OB Postpartum Uncomplicated
Sign of postpartum hemorrhage A postpartum patient should be closely monitored for hemorrhage. If the perineal pad soaks in 15 minutes, the patient is hemorrhaging and needs immediate medical attention. Excessive hemorrhaging is not a normal finding after childbirth. Lochial discharge occurs after childbirth but is different from active bleeding. Hypotension may not increase bleeding in the postpartum patient.
The nurse finds that a postpartum patient's perineal pad is soaked within 15 minutes. What should the nurse infer from the finding? 1 Normal finding after childbirth 2 Sign of excessive hemorrhage 3 Presence of lochial discharge 4 Sign of postpartum hypotension
Apply ice packs in the perineum If the patient reports severe perineal pain after vaginal delivery, the nurse should apply ice packs in the first 24 hours to reduce edema, pain, and vulvar irritation. Administering fluids and blood compensates for blood loss in the patient, but they do not reduce pain. Postpartum hematologic studies are performed to assess the consequences of blood loss. This intervention does not reduce pain in the patient.
A patient who underwent a vaginal delivery 3 hours earlier reports having severe perineal pain. Which would be the first step taken by the nurse in this situation? 1 Apply ice packs in the perineum. 2 Administer fluids to the patient. 3 Administer blood to the patient. 4 Refer the patient for hematologic tests.
3 months The PHP will prescribe oral anticoagulation therapy to the patient for 3 months. Two months of therapy would not be sufficient to achieve the desired effects in the patient. Four to five months of anticoagulant therapy may increase the risk of osteoporosis, because anticoagulants antagonize the action of vitamin K. Vitamin K is a primary vitamin required for the growth of bones and maintenance of bone density.
A patient with venous thromboembolism is given I.V. heparin as prescribed by the primary health care provider (PHP). After 3 days the patient is prescribed oral anticoagulants. What duration of oral anticoagulant therapy does the nurse expect the PHP to prescribe? 1 2 months 2 3 months 3 4 months 4 5 months
Foods high in tyramine during the course of therapy The nurse should instruct the patient to avoid foods high in tyramine, such as cheese, because these foods interact with monoamine oxidase inhibitors (MAOIs) and cause hypertensive crisis. Patients who take MAOIs can have fluids and foods high in fiber, because they do not interact with the medications. Increasing fluid intake helps prevent dehydration, and fibrous foods help prevent constipation. MAOIs do not increase potassium levels in the body. Therefore the patient can have foods high in potassium.
A postpartum patient experiencing depression has been prescribed monoamine oxidase inhibitors (MAOIs). What is important to teach the patient about this medication? To avoid: 1 Excessive fluids during the course of therapy 2 Foods high in fiber during the course of therapy 3 Foods high in tyramine during the course of therapy 4 Foods high in potassium during the course of therapy
At the time of discharge Contraception is an important aspect of patient care. It should be discussed with the patient at the time of discharge. The patient may start to ovulate as early as 1 month postpartum; therefore contraception methods should be explained to the patient at discharge. Waiting for the patient's follow-up visit or for a month or more to educate the patient about contraception may be too late, and the patient may conceive again.
A postpartum patient is being prepared for discharge and is instructed to visit the clinic after 6 weeks for follow-up. When should the nurse discuss contraceptive options with the patient? 1 At the time of discharge 2 At the time of follow-up 3 After a month 4 After 2 months
the mother should sleep when the baby sleeps Limit visitors and activities Accept help from others for household work The patient's responses indicate that she is experiencing postpartum fatigue. It is important to save energy during this period and sleep when the baby sleeps. The nurse should advise the patient and her partner to limit visitors and activities. Fatigue may increase further if the patient provides care and feeding for the newborn and performs other household responsibilities such as preparing meals and doing laundry. Therefore, she should accept help from other family members for household work for at least first 6 weeks after childbirth. The patient is lactating and needs proper nutrition. Therefore the nurse should not ask the patient to skip meals. Because the patient does not report having pain, the nurse need not suggest the use of pain medications.
A postpartum patient tells the nurse, "It has been several weeks since I had my baby, and I'm still tired all the time." What advice should the nurse provide to the patient in this situation? Select all that apply. 1 The mother should sleep when the baby sleeps. 2 Limit visitors and activities. 3 Skip meals and consume plenty of water. 4 Have the patient take over-the-counter pain medications. 5 Accept help from others for household work.
