Postpartum

Realizing that late postpartum hemorrhage is a risk, which educational point will the registered nurse (RN) provide to the postpartum woman prior to her discharge home? Select all that apply.

how to monitor the funds and when to call the healthcare provider how to monitor color of lochia and when to call the healthcare provider how to monitor amount of lochia and when to call the healthcare provider

A nurse is caring for a client who is 32 hours postpartum. The client reports nipple soreness and breast engorgement. Which of the following recommendations Question Feedback should the nurse provide?

"Call me so I can check your baby's latch the next time you breastfeed."

oxytocin, methylergonovine, misoprostol, carboprost, and prostaglandins

Oxytocics

PREEDA acronym for wound infection assessment

Pain Redness Edema Ecchymosis Drainage Approximation

Which intervention will the registered nurse (RN) implement to determine resolution of postpartum hemorrhage after the administration of methylergonovine to a woman 10 hours after delivery? Select all that apply.

monitor fundal height and consistency monitor amount and character of lochia

Manual manipulation is used to reposition the uterus of a client experiencing uterine inversion. After the repositioning, which type of medication would the nurse administer as prescribed to the client?

oxytocin agent

The nurse receives a report on a client with type 1 diabetes whose delivery was complicated by polyhydramnios and macrosomia. The nurse is aware of these complications and knows to monitor the client closely for which of the following?

postpartum hemorrhage

The client, who has just been walking around her room, sits down and reports leg tightness and achiness. 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

uterine inversion

turning of the uterus inside out after birth of the fetus

Which intervention will the registered nurse (RN) teach the new mother to help promote breastfeeding with the sleepy two day old newborn? Select all that apply.

use tactile stimulation to help stimulate the newborn to arouse position the sleeping newborn in the burping position and stroke the back remove the newborn's blankets and clothing down to a diaper and t-shirt

rugae of vagina

walls of vagina folds/ridges allows for stretching

Which instruction will the registered nurse (RN) provide to the two day postpartum mother who is crying because of breast pain that is related to breast engorgement? Select all that apply.

take an antiinflammatory drug such as ibuprofen as prescribed for discomfort apply warm compresses to the breasts 30 minutes before breastfeeding apply cold compresses to the breast after breastfeeding for 20 minutes

A new mother gave birth to her baby 24 hours ago and today has been content to rest in her hospital bed, hold her baby, allow the nurse to care for her, and to discuss her labor and birth experience with visitors. Which phase of the postpartum restorative period is this client in?

taking in phase

S/S of retained fragments of the placenta in the uterus

Profuse dark lochia with blood clots, loss of appetite, tachycardia, and pelvic pain

postpartum blues

Tearfulness, insomnia, lack of appetite, sleep pattern disturbances, crying, and feeling letdown. Typically resolve in 10 days without intervention

Which assessment made by the registered nurse (RN) supports that the 14 day old newborn is receiving adequate transfer of milk when breastfeeding? Select all that apply.

the newborn is feeding at least 10 to 12 times per day the newborn has at least 6 diapers per day with clear urine noted the breast is less firm after feeding the newborn

postpartum depression

the sadness and inadequacy felt by some new mothers in the days and weeks after giving birth

uterine tamponade

the uterus is packed or a balloon is inserted to try to occlude the blood vessels from which the bleeding is occurring by compressing the inside of the organ.

Postpartum chills

Normal, can last up 2 hrs NI: blankets and provide warm fluids

A nurse is providing postpartum discharge teaching for a client who is breastfeeding. The client states, "I've heard that I can't use any birth control until I stop breastfeeding." Which of the following responses should the nurse make?

" A progestin-only pill or injection is available for use while you are breastfeeding"

A nurse is teaching a client who is postpartum and breastfeeding. Which of the following statements should the nurse include?

"A reduction in sexual interest could indicate postpartum depression."

Von Willebrand Disease

An inherited bleeding disorder caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation (affects 1/1000 ppl)

breast changes

Become heavier 3-4 days after delivery

A nurse is caring for a client who is 2 hours postpartum and is exhibiting signs of hypovolemic shock. Which of the following actions should the nurse take?

Elevate the clients legs to a 30 degree angle

A postpartum nurse is caring for a client who reports abdominal cramping. Which of the following actions should the nurse take?

Encourage the client to interact with the newborn

Subinvolution

Failure of the uterus to reduce to its normal size and condition after pregnancy

T/F: HCP should be notified mom is still breast feeding even after 6 wk period

True

Ecchymosis

bruise

mastitis

inflammation of the breast (infection of breast)

A nurse is caring for a non-breastfeeding client in the postpartum period. The client report engorgement. What suggestion should the nurse provide to alleviate breast discomfort?

Wear a well-fitting bra.

The registered nurse (RN) will include which instruction related to deep vein thrombosis (DVT) for the post cesarean birth woman prior to discharging her home? Select all that apply.

limit walking to only going to the bathroom the first week avoid crossing your legs when sitting or lying in bed maintain a daily fluid intake of 64-80 ounces of water

vaginitis

inflammation of the lining of the vagina (infection)

The nurse is developing a teaching plan for a client who has decided to bottle-feed her newborn. Which information would the nurse include in the teaching plan to facilitate suppression of lactation?

instructing her to apply ice packs to both breasts every other hour

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman makes which statement?

