M28.C Postpartum Depression

A postpartum client is concerned that symptoms of postpartum depression have not improved after taking antidepressant medication for 3 days. Which response should the nurse make to this​ client? A. ​"It can take up to 2 weeks for the medication to be​ effective." B. ​"The medication should be effective now. You may need to change​ drugs." C. ​"We can add an additional medication and see how the two work​ together." D. ​"Let's increase your dose and see if that​ works."

A Rationale: Antidepressants can take several weeks to have an effect. The nurse should remind the client that it might be several more days to a couple weeks before feelings improve. It is beyond the scope of practice for a nurse to increase the​ dose, change​ medications, or add additional medications.

The nurse is caring for a client with postpartum depression. Which medication should the nurse anticipate being prescribed for this​ client? A. Sertraline​ (Zoloft) B. Sleeping medication C. Antipsychotic D. Lithium

A Rationale: Sertraline​ (Zoloft) and paroxetine​ (Paxil) are two commonly prescribed antidepressants for clients with postpartum depression. Lithium and antipsychotics are used for clients with postpartum psychosis. Sleeping medication can help a client sleep better but may not be recommended during the postpartum period since it may interfere with the ability to provide newborn care.

The nurse is preparing to admit a client to the psychiatric unit for treatment of postpartum psychosis. Which nursing diagnosis should the nurse make a priority for this​ client? A. ​Violence: Self-Directed, Risk for B. Social​ Interaction, Impaired C. ​Parenting, Impaired D. ​Coping, Ineffective

A ​Rationale: A client with postpartum psychosis is at risk for harm to self or the baby. Diagnoses pertaining to client safety are always the priority. The other nursing diagnoses are also important and may apply to this client but are not the priority.​ (NANDA-I ©​ 2014) Next question

A postpartum client asks if a doula is necessary when the spouse is away on business trips. Which response should the nurse make to this​ client? A. ​"A postpartum doula helps you to stay rested and​ well-fed so you can better care for the​ baby." B. ​"A postpartum doula will make sure that the baby is healthy and putting on​ weight." C. ​"A postpartum doula will take over all of the baby care for​ you." D. ​"A postpartum doula will ensure that you and the baby are​ safe."

A ​Rationale: A postpartum doula helps the postpartum client to stay rested and​ well-fed to provide better care to self and the baby. The doula will also help with household tasks as necessary. A doula does not ensure safety or help the baby stay healthy and gain weight. A doula also does not take over all baby care​ tasks, but instead helps the client with transitioning to motherhood.

The nurse is preparing a class to prevent postpartum depression in postpartum clients. Which strategy should the nurse​ include? A. Joining a postpartum support group B. Taking prophylactic antidepressant medications C. Focusing all attention on caring for the infant once home D. Avoiding placing the infant on a schedule for the first weeks

A ​Rationale: Joining a postpartum support group can provide needed teaching and support to clients new to motherhood. In most​ situations, it is not appropriate for postpartum clients to take antidepressants to prevent postpartum depression. It is important for postpartum clients to maintain outside interests even once the baby has arrived. Sticking to a schedule can help to structure the day and keep active.

A client reports feelings of​ sadness, difficulty​ sleeping, and appetite changes since delivering a baby 6 weeks ago. Which screening test should the nurse anticipate​ using? A. Postpartum Depression Screening Scale B. Client Health Questionnaire C. Hamilton Depression Rating Scale D. Depression After Delivery

A ​Rationale: The nurse should prepare to use the Postpartum Depression Screening Scale to screen this client for postpartum depression. Depression After Delivery is an online resource for clients or families with postpartum depression. The Hamilton Depression Rating Scale and Client Health Questionnaire are screening tests for​ depression, but they are not specific to postpartum depression.

A client who is 5 weeks postpartum asks if hearing voices talking about the baby is normal. Which health problem should the nurse suspect is occurring with this​ client? A. Postpartum psychosis B. Postpartum depression C. Baby blues D. Postpartum blues

A ​Rationale: The nurse should suspect that the client is experiencing postpartum psychosis due to the presence of hallucinations and delusions. The baby blues are also known as the postpartum blues and cause crying​ spells, mood​ swings, and feeling sad or overwhelmed. Symptoms of postpartum depression include severe​ depression, problems​ sleeping, appetite​ changes, or feeling sad​ and/or hopeless.

A client is being discharged after treatment for postpartum psychosis. Which finding should indicate to the nurse that care has been​ effective? A. Both client and newborn have remained safe and free from injury or harm. B. The client is oriented to​ person, time,​ place, and circumstance. C. The​ client's vital signs remain within the normal range. D. The client understands that recovery should occur within 10 to 14 days.

