, and I will have a low-risk pregnancy without additional testing.

2. ~ HIV transmission can occur during pregnancy and through breast milk; however, it is believed that the majority of all infections occur during labor and birth.

A woman is 32 weeks pregnant. She is HIV-positive but asymptomatic. The nurse knows what would be important in managing her pregnancy and delivery? 1. An amniocentesis at 30 and 36 weeks 2. Weekly non-stress testing beginning at 32 weeks gestation 3. Application of a fetal scalp electrode as soon as her membranes rupture in labor 4. Administration of intravenous antibiotics during labor and delivery

2. ~ Weekly non-stress testing (NST) is begun at 32 weeks gestation and serial ultrasounds are done to detect IUGR.

The nurse is doing preconception counseling with a 28-year-old woman with no prior pregnancies. Which statement made by the client indicates to the nurse that the client has understood the teaching? 1. I can continue to drink alcohol until I am diagnosed as pregnant. 2. I need to stop drinking alcohol completely when I start trying to get pregnant. 3. A beer once a week will not damage the fetus. 4. I can drink alcohol while breastfeeding because it doesn't pass into breast milk.

2. ~ Women should discontinue drinking alcohol when they start to attempt to become pregnant due to possible effects of alcohol on the fetus.

The home care nurse visits a pregnant client who has a diagnosis of preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the PHCP? 1. Urinary output has increased 2. Dependent edema has resolved 3. Blood pressure reading is at the prenatal baseline 4. The client complains of a headache and blurred vision

4. The client complains of a headache and blurred vision If the client complains of a headache and blurred vision, the PHCP should be notified because thee are signs of worsening preeclampsia. Options 1, 2, and 3 are normal findings.

A pregnant woman is married to an intravenous drug user. She had a negative HIV screening test just after missing her first menstrual period. What would indicate that the client needs to be retested for HIV? 1. Hemoglobin of 11 g/dL and a rapid weight gain 2. Elevated blood pressure and ankle edema 3. Shortness of breath and frequent urination 4. Persistent candidiasis

4. ~ Signs and symptoms of infections include fever, weight loss, fatigue, persistent candidiasis, diarrhea, cough, and skin lesions (Kaposis sarcoma and hairy leukoplakia in the mouth).

A 20-year-old woman is at 28 weeks gestation. Her prenatal history reveals past drug abuse, and urine screening indicates that she has recently used heroin. The nurse should recognize that the woman is at increased risk for which condition? 1. Erythroblastosis fetalis 2. Diabetes mellitus 3. Abruptio placentae 4. Pregnancy-induced hypertension

4. ~ Women who use heroin are at risk for poor nutrition, anemia, and pregnancy-induced hypertension (or preeclampsia-eclampsia).

B (A rapid labor and delivery may cause exhaustion of the uterine muscle and prevent contraction.)

A postpartum client would be at increased risk for postpartum hemorrhage if she delivered a: a. 5-lb, 2-oz infant with outlet forceps. b. 6.5-lb infant after a 2-hour labor. c. 7-lb infant after an 8-hour labor. d. 8-lb infant after a 12-hour labor.

A (Rationale: Sudden dyspnea, diaphoresis and confusion are the classic signs of the dislodgment of a thrombus (stationary blood clot) from a varicose vein and its travel to and its becoming enlodged in the pulmonary circulation. Chills and fever would indicate infection. A person with a pulmonary embolism would be hypotensive and not hypertensive.)

A woman with a past history of varicose veins has just delivered and the nurse suspects she has developed a pulmonary embolism. Which of the data below would lead to this nursing judgment? A. Sudden dyspnea and confusion B. Hypertension C. Chills and fever D. Leg pain

C (Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage.)

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postdelivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: A. Cryoprecipitate B. Factor VIII and vWf C. Desmopressin D. Hemabate

D (D&C allows examination of the uterine contents and removal of any retained placenta or membranes.)

If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. D&C

B (An abnormal odor of the lochia indicates infection in the uterus.)

If the nurse suspects a uterine infection in the postpartum client, she should assess the: a. pulse and blood pressure. b. odor of the lochia. c. episiotomy site. d. abdomen for distention.

A (The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of a slight trauma, such as venipuncture sites.)

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: A. Disseminated intravascular coagulation B. Amniotic fluid embolism C. Hemorrhage D. HELLP syndrome

A, B, D

Medications used to manage postpartum hemorrhage include (choose all that apply): A. Pitocin B. Methergine C. Terbutaline D. Hemabate E. Magnesium sulfate

D (Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth.)

One of the first symptoms of puerperal infection to assess for in the postpartum woman is: A. Fatigue continuing for longer than 1 week B. Pain with voiding C. Profuse vaginal bleeding with ambulation D. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth

B (Lochia and infectious material are eliminated by gravity drainage.)

The client who is being treated for endometritis is placed in Fowler's position because it: a. promotes comfort and rest. b. facilitates drainage of lochia. c. prevents spread of infection to the urinary tract. d. decreases tension on the reproductive organs.

D (Rationale: A woman that develops postpartum psychosis usually does so within four weeks of delivery. Only 1% of women develop this disorder. Suicide and infanticide are common and the disorder is considered a medical emergency. Delusions and hallucinations accompany the disorder and the woman usually has a past history of a psychiatric disorder and treatment.)

The clinic nurse is caring for a woman who is suspected of developing postpartum psychosis. Which of the following statements characterizes this disorder: A. Symptoms start within several days of delivery B. The disorder is common in postpartum women C. Suicide and infanticide are uncommon in this disorder D. Delusions and hallucinations accompany this disorder

B (If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage.)

The nurse knows that a measure for preventing late postpartum hemorrhage is to: a. administer broad-spectrum antibiotics. b. inspect the placenta after delivery. c. manually remove the placenta. d. pull on the umbilical cord to hasten the delivery of the placenta.