"I can take ibuprofen if I have any pain."

A nurse is teaching about mastitis to a client who is postpartum and breastfeeding her newborn. Which of the following statements by the client indicates an understanding of the teaching?

"I will avoid any of my family members who are ill."

A nurse is providing care to a postpartum woman who gave birth about 2 days ago. The cli the nurse, "I haven't moved my bowels yet. Is this a problem?" Which response by the nurs be most appropriate?

"It might take up to a week for your bowels to return to their normal pattern."

A nurse is making an initial call on a new mother who gave birth to her third baby 5 days ago. The woman says, "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother?

"It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the birth. They will most likely go away in a day or two."

The nurse who works on a postpartum floor is mentoring a new graduate. She informs the new nurse that a postpartum assessment of the mother includes which assessments? Select all that apply.

-VS of mother -pain level -head to toe assessment

A nurse is caring for a client who had a vaginal delivery 24 hours ago. Which of the following findings should the nurse report to the provider?

3+ deep tendon reflexes

How much should the uterus shrink after delivery ?

-Palpated at or up to 3 cm below the umbilicus just after birth -Palpated at or 1 cm above the umbilicus 12 hours after birth -After 1st 24 hours, descends toward the pelvis at 1 - 2 cm/day

How long is the postpartum period?

6 weeks after delivery

Postpartum angiopathy

A rare vasoconstrictive condition with a presentation similar to that of stroke

A nurse is assessing a client who is postpartum following a vacuum-assisted birth. For which of the following findings should the nurse monitor to identify a cervical laceration?

A slow trickle of bright red blood and a firm fundus

A nurse is providing care to a postpartum woman. The nurse determines that the client is in taking-in phase based on which finding?

A) Client states, "He has my eyes and nose."

Endocrine system changes

Decrease in estrogen and progesterone and insulinase levels High prolactin levels if breast feeding

After the birth of the newborn, the mother is ready to be discharged home. The client's mother is present and will remain with her for 1 month. The client's mother tells the nurse that her daughter will not be allowed to leave the house for the first month after the birth, based on the family's cultural customs. How should the nurse respond to this statement?

Accept the mother's statement and perform discharge teaching accordingly.

A nurse is planning care for a client who is postpartum. Which of the following strategies should the nurse include in the plan to prevent bladder distention?

Run water in the sink while the client sits on the toilet

involution

Shrinking of the uterus (womb) to its normal size after childbirth.

Uterine inversion medication

Terbutaline (tocolytics)

coagulopathy

a disorder in which the blood's ability to clot is impaired. A coagulopathy may lead to PPH and, in turn, PPH results in a loss of clotting factors, thus limiting the body's ability to stop the bleeding.

A client who gave birth 5 hours ago has completely saturated a perineal pad within 15 min Which action by the nurse should be implemented first?

Assess the fundus

A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would question the woman about which symptom?

Hardening of an area in the affected breast

Frequency Of postpartum vs assessments

Hr 1: every 15 min Hr 2: every 30 min Hr 3-4: every hour Afterwards: Q4-8H

Amount of blood loss indicated for PPH

Vaginal= 500< C section= 1000<

Realizing the increased risk of a urinary tract infection (UTI) for the postpartum woman 8 hours post delivery, which intervention will the registered nurse (RN) implement? Select all that apply.

monitor for signs/symptoms of a UTI assess for bladder distention after each void monitor intake and output every 12 hours encourage the woman to void every two hours

Which assessment finding indicates a lack of improvement for the postpartum woman diagnosed with endometritis who has received antibiotic therapy for 48 hours? Select all that apply.

presence of a heart rate of 116 oral temperature of 101 F (38.3 C) presence of foul-smelling lochia

A postpartum nurse is caring for a client who has developed hemorrhagic shock. Which of the following manifestations should the nurse expect?

weak, irregular pulse

Oxytocin and Misoprostol can cause...

Hypotension

What exercises can help pelvic floor muscle tone?

Kebbel's, pelvic floor exercises

Methylergonovine, ergonovine, and carboprost is contraindicated in...

Patients with hypertension

boggy uterus

a uterus that feels soft and spongy, rather than firm and well contracted.

endometritis

inflammation of the inner lining of the uterus (infection of uterus)

A nurse in a postpartum unit is caring for a client who plans to breastfeed her newborn exclusively. The client has a prescription for depot medroxyprogesterone acetate (DMPA). At which of the following times should the nurse schedule the client to receive the first dose of the medication?

6 weeks postpartum

A nurse is preparing to massage the fundus of a client who is postpartum and experiencing uterine atony. In what order should the nurse take the following actions when performing a fundal massage? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Ask the client to lie on her back with her knees flexed. Place a hand just above the client's symphysis pubis. Position a hand around the top of the client's fundus. Rotate the upper hand to massage the client's uterus. Use slight downward pressure to compress the client's fundus.

