W10 OBGYN

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? A) "I just feel so overwhelmed and tired." B) "I'm feeling so guilty and worthless lately." C) "It's strange, one minute I'm happy, the next I'm sad." D) "I keep hearing voices telling me to take my baby to the river."

"I'm feeling so guilty and worthless lately." Indicators for postpartum depression include feelings related to restlessness, worthlessness, guilt, hopeless, and sadness along with loss of enjoyment, low energy level, and loss of libido. Thus, the statement by the mother about feeling guilty and worthless suggest postpartum depression. The statements about being overwhelmed and fatigued and changing moods suggest postpartum blues. The statement about hearing voices suggests postpartum psychosis.

The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which of the following would the nurse most likely include in this teaching plan? (Select all that apply.) A) Taking the prescribed antibiotic until it is finished B) Checking temperature once a week C) Washing hands before and after perineal care D) Handling perineal pads by the edges E) Directing peribottle to flow from back to front

A) Taking the prescribed antibiotic until it is finished C) Washing hands before and after perineal care D) Handling perineal pads by the edges

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 is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which condition? A. hematoma B. laceration C. uterine atony D. bladder distention

Ans: A Feedback: The woman most likely has a hematoma based on the findings: firm uterus with bright-red bleeding; localized bluish bulging area just under the skin surface in the perineal area; severe perineal or pelvic pain; and difficulty voiding. A laceration would involve a firm uterus with a steady stream or trickle of unclotted bright-red blood in the perineum. Bladder distention would be palpable along with a soft, boggy uterus that deviates from the midline. Uterine atony would be noted by an uncontracted uterus.

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which measure would the nurse include as the most cost-effective method for prevention? A. prophylactic heparin administration B. compression stockings C. early ambulation D. warm compresses

Early ambulation Although compression stockings and prophylactic heparin administration may be appropriate, the most cost-effective preventive method is early ambulation. It is also the easiest method. Warm compresses are used to treat superficial venous thrombosis.

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? A. Notify the health care provider. B. Encourage the client to void. C. Massage the uterine fundus. D. Apply warm soaks to the area.

Massage the uterine fundus or Notify the health care provider Perineal pad saturation within 15 minutes during the early postpartum period is indicative of bleeding, which is commonly due to uterine atony and can lead to postpartum hemorrhage. Fundal assessment and massage should be performed first to control bleeding.

A postpartum client is prescribed medication therapy as part of the treatment plan for postpartum hemorrhage. Which medication would the nurse least expect to administer in this situation? A. methylergonovine B. carboprost C. oxytocin D. nifedipine

Nifedipine Nifedipineis a tocolytic. The medications for postpartum hemorrhage are: -oxytocin -methylergonovine -misoprostol -carboprost

A postpartum woman is ordered to receive oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? A. Give as a vaginal or rectal suppository. B. Administer the drug as an IV bolus injection. C. Withhold the drug if the woman is hypertensive. D. Piggyback the IV infusion into a primary line.

Piggyback the IV infusion into a primary line. When giving oxytocin, it should be diluted in a liter of IV solution and the infusion set up to be piggy-backed into a primary line to ensure that the medication can be discontinued readily if hyperstimulation or adverse effects occur. It should never be given as an IV bolus injection. Methylergonovine is not given if the woman is hypertensive. Dinoprostone is available as a vaginal or rectal suppository.

The nurse is conducting a class for postpartum women about mood disorders. The nurse describes a transient, self-limiting mood disorder that affects mothers after childbirth. The nurse determines that the women understood the description when they identify the condition as postpartum: A. psychosis. B. bipolar disorder. C. depression. D. blues.

Postpartum blues Postpartum blues affects 50% to 70% of new mothers. It is believed to be related to hormonal fluctuations after childbirth.

A nurse is providing a refresher class for a group of postpartum nurses. The nurse reviews the risk factors associated with postpartum hemorrhage. The group demonstrates understanding of the information when they identify which risk factors associated with uterine tone? Select all that apply. A. Rapid labor B. operative birth C. retained blood clots D. fetal malpostion E. hydramnios

Rapid labor & hydramnios Risk factors associated with uterine tone include hydramnios, rapid or prolonged labor, oxytocin use, maternal fever, or prolonged rupture of membranes. Retained blood clots are a risk factor associated with issue retained in the uterus. Fetal malposition and operative birth are risk factors associated with trauma of the genital tract.

A group of nurses are reviewing information about mastitis and its causes in an effort to develop a teaching program on prevention for postpartum women. The nurses demonstrate understanding of the information when they focus the teaching on ways to minimize risk of exposure to which organism? A. E. coli B. Klebsiella C. Proteus D. S. aureus

S. aureus The most common infectious organism that causes mastitis is S. aureus, which comes from the breast-feeding infant's mouth or throat. E. coli is another, less common cause. E.coli, Proteus, and Klebsiella are common causes of urinary tract infections.