Being affected by Rh incompatibility Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus that is Rh positive. During pregnancy and at the time of the delivery, some of the baby's Rh-positive blood can enter the maternal circulation, causing the woman's immune system to form antibodies against the Rh-positive blood. The administration of Rh immune globulin prevents the woman from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen. Rh immune globulin suppresses the immune response, so it is not useful to protect the next child from having decreased immunity or infection. Therefore the woman who receives both Rh immune globulin and a live virus immunization such as rubella must be tested in 3 months to see whether she has developed immunity. If not, the woman will need another dose of the vaccine. Physiologic jaundice in newborns is caused by the immaturity of the baby's liver, which leads to the slow processing of bilirubin. It is not caused by the injection of Rh immune globulin.
After delivery, the primary health care provider (PHP) prescribes Rh immune globulin to a postpartum patient. The nurse asks the PHP, "What is the purpose of this medication?" Which is the best response by the PHP? "It protects the patient's next baby from: 1 Having decreased immunity." 2 Developing a rubella infection." 3 Developing physiological jaundice." 4 Being affected by Rh incompatibility."
Deep vaginal lacerations and hematomas When the fetal head exerts prolonged pressure on the vaginal mucosa during labor, it reduces the flow of blood to the vaginal tissue and causes ischemia. Because of the reduced oxygen supply and tissue damage, the patient may have necrosis of the vaginal mucosa. This leads to deep vaginal lacerations and vaginal hematomas. After labor the patient typically has uterine distention caused by the change in the position of the uterus and the loss of pelvic muscle strength. However, exertion of pressure by the fetal head does not cause uterus distention or the loss of pelvic muscle strength. During pregnancy, the placenta attaches to the uterus if the patient has defective endometrium. The placenta does not attach to the vaginal mucosa during labor.
After physical assessment of a patient during labor, the nurse finds that the fetal head is exerting pressure on the patient's vaginal mucosa. Which postpartum complication does the nurse expect in the patient? 1 Distention of the uterus 2 Loss of pelvic muscle strength 3 Deep vaginal lacerations and hematomas 4 Adherence of the placenta to the vagina
Checking the perineum frequently Even though the retained placental fragment has been removed, the patient is still at risk for postpartum hemorrhage. Because vital signs change late, checking the perineum is the best way to assess for postpartum hemorrhage and is the priority.
After removal of the retained placental fragment, the patient is recovering on the mother-baby (postpartum) unit. What should the nurse identify as the priority of care? 1 Monitoring the infant's ability to nurse. 2 Checking the perineum frequently. 3 Assessing vital signs frequently. 4 Encouraging the patient to ambulate.
Preparing the patient for the removal of the retained placental fragment, including the use of anesthesia The patient will need to have the retained placental fragment removed under anesthesia because of the time period since delivery. The patient should be nothing by mouth (NPO) at this time because of the expected anesthesia. The infant can nurse, but the retained placental fragment will not allow the uterus to contract. After removal of a retained placenta, the woman is at continued risk for primary pulmonary hypertension (PPH) and infection.
It has been determined after ultrasound that a small piece of the placenta remains in the uterus over an hour after birth, causing the fundus not to be firm and excessive bleeding to continue. Because the patient delivered a large infant with a small dose of intravenous pain medication, what action should the nurse take? 1 Preparing the patient for the removal of the retained placental fragment, including the use of anesthesia. 2 Encouraging the consumption of oral fluids to expand the fluid volume. 3 Preventing the mother from nursing her infant until her vital signs are stable. 4 Encouraging the mother to nurse as much as possible to clamp down the fundal vessels.
Venous thromboembolism (VTE) Homans' sign is an assessment test used to determine whether the patient has VTE. Presence of Homans' sign indicates that the patient may have VTE. Uterine atony can be assessed by palpating the uterine fundus. Hypotensive shock can be assessed by checking the patient's vitals. Mastitis can be assessed by the examining the patient's breasts.
On reviewing the medical reports of a postpartum patient, the nurse finds that the patient has Homans' sign. What does the nurse interpret from this finding? 1 Risk of uterine atony 2 Hypotensive shock 3 Risk of developing mastitis 4 Venous thromboembolism (VTE)
massage her fundus A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action is to massage the fundus until firm. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.
The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action is to: 1 place her on a bedpan to empty her bladder. 2 massage her fundus. 3 call the physician. 4 administer Methergine, 0.2 mg IM, which has been ordered prn.
