Ch 14 High risk postpartum nursing care

A postpartal woman has a past history of thrombophlebitis. Which of the following would help you to determine whether she is developing this postpartally? 1 ask her if she feels any warmth in her legs 2 assess for calf redness and edema 3 take her temp every 4 hrs 4 palpate her feet for tingling or numbness

2

The perinatal nurse accurately defines postpartum hemorrhage by including a decrease in hematocrit levels from pre-to post birth by: 1 5% 2 8% 3 10% 4 15%

3

T or F A hematoma is the collection of blood beneath the intact skin layer following an injury to a blood vessel

True

A postpartum pt informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the pt's medical record and associates which risk factors related to a possible UTI? Select all that apply 1 neonatal macrosomia 2 use of a vacuum extractor 3 poor oral fluid intake 4 urinary cath during labor 5 low grade fever 101.3

1,2,3,4

A postpartum woman has been diagnosed with postpartum psychosis. Which of the following actions should the nurse perform? 1 supervise all infant care 2 maintain client on strict bed rest 3 restrict visitation to her partner 4 carefully monitor toileting

1

Approximately 8 hrs ago, Juanita, a 32 yr old G1 P0, gave birth after 2 1/2 hrs of pushing. She required an episiotomy and a assisted birth (forceps) d/t the weight and size of her baby (9lbs 9oz). The perinatal nurse is performing an assessment of Juanita's perineal area. A slight bulge is palpated and the presence of ecchymoses to the right of the episiotomy is noted. The area feels "full" and is approximately 4 cm in diameter. Juanita describes this area as "very tender". The most likely cause of these s/s is: 1 hematoma formation 2 sepsis in the episiotomy site 3 inadequate repair of the episiotomy 4 postpartum hemorrhage

1

The nurse is aware the greatest source of bleeding during childbirth occurs following detachment of the placenta. Which physiological change takes place immediately after the expulsion of the placenta to decrease the amount of blood loss? 1 contractions of the uterine myometrium 2 factor VIII complex increases during gestation 3 platelet activity increases before labor and delivery 4 fibrin formation increases before the birth occurs

1

The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply 1 increases in maternal age 2 prepregnancy obesity 3 cesarean deliveries 4 inability to pay for health care 5 preexisting chronic medical conditions

1,2,3,5

The nurse is collecting info during a follow-up OB appointment with a pt who delivered 3 months ago. The pt reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply 1 the father exhibited depression during the pregnancy 2 the birth of this fourth child was unexpected and unplanned 3 the father expresses feeling bored and underappreciated in his job 4 the father is recently estranged from his parents and siblings 5 the mother experienced a prolonged labor and a cesarean birth.

1,2,4

The nurse is preparing a postpartum pt for discharge. For which reasons does the nurse instruct the patient to call the PCP? Select all that apply 1 foul smelling lochia 2 hot, red, painful breasts 3 mild headaches 4 not sleeping well 5 frequent, painful urination

1,2,5

A postpartum nurse has received an exchange report on the four following mother-baby couplets. Based on the provided info, which couplet should the nurse first assess? 1 a 25 yr old G2P1 who is 36 hrs postbirth and is having difficulty breastfeeding her baby. Her fundus is firm at the umbilicus, and lochia is moderate to scant. 2 a 16 yr old G1P0 who will be discharged in the afternoon. It was reported that she refers to her baby as "it" and that she requested to have her baby stay in the nursery so she could sleep. 3 A 32 yr old G5P4 woman who delivered a 4500g baby 2 hrs ago after a 20 hr labor that was augmented. It was reported that her fundus is 2 cm above umbilicus with moderate lochia 4 a 28 yr old G2P1 who delivered a 3800 g baby by elective cesarean birth. She had spinal anesthesia and was given intrathecal preservative free morphine for postoperative pain management. Her vs are 115/75, 80, 18, 98

3

The perinatal nurse notifies the physician of the findings related to Juanita's assessment. The first step in care will most likely be to: 1 prepare Juanita for surgery 2 administer IV fluids 3 apply ice to the perineum 4 insert a urinary cath

3

The nurse is assessing a pt who is 36 hrs postpartum following a cesarean delivery. Which findings cause the nurse to conclude that a wound infection is developing? Select all that apply 1 temp increase from 99.8 to 100.5 2 incisional tenderness with palpation 3 increased margins of incisional redness 4 notable warm skin around the incision 5 serosanguinous drainage from the suture line

3,4

A client is 1 hr postpartum from a vacuum delivery over a midline episiotomy of a 4500 g neonate. Which of the following nursing diagnoses is appropriate for this mother? 1. risk for altered parenting 2 risk for imbalance nutrition; less that body requirements 3 risk for ineffective individual coping 4 risk for fluid volume deficit

4

Postpartum women are at an increased risk of thrombus formation immediately following birth d/t an increased _________ level.

Plasma fibrinogen

A pt who is 8 months postpartum arrives for an OB appointment. The nurse notices that both the pt and the infant appear unkempt. The nurse anticipates a diagnosis of __________.