A nurse is assessing a postpartum client. Which finding would the cause the nurse the greatest concern? A. sharp stabbing chest pain with shortness of breath B. perineal pain with swelling along the episiotomy C. leg pain on ambulation with mild ankle edema D. calf pain with dorsiflexion of the foot

Sharp stabbing chest pain with shortness of breath Sharp stabbing chest pain with shortness of breath suggests pulmonary embolism, an emergency that requires immediate action. Leg pain on ambulation with mild edema suggests superficial venous thrombosis. Calf pain on dorsiflexion of the foot may indicate deep vein thrombosis or a strained muscle or contusion. Perineal pain with swelling along the episiotomy might be a normal finding or suggest an infection. Of the conditions, pulmonary embolism is the most urgent.

A client is experiencing postpartum hemorrhage, and the nurse begins to massage her fundus. Which action would be most appropriate for the nurse to do when massaging the woman's fundus? A. Use an up-and-down motion to massage the uterus. B. Wait until the uterus is firm to express clots. C. Place the hands on the sides of the abdomen to grasp the uterus. D. Continue massaging the uterus for at least 5 minutes.

Wait until the uterus is firm to express clots The uterus must be firm before attempts to express clots are made because application of firm pressure on an uncontracted uterus could lead to uterine inversion. One hand is placed on the fundus and the other hand is placed on the area above the symphysis pubis. Circular motions are used for massage. There is no specified amount of time for fundal massage. Uterine tissue responds quickly to touch, so it is important not to overmassage the fundus.

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching? A) "I need to call my doctor if my temperature goes above 100.4° F." B) "When I put on a new pad, I'll start at the back and go forward." C) "If I have chills or my discharge has a strange odor, I'll call my doctor." D) "I'll point the spray of the peribottle so the water flows front to back."

When I put on a new pad, I'll start at the back and go forward The woman needs additional teaching when she states that she should apply the perineal pad starting at the back and going forward. The pad should be applied using a front-to-back motion. Notifying the health care provider of a temperature above 100.4 degrees F, aiming the peri-bottle spray so that the flow goes from front to back, and reporting danger signs such as chills or lochia with a strange odor indicate effective teaching.

A woman developed abruptio placenta during the birth of her neonate. The nurse would monitor the client closely for changes. Which finding would be a cause for alarm? A. severe uterine pain B. board-like abdomen C. inversion of the uterus D. appearance of petechiae

appearance of petechiae explanation: A complication of abruptio placentae is disseminated intravascular coagulation (DIC), which is manifested by petechiae, ecchymoses, and other signs of impaired clotting. Severe uterine pain, a board-like abdomen, and uterine inversion are not associated with abruptio placentae

A nurse is making a home visit to a postpartum client. Which finding would most likely lead the nurse to suspect that a woman is experiencing postpartum psychosis? A. insomnia B. delirium C. sadness D. feelings of guilt

delirium Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. It is manifested by depression that escalates to delirium, hallucinations, anger toward self and infant, bizarre behavior, mania, and thoughts of hurting herself and the infant. Feelings of guilt, sadness, and insomnia are associated with postpartum depression.

A multipara client develops thrombophlebitis after delivery. Which assessment finding would lead the nurse to intervene immediately? A. dyspnea, bradycardia, hypertension, and confusion B. dyspnea, diaphoresis, hypotension, and chest pain C. weakness, anorexia, change in level of consciousness, and coma D. pallor, tachycardia, seizures, and jaundice

dyspnea, diaphoresis, hypotension, and chest pain Sudden unexplained shortness of breath and complaints of chest pain along with diaphoresis and hypotension suggest pulmonary embolism, which requires immediate action. Other signs and symptoms include tachycardia, apprehension, hemoptysis, syncope, and sudden change in the woman's mental status secondary to hypoxemia. Anorexia, seizures, and jaundice are unrelated to a pulmonary embolism.

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? A. hardening of an area in the affected breast B. no breast milk in the affected breast C. an inverted nipple on the affected breast D. an ecchymotic area on the affected breast

hardening of an area in the affected breast Mastitis is characterized by a tender, hot, red, painful area on the affected breast. An inverted nipple is not associated with mastitis. With mastitis, the breast is distended with milk, the area is inflamed (not ecchymotic), and there is breast tenderness.

After presenting an in-service presentation on measures to prevent postpartum hemorrhage, the nurse determines that the teaching was successful when the group identifies which measure to prevent postpartum hemorrhage due to retained placental fragments? A. inspecting the placenta after delivery for intactness B. applying pressure to the umbilical cord to remove the placenta C. manually removing the placenta at delivery D. administering broad-spectrum antibiotics

inspecting the placenta after delivery for intactness After birth, a thorough inspection of the placenta is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not postpartum hemorrhage. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.

A nurse is developing a program to help reduce the risk of late postpartum hemorrhage in clients in the labor and birth unit. Which measure would the nurse emphasize as part of this program? A. inspecting the placenta after delivery for intactness B. applying pressure to the umbilical cord to remove the placenta C. manually removing the placenta at delivery D. administering broad-spectrum antibiotics

inspecting the placenta after delivery for intactness explanation: After the placenta is expelled, a thorough inspection is necessary to confirm its intactness because