Ch. 23 Conditions Occurring after Delivery

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'm feeling so guilty and worthless lately

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 reviewing orders written for a postpartum patient with a fourth-degree perineal laceration. Which order should the nurse question before implementing?

administering an enema

a postpartum woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this?

assess for pedal edema

the nurse notes uterine atony in the postpartum client. Which assessment is completed next?

assessment of the perineal pad

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

oxytocin

the LPN has reported that uterine massage is ineffective on a client. The nurse anticipates the health care provider will prescribe which medication to address this issue?

oxytocin

The nurse suspects that a mother who delivered her infant 2 weeks ago is experiencing postpartum depression. What is the first line of treatment for this client?

administrating a selective serotonin reuptake inhibitor

a nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client?

check the lochia

A nurse is preparing a class for a group of new parents on the psychological adaptations that occur after the birth. The nurse should include which signs and symptoms that might suggest postpartum depression?

restlessness, feelings or worthlessness, feeling overwhelmed

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?

teach that adequate hydration helps clear the infection quicker

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?

decreased interest in life, loss of confidence, inability to concentrate

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?

venous duplex ultrasound of the right leg

The mental health clinical nurse specialist is teaching a postpartum nurse how to use the Postpartum Depression Predictor Scale (PDSS) to assess for postpartum depression. The nurse specialist determines the need for additional teaching when the nurse identifies which component as being screened with the scale?

family and social support system

which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage?

uterine atony

The nurse is caring for a woman who experienced a vaginal birth 6 hours prior. The health care provider is concerned the woman may have retained placental tissue. What assessment finding would alert the nurse to further assess the client for complications of retained placental tissue?

the client's pulse is 130 beats/min at rest and base line was 98 beat/min

the client, who has just been walking around her room, sits down and reports leg tightness and ashiness. After resting, she states she is feeling much better. The nurse recognizes that this discomfort could be due to which cause?

thromboembolic disorder of the lower extremities

the nursing instructor is leading a discussion exploring the various conditions that can result in postpartum hemorrhage. The instructor determines the session is successful when the students correctly choose which condition is most frequently the cause of postpartum hemorrhage?

uterine atony

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?

hypovolemia

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 depression

the nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount?

500 mL

The nurse determines that a pregnant patient is at risk for developing a deep vein thrombosis. What should the nurse instruct the patient to reduce the risk of this potential complication?

Avoid standing in one position, don't cross the legs at the knee, and don't wear knee-high stockings

A postpartum client with a history of deep vein thrombosis is being discharged on anticoagulant therapy. The nurse teaches the client about the therapy and measures to reduce her risk for bleeding. Which statement by the client indicates the need for additional teaching?

I should brush my teeth vigorously to stimulate the gums

A woman who delivered her infant by cesarean section 1 week ago called her physician's office to report chills, fever of 101.6℉ (38.7℃) and a poor appetite. She also tells the nurse that she is having strong afterbirth pains and her lochia has increased in volume and has an odor. Lab work shows an elevated WBC count. Which of these reported findings is the most significant finding related to the suspected diagnosis of endometritis?

fever

the postpartum nurse is assessing clients, and all have given birth within the past 24 hours. Which client assessment leads the nurse to suspect the woman is experiencing postpartum blues?

a 30 year old woman who is teary eyes when asked how she and the baby are doing with breastfeeding

The nurse observes an ambulating postpartum woman limping and avoiding putting pressure on her right leg. Which assessments should the nurse prioritize in this client?

assess for warmth, erythema, and pedal edema

which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication?

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

A postpartum client who was discharged home returns to the primary health care facility after 2 weeks with reports of fever and pain in the breast. The client is diagnosed with mastitis. What education should the nurse give to the client for managing and preventing mastitis?

perform hand washing before and after breastfeeding

it is discovered that a new mother has developed a postpartum infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition?

client's temperature remains below 100.4 orally

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 woman who gave birth to a health baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which condition does the nurse believe is causing this experience?

postpartum baby blues

A client who gave birth to twins 6 hours ago becomes restless and nervous. Her blood pressure falls from 130/80 mm Hg to 96/50 mm Hg. Her pulse drops from 80 to 56 bpm. She was induced earlier in the day and experienced placental abruption (abruptio placentae). Based on this information, what postpartum complication would the nurse expect is happening?

hemorrhage

a postpartum patient is prescribed methylergonovine 0.2 for uterine subinvolution. Which action should the nurse take before administering the medication to the patient?

measure blood pressure

A nurse is assessing a client who gave birth vaginally about 4 hours ago. The client tells the nurse that she changed her perineal pad about an hour ago. On inspection, the nurse notes that the pad is now saturated. The uterus is firm and approximately at the level of the umbilicus. Further inspection of the perineum reveals an area, bluish in color and bulging just under the skin surface. Which action would the nurse do next?

notify the health care provider

A nurse is assessing a postpartal client. Which assessment finding would the nurse correlate to an increased loss of blood during and after delivery?

pale conjunctiva, orthostatic hypotension, anemia

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?

report this immediately to the health care provider

which recommendation should be given to a client with mastitis who is concerned about breastfeeding her neonate?

she should continue to breastfeed; mastitis will not infect the neonate

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

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?

uterine protrusion into the vagina