Maternity Test 2 Chapter 23 Application

After teaching a class of pregnant women on ways to decrease the postpartum complication of thrombotic conditions, the nurse recognizes more teaching is needed when one of the participants states: "He has to do the deep breathing exercises with me." "Using passive range-of-motion exercises in bed sounds easy enough." "At least I don't have to give up smoking for this one." "I should drink more so I don't get dehydrated."

"At least I don't have to give up smoking for this one."

A nurse is conducting a class for pregnant women who are in their third trimester. The nurse is reviewing information about the emotional changes that occur in the postpartum period, including postpartum blues and postpartum depression. After reviewing information about postpartum blues, the group demonstrates understanding when they make which statement about this condition? "Postpartum blues is a long-term emotional disturbance." "Extended psychotherapy is needed for treatment." "Getting some outside help for housework can lessen feelings of being overwhelmed." "The mother loses contact with reality."

"Getting some outside help for housework can lessen feelings of being overwhelmed."

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement? "I will call my health care provider if my stools are black and tarry." "I will use a soft toothbrush to brush my teeth." "I can take ibuprofen if I have any pain." "I need to avoid drinking any alcohol."

"I will use a soft toothbrush to brush my teeth."

A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression? "I keep hearing voices telling me to take my baby to the river." "I just feel so overwhelmed and tired." "It's strange, one minute I'm happy, the next I'm sad." "I'm feeling so guilty and worthless lately."

"I'm feeling so guilty and worthless lately."

The nurse is teaching a prenatal class about preparing for their expanding families. What is helpful advice from the nurse? "The hormones of pregnancy may cause anxiety or depression postpartum." "Expect your other children to react positively to their new brother/sister." "Caring for your new infant is instinctual and will come naturally to you." "Your old coping methods will adequately get you through this period of adjustment."

"The hormones of pregnancy may cause anxiety or depression postpartum."

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I am sad because I am not spending as much time with my toddler now that my newborn is here." "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? "I need to call my doctor if my temperature goes above 100.4° F (38° C)." "When I put on a new pad, I'll start at the back and go forward." "I'll point the spray of the peri-bottle so the water flows front to back." "If I have chills or my discharge has a strange odor, I'll call my doctor."

"When I put on a new pad, I'll start at the back and go forward."

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? 750 mL 1000 mL 250 mL 500 mL

1000 mL

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? 750 mL 500 mL 300 mL 1000 mL

500 mL

What would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis? Platelet level Fibrinogen level Prothrombin time Activated partial thromboplastin time

Activated partial thromboplastin time

The nurse is reviewing orders written for a postpartum patient with a fourth-degree perineal laceration. Which order should the nurse question before implementing? Administering an enema Providing a sitz bath Urging to drink all the milk provided during meals Administering acetaminophen and codeine for pain

Administering an enema

The nurse notes uterine atony in the postpartum client. Which assessment is completed next? Assessment of bowel function Assessment of the lung fields Assessment of laboratory data Assessment of the perineal pad

Assessment of the perineal pad

Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication? She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. Her perineum is obviously edematous on inspection. At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. She says she is extremely thirsty.

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.

A client develops mastitis 3 weeks after giving birth. What part of client self-care is emphasized as most important? Administer antibiotic medication for the full 10 days even if she begins to feel better Increase her fluid intake to ensure that she will continue to produce adequate milk Breastfeed or otherwise empty her breasts every 1 to 2 hours Use NSAIDs, warm showers, and warm compresses to relieve her discomfort

Breastfeed or otherwise empty her breasts every 1 to 2 hours

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? Assess the temperature. Assess the fundal height. Monitor the pain level. Check the lochia.

Check the lochia.

The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? Wear sterile gloves when assessing the pad and perineum. Perform the examination as quickly as possible. Instruct the client to empty her bladder before the examination. Place the client in a supine position with her arms overhead for the examination of her breasts and fundus.

Instruct the client to empty her bladder before the examination

The nurse is assessing vital signs on the client and notes a normal blood pressure along with an elevated pulse when the patient moves from a lying to a standing or sitting position. What would this indicate? Delayed labor Overhydration Low fluid volume Arrested labor

Low fluid volume

A postpartum patient is prescribed methylergonovine 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient? Measure urine output. Measure blood pressure. Assess ambulation. Evaluate current hematocrit level.

Measure blood pressure.

What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? Calcium gluconate Magnesium sulfate Oxytocin Domperidone

Oxytocin

A postpartum woman is prescribed oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? Administer the drug as an IV bolus injection. Withhold the drug if the woman is hypertensive. Piggyback the IV infusion into a primary line. Give as a vaginal or rectal suppository.

Piggyback the IV infusion into a primary line.

A postpartum client calls the nurse to her room and states that she knows something awful is going to happen to her. What should the nurse do? Call a code. Ask if she would like to see the social worker. Tell her she is being silly; nothing is going to happen to her. Report this immediately to the health care provider.

Report this immediately to the health care provider.

The nurse is assessing a postpartum client at a 6-week well-care check and notes questionable behavior on assessment. Which behaviors should the nurse prioritize and report to the RN or health care provider? Restless and agitated, concerned with self and not the infant States being tired and happy at same time Tearful during appointment Talkative and asking questions

Restless and agitated, concerned with self and not the infant

The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? On her left side Trendelenburg Flat in bed Semi-Fowler

Semi-Fowler

The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse? Instruct to use a sitz bath while voiding. Advise her to take acetaminophen to ease symptoms. Teach that adequate hydration helps clear the infection quicker. Ask primary care provider to prescribe an analgesic.

Teach that adequate hydration helps clear the infection quicker.

Which situation should concern the nurse treating a postpartum client within a few days of birth? The client would like to watch the nurse give the baby her first bath. The client is nervous about taking the baby home. The client feels empty since she gave birth to the neonate. The client would like the nurse to take her baby to the nursery so she can sleep.

The client feels empty since she gave birth to the neonate.

A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? Pain in the lower abdomen Uterine protrusion into the vagina Foul smelling lochia Uterine bleeding present

Uterine protrusion into the vagina

Which measurement best describes delayed postpartum hemorrhage? blood loss in excess of 1,000 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 300 ml, occurring at least 24 hours and up to 12 weeks after birth blood loss in excess of 800 ml, occurring at least 24 hours and up to 12 weeks after birth

blood loss in excess of 500 ml, occurring at least 24 hours and up to 12 weeks after birth

A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which condition in the mother and the newborn? hemorrhage infection hypovolemia trauma

infection

The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders? medications used during labor and birth preexisting conditions in the client drop in estrogen and progesterone levels after birth lack of social support from family or friends

drop in estrogen and progesterone levels after birth

A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? dyspnea, diaphoresis, hypotension, and chest pain dyspnea, bradycardia, hypertension, and confusion weakness, anorexia, change in level of consciousness, and coma pallor, tachycardia, seizures, and jaundice

dyspnea, diaphoresis, hypotension, and chest pain

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which measure would the nurse include as the most cost-effective method for prevention? prophylactic heparin administration warm compresses early ambulation compression stockings

early ambulation

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also reports significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? hematoma uterine atony laceration bladder distention

hematoma

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

hypovolemia

A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. manifestations of mania loss of confidence bizarre behavior decreased interest in life inability to concentrate

loss of confidence decreased interest in life inability to concentrate

A woman is experiencing a postpartum hemorrhage due to uterine atony. Which risk factor would the nurse recognize as contributory to this specific problem? fetal demise placenta accreta multiparity preeclampsia

multiparity

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

postpartum depression

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? flushing seizures headache uterine hyperstimulation

seizures

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? moderate amount of lochia rubra uterine atony hemoglobin level of 12 g/dl (120 g/L) thrombophlebitis

uterine atony

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

venous duplex ultrasound of the right leg