A (Methergine provides long-sustained contraction of the uterus.)

The nurse should expect medical intervention for subinvolution to include: a. oral methylergonovine maleate (Methergine) for 48 hours. b. oxytocin intravenous infusion for 8 hours. c. oral fluids to 3000 mL/day. d. intravenous fluid and blood replacement.

B (Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples.)

The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by: A. Washing the nipples and breasts with mild soap and water once a day B. Using proper breastfeeding techniques C. Wearing a nipple shield for the first few days of breastfeeding D. Wearing a supportive bra 24 hours a day

A (Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage.)

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: A. Uterine atony B. Uterine inversion C. Vaginal hematoma D. Vaginal laceration

D (Postpartum blues affects 50% to 70% of new mothers. It is believed to be related to hormonal fluctuations after childbirth.)

Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? a. Postpartum depression b. Postpartum psychosis c. Postpartum bipolar disorder d. Postpartum blues

A pregnant asthmatic client is being seen for her initial prenatal visit. The nurse knows that the fetal implications of maternal asthma include which of the following? (SATA) 1. Prematurity 2. Low birth weight 3. Hypoxia with maternal exacerbation 4. Congenital anomalies from the medications 5. Perinatal transfer of the asthma

1, 2, 3 ~ 1. One implication of maternal asthma is that the infant is at risk for prematurity. 2. One implication of maternal asthma is that the infant is at risk for low birth weight. 3. One implication of maternal asthma is that the infant is at risk for hypoxia if the mother has an exacerbation of her asthma.

The nurse is working with a woman who abuses stimulants. The nurse is aware that the fetus is at risk for which of the following? (SATA) 1. Withdrawal symptoms 2. Cardiac anomalies 3. Sudden infant death syndrome 4. Being small for gestational age 5. Fetal alcohol syndrome

1, 2, 3, 4 ~ 1. Infants born to mothers who abuse stimulants such as amphetamines can have withdrawal symptoms. 2. Infants born to mothers who abuse stimulants such as cocaine can be born with cardiac anomalies. 3. Infants born to mothers who abuse stimulants such as cocaine can have sudden infant death syndrome. 4. Infants born to mothers who abuse stimulants such as nicotine can be small for gestational age.

The nurse is evaluating the goal Client will remain free of opportunistic infections for an HIV-positive pregnant client. The nurse determines the goal was met when the client has which of the following? (SATA) 1. An absolute CD4+ T-lymphocyte count below 200 2. No complaint of chills or fever during the pregnancy 3. Weight gain of 30 lbs during the pregnancy 4. ESR above 20 mm/hr 5. Normal erythrocyte sedimentation rate maintained during the pregnancy

2, 3, 5 ~ 2. Not having chills, fever, or a sore throat throughout the pregnancy is an indication the client did not have an infection. 3. Weight gain of 25 to 35 pounds is normal for a pregnancy. This client met the goal for nutrition and remaining infection-free. 5. Having a normal erythrocyte sedimentation rate during the pregnancy is an expected outcome.

Which of the following symptoms, if progressive, are indicative of CHF, the heart's signal of it's decreased ability to meet the demands of pregnancy? (SATA) 1. Palpitations 2. Heart murmurs 3. Dyspnea 4. Frequent urination 5. Rales

1, 2, 3, 5 ~ 1. Palpitations are indicative of CHF. 2. Heart murmurs are indicative of CHF. 3. Dyspnea is indicative of CHF. 5. Rales are indicative of CHF.

C (The organisms are localized in the breast tissue and are not excreted in the breast milk.)

A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that: a. the infant is protected from infection by immunoglobulins in the breast milk. b. the infant is not susceptible to the organisms that cause mastitis. c. the organisms that cause mastitis are not passed to the milk. d. the organisms will be inactivated by gastric acid.

A (Inversion of the uterus and hypovolemic shock are considered medical emergencies.)

What PPH conditions are considered medical emergencies that require immediate treatment? A. Inversion of the uterus and hypovolemic shock B. Hypotonic uterus and coagulopathies C. Subinvolution of the uterus and idiopathic thrombocytopenic purpura D. Uterine atony and disseminated intravascular coagulation

B (Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony.)

What woman is at greatest risk for early postpartum hemorrhage? A. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress B. A woman with severe preeclampsia on magnesium sulfate whose labor is being induced C. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor D. A primigravida in spontaneous labor with preterm twins

The nurse is working with a pregnant woman who has systemic lupus erythematosus (SLE). What does the nurse anticipate the infant might be born with? (SATA) 1. A tendency to bleed excessively 2. An increased chance of developing infections 3. A hemoglobin less than optimal for good health 4. Problems with vision 5. Hearing loss

1, 2, 3 ~ 1. This is true, as the infant might be born with thrombocytopenia. 2. This is true, as the infant might be born with neutropenia. 3. This is true, as the infant might be born with anemia.

The nurse is evaluating the plan of care for a pregnant client with a heart disorder. The nurse concludes that the plan was successful when data indicate which of the following? (SATA) 1. The client gave birth to a healthy baby. 2. The client did not develop congestive heart failure. 3. The client developed thromboembolism. 4. The client identified manifestations of potential complications. 5. The client can identify her condition and its impact on her pregnancy, labor and birth, and postpartum period.

1, 2, 4, 5 ~ 1. Giving birth to a healthy baby is an expected outcome of the pregnancy. 2. An expected outcome is that the woman does not develop congestive heart failure, thromboembolism, or infection. 4. An expected outcome is that the woman is able to identify potential complications and notify the healthcare provider. 5. The woman must be able to discuss her condition and its possible impact on her pregnancy, labor and birth, and the postpartum period.