A ​Rationale: The priority goal should be for the baby and client to remain safe and free from harm. The fact that this has happened indicates that the goal has been met and effective nursing care has been provided for this client. Even though vital signs and level of orientation are within normal​ limits, they do not specifically address the​ client's condition and needs. Full recovery from postpartum​ blues, not postpartum​ psychosis, is within 10 to 14 days. OK

The nurse is caring for a client with postpartum psychosis. Which clinical therapy should the nurse expect to be prescribed for this health​ problem? (Select all that​ apply.) A. Lithium and antipsychotics B. ​Short-term institutionalization C. Support groups D. Mental health counseling E. Supervision when caring for infant or other children

ABCE ​Rationale: Clinical therapies for postpartum psychosis include lithium and antipsychotics. Support groups and​ short-term institutionalization may be​ required, as well as supervision when caring for the infant or other children. Mental health counseling is indicated for postpartum depression.

The nurse is preparing a presentation about the potential genetic causes of postpartum depression. Which neurotransmitter should the nurse include in the​ presentation? (Select all that​ apply.) A. Dopamine B. Adrenalin C. Norepinephrine D. Serotonin E. Acetylcholine

ACD Rationale: Variants in the genes that code for enzymes affecting the neurotransmitters​ serotonin, dopamine, and norepinephrine​ (noradrenalin) may be involved in the development of postpartum depression or major depression. Adrenalin and acetylcholine are not involved in mood or associated with depression.

The nurse reviews data collected during the assessment of a client with postpartum depression. Which goal should the nurse identify for this​ client? (Select all that​ apply.) A. The newborn will be integrated into the family appropriately. B. The client is safe and does not harm self. C. The infant remains free from injury or harm. D. The client asks for additional support when it is needed. E. The client will be able to describe feelings and concerns.

ADE ​Rationale: Asking for​ support, describing feelings and​ concerns, and integrating the newborn into the family unit are all essential goals for a client with postpartum depression. Remaining free from injury​ (both client and​ baby) is especially important for clients with postpartum psychosis.

9) What is the greatest risk for a woman diagnosed with postpartum psychosis? A) Infanticide B) Hallucinations C) Insomnia D) Poor judgment

Answer: A Explanation: A) All of these are common symptoms of postpartum psychosis, but the greatest risk for a woman with postpartum psychosis is suicide and/or infanticide. The woman who is psychotic may experience delusions or hallucinations that support her perceptions that the infant should not be allowed to live.

5) Which data should suggest to the home health nurse that the client experiencing postpartum depression is improving? A) Client wearing clean clothes, holding baby while rocking in a chair B) Spouse making dinner, client in bed asleep, baby in rocker in the kitchen C) Dirty dishes in the sink, beds unmade, and client wearing clothing for sleep D) Client watching television in the living room while the baby is in the crib crying

Answer: A Explanation: A) The nurse who observes the client wearing clean clothes, holding the baby while rocking in a chair, should determine that treatment for postpartum depression has been effective because these are signs the client is improving. The other choices would indicate lack of interest in child care and care of the home. The client who is sleeping while the spouse is making dinner and watching the baby would indicate treatment has not been effective at all.

4) The home care nurse is planning care for a client with a history of postpartum depression after the births of all her children. Based on this data, which will the nurse include in the client's plan of care? Select all that apply. A) Encouraging the client to take advantage of those who want to help and maintain outside interests B) Contacting the healthcare provider to ensure the client is prescribed medication for postpartum depression C) Ensuring the client is getting adequate sleep D) Focusing on the care the other children need E) Instructing the client to eat a healthful diet with limited alcohol intake

Answer: A, C, E Explanation: A) Because the client has a history of postpartum depression with other children, the nurse needs to plan prevention strategies for the client. By taking advantage of those who want to help and maintaining outside interests, the client may prevent the onset of postpartum depression. Instructing to eat a healthful diet with limited alcohol intake and get adequate sleep are other strategies to prevent postpartum depression. The other interventions would not help prevent postpartum depression.

1) The postpartum client states that she cannot understand why she does not enjoy being with her baby. Based on this data, which does the nurse suspect the client is experiencing? A) Postpartum infection B) Postpartum depression C) Postpartum psychosis D) Postpartum blues

Answer: B Explanation: A) Postpartum depression is characterized by feelings of failure and self-accusation, among others. Postpartum psychosis is more severe, and includes hallucinations and irrationality, which are not represented in this situation. Postpartum infection has nothing to do with this situation. Postpartum blues is characterized by mild depression interspersed with happier feelings, and is self-limiting.