Multiparous, overweight, and has undergone a hysterectomy Patients who have had multiple childbirths (multiparous) have a higher risk of urinary incontinence because of increased laxity of the pelvic floor muscles. An obese patient who has undergone a hysterectomy has a higher risk of developing urinary incontinence, because the hysterectomy can damage the nerve supply to the bladder. This, in turn, causes urinary incontinence. A patient who is nulliparous, is underweight, and has undergone colectomy is not at risk of urinary incontinence. Colectomy is the surgical removal of the colon and does not cause urinary incontinence. A patient who is nulliparous, is underweight, and has undergone splenectomy has a lower risk of developing urinary incontinence. Splenectomy is the surgical removal of the spleen and does not increase the risk of developing urinary incontinence. A patient who is primiparous, is underweight, and has undergone cholecystectomy has a lower risk of developing urinary incontinence. Cholecystectomy is the surgical removal of the gallbladder and does not cause urinary incontinence.
The nurse is assessing a patient who has urinary incontinence. Which condition most likely increased the risk of the patient's urinary incontinence? 1 Nulliparous, underweight, and has undergone a colectomy 2 Nulliparous, underweight, and has undergone a splenectomy 3 Multiparous, overweight, and has undergone a hysterectomy 4 Primiparous, underweight, and has undergone a cholecystectomy
Provide education about newborn care when the father is present To facilitate father-infant bonding, the nurse should include the father while giving instructions about newborn care. If the nurse asks the father to change the baby's diaper, the father may be anxious and may not be willing to do it. Instead, the nurse should show the father how to change the diapers and then ask the latter to return demonstrate the process. Asking the father why he is anxious or reassuring him that it will take time to get used to the newborn may not improve father-child bonding or reduce his fear about handling the newborn.
The nurse is caring for a family who has a newborn. The father appears to be very anxious and nervous when the newborn's mother asks him to bring the baby. Which nursing intervention is most beneficial in promoting father-infant bonding? 1 Hand the father the newborn and instruct him to change the diaper. 2 Ask the father why he is so anxious and nervous. 3 Tell the father that he will get used to the newborn in time. 4 Provide education about newborn care when the father is present.
Urine output less than 30 mL/hr Renal failure is the most significant complication associated with disseminated intravascular coagulation (DIC). A urine volume of less than 30 mL/hr indicates renal failure. The presence of pus cells in the urine indicates renal infection, which is not a complication associated with DIC. The presence of red blood cells in the urine indicates hemorrhage in the renal tubules. The normal pH of urine is 7. A pH of less than 6 indicates that the urine is acidic, which may be caused by diabetes.
The nurse is caring for a patient who is diagnosed with disseminated intravascular coagulation. Which finding would indicate that the patient has developed a renal complication? 1 Urine pH less than 6 2 Urine output less than 30 mL/hr 3 Presence of pus cells in the blood 4 Red blood cells in the urine
Maintain a diet that is rich in fiber The nurse asks the patient to maintain a diet high in fiber, because fiber helps ease defecation in patients with rectocele. Increased intake of fluids should be encouraged to help in softening the stools. A diet that is high in protein does not ease defecation. Antidiarrheals cause retention of stools and should not be administered to patients with rectocele.
The nurse is caring for a patient with a mild rectocele. The patient reports no improvement in her condition even after using vaginal pessaries. What instruction does the nurse give to the patient? 1 "Maintain a low-protein diet." 2 "Decrease the intake of fluids." 3 "Take antidiarrheal drugs regularly." 4 "Maintain a diet that is rich in fiber."
Potential risk of hypovolemic shock If a patient with excessive postpartum hemorrhage shows signs such as grayish, cool, and clammy skin, the patient is at risk of developing hypovolemic shock. If the patient has foul-smelling lochia, then the patient might be at risk of infection. Every patient experiences pain after giving birth; however, a change in skin color does not result from pain. If the patient has not voided urine within 8 hours after birth, then the patient might be at risk of impaired urinary elimination.
The nurse is caring for a patient with excessive postpartum hemorrhage. The nurse observes that the patient's skin has turned grayish. What does the nurse infer from this finding? 1 Risk of infection 2 Evidence of severe pain 3 Potential risk of hypovolemic shock 4 Potential risk of impaired urinary elimination
Complete the child care activities silently, without looking at the baby The psychosocial assessment includes evaluating adaptation to parenthood, as evidenced by the parents' reactions to the baby and interactions with the new baby. Good attachment behaviors include seeking eye contact with the baby and talking to the baby during caretaking activities; the nurse should investigate the behaviors when these are not observed. Changing diapers, positioning baby comfortably, and maintaining eye-to-eye contact are appropriate behaviors that increase parent-infant attachment.
The nurse is caring for a postpartum patient who gave birth recently. The nurse is evaluating the parent's behavior toward the new baby. Which parent-infant behaviors should the nurse investigate further? 1 Change the baby's diapers when needed. 2 Position the baby comfortably. 3 Demonstrate eye-to-eye contact with the baby. 4 Complete the child care activities silently, without looking at the baby.