During the history, the client admits to being HIV-positive and says she knows that she's about 16 weeks pregnant. Which statements made by the client indicate an understanding of the plan of care both during the pregnancy and postpartally? (SATA) 1. During labor and delivery, I can expect the zidovudine (ZDV) to be given in my IV. 2. After delivery, the dose of zidovudine (ZDV) will be doubled to prevent further infection. 3. My baby will be started on zidovudine (ZDV) for six weeks following the birth. 4. My baby's zidovudine (ZDV) will be given in a cream form. 5. My baby will not need zidovudine (ZDV) if I take it during my pregnancy.

1, 3 ~ 1. ART therapy generally it includes oral Zidovudine (ZDV) daily, IV ZDV during labor and until birth, and ZDV therapy for the infant for 6 weeks following birth. 3. ART therapy generally it includes oral Zidovudine (ZDV) daily, IV ZDV during labor and until birth, and ZDV therapy for the infant for 6 weeks following birth.

The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? 1. "I will need to increase my insulin dosage during the first 3 months of pregnancy." 2. "My insulin dose will likely need to be increased during the second and third trimesters." 3. "Episodes of hypoglycemia are most likely to occur during the first 3 months of pregnancy." 4. "My insulin needs should return to prepregnant levels within 7 to 10 days after birth if I am bottle-feeding."

1. "I will need to increase my insulin dosage during the first 3 months of pregnancy." Insulin needs decrease in the first trimester of pregnancy because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in options 2, 3, and 4 are accurate and signify that the client understands control of her diabetes during pregnancy.

The nurse in a maternity unit is providing emotional support to a client and her significant other who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicates a component of the normal grieving process? 1. "We want to attend a support group." 2. "We never want to try to have a baby again." 3. "We are going to try to adopt a child immediately." 4. "We are okay, and we are going to try to have another baby immediately."

1. "We want to attend a support group." A support group can help the parents work through their pain by nonjudgmental sharing of feelings. The correct option identifies a statement that indicates positive, normal grieving. Although the other options may indicate reactions of the client and significant other, they are not specifically a part of the normal grieving process.

A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the baby. Which statement by the nurse would assist the family in their period of grief? 1. "What can I do for you?" 2. "Now you have an angel in heaven." 3. "Don't worry, there is nothing you could have done to prevent this from happening." 4. "We will see to it that you have an early discharge so that you don't have to be reminded of this experience."

1. "What can I do for you?" When a loss or death occurs, the nurse should ensure that parents have been honestly told about the situation by their primary health care provider or others on the health care team. It is important for the nurse to be with the parents at this time and to use therapeutic communication techniques. The nurse must also consider cultural and religious/spiritual practices and beliefs. The correct option provides a supportive, giving, and care response. Options 2, 3, and 4 are blocks to communication and devalue the parents' feelings.

The nurse is providing instructions to a pregnant client with human immunodeficiency virus (HIV) infection regarding care to the newborn after delivery. The client asks the nurse about the feeding options that are available. Which response should the nurse make to the client? 1. "You will need to bottle-feed your newborn." 2. "You will need to feed your newborn by nasogastric tube feeding." 3. "You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding." 4. "You will be able to breast-feed for 9 months and then will need to switch to bottle feeding."

1. "You will need to bottle-feed your newborn." Prenatal transmission of HIV can occur during the antepartum period, during labor and birth, or in the postpartum period if the mother is breast feeding. Clients who has HIV will most likely be advised not to breast feed; however, PHCPs recommendations regarding breast feeding are always followed. There is no physiological reason why newborn needs to be fed by nasogastric tube.

The nurse in a maternity unit is reviewing the client's records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. 1. A primigravida with abruptio placenta 2. A primigravida who delivered a 10lb infant 3 hours ago 3. A gravida 2 who has just been diagnosed with dead fetus syndrome 4. A gravida 4 who delivered 8 hours ago and has lost 500 mL of blood 5. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension

1. A primigravida with abruptio placenta 3. A gravida 2 who has just been diagnosed with dead fetus syndrome 5. A primigravida at 29 weeks of gestation who was recently diagnosed with gestational hypertension In a pregnant client, DIC is a condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation. Predisposing conditions include abruptio placentae, amniotic fluid embolism, gestational hypertension, HELLP syndrome, intrauterine fetal death, liver disease, sepsis, severe postpartum hemorrhage, and blood loss. Delivering a large newborn is not considered a risk factor for DIC. Hemorrhage is a risk factor for DIC; however, a loss of 500 mL is not considered hemorrhage.

An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruptio placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription? 1. Delivery of the fetus 2. Strict monitoring of intake and output 3. Complete bed rest for the remainder of the pregnancy 4. The need for weekly monitoring of coagulation studies until the time of delivery

1. Delivery of the fetus Abruptio placentae is the premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the client or fetus is in jeopardy. Because delivery of the fetus is necessary, options 2, 3, and 4 are incorrect regarding management of a client with abruptio placentae.

The home care nurse is monitoring a pregnant client who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which sign of preeclampsia? 1. Hypertension 2. Low grade fever 3. Generalized edema 4. Increased pulse rate

1. Hypertension A sign of a preeclampsia is persistent hypertension. A low grade fever or increased pulse rate is not associated with preeclampsia. Generalized edema may occur but is not a specific sign of preeclampsia because it can occur in many conditions.

A woman's history and appearance suggest drug abuse. What is the nurse's best approach? 1. Ask the woman directly, "Do you use any street drugs?" 2. Ask the woman whether she would like to talk to a counselor. 3. Ask some questions about over-the-counter medications and avoid mention of illicit drugs. 4. Explain how harmful drugs can be for her baby.