10) Which nursing intervention would the nurse anticipate carrying out to meet the needs of the family of a client experiencing postpartum depression? A) Emotional support for the newborn B) Emotional support for the father C) Temporary placement of the newborn in foster care D) Child care for the newborn

Answer: B Explanation: A) The father may have a difficult time adjusting to both a newborn and the mother's postpartum depression. The father may feel hurt or worried about the mother and overwhelmed by additional responsibilities. Although newborns need security and safety, nursing interventions of emotional support are not age appropriate. The child should not be placed in foster care unless the mother threatens harm to the newborn and no one else is available to care for the child. The nurse is not responsible for providing child care for the newborn.

3) The nurse caring for a postpartum client would consider the nursing diagnosis of ineffective coping when the client demonstrates which behavior? A) Reading material on care of a newborn B) Lying in bed, lights dim, and refusing to spend time with the baby C) Cuddling the new infant D) Talking with friends and family on the phone

Answer: B Explanation: A) The postpartum client who is lying in bed in a darkened room and not wanting to spend time with the new baby is demonstrating signs of ineffective coping. The other behaviors would not indicate ineffective copying but rather effective coping.

8) A nurse working in labor and delivery is assessing a client's risk for developing postpartum depression. Which is a risk factor for this disorder? A) Multiparity (multiple pregnancies) B) Overwhelming family support C) History of bipolar disorder D) Supportive relationship with spouse

Answer: C Explanation: A) A history of bipolar disorder is a risk factor for the development of postpartum depression. Primiparity (first pregnancy) is a risk factor, not multiparity. Lack of family support and lack of spousal support are risk factors for the development of postpartum depression.

2) The nurse is assessing a client who is 4 weeks postpartum. The client reports having no appetite and wanting to sleep all day. What does this information suggest to the nurse? A) The client is feeling blue, which is normal. B) The client's sleep-wake cycle is disrupted. C) The client may be experiencing postpartum depression. D) The client is developing postpartum psychosis.

Answer: C Explanation: A) Lack of appetite and the desire to sleep are symptoms of developing postpartum depression. The client could be developing postpartum depression and not just "the blues." The client would need to have more acute symptoms such as hearing voices to consider postpartum psychosis. The nurse has no way of knowing what the client's sleep-wake cycle is, so this choice is incorrect.

6) A client who is breastfeeding has been diagnosed with postpartum depression after delivering her first child. Which medications does the nurse anticipate being prescribed for this client? Select all that apply. A) Diazepam B) Phenytoin C) Paroxetine D) Fluoxetine E) Sertraline

Answer: C, E Explanation: A) Sertraline is recommended to be the first-line treatment for postpartum depression. Paroxetine is the alternative first-line treatment for postpartum depression. Fluoxetine is not recommended for lactating women because of the long half-life and the risk of the medication crossing into the breast milk. Diazepam and phenytoin are not used to treat postpartum depression.

7) The nurse is instructing a new mother on the strategies to prevent the development of postpartum depression. Which instructions will the nurse include in the teaching session with the client? Select all that apply. A) Restrict fluids and eat a low-fat diet help to avoid the onset of postpartum depression. B) Realize that feeling depressed after delivering a baby is normal and can last for months. C) The only way to avoid postpartum depression is to not have children. D) Encourage the client to plan how to manage the baby's care needs at home to help adjust to motherhood. E) Instruct the client to recognize the signs and symptoms of postpartum depression and phone the healthcare provider if these occur.

Answer: D, E Explanation: A) The nurse should instruct the client on the signs and symptoms of postpartum depression with the direction to phone her healthcare provider if this occurs. The nurse should also encourage the client to plan how to manage the baby's care needs at home to help adjust to motherhood. It is not normal to feel depressed for months after delivering a baby. Not having children is not the only way to avoid postpartum depression. Restricting fluids and eating a low-fat diet will not prevent postpartum depression and could harm the new mother's physiologic status.

A postpartum client is severely depressed and has a history of suicide attempts. Which should be the priority nursing​ intervention? A. Contact the healthcare provider. B. Ask about suicidal thought processes. C. Arrange for hospitalization. D. Ensure that the client is never left alone with the baby.

B Rationale: The nurse should first ask the client about suicidal ideations and potential plans. If the client is suicidal with a specific plan and means or​ access, hospitalization may be indicated. If​ not, medication or psychotherapy may be required instead. It is not necessary to avoid leaving the client alone with the baby unless the client is demonstrating delusions or is actively suicidal.

The nurse is assessing a client for postpartum blues. Which feeling​ voiced, or behavior​ observed, should the nurse recognize as a symptom of this​ disorder? (Select all that​ apply.) A. Irrational thoughts B. Overwhelmed C. Sleepiness D. Fatigue E. Tearfulness

BDE ​Rationale: Postpartum blues can manifest as​ fatigue, anxiousness,​ tearfulness, loss of​ appetite, and feelings of being overwhelmed and being​ "let down." Sleepiness is a normal occurrence during the postpartum period and is not a finding that supports postpartum blues. Irrational thoughts would support a diagnosis of postpartum​ psychosis, not postpartum blues.