Place a covered ice pack on the affected area Patients with episiotomy may have soreness and back pain. To relieve soreness and back pain, the nurse should advise the patient to place an ice pack on the affected area. This provides comfort and reduces the inflammation and pain. A sitz bath helps relieve lower back pain and discomfort, so the patient should be encouraged to use sitz baths at a temperature of 38° to 40° C (100° to 104° F) at least twice a day to prevent edema. Not cleaning the perineal area may cause infection, so the nurse should advise the patient to clean her perineum frequently. Drinking plenty of water and eating foods such as fresh fruit and vegetables that contain fibers can relieve constipation or hemorrhoids but does not help reduce soreness.
The nurse is caring for a postpartum patient who has an episiotomy wound. The nurse finds that the patient has soreness at the incision site and lower back pain. What does the nurse tell the patient? 1 Avoid using sitz baths. 2 Avoid cleaning the perineal area frequently. 3 Place a covered ice pack on the affected area. 4 Drink plenty of water and eat foods containing fiber.
Estimate fetal age Measurement of the crown-rump length (CRL) is useful in approximating fetal age in the first trimester. Hydrocephalus cannot be detected during the first trimester. Ultrasonography is used to detect structural defects in the second trimester. It is too early in this pregnancy to determine fetal linear growth.
The nurse is caring for a pregnant client who is undergoing an ultrasound examination during the first trimester. The nurse explains that an ultrasound during the first trimester is utilized in order to do what? 1 Estimate fetal age 2 Detect hydrocephalus 3 Rule out congenital defects 4 Approximate fetal linear growth
To strengthen the perineal muscles Kegel exercises strengthen and increase the elasticity of the pubococcygeus muscle, which is the main perineal muscle. They improve vaginal tone and also help prevent stress incontinence and hemorrhoids. Kegel exercises do not prevent urine retention, relieve lower back pain, or tone abdominal muscles.
The nurse is helping prepare a patient for discharge after childbirth. During a teaching session, the nurse instructs the patient to do Kegel exercises. What is the purpose of these exercises? 1 To prevent urine retention 2 To provide relief of lower back pain 3 To tone the abdominal muscles 4 To strengthen the perineal muscles
Ask the patient to urinate and empty her bladder Before assessing the patient's fundus, the nurse should ask the patient to empty her bladder for an accurate assessment. Then the nurse asks the woman to lie flat on her back with her knees flexed, not on her side. Massaging the fundus is an appropriate intervention if the fundus is boggy and soft. The fundus should be massaged gently until firm.
The nurse is preparing to assess the fundus of a postpartum patient. What nursing action is needed before assessment? 1 Have the patient turn on her side. 2 Position the patient to lie flat on her back with her legs extended. 3 Ask the patient to urinate and empty her bladder. 4 Massage the fundus gently before determining its level.
Kegel exercises Kegel exercises consist of the voluntary contraction and relaxation of the pubococcygeal muscle, similar to trying to start and stop the flow of urine. This strengthens the pelvic floor muscles and helps the patient decrease the stress incontinence that occurs during sneezing and coughing. Sit-ups and abdominal exercises should not be performed until the patient's 4-week postpartum follow-up appointment. Pelvic tilt exercises consist of alternate arching and straightening of the back to strengthen the back muscles and relieve back discomfort.
The nurse is reinforcing discharge instructions to a postpartum patient after a cesarean birth. The patient reports leaking urine every time she sneezes or coughs. Which exercises should the nurse teach to the patient? 1 Sit-ups 2 Abdominal exercises 3 Kegel exercises 4 Pelvic tilt exercises
Perform perineal care after toiling until healing occurs. Prevention of infection is the priority. Resting should be encouraged; however, it is not the priority at this time. Stair climbing may cause some discomfort but is not detrimental to healing. There is no limit to the number of sitz baths per day that the client may take if they provide comfort.
The nurse is teaching a client to care for her episiotomy after discharge. Which priority instruction should the nurse include in her instructions? 1 Rest with legs elevated at least two times a day. 2 Avoid stair climbing for several days after discharge. 3 Perform perineal care after toileting until healing occurs. 4 Continue sitz baths three times a day if they provide comfort.
Massaging the uterine fundus A uterus that is displaced and above the fundus indicates relaxation of the uterine muscle. Fundal massage is necessary to stimulate uterine contractions. The status of the fundus and correction of uterine relaxation must be done before the client is helped to the bathroom, the amount of lochia is assessed, or methylergonovine is administered.
