Ch 19 Postpartum Woman at Risk

A nurse is caring for a postpartum client with urinary tract infection. Which instruction would the nurse include in the teaching plan for the client to help prevent future infections?

"Empty your bladder frequently"

On the third day postpartum, which temperature is internationally defined as a postpartal infection?

100.4° F (38° C)

On completing fundal palpation, the nurse notes that the fundus is situated in the client's left abdomen. Which action is appropriate?

Ask the client to empty her bladder

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?

Ask the client when she last changed her perineal pad

A postpartal woman is developing a thrombophlebitis in her right leg. Which assessment would the nurse use to assess for thrombophlebitis? Select all that apply.

Assess for redness and warmth in the affected leg. Assess for edema in the affected leg. Assess for a low-grade fever.

Which assessment would lead the nurse to believe a postpartal woman is developing a urinary complication?

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

The nurse is conducting discharge teaching with a postpartum woman. What would be an important instruction for this client?

Call her caregiver if lochia moves from serosa to rubra

A postpartum client saturates a peripad in 30 minutes. What is the nurse's first action in this situation?

Massage the fundus

A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action?

Obtain a clean-catch urine specimen

What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage?

Oxytocin

Which recommendation should be given to a client with mastitis who is concerned about breast-feeding her neonate?

She should continue to breast-feed; mastitis will not infect the neonate.

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching?

Symptoms include fever, chills, malaise, and localized breast tenderness.

A nurse is developing a program to help reduce the risk of late postpartum hemorrhage in clients in the labor and birth unit. Which measure would the nurse emphasize as part of this program?

inspecting the placenta after delivery for intactness

On a follow-up visit to the clinic, a nurse suspects that a postpartum client is experiencing postpartum psychosis. Which finding would most likely lead the nurse to suspect this condition?

delusional beliefs

A nurse is assessing a postpartum client. Which finding would the cause the nurse the greatestconcern?

sharp stabbing chest pain with shortness of breath

A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition?

uterine atony

What postpartum client should the nurse monitor most closely for signs of a postpartum infection?

A client who had a nonelective cesarean birth

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 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?

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

The nurse is concerned that a postpartum patient with a cervical laceration is developing hypovolemic shock. What did the nurse assess in this patient?

Weak and rapid pulse