1. If drug abuse is suspected, the nurse should ask direct questions and be matter-of-fact and nonjudgmental to elicit honest responses.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting HIV? Select all that apply. 1. The client has a history of intravenous drug use 2. The client has a significant other who is heterosexual 3. The client has a history of sexually transmitted infections 4. The client has had one sexual partner for the past 10 years 5. The client has a previous history of gestational diabetes mellitus

1. The client has a history of intravenous drug use 3. The client has a history of sexually transmitted infections HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. Clients who fall into the high risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. Gestational diabetes mellitus does not predispose the client to HIV. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV>

The nurse is caring for a pregnant woman who admits to using cocaine and ecstasy on a regular basis. The client states, "Everybody knows that alcohol is bad during pregnancy, but whats the big deal about ecstasy?" What is the nurse's best response? 1. Ecstasy can cause a high fever in you and therefore cause the baby harm. 2. Ecstasy leads to deficiencies of thiamine and folic acid, which help the baby develop. 3. Ecstasy produces babies with small heads and short bodies with brain function alterations. 4. Ecstasy produces intrauterine growth restriction and meconium aspiration.

1. ~ Hyperthermia (elevated temperature) is a side effect of MDMA (ecstasy).

The client with insulin-dependent type 2 diabetes and an HbA1c of 5.0% is planning to become pregnant soon. What anticipatory guidance should the nurse provide this client? 1. Insulin needs decrease in the first trimester and usually begin to rise late in the first trimester as glucose use and glycogen storage by the woman and fetus increase. 2. The risk of ketoacidosis decreases during the length of the pregnancy. 3. Vascular disease that accompanies diabetes slows progression. 4. The baby is likely to have a congenital abnormality because of the diabetes.

1. ~ Insulin needs decrease in the first trimester and usually begin to rise late in the first trimester as glucose use and glycogen storage by the woman and fetus increase.

The prenatal clinic nurse has received four phone calls. Which client should the nurse call back first? 1. Pregnant woman at 28 weeks with history of asthma who is reporting difficulty breathing and shortness of breath 2. Pregnant woman at 6 weeks with a seizure disorder who is inquiring which foods are good folic acid sources for her 3. Pregnant woman at 35 weeks with a positive HBsAG who is wondering what treatment her baby will receive after birth 4. Pregnant woman at 11 weeks with untreated hyperthyroidism who is describing the onset of vaginal bleeding

1. ~ The goal of therapy is to prevent maternal exacerbations because even a mild exacerbation can cause severe hypoxia-related complications in the fetus.

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction? 1. "I will watch to see if I pass any tissue." 2. "I will maintain strict bed rest throughout the remainder of the pregnancy." 3. "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." 4. "I will avoid sexual intercourse until the bleeding has stopped and for 2 weeks following the last episode of bleeding."

2. "I will maintain strict bed rest throughout the remainder of the pregnancy." Strict bed rest throughout the remainder of the pregnancy is not required for a threatened abortion. The client should watch for the evidence of the passage of tissue. The client is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The client is advised to curtail sexual activities until bleeding has ceased and for 2 weeks after the last evidence of bleeding or as recommended by the health care provider.

The nurse is planning to admit a pregnant client who is obese. In planning care for this client, which potential client needs should the nurse anticipate? Select all that apply. 1. Bed rest as a necessary preventive measure may be prescribed 2. Administration of subcutaneous heparin postdelivery as prescribed 3. An overbed lift may be necessary if the client requires a cesarean section 4. Less frequent cleansing of a cesarean incision, if present, may be prescribed 5. Thromboembolism stockings or sequential compression devices may be prescribed

2. Administration of subcutaneous heparin postdelivery as prescribed 3. An overbed lift may be necessary if the client requires a cesarean section 5. Thromboembolism stockings or sequential compression devices may be prescribed The obese pregnant client is at risk for complications such as venous thromboembolism and increased need for cesarean section. Additionally, the obese client requires special considerations pertaining to nursing care. To prevent venous thromboembolism, particularly in the client who required cesarean section, frequent and early ambulation (not bed rest), prior to and after surgery, is recommended. Routine administration of prophylactic pharmacological venous thromboembolism medications such as heparin is also commonly prescribed. An overbed lift may be needed to transfer a client from a bed to an operating table if cesarean section is necessary. Increased monitoring and cleansing of a cesarean incision, if present, is necessary due to an increased risk for infection secondary to increased abdominal fat. Thromboembolism stockings or sequential compression devices will likely be prescribed because of the client's increased risk of blood clots.

The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa? 1. Infection 2. Hemorrhage 3. Chronic hypertension 4. Disseminated intravascular coagulation

2. Hemorrhage In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine segment does not contain the same intertwining musculature as the fundus of the uterus, and this site is more prone to bleeding. Options 1, 3, and 4 are not risks that are related specifically to placenta previa.

A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss, and fatigue. After assessment of the client, tuberculosis is suspected. A sputum culture is obtained and identifies Mycobacterium tuberculosis. Which instruction should the nurse include in the client's teaching plan? 1. Therapeutic abortion is required 2. Isoniazid plus rifampin will be required for 9 months 3. She will have to stay at home until treatment is completed 4. Medication will not be started until after delivery of the fetus

2. Isoniazid plus rifampin will be required for 9 months More than one medication may be used to prevent the growth of resistant organisms in a pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for the pregnant client is isoniazid plus rifampin daily for 9 months. Ethambutol is added initially if medication resistance is suspected. Pyridoxine (vitamind B6) often is administered with isoniazid to prevent fetal neurotoxicity. The client does not need to stay at home during treatment, and therapeutic abortion is not required.

The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the primary health care provider's prescriptions and should question which prescription? 1. Prepare the client for an ultrasound 2. Obtain equipment for a manual pelvic examination 3. Prepare to draw a hemoglobin and hematocrit blood sample 4. Obtain equipment for external electronic fetal heart rate monitoring

2. Obtain equipment for a manual pelvic examination Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Manual pelvic examinations are contraindicated when vaginal bleeding is apparent until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin and hematocrit levels are monitored, and external electronic fetal heart rate monitoring is initiated. Electronic fetal monitoring (external) is crucial in evaluating the status of the fetus, who is at risk for severe hypoxia.