A spouse asks about suggestions for a meaningful gift to help the postpartum client with the care of the newborn. Which suggestion should the nurse​ make? A. Jewelry B. A fitness membership C. A journal D. A new movie

C ​Rationale: A journal is a great gift for the client to write down feelings during the transition into motherhood. It can also serve as a memory book for when the baby is older. Jewelry is a thoughtful​ gift, but it will not help the client in the beginning of motherhood. A new movie is enjoyable but not necessarily meaningful. A fitness membership can be useful to some​ clients, but is not meaningful and will likely not be used for at least several weeks to months.

A postpartum client was screened for depression 6 weeks ago. Which action should the nurse take during the​ client's 3-month​ follow-up wellness​ appointment? A. Document that the assessment was previously performed. B. Perform an abbreviated assessment for signs of postpartum psychosis or severe depression. C. Reassess the client for postpartum depression because of the possibility of new symptoms. D. Prepare for a complete physical​ assessment; there is no need to reassess for postpartum depression.

C ​Rationale: Clients should be assessed for postpartum depression up to 3 to 4 months after delivery. Even though the client had been previously assessed for the​ condition, the nurse should still perform a full reassessment due to the possibility of new or emerging symptoms. OK

A client who is several months postpartum asks when difficulty​ sleeping, frequent​ crying, difficulty​ concentrating, and feeling like being in a fog all the time will dissipate. Which response should the nurse make to this​ client? A. ​"Symptoms usually resolve within 10 to 14​ days." B. ​"It's hard to know when you will feel​ better." C. ​"Everyone is a little different but about half of women are feeling better by 6​ months." D. ​"Most women feel better within 4 weeks after starting​ treatment."

C ​Rationale: Everyone's experience with postpartum depression is a little​ different, but around half of women with the health problem report still having symptoms by around 6 months. Just stating that​ it's hard to know when she will feel better​ doesn't provide any useful education or information. Symptoms of postpartum blues usually resolve within 10 to 14 days.

A client with postpartum blues agrees to reach out for help when needed. Which intervention should the nurse use to help the client achieve this​ goal? A. The need to avoid being alone with the baby until full recovery. B. Client education regarding what to expect with the baby blues. C. Provide community resources available to postpartum clients. D. Signs of postpartum psychosis and when to contact the provider.

C ​Rationale: If the client needs additional help or​ support, the nurse should provide a list of appropriate​ community, local, or​ web-based resources. It is not necessary for the client to avoid being alone with the baby or to discuss postpartum psychosis because the client has been diagnosed with the postpartum​ blues, which are expected to resolve within 10 to 14 days. Providing information about what to expect is important but​ doesn't address the​ client's goal.

A client new to motherhood is upset because the house is not clean. Which advice should the nurse provide to this​ client? A. ​"Don't worry about getting anything done until the baby is at least a year​ old." B. ​"Try to keep the house picked up for your guests when they come​ over." C. ​"Try to focus on getting one thing done each day instead of an entire​ to-do list." D. ​"Make a list of the tasks that need to be accomplished each​ day."

C ​Rationale: It is important for the client to recognize that it might be unrealistic to complete the same amount of tasks that were completed prior to having the baby. Prioritizing daily tasks and focusing on one task each day can help to reset expectations and reduce the risk of postpartum depression.

The nurse is facilitating a postpartum support group. Which woman should the nurse be most concerned about worsening postpartum​ depression? A. An unmarried woman with strong family support B. A married woman whose husband travels for work a great deal C. An unmarried woman who recently moved to a new town and is staying home to care for the baby D. A married woman who has strong family relationships with parents and​ in-laws

C ​Rationale: Women with new babies need a tremendous amount of support as they transition into parenthood. Being isolated from a social network can worsen symptoms of postpartum depression. The nurse should be most concerned about the unmarried woman who recently moved to a new town. This woman does not have support from a spouse and is new to the​ community, which indicates that she may not have family or social support as well.

The nurse is caring for a client diagnosed with postpartum psychosis who is breastfeeding. Which medication should the nurse anticipate being​ prescribed? A. Nefazodone B. Fluoxetine C. Doxepin D. Nortriptyline

D ​Rationale: Nortriptyline and some selective serotonin reuptake inhibitors​ (SSRIs) are generally safe to use during lactation and would likely be the first medications prescribed. Although it is an​ SSRI, fluoxetine should be used very carefully in lactating clients. Doxepin and nefazodone should be avoided during breastfeeding.