Immune Thrombocytopenic Purpura (ITP)

Autoimmune platelet destruction is a common cause of thrombocytopenia and should be supsected in patients with echymoses, petechiae, mucosal bleeding, and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) .

A client develops noninfective mastitis 3 weeks after giving birth. What part of client self-care is emphasized as most important?

Breast feed or otherwise empty your breasts every 1 to 2 hours.

A nurse is performing an assessment on a female client who gave birth 24 hours ago. On assessment, the nurse finds that the fundus is 2 cm above the umbilicus and boggy. Which intervention is a priority?

Have the client void, and then massage the fundus until it is firm.

After pains

Intermittent contractions following delivery to help uterus shrink and prevent hemorrhage

A nurse is providing education to a client who is 4 weeks postpartum and is breastfeeding. The client asks about expected weight loss. Which of the following responses should the nurse make?

Losing 2.2 pounds each month would be acceptable

approximation

Pertains to the proximity of wound edges to eachother

Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

Uterine atony, placenta previa, operative procedures

Postpartum assessment includes assessment of

Vital signs, status of uterus, and vaginal bleeding

A nurse is providing teaching about newborn baths to a client who is 2 days postpartum. Which of the following pieces of information should the nurse include?

Wash the newborn's face with plain warm water

pyelonephritis

a UTI that has ascended to the kidneys. It is often referred to simply as a kidney infection. In addition to cystitis symptoms, people with pyelonephritis will complain of fever and back pain. They often report chills and flu-like symptoms.

postpartum psychosis

a rare and severe form of depression that occurs in women just after giving birth and includes delusional thinking and hallucinations (EMERGENT)

vaginosis

any abnormality of vaginal discharge

Which intervention will the registered nurse (RN) implement before completing a fundal assessment of a woman who delivered six hours ago? Select all that apply.

assess need for pain medication before exam position the woman in supine position explain the purpose of the examination instruct the woman to empty her bladder

A nurse is caring for a client who has just given birth. What is the best method for the nurse assess this client for postpartum hemorrhage?

by frequently assessing uterine involution

The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which finding would the nurse expect when assessing the client's fundus?

cannot be palpated

atony

lack of normal muscle tone

Hypercoagulability during pregnancy protects the mother against excessive blood loss during birth. It also can increase a woman's risk of developing a blood clot. It does this by which means? Select all that apply.

• stasis • altered coagulation • localized vascular damage

A nurse is assessing a client on the first postpartum day. Findings include the following: funds firm and one fingerbreadth above and to the right of the umbilicus, moderate lochia rubra with small clots, temperature 37.3°C (99.2°F), and pulse rate 52/min. Which of the following actions should the nurse take?

Ask the client when she last voided

What two elements play the biggest role in becoming a mother after delivery of her newborn?

Love and attachment to the child and engagement with the child

A nurse is caring for a postpartum client 8 hr after delivery. Which of the following factors places the client at risk of uterine atony? (Select all that apply.)

Magnesium sulfate infusion Distended bladder Prolonged labor

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

Massage the fundus

A nurse is caring for a client who is 8 hr postpartum and is experiencing hemorrhage. Which of the following actions should the nurse implement after notifying the provider? (Select all that apply.)

Massage the fundus Administer oxytocin with IV fluids Insert an indwelling urinary catheter Place the client in a lateral position with her legs elevated 30°

A nurse is assessing a postpartum client and observes a steady trickle of bright red blood from the client's vagina. The uterus is palpated as firm, midline, and located 1 cm below the umbilicus. Which of the following actions should the nurse take?

Notify the provider

The nurse is assessing the fundus of a client on postpartum day 1. What should the nurse expect when palpating the fundus?

fundus one fingerbreadth below umbilicus and firm

A nurse is reviewing risk factors for postpartum depression with a newly licensed nurse. Which of the following risk factors should the nurse include?

gestational diabetes

Elevation of a client's temperature is a crucial first sign of infection. However, when is elevated temperature not a warning sign of impending infection?

during the first 24 hours after birth owing to dehydration from exertion

Which intervention will the registered nurse (RN) implement to promote the attachment process for a mother whose newborn is in the Neonatal Intensive Care Unit (NNICU)? Select all that apply.

encourage the mother to reach through the incubator and stroke the infant position the mother close to the incubator to allow her better viewing access talk about what to expect in the NNICU room before the mother's first visit

A client who gave birth by cesarean birth 3 days ago is bottle-feeding her neonate. While collecting data the nurse notes that vital signs are stable, the fundus is four fingerbreadths below the umbilicus, lochia are small and red, and the client reports discomfort in her breasts, which are hard and warm to touch. The best nursing intervention based on this data would be:

encouraging the client to wear a supportive bra.

The registered nurse (RN) is caring for a 26 year-old woman who delivered six hours ago and identifies which client labor/delivery factor that increases the woman's risk of developing early postpartum hemorrhage? Select all that apply.

labor lasted 22 hours 50 minutes third stage of labor woman delivering twins

Prior to discharge from the hospital, a nurse is checking the fundal height for a new mother who delivered 2 days ago. The nurse would anticipate which finding?

two fingerbreadths below the umbilicus