The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment findings should the nurse expect to note if this condition is present? 1. Soft abdomen 2. Uterine tenderness 3. Absence of abdominal pain 4. Painless, bright red vaginal bleeding

2. Uterine tenderness Abruptio placentae is the premature separation of the placenta from the uterine wall after the twentieth week of gestation and before the fetus is delivered. In abruptio placentae, acute abdominal pain is present. Uterine tenderness accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen fells hard and board like on palpation as the blood penetrates the myometrium and causes uterine irritability. A soft abdomen and painless, bright red vaginal bleeding in the second or third trimester of pregnancy are signs of placenta previa.

A newly diagnosed insulin-dependent type 1 diabetic with good blood sugar control is at 20 weeks gestation. She asks the nurse how her diabetes will affect her baby. What would the best explanation include? 1. Your baby could be smaller than average at birth. 2. Your baby will probably be larger than average at birth. 3. As long as you control your blood sugar, your baby will not be affected at all. 4. Your baby might have high blood sugar for several days.

2. ~ Characteristically, infants of mothers with diabetes are large for gestational age (LGA) as a result of high levels of fetal insulin production stimulated by the high levels of glucose crossing the placenta from the mother. Sustained fetal hyperinsulinism and hyperglycemia ultimately lead to excessive growth, called macrosomia, and deposition of fat.

The nurse is assessing a woman at 10 weeks gestation who is addicted to alcohol. The woman asks the nurse, "What is the point of stopping drinking now if my baby probably has been hurt by it already?" What is the best response by the nurse? 1. It won't help your baby, but you will feel better during your pregnancy if you stop now. 2. If you stop now, you and your baby have less chance of serious complications. 3. If you limit your drinking to once a week, your baby will be okay. 4. You might as well stop it now, because once your baby is born, you'll have to give up alcohol if you plan on breastfeeding.

2. ~ Chronic abuse of alcohol can undermine maternal health by causing malnutrition, bone marrow suppression, increased incidence of infections, and liver disease. The effects of alcohol on the fetus may result in fetal alcohol spectrum disorders (FASD).

A client is at 12 weeks gestation with her first baby. She has cardiac disease, class III. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurses response be? 1. Heparin is used when coagulation problems are resolved. 2. Heparin is safer because it does not cross the placenta. 3. They are the same drug, but heparin is less expensive. 4. Coumadin interferes with iron absorption in the intestines.

2. ~ Heparin is safest for the client to take because it does not cross the placental barrier.

A 26-year-old client is 28 weeks pregnant. She has developed gestational diabetes. She is following a program of regular exercise, which includes walking, bicycling, and swimming. What instructions should be included in a teaching plan for this client? 1. Exercise either just before meals or wait until 2 hours after a meal. 2. Carry hard candy (or other simple sugar) when exercising. 3. If your blood sugar is 120 mg/dL, eat 20 g of carbohydrate. 4. If your blood sugar is more than 120 mg/dL, drink a glass of whole milk.

2. ~ The nurse should advise her to carry a simple sugar such as hard candy because of the possibility of exercise-induced hypoglycemia.

Women with HIV should be evaluated and treated for other sexually transmitted infections and for what condition occurring more commonly in women with HIV? 1. Syphilis 2. Toxoplasmosis 3. Gonorrhea 4. Herpes

2. ~ Women with HIV should be evaluated and treated for other sexually transmitted infections and for conditions occurring more commonly in women with HIV, such as tuberculosis, cytomegalovirus, toxoplasmosis, and cervical dysplasia.

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching? 1. "I should stay on the diabetic diet." 2. "I should perform glucose monitoring at home." 3. "I should avoid exercise because of the negative effects on insulin production." 4. "I should be aware of any infections and report signs of infection immediately to my obstetrician."

3. "I should avoid exercise because of the negative effects on insulin production." Exercise is safe for a client with gestational diabetes mellitus and is helpful in lowering the blood glucose level. Dietary modifications are the mainstay of treatment, and the client is placed on a standard diabetic diet. Many clients are taught to perform blood glucose monitoring. If the client is not performing the blood glucose monitoring at home, it is performed at the clinic or obstetrician's office. Signs of infection need to be reported to the obstetrician.

The nurse is providing instructions to a pregnant client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse? 1. "I should increase my sodium intake during pregnancy." 2. "I should lower my blood volume by limiting my fluids." 3. "I should maintain a low-calorie diet to prevent any weight gain." 4. "I should drink adequate fluids and increase my intake of high-fiber foods."

4. "I should drink adequate fluids and increase my intake of high-fiber foods." Constipation can cause the client to use the Valsalva maneuver. The Valsalva maneuver should be avoided in clients with cardiac disease because it can caused blood to rush to the heart and overload the cardiac system. Constipation can be prevented by the addition of fluids and a high-fiber diet. A low calorie diet is not recommended during pregnancy and could be harmful to the fetus. Sodium should be restricted as prescribed by the primary health care provider, because excess sodium would cause an overload to the circulating blood volume and contribute to cardiac complications. Diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of nutrients.

The nurse is performing an assessment on a client diagnosed with placenta previa. Which assessment findings should the nurse expect to note? Select all that apply. 1. Uterine rigidity 2. Uterine tenderness 3. Severe abdominal pain 4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age

4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Painless, bright red vaginal bleeding in the second or third trimester or pregnancy is a sign of placenta previa. The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. In abruptio placentae, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. In addition, in abruptio placentae, the abdomen feels hard and board like on palpation, as the blood penetrates the myometrium and causes uterine irritability.