What is the priority nursing intervention for the postpartum client whose fundus is three fingerbreadths above the umbilicus, boggy, and midline? 1 Massaging the uterine fundus 2 Helping the client to the bathroom 3 Assessing the peripad for the amount of lochia 4 Administering intramuscular methylergonovine (Methergine) 0.2 mg
Test the leaking fluid with Nitrazine paper Nitrazine paper will turn dark blue if amniotic fluid is present; it remains the same color in the presence of urine. Temperature assessment is not specific to ruptured membranes at this time; vital signs are part of the initial assessment. Although this may be done as part of the initial assessment, a urine test is unrelated to leakage of amniotic fluid. Inspecting the vagina for leaking fluid will not confirm rupture of the membranes.
When a client at 39 weeks' gestation arrives at the birthing suite she says, "I've been having contractions for 3 hours, and I think my water broke." What will the nurse's action be to confirm that the membranes have ruptured? 1 Take the client's oral temperature. 2 Test the leaking fluid with Nitrazine paper. 3 Obtain a clean-catch urine specimen. 4 Inspect the perineum for leaking fluid.
Maintaining aseptic conditions during labor The most effective and least expensive intervention that helps reduce the risk of infection in the patient is to maintain aseptic conditions during labor. This helps reduce the invasion of microorganisms that may cause urinary tract infections (UTIs). Providing good nutrition helps prevent lethargy and anemia in the patient. Antibiotic therapy can be started if the patient already has a UTI, but they are not safe to be given as a prophylactic treatment during pregnancy, because they have teratogenic effects. Teaching comfort measures does not help in preventing infection.
Which intervention does the nurse expect to be the most effective and least expensive for reducing the risk of urinary tract infections in the patient after the labor? 1 Providing good nutrition after labor 2 Teaching comfort measures after labor 3 Providing antibiotic therapy before labor 4 Maintaining aseptic conditions during labor
Mastitis Mastitis is an infection in a breast, usually confined to a milk duct. Most women who suffer this are first-time mothers who are breastfeeding. Endometritis is the most common postpartum infection. Incidence is higher after a cesarean birth and not limited to first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal examinations, and epidural anesthesia.
Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? 1 Endometritis 2 Wound infections 3 Mastitis 4 Urinary tract infections (UTIs)
Ask the patient when she last changed her perineal pad It is likely that when the morning assessment was done, the patient had not been to the bathroom. In this situation, the patient's perineal pad may have been in place all night. Second, the lochia may have pooled during the night, resulting in heavy flow in the morning. Therefore the nurse should ask when the patient last changed the pad. The nurse need not call the (PHP) unless the patient has severe postpartum hemorrhage. Vigorous massage of the fundus is done to increase the tone of the uterine muscles. This would not be recommended until the patient has gone to the bathroom, changed her perineal pad, and emptied her bladder. If the nurse is uncertain, it is appropriate to have another qualified person check the patient, but only after a complete assessment of the patient's status.
While assessing a postpartum patient early in the morning, the nurse finds that the patient's perineal pad is completely saturated. What is the first step the nurse should take in this situation? 1 Ask the patient when she last changed her perineal pad. 2 Inform the primary health care provider (PHP) immediately. 3 Massage the patient's uterine fundus vigorously. 4 Ask the night duty nurse to review the assessment.
Assess the fetal heart rate (FHR) The FHR will reflect how the fetus tolerated the rupture of the membranes; if there is compression of the cord, it will be reflected in a change in the FHR. Although the client's comfort is important, it is not the priority. Although the practitioner should be notified, it is not the priority. Blood pressure is not influenced by rupture of the membranes.
While the nurse is caring for a client in active labor whose fetus is at station 0, the client's membranes rupture spontaneously. The nurse determines that the fluid is clear and odorless. What should the nurse do next? 1 Change the bedding. 2 Notify the practitioner. 3 Assess the fetal heart rate (FHR). 4 Obtain the client's blood pressure.
Oxytocin Continuous I.V. infusion of 10 to 40 units of oxytocin (Pitocin) added to 1000 mL of lactated Ringer's or normal saline solution is a primary intervention in the management of postpartum bleeding. Drugs like misoprostol (Cytotec), ergonovine (Ergotrate), and methylergonovine (Methergine) are prescribed only if the patient is not responding to oxytocin (Pitocin).
