OB Chapter 19

You are the nurse giving an educational presentation to the local Le Leche league chapter. One woman asks you about mastitis. What would be your best response? a) Risk factors include frequent feeding. b) Risk factors include nipple piercing. c) Risk factors include breast pumps. d) Risk factors include complete emptying of the breast

Risk factors include nipple piercing.

When assessing a client who is 5 days pospartum, which of the following would alert the nurse to suspect that the client is experiencing late postpartum hemorrhage? a) Fundal tenderness b) Increased rectal pressure c) Rubra colored lochia d) Oliguria

Rubra colored lochia

When giving a postpartum client self-care instructions, the nurse instructs her to report heavy or excessive bleeding. How should the nurse describe "heavy bleeding?" a) Saturating 1 pad in 8 hours b) Saturating 1 pad in 15 minutes c) Saturating 1 pad in 1 hour d) Saturating 1 pad in 4 to 6 hours

Saturating 1 pad in 1 hour

A postpartum woman is diagnosed as having endometritis. Which position would you expect to place her in based on this diagnosis? a) On her left side. b) Flat in bed. c) Trendelenburg. d) Semi-Fowler's.

Semi-Fowler's.

Which of the following instructions would the nurse include in the teaching plan for a postpartum woman with mastitis? a) "Stop breast-feeding until the pain and swelling subside." b) "Try applying warm compresses to your breasts to encourage the milk to be released." c) "You'll need to take this medication to stop the milk from being produced." d) "Limit the amount of fluid you drink so your breasts don't get much fuller."

"Try applying warm compresses to your breasts to encourage the milk to be released."

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

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

On the third day postpartum, which temperature is internationally defined as a postpartal infection? a) 99.6°F (37.5°C) b) 100.4°F (38°C) c) 104.2°F (40.1°C) d) 102.4°F (39.1°C)

100.4°F (38°C)

Which recommendation should be given to a client with mastitis who's concerned about breast-feeding her neonate? a) She shouldn't use analgesics because they aren't compatible with breastfeeding b) She should supplement feeding with formula until the infection resolves c) She should continue to breast-feed; mastitis won't infect the neonate d) She should stop breast-feeding until completing the antibiotic

She should continue to breast-feed; mastitis won't infect the neonate

The nurse is teaching a client with newly diagnosed mastitis about her condition. The nurse would inform the client that she most likely contracted the disorder from which organism? a) Escherichia coli b) Staphylococcus aureus c) Group beta-hemolytic streptococci (GBS) d) Streptococcus pyogenes

Staphylococcus aureus

The nurse assesses the patient who is one hour postpartum and observes a heavy steady gush of bright red blood from the vagina in the presence of a firm fundus. Select the most likely cause of the signs and symptoms. a) Infection of the uterus. b) Uterine atony. c) Lacerations. d) Perineal hematoma.

Lacerations.

The nurse is assessing the breast of a woman who is 1 month postpartum. The woman is complaining of a painful area on one breast with a red area. The nurse notes a local area on one breast, red and warm to touch. Which of the following should the nurse suspect is the potential diagnosis? a) Breast yeast b) Engorgement c) Mastitis d) Plugged milk duct

Mastitis

Which of the following instructions should the nurse offer a client as primary preventive measures to prevent mastitis? a) Avoid massaging the breast area b) Perform handwashing before breastfeeding c) Avoid frequent breastfeeding d) Apply cold compresses to the breast

Perform handwashing before breastfeeding

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? a) 250 mL b) 100 mL c) 300 mL d) 500 mL

500 mL

Mrs. M. and her infant are being discharged home after an unplanned cesarean delivery. You explain to her that she is at a higher risk for postpartum infection than most patients. What is the major risk factor for a post-partum infection? a) A planned cesarean birth. b) Labor more than 12 hours long. c) A nonelective cesarean birth. d) Labor less than 12 hours long.

A nonelective cesarean birth.

Which of the following behaviors exhibited by a 4-hour postpartum woman requires further interventions by the nurse? a) Returns her son to the nursery because of fatigue. b) Absent verbalization about the birthing process. c) Cuddles her son close to her while feeding. d) Tells visitors about her son and the labor.

Absent verbalization about the birthing process.

A nurse is assessing vital signs for a postpartum patient 48 hours after delivery. The vital signs are: Temp 101.2F; HR 82; RR 18; BP 125/78. How will the nurse interpret the vital signs? a) Shock b) Infection c) Normal vital signs d) Dehydration

Infection

When completing the morning postpartum data collection, the nurse notices the client's perineal pad is completely saturated. Which action should be the nurse's first response? a) Ask the client when she last changed her perineal pad b) Have the charge nurse review the assessment c) Immediately call the primary care provider d) Vigorously massage the fundus

Ask the client when she last changed her perineal pad

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

Assess the woman's fundus

A nurse is assigned to care for a client with lacerations. The nurse knows that which of the following would be the most likely cause of lacerations of the genital tract? a) Birth of a large newborn b) History of hypertension c) Development of endometritis d) Excessive traction on umbilical cord

Birth of a large newborn

You are caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would you need to assess before the woman ambulates? a) Height, level of orientation, support systems b) Blood pressure, pulse, complaints of dizziness c) Attachment, lochia color, complete blood cell count d) Degree of responsiveness, respiratory rate, fundus location

Blood pressure, pulse, complaints of dizziness

You are conducting discharge teaching with a postpartum woman. What would be an important instruction for this patient? a) Call her caregiver if lochia moves from serosa to alba. b) Call her caregiver if lochia moves from rubra to serosa. c) Call her caregiver if amount of lochia decreases. d) Call her caregiver if lochia moves from serosa to rubra.