The nurse is performing an assessment on a pregnant client in the last trimester with a diagnosis of preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis? 1. Enlargement of the breasts 2. Complaints of feeling hot when the room is cool 3. Periods of fetal movement followed by quiet periods 4. Evidence of bleeding, such as in the gums, petechiae, and purpura

4. Evidence of bleeding, such as in the gums, petechiae, and purpura Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the primary health care provider if noted on assessment. Options 1, 2, and 3 are normal occurrences in the last trimester of pregnancy.

The nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to her newborn during postpartum hospitalization. Which maternal action best exemplifies the mother's knowledge of potential disease transmission to the newborn? 1. The mother requests that the window be closed before feeding 2. The mother holds the newborn properly during feeding and burping 3. The mother tests the temperature of the formula before initiating feeding 4. The mother washes and dries her hands before and after self-care of the perineum and asks for a pair of gloves before feeding

4. The mother washes and dries her hands before and after self-care of the perineum and asks for a pair of gloves before feeding Hepatitis B virus is highly contagious and is transmitted by direct contact with blood and body fluids of infected persons. The rationale for identifying childbearing clients with this disease is to provide adequate protection of the fetus and the newborn, to minimize transmission to other individuals, and to reduce maternal complications. The correct option provides the best evaluation of maternal understanding of disease transmission. Option 1 will not affect disease transmission since hepatitis B does not spread through airborne transmission. Options 2 and 3 are appropriate feeding techniques for bottle feeding but do not minimize disease transmission for hepatitis B.

A 26-year-old client is 26 weeks pregnant. Her previous births include two large-for-gestational-age babies and one unexplained stillbirth. Which tests would the nurse anticipate as being most definitive in diagnosing gestational diabetes? 1. A 50g, 1-hour glucose screening test 2. A single fasting glucose level 3. A 100g, 1-hour glucose tolerance test 4. A 100g, 3-hour glucose tolerance test

4. ~ Gestational diabetes is diagnosed if two or more of the following values are met or exceeded after taking the 100 g, 3-hour OGTT: Fasting: 95 mg/dL; 1 hour: 180 mg/dL; 2 hours: 155 mg/dL; 3 hours: 140 mg/dL.

While doing a prenatal assessment on a woman who has hepatitis B and intends to become pregnant, the nurse explains the impact of the hepatitis B on pregnancy and birth. Which statement does the nurse include in the teaching? 1. Your baby contracted hepatitis B from you when she was conceived. 2. Don't worry about your baby during the birth. You're more likely to be affected then by the hepatitis B. 3. Your baby will be immune to your hepatitis B. 4. Hepatitis B does not usually affect the course of pregnancy.

4. ~ Hepatitis B does not usually affect the course of pregnancy.

The client has just been diagnosed as diabetic. The nurse knows teaching was effective when the client makes which statement? 1. Ketones in my urine mean that my body is using the glucose appropriately. 2. I should be urinating frequently and in large amounts to get rid of the extra sugar. 3. My pancreas is making enough insulin, but my body isn't using it correctly. 4. I might be hungry frequently because the sugar isn't getting into the tissues the way it should.

4. ~ The client who understands the disease process is aware that if the body is not getting the glucose it needs, the message of hunger will be sent to the brain.

A 21-year-old at 12 weeks gestation with her first baby has known cardiac disease, class III, as a result of childhood rheumatic fever. During a prenatal visit, the nurse reviews the signs of cardiac decompensation with her. The nurse will know that the client understands these signs and symptoms if she states that she would notify her doctor if she had which symptom? 1. A pulse rate increase of 10 beats per minute 2. Breast tenderness 3. Mild ankle edema 4. A frequent cough

4. ~ The hearts signal of its decreased ability to meet the demands of pregnancy includes frequent cough (with or without hemoptysis).

A 21-year-old woman is at 12 weeks gestation with her first baby. She has cardiac disease, class III, as a result of having had childhood rheumatic fever. Which planned activity would indicate to the nurse that the client needs further teaching? 1. I will be sure to take a rest period every afternoon. 2. I would like to take childbirth education classes in my last trimester. 3. I will have to cancel our trip to Disney World. 4. I am going to start my classes in water aerobics next week.

4. ~ With the slightest exertion, the client's heart rate will rise, and she will become symptomatic. Therefore, she should not establish a new exercise program.

B (Rationale: When caring for a client who has suffered perinatal loss, the nurse should provide opportunity for her to bond with the dead infant and for the infant to become part of the family unit. Parents not given that opportunity may have fantasies about the infant that are worse than reality. If the child has gross deformities, the nurse should prepare the client for these. If the client doesn't ask about her child, the nurse should encourage her to do so and provide any information she seems ready to hear. The client needs a full explanation of all factors related to the experience so she can grieve appropriately. Allowing the father to determine which information the client is given is inappropriate.)

A client gives birth to a stillborn infant at 36 weeks. When caring for this client, which strategy by the nurse would be most helpful? A. Be selective in providing the information that the client seeks B. Encourage the client to see, touch and hold the dead infant C. Provide information about the possible causes of the stillbirth only if the client requests it D. Let the child's father decide what information the mother receives.

B (Rationale: Cardiac output increases immediately after delivery as blood that had been diverted to the uterus reenters the central circulation. A client who cannot tolerate these changes may experience cardiac decompensation and cardiac failure. After delivery, renal function increases. There is usually not an increase in pain after delivery except for small increments attributable to uterine cramps, perineal discomfort and breast tenderness. Although hepatic blood flow decreases to normal levels after delivery, this does not affect cardiac function.)