PPD

Which of the following is an indication for the administration of methylergonovine? 1 boggy uterus that does not respond to massage and oxytocin therapy 2 woman with a large hematoma 3 woman with a deep vein thrombosis 4 woman with severe postpartum depression

1

The nurse is providing postpartum care for a pt after a vag delivery. Which assessment findings causes the nurse to suspect endometritis from beta-hemolytic streptococcus? 1 scant amount of odorless lochia 2 presence of headache, malaise, and chills 3 pain or discomfort in the midline lower abdomen 4 elevated temp greater than 100.4

1

The perinatal nurse recognizes that a risk factor for postpartum depression is: 1 inadequate social support 2 age >35 yrs old 3 gestational hypertension 4 regular schedule of prenatal care

1

Which of the following would lead you to believe a postpartal woman is still in the taking in phase of the postpartal period? 1 she spent the majority of the day talking about labor 2 she states she is "starving" and cannot get enough to eat 3 she walked to take a shower and washed her hair 4 she was interested in learning how to give her infant a bath

1

Which of the following are primary risk factors for subinvolution of the uterus? Select all that apply 1 fibroids 2 retained placental tissue 3 metritis 4 UTI

1,2,3

The labor and delivery unit nurses are adopting methods to reduce the number of women who develop postpartum depression. Research from Dennis and Dowswell provides evidence based suggestions regarding beneficial interventions. Which suggestions do the nurses consider? Select all that apply 1 telephone based peer support 2 partner report of symptoms 3 interpersonal psychotherapy 4 teaching for self recognition of problems 5 professionally based postpartum home visits

1,3,5

A woman who is 2 days postpartum has painful hemorrhoids postpartally. Which of the following positions would you suggest she use for resting? 1 spine with uterus pressed to the side 2 sim's position 3 knee chest position 4 trendelenburg position

2

Karen, a G2 P2, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. What is the nurse's most appropriate actions? 1. Assess vital signs including blood pressure and pulse. 2. Massage the uterine fundus with continual lower segment support. 3 Measure and document each perineal pad changed in order to assess blood loss. 4. Assess for bladder distention and encourage patient to void.

2

The nurse is preparing discharge teaching for a postpartum pt who exhibits s/s of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management? 1 application of hot packs to the perineal area 2 info applicable to medication therapy 3 instructions to improve circulation by ambulating 4 medicating for pain above level 4 on a 0-10 scale

2

The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room? 1. Ask the patient how many peripads she considered to be "soaked." 2. Collect blood in calibrated, under-buttocks drapes for vaginal birth. 3. Place a basin at the foot of the delivery table to catch any blood. 4. Rely on the primary health care provider's estimate of blood loss.

2

The perinatal nurse teaches the postpartum woman about warning signs regarding development of postpartum infection. S/s that merit assessment by the health care provider include the development of a fever and: 1 breast engorgement 2 uterine tenderness 3 diarrhea 4 emotional lability

2

Which of the following sites is priority for the nurse to assess when caring for a breastfeeding client, G8 P5, who is 1 hr postdelivery? 1 nipples 2 fundus 3 lungs 4 rectum

2

The nurse continues to monitor a pt after a vag delivery with an estimated blood loss of 1,000mL. Which assessment finding does the nurse recognize as requiring Stage 3 hemorrhage protocol? 1 increased pt restlessness 2 manifestations of severe pain 3 development of abnormal v/s 4 pt requests water for extreme thirst

3

The nurse in a labor and delivery dept carefully assesses postpartum pt for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign eval? 1 blood pressure may be elevated from prenatal conditions 2 respirations are increased d/t activity of labor 3 changes in blood pressure may not be an immediate sign 4 heart rate may increase with intensity of labor

3

The nurse is assisting the primary care provider with the third stage of vag delivery. The pt is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for the pt? 1 methylergonovine 2 fresh frozen plasma 3 carboprost-tromethamine 4 mag sulfate

3

The nurse is providing care for a pt who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this pt? 1 prescriptions for antidepressants/antipsychotic drugs 2 discharge to home with 24 hr observation in place 3 immediate hospitalization in a psychiatric unit 4 prescribed neonate visits during in pt treatment

3

The nurse is providing care for a pt who is 8 hrs post partum after vag delivery. The pt reports severe perineal pain unaffected by pain medications. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take? 1 continue to apply ice to the are for 24 hrs 2 monitor v/s and report any abnormal readings 3 contact the PCP for further evaluation 4 relieve pressure by placing pt in a side-lying position

3

The nurse on a postpartum unit observes a pt who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The pt states, "I think that my baby is deformed inside and we have to fix him." Which risk factor is most strongly related to possible postpartum psychosis (PPP)? 1 separation from the baby's father 2 personal history of bipolar disorder 3 prolonged labor resulting in cesarean 4 loss of first child from a heart defect

3

The lactation nurse takes a phone call from a mother who is breastfeeding her 2 month old infant. The mother reports an area of redness and warmth on the breast and a painful burning sensation when breastfeeding. Which statement by the nurse is correct if mastitis is suspected? 1 if your nipples are cracked, you will need to stop breastfeeding 2 pump your milk and throw it away until the infection is gone 3 the baby gave you an infection and needs to be on antibiotics 4 continuing to breastfeed will help clear up the condition

4

The nurse is closely monitoring a pt who is postpartum and at risk for PPH. Which assessment finding will cause the nurse to contact the PCP immediately? 1 the uterus is displaced 2 the uterine fundus is boggy 3 small clots are expressed with massage 4 peripad weighs 100 g within 15 min

4

The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first: 1 methergine 2 ergotrate 3 carboprost 4 oxytocin or pitocin

4

While making a home visit to a woman on her 3rd day postpartum, you discover this new mother sitting by her bed crying. She states nothing is wrong; she just "feels sad". Which of the following would be your best response to her? 1 I'll keep confidential any problem you want to discuss with me 2 you have a beautiful boy; you shouldn't feel sad about that 3 do you wish you'd had a girl instead of a boy? 4 feeling sad when you know you shouldn't must be very confusing

4

T or F A hematoma is a localized collection of blood connective or soft tissue under the skin that follows injury of or laceration to a blood vessel without injury to the overlying tissue. At the time of injury, pressure necrosis and inadequate hemostasis occur

True

T or F Metritis is an infection that usually starts at the placental site

True

T or F Abruptio placenta is a risk factor for amniotic fluid embolism

True