A postpartum patient has uterine atony. What medication does the nurse expect the primary health care provider to prescribe to the patient? 1 Oxytocin (Pitocin) 2 Misoprostol (Cytotec) 3 Ergonovine (Ergotrate) 4 Methylergonovine (Methergine)
Accompanied by progressive cervical dilation Progressive cervical dilation is the only positive sign of true labor; the cervix dilates in response to regular, coordinated uterine contractions. The contractions of true labor increase in length and intensity. A continuous contraction may have an adverse effect on the fetus; immediate intervention is required. The membranes may rupture before contractions begin; more frequently they rupture after true labor is established.
At 39 weeks' gestation a client asks the nurse about the difference between true and false labor. Which information regarding true labor contractions should the nurse include in a response to the client's question? 1 Usually fluctuate in length 2 Continuous, without relaxation 3 Related to time of membrane rupture 4 Accompanied by progressive cervical dilation
Advise the patient to wear a breast binder for the first 72 hours after giving birth Suppression of lactation is recommended in cases of neonatal death. To suppress lactation, the nurse should advise the patient to wear a breast binder continuously for the first 72 hours after delivery. Running warm water over the breast stimulates lactation. Mild analgesics can be administered to reduce breast engorgement, but they are not used to suppress lactation. Administration of oral or intravenous fluids may stimulate lactation.
What intervention does the nurse perform to suppress lactation in a patient who had a stillbirth? 1 Run warm water over the patient's breasts. 2 Administer strong analgesics. 3 Administer oral and intravenous fluids. 4 Advise the patient to wear a breast binder for the first 72 hours after giving birth.
Postpartum hemorrhage (PPH) The uterine walls are overstretched in multifetal gestation, so it contracts poorly after birth. This may cause uterine atony leading to postpartum hemorrhage (PPH). Multifetal gestation does not cause vaginal hematomas, von Willebrand disease (vWD), or abnormal limb development of the fetus. Vaginal hematomas occur more commonly in association with a forceps-assisted birth. vWD is a type of hemophilia, which is a hereditary bleeding disorder. Abnormal development of fetal limbs is usually a complication associated with teratogenic drugs.
After reviewing a patient's medical reports, the nurse finds that the patient has multifetal gestation. What is the most likely complication associated with this? 1 Vaginal hematomas 2 von Willebrand disease (vWD) 3 Postpartum hemorrhage (PPH) 4 Abnormal development of limbs
A full bladder may inhibit the progress of labor. A full bladder encroaches on the uterine space and impedes the descent of the fetal head. The bladder may become atonic, but is not physically damaged during the course of labor. A full bladder may lead to prolonged labor, but generally does not jeopardize fetal status as long as adequate placental perfusion continues. A full bladder during labor does not predispose the client to infection.
The nurse assists a client to the bathroom to void several times during the first stage of labor. Why is this is an important component of nursing? 1 A full bladder is often injured during labor. 2 A full bladder may inhibit the progress of labor. 3 A full bladder jeopardizes the status of the fetus. 4 A full bladder predisposes the client to urinary infection.
Check her perineum The patient is exhibiting increasing anxiety, which can signal the presence of postpartum hemorrhage. Risk factors for postpartum hemorrhage include a large fetus, prolonged labor, and a forceps-assisted birth. Because vital signs change late, the fastest way to see the amount of current hemorrhage is to check the perineum. The fundus would be massaged and additional nursing and medical interventions would be instituted.
A 28-year-old multipara delivered a 9 pound, 3 ounce baby girl an hour ago after a 22-hour labor with a forceps-assisted birth. As the patient is holding her daughter, she keeps shifting position and is becoming increasingly irritable and annoyed with everyone in the room. What action should the nurse initially take? 1 Massage the fundus. 2 Check her perineum. 3 Assess her vital signs. 4 Check the tone of her fundus.
Document the results because they are expected at 20-weeks' gestation. All data presented are expected for a client at 20-weeks' gestation and should be documented. There is no need for immediate intervention or an emergency admission because all findings are expected.
A client who is at 20-weeks' gestation visits the prenatal clinic for the first time. Assessment reveals temperature of 98.8° F (37.1° C), pulse of 80 beats per minute, blood pressure of 128/80 mm Hg, weight of 142 lb (64.4 kg) (pre-pregnancy weight was 132 lb (59.9 kg), fetal heart rate (FHR) of 140 beats per minute, urine that is negative for protein, and fasting blood glucose level of 92 mg/dL (5.2 mmol/L). What should the nurse do after making these assessments? 1 Report the findings because the client needs immediate intervention. 2 Document the results because they are expected at 20-weeks' gestation. 3 Record the findings in the medical record because they are not within the norm but are not critical. 4 Prepare the client for an emergency admission because these findings may represent jeopardy to the client and fetus.