A client with cardiac disease delivers a baby. Afterwards, the nurse assesses the client for signs of cardiac decompensation. During the postpartum period, which condition can cause cardiac decompensation? A. Increased pain B. Increased cardiac output C. Decreased renal function D. Decreased hepatic blood flow

B (Treatment of excessive bleeding requires the collaboration of the physician and the nurses. Do not leave the client alone.)

A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000 g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. The nurse should: a. continue to massage the fundus. b. notify the physician. c. recheck vital signs. d. insert a Foley catheter.

B (The initial management of excessive postpartum bleeding is firm massage of the uterine fundus.)

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: A. Establish venous access B. Perform fundal massage C. Prepare the woman for surgical intervention D. Catheterize the bladder

B (Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction.)

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: a. uterine atony. b. lacerations of the genital tract. c. perineal hematoma. d. infection of the uterus.

B (Rationale: Based on the signs and symptoms presented by the client (especially the elevated temperature), the physician should be notified because the client probably has mastitis, an infection in the breast. An antibiotic that is tolerated by the infant as well as the mother may be prescribed. The mother should continue to nurse on both breasts but should start the infant on the unaffected breast while the affected breast lets down.)

A ten-day postpartum breastfeeding client telephones the postpartum unit complaining of a reddened, painful breast and elevated temperature. Based on assessment of the client's complaints, the nurse tells the client to: A. "Stop breastfeeding because you probably have an infection." B. "Notify your physician because you may need medication." C. "Continue breastfeeding because this is a normal response in breastfeeding mothers." D. "Breastfeed only with the unaffected breast."

A (Amniotic fluid embolism (AFE))

A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. Three thromboembolic conditions are of concern during the postpartum period and include all except: a) Amniotic fluid embolism (AFE) b) Superficial venous thrombosis c) Deep vein thrombosis d) Pulmonary embolism

A (A WBC count in the upper ranges of normal (20,000 to 30,000) may indicate an infection.)

A white blood cell (WBC) count of 28,000 cells/mm3 on the morning of the first postpartum day indicates: a. possible infection. b. normal WBC limit. c. serious infection. d. suspicion of sexually transmitted disease.

B (Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated.)

A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? a. Call for help. b. Assess the fundus for firmness. c. Take her blood pressure. d. Check the perineum for lacerations.

C (Rationale: Since the client is already hemorrhaging, it is inappropriate to initiate a pad count. Fundal massage and administration of oxytocics would be indicated if the hemorrhage is due to uterine atony. If a full bladder is displacing the uterus and preventing it from contracting, insertion of an indwelling catheter would be an appropriate response.)

A woman is experiencing an early postpartum hemorrhage. Which of the following actions would be inappropriate? A. Insertion of an indwelling urinary catheter B. Fundal massage C. Pad count D. Administration of oxytocics

C (Pain and tenderness in the extremities, which show warmth, redness, and hardness, is likely thrombophlebitis. A Doppler ultrasound is a common noninvasive way to confirm diagnosis.)

A woman who has recently given birth complains of pain and tenderness in her leg. Upon physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect _____ and should confirm the diagnosis by _____. A. Disseminated intravascular coagulation; asking for laboratory tests B. von Willebrand disease; noting whether bleeding times have been extended C. Thrombophlebitis; using real time and color Doppler ultrasound D. Coagulopathies; drawing blood for laboratory analysis

C (A parent that is grieving over a recent loss (in the process of detachment) will have the most difficulty bonding with the new baby. Knowledge of parent-infant attachment or being an only child are not related to successful bonding. A job loss does not have the impact that death of a family member does.)

During the early postpartum period, the nurse is evaluating a client's attachment to her neonate. Which type of parent has the most difficulty attaching to her newborn? A. One who has little knowledge of parent-infant attachment B. One who recently lost a job C. One whose father recently died D. One who is an only child

A (500 mL in the first 24 hours after vaginal delivery.)

Early postpartum hemorrhage is defined as a blood loss greater than: a. 500 mL in the first 24 hours after vaginal delivery. b. 750 mL in the first 24 hours after vaginal delivery. c. 1000 mL in the first 48 hours after cesarean delivery. d. 1500 mL in the first 48 hours after cesarean delivery.

C (Blue cohosh)

Herbal remedies have been used with some success to control PPH after initial management. Some herbs have homeostatic actions, whereas others work as oxytocic agents to contract the uterus. ________________ is a commonly used oxytocic herbal remedy. a) Witch hazel b) Lady's mantel c) Blue cohosh d) Yarrow

A (Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters.)

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? A. Administration of blood B. Preparation of the client for invasive hemodynamic monitoring C. Restriction of intravascular fluids D. Administration of steroids

A (A full bladder displaces the uterus and prevents contraction of the uterus and uterine atony is the primary cause of postpartum hemorrhage. Shock, infection and DIC are not related to bladder distention)

In the fourth stage of labor, a full bladder increases the risk for A. Hemorrhage B. Dissesminated intravascular coagulation C. Infection D. Shock

D (Placenta abruptio is premature separation of the placenta as opposed to partial or complete adherence. This occurs between the 20th week of gestation and delivery in the area of the decidua basilis. Symptoms include localized pain and bleeding.)

It is important for the perinatal nurse to be knowledgeable regarding conditions of abnormal adherence of the placenta. This occurs when the zygote implants in an area of defective endometrium and results in little to no zone separation between the placenta and decidua. Which classification of separation is not recognized as an abnormal adherence pattern? A. Placenta accreta B. Placenta increta C. Placenta percreta D. Placenta abruptio

D (Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH.)

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage. For instance: A. PPH is easy to recognize early; after all, the woman is bleeding. B. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH. C. If anything, nurses and doctors tend to overestimate the amount of blood loss. D. Traditionally, PPH has been classified as early or late with respect to birth.

B (The leading cause of PPH is uterine atony, which complicates one in 20 births. The uterus is overstretched and contracts poorly after the birth.)