Call her caregiver if lochia moves from serosa to rubra.

Which of the following would be essential to implement to prevent late postpartum hemorrhage? a) Administering broad-spectrum antibiotics b) Inspecting the placenta after delivery for intactness c) Manually removing the placenta at delivery d) Applying pressure to the umbilical cord to remove the placenta

Inspecting the placenta after delivery for intactness

Within 24 hours of delivery, Diane begins to complain of pain in the pelvic region. Comfort measures and medication fail to eliminate the pain, her pulse is rapid, and her blood pressure, hematocrit, and hemoglobin are low. Her fundus is firm, however, and her lochia is dark red and flowing in only moderate amounts; no pooling is evident. You suspect a) Retained placental fragments b) Deep-vein thrombosis c) Lacerations in the uterus d) Deep pelvic hematoma

Deep pelvic hematoma

Which of the following would most likely lead the nurse to suspect that a woman is experiencing postpartum psychosis? a) Sadness b) Delirium c) Insomnia d) Feelings of guilt

Delirium

A woman is two weeks postpartum when she calls the clinic and tells the nurse that she has a fever of 101°F. She complains of abdominal pain and a "bad smell" to her lochia. The nurse recognizes that these symptoms are associated with which condition? a) Endometritis b) Episiotomy infection c) Subinvolution d) Mastitis

Endometritis

You administer methylergonovine (Methergine) 0.2 mg to a postpartal woman with uterine subinvolution. Which of the following assessments should you make prior to administering the medication? a) Her hematocrit level is over 45%. b) She can walk without experiencing dizziness. c) Her urine output is over 50 mL/h. d) Her blood pressure is below 140/90.

Her blood pressure is below 140/90.

Which assessment on the third postpartal day would make you evaluate a woman as having uterine subinvolution? a) Her uterus is three finger widths under the umbilicus. b) Her uterus is at the level of the umbilicus. c) Her uterus is 2 cm above the symphysis pubis. d) She experiences "pulling" pain while breastfeeding.

Her uterus is at the level of the umbilicus.

When working in a free clinic for children, the nurse observes a mother with her 2 week infant. Which of the following behaviors should the nurse bring to the attention of the health care provider? a) Non-responsive to the infant crying b) Breastfeeding the infant in public c) Discussing her birth with another new mom d) Talking to the infant and rocking the infant

Non-responsive to the infant crying

The nurse has attempted to massage a boggy uterus to firm state without success. The next intervention the nurse should anticipate is the administration of what medication? a) Digoxin b) Oxytocin c) Ibuprofen d) Penicillin

Oxytocin

Two weeks after their baby is born, Tom calls to report that his wife Sylvia is behaving strangely. She is extremely talkative and energetic and he has not observed her sleeping for more than an hour or two at a time. She is also forgetting to eat and neglecting her appearance, but worse, she seems to barely be aware of the baby's needs and appears surprised when Tom asks her about the child, "As if," Tom says, "she's forgotten that we even have a baby!" You tell him to bring her in right away, because you suspect Sylvia is suffering from what condition? a) Postpartum psychosis b) Postpartum depression c) Maladjustment d) Postpartum blues

Postpartum psychosis

When planning care for a postpartum patient, the nurse is aware the most common site for postpartum infection is which of the following? a) Reproductive b) Integumentary c) Breast d) Urinary

Reproductive

When reviewing the causes of late postpartum hemorrhage, which of the following would the nurse identify as the most common cause? a) Cervical or vaginal lacerations b) Retained placental fragments c) Uterine atony d) Uterine inversion

Retained placental fragments

A woman delivered a healthy baby girl two days ago. This is her third child and both of the other children are also girls. Which observation by the nurse indicates the need for additional assessment and follow-up? a) The woman actively participates in the care of her baby. b) The woman comments that her baby has red hair like her grandmother. c) The woman tells a friend, referring to her baby, "It just cries all the time." d) The woman reports that she will be happy to get home because she does not like hospital food.

The woman tells a friend, referring to her baby, "It just cries all the time."

Which of the following is the most frequent reason for postpartum hemorrhage? a) Endometritis. b) Uterine atony. c) Perineal lacerations. d) Disseminated intravascular coagulation.

Uterine atony.

Which complication is most likely responsible for a late postpartum hemorrhage? a) Perineal laceration b) Uterine subinvolution c) Clotting deficiency d) Cervical laceration

Uterine subinvolution

When assessing a postpartum patient who was diagnosed with a cervical laceration that has been repaired, what sign should the nurse report as a possible development of hypovolemic shock? a) Warm and flushed skin b) Weak and rapid pulse c) Decreased respiratory rate d) Elevated blood pressure

Weak and rapid pulse

Choice Multiple question - Select all answer choices that apply. A nurse discovers a perineal hematoma in a woman who has recently given birth. Which of the following interventions should the nurse make in this case? (Select all that apply.) a) Administer an antibiotic b) Administer a mild analgesic as prescribed c) Apply an ice pack to the site d) Administer methotrexate e) Perform fundal massage f) Estimate the size of the hematoma and report it

• Estimate the size of the hematoma and report it • Administer a mild analgesic as prescribed • Apply an ice pack to the site