Your diaphragm has been displaced upward The pressure of the enlarging fetus causes upward displacement of the diaphragm, which results in thoracic breathing; this limits the descent of the diaphragm on inspiration. The lower rib cage expands; it does not become restricted. There is no change in the size of the lungs during pregnancy. The thoracic cage enlarges; it does not rise.
A client at 35 weeks' gestation asks the nurse why her breathing has become more difficult. How should the nurse respond? 1 "Your lower rib cage is more restricted." 2 "Your diaphragm has been displaced upward." 3 "Your lungs have increased in size since you got pregnant." 4 "The height of your rib cage has increased since you got pregnant."
There is a risk of hypotension, and the large amount of IV fluid reduces this risk. Once an epidural is initiated there is a risk of hypotension (low blood pressure), which may result in fetal distress. This risk is reduced by the administration of 500 to 2000 mL. Epidural medication is administered through a catheter placed by the anesthetist. Quoting institutional policy does not provide the explanation for administering the solution. Providing 500 mL of fluid is useful in counteracting the risk of hypotension; however, it is not given as a means of determining that the line is patent before the administration of medication.
A client in active labor has requested epidural anesthesia for pain management. The anesthetist has completed an evaluation, and the nurse has initiated an intravenous fluid bolus. The client's partner asks why this is necessary. What is the best explanation? 1 It is the policy of the institution to provide 2 bags of lactated Ringer solution. 2 There is a risk of hypotension, and the large amount of IV fluid reduces this risk. 3 Giving the large amount of IV fluid is a means of hydrating the client when she is unable to drink. 4 The client must be given 500 mL of fluid to ascertain that the line is patent.
Checking the perineal area for the presenting part. The primary action by the nurse should be to confirm whether birth is imminent by checking the perineal area to determine whether the presenting part is emerging. Confirming the client's sensation is the priority; the nurse should remain with the client and ask a colleague to call the practitioner if birth is imminent. Stating that birth is not imminent demeans the client, and she may be correct. Holding the knees together is contraindicated. If birth is imminent, this could cause injury to the fetus, and if it is not imminent, this position is uncomfortable and unnecessary.
A client in active labor starts screaming, "The baby is coming! Do something!" What is the nurse's primary action? 1 Notifying the practitioner of the imminent birth 2 Telling the client that it is too soon and encouraging her to pant 3 Checking the perineal area for the presenting part 4 Helping the client hold her knees together and explaining what to expect
Retroperitoneal hematoma Retroperitoneal hematoma is the accumulation of blood in the retroperitoneal space. It is caused by the rupture of the cesarean scar during labor. Retroperitoneal hematoma is characterized by such symptoms as persistent perineal pain, a feeling of pressure in the vagina, and shock. Therefore it is evident that the patient has this condition. Persistent perineal pain, a feeling of pressure in the vagina, and shock are not associated with rectocele, endometritis, or impaired lactation. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. Endometritis is characterized by fever, increased pulse rate, chills, anorexia, nausea, fatigue, pelvic pain, uterine tenderness, and foul-smelling lochia. Because the patient did not report these symptoms, the patient does not have endometritis. Perineal pain, a feeling of pressure in the vagina, and shock do not affect lactation, so the patient does not have impaired lactation.
A patient who has undergone cesarean surgery reports to the nurse persistent perineal pain and feeling pressure in the vagina. The nurse finds that the patient is in shock. What clinical condition should the nurse suspect based on this assessment? 1 Rectocele 2 Endometritis 3 Impaired lactation 4 Retroperitoneal hematoma
Endometritis Endometritis is a common postpartum infection. It usually begins as a localized infection at the placental site and spreads to the entire endometrium. Fever, loss of appetite, pelvic pain, and foul-smelling lochia are symptoms of endometritis. An increased pulse rate and uterine tenderness are also common in this condition. Therefore the nurse can infer that the patient has endometritis. Cystocele is the protrusion of the bladder downward into the vagina. Rectocele is the herniation of the anterior rectal wall through the relaxed or ruptured vaginal fascia and rectovaginal septum. The symptoms reported by the patient are not indicative of these conditions. Because the nurse does not find any collection of blood in the patient, the patient does not have hematoma.