Nurses should first look for the most common cause of PPH, _____, by _____. A. Lacerations of the genital tract; checking for the source of blood B. Uterine atony; evaluating the contractility of the uterus C. Inversion of the uterus; feeling for a smooth mass through the dilated cervix D. Retained placenta; noting the type of bleeding

C (Adequate fluid intake prevents urinary stasis, dilutes urine, and flushes out waste products.)

Nursing measures that help prevent postpartum urinary tract infection include: a. promoting bed rest for 12 hours after delivery. b. discouraging voiding until the sensation of a full bladder is present. c. forcing fluids to at least 3000 mL/day. d. encouraging the intake of orange, grapefruit, or apple juice.

B (Rho(D) immune globulin (RhoGam) is given to the Rho(D)-negative mother, within 72 hours after delivery of an Rho(D)-positive baby (if the Coombs is negative). RhoGam is never given to the baby.)

The client has just given birth to a healthy, full-term infant. The client is Rho(D) negative and her baby is Rho(D) positive. Which intervention will take place to reduce the possibility of isoimmunization? A. Administering Rho(D) immune globulin to the baby, IM, within 72 hours B. Administering Rho(D) immune globulin to the mother, IM, within 72 hours C. Administering Rho(D) immune globulin to the mother, IM, at her 6-week visit D. Administering Rho(D) immune globulin to the mother, IM, within 3 months

C (The initial management of excessive postpartum bleeding is firm massage of the uterine fundus.)

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: A. Call the woman's primary health care provider B. Administer the standing order for an oxytocic C. Palpate the uterus and massage it if it is boggy D. Assess maternal blood pressure and pulse for signs of hypovolemic shock

C (Strict adherence by all health care personnel to aseptic techniques during childbirth and the postpartum period is very important and the least expensive measure to prevent infection.)

The most effective and least expensive treatment of puerperal infection is prevention. What is important in this strategy? A. Large doses of vitamin C during pregnancy B. Prophylactic antibiotics C. Strict aseptic technique, including handwashing, by all health care personnel D. Limited protein and fat intake

C (Tenderness, heat, and swelling are classic signs of thrombophlebitis that appear at the site of the inflammation.)

The mother-baby nurse must be able to recognize what sign of thrombophlebitis? a. Visible varicose veins b. Positive Homans' sign c. Local tenderness, heat, and swelling d. Pedal edema in the affected leg

A (During the early postpartum period, lochia rubra should be moderate to significant. Scant lochia may indicate that large clots are blocking the flow. Thirst, fatigue and a temperature up to 100.4oF (38oC) are normal within the first 24 hours. Immediately after delivery, vasomotor changes may cause a shaking chill.)

The nurse assesses a client who delivered 24 hours ago. Which of the following suggests the need for further assessment? A. Scant lochia rubra B. Chills C. Thirst and fatigue D. A temperature of 100.2oF (37.9oC)

A (Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments.)

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by: A. Subinvolution of the placental site B. Defective vascularity of the decidua C. Cervical lacerations D. Coagulation disorders

B, C, D, E (Postpartum hemorrhage often results in anemia, and iron therapy may need to be initiated. Exhaustion is common after hemorrhage. It may take the new mother weeks to feel like herself again. Fatigue may interfere with normal parent-infant bonding and attachment processes. The mother is likely to require assistance with housework and infant care. Excessive blood loss increases the risk for infection.)

The visiting nurse must be aware that women who have had a postpartum hemorrhage are subject to a variety of complications after discharge from the hospital. These include: (Choose those that apply.) a. dehydration. b. anemia. c. exhaustion. d. failure to attach to her infant. e. postpartum infection.

C (Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this are first-timers who are breastfeeding.)

What infection is contracted mostly by first-time mothers who are breastfeeding? A. Endometritis B. Wound infections C. Mastitis D. Urinary tract infections

B (Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.)

What instructions should be included in the discharge teaching plan to assist the client in recognizing early signs of complications? a. Palpate the fundus daily to ensure that it is soft. b. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding. c. Report any decrease in the amount of brownish red lochia. d. The passage of clots as large as an orange can be expected.

B (Degradation of fibrin leads to the accumulation of fibrin split products in the blood.)

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? A. Bleeding time of 10 minutes B. Presence of fibrin split products C. Thrombocytopenia D. Hyperfibrinogenemia

D (Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised, and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion.)

When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: A. Absence of cyanosis in the buccal mucosa B. Cool, dry skin C. Diminished restlessness D. Urinary output of at least 30 ml/hr

A (Early and frequent feedings prevent stasis of milk, which contributes to engorgement and mastitis.)

Which measure may prevent mastitis in the breastfeeding mother? a. Initiating early and frequent feedings b. Nursing the infant for 5 minutes on each breast c. Wearing a tight-fitting bra d. Applying ice packs before feeding

C (Leg exercises promote venous blood flow and prevent venous stasis while the client is still on bed rest.)

Which nursing measure would be appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth? a. Roll a bath blanket and place it firmly behind the knees. b. Limit oral intake of fluids for the first 24 hours. c. Assist the client in performing leg exercises every 2 hours. d. Ambulate the client as soon as her vital signs are stable.

D (Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning.)

Which statement by a postpartal woman indicates that further teaching is not needed regarding thrombus formation? a. "I'll stay in bed for the first 3 days after my baby is born." b. "I'll keep my legs elevated with pillows." c. "I'll sit in my rocking chair most of the time." d. "I'll put my support stockings on every morning before rising."

D (A temperature elevation to greater than 100.4° F on 2 postpartum days not including the first 24 hours indicates infection.)

Which temperature indicates the presence of postpartum infection? a. 99.6° F in the first 48 hours b. 100° F for 2 days postpartum c. 100.4° F in the first 24 hours d. 100.8° F on the second and third postpartum days