A postpartum patient who had a cesarean section reports to the nurse a fever, loss of appetite, pelvic pain, and foul-smelling lochia. Upon assessment, the nurse finds that the patient has an increased pulse rate and uterine tenderness. The laboratory reports indicate significant leukocytosis. What clinical condition should the nurse suspect based on these findings? 1 Cystocele 2 Rectocele 3 Hematoma 4 Endometritis
Asthma Methyl prostaglandin F2α (Carboprost) causes uterine contractions (UCs) and is used to prevent postpartum hemorrhage (PPH). It also causes bronchoconstriction. If it is administered to an asthmatic patient, it may aggravate bronchoconstriction and cause status asthmaticus. Therefore it is contraindicated in asthmatic patients. Thus the nurse should check for the history of asthma in the patient before administering 15-methyl prostaglandin F2α. 15-Methylprostaglandin F2α does not interfere with blood sugar levels, joint structure, or cerebral blood flow. Therefore it can be safely administered to patients with diabetes, joint pain, and migraine pain.
A primary health care provider prescribed 15-methyl prostaglandin F2α (Carboprost) to a patient. What history does the nurse check before administering this drug to the patient to prevent complications? 1 Asthma 2 Diabetes 3 Joint pain 4 Migraine pain
Thromboembolism Thromboembolism is a postpartum complication caused by hormonal imbalances, stress of childbirth, and long periods of immobility. This complication can be prevented by encouraging early ambulation. Ambulation does not help relieve bladder distention, orthostatic hypotension, or postpartum hemorrhage. The first priority in bladder distention is to help her to the bathroom or onto a bedpan if she is unable to ambulate. Orthostatic hypotension can be managed by asking the patient to change positions slowly. Postpartum hemorrhage has multiple causes and is not managed by ambulation.
The nurse helps a postpartum patient ambulate around the patient's bed. What complication is the nurse trying to prevent? 1 Bladder distention 2 Thromboembolism 3 Orthostatic hypotension 4 Postpartum hemorrhage
Keep changing positions in the bed The nurse instructs the patient to change the positions frequently, because this may decrease discomfort. A patient with deep vein thrombosis should rest and avoid exercise, because exercise can cause the embolus to rupture, leading to severe complications. The patient should avoid keeping her knees in a sharply flexed position, because this can cause pooling of the blood in lower extremities. Rubbing the affected area frequently may cause the clot to dislodge and thus should be avoided.
The nurse is caring for a postpartum patient who has deep vein thrombosis and is receiving warfarin (Coumadin) therapy. What instruction should the nurse give to the patient? 1 "Perform exercises regularly." 2 "Rub the affected area frequently." 3 "Keep the knees in a flexed position." 4 "Keep changing positions in the bed."
Incontinence Urinary incontinence is a symptom associated with cystocele. A cystocele can damage the bladder neck and urethra, thereby causing incontinence. A patient with a rectocele has problems during defecation. Genital fistulas are abnormal passageways between the vagina and other genital organs. A prolapsed uterus is a condition in which the uterus comes out of the vagina.
During an examination, the nurse finds that a patient has a cystocele. What other associated complication does the nurse expect the patient to have? 1 Rectocele 2 Incontinence 3 Genital fistulas 4 Prolapsed uterus
"I know this is hard for you. Let me try to help you coach her during this difficult phase." Both the father and the mother need additional support during the transition phase of the first stage of labor. Telling the father not to run out on his wife is judgmental; it suggests that the father will be failing his wife by leaving. The husband should be present throughout labor to support his wife, and he should be assisted in this role. Telling the father to sit in the waiting room does not encourage the husband to fulfill his role of supporting his wife during labor.
The husband of a client who is in the transition phase of the first stage of labor becomes very tense and anxious and asks a nurse, "Would it be best for me to leave, since I don't seem to be doing my wife much good?" What is the appropriate response by the nurse? 1 "This is the time when your wife needs you. Don't run out on her now." 2 "I know that this is hard for you. Let me try to help you coach her during this difficult phase." 3 "I know that this is hard for you. Why don't you go have a cup of coffee to help you relax and then come back in a little while?" 4 "If you feel that way, you'd best go out and sit in the fathers' waiting room for a while. You'll just end up transmitting your anxiety to your wife."
Misoprostol (Cytotec) Oxytocin (Pitocin) is the primary drug administered to induce uterine contractions (UCs). When the uterus fails to respond to oxytocin, misoprostol (Cytotec) is administered to induce contractions. Paroxetine (Paxil) is an antidepressant drug used in the treatment of postpartum depression. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that serves as an antidepressant and is administered for postpartum depression. Mirtazapine (Remeron) is a drug used in the treatment of depression.
The nurse caring for a patient finds excessive postpartum bleeding caused by uterine atony. Upon further assessment, the nurse finds no improvement in the bleeding after administration of oxytocin (Pitocin). What does the primary health care provider prescribe to the patient? 1 Paroxetine (Paxil) 2 Sertraline (Zoloft) 3 Misoprostol (Cytotec) 4 Mirtazapine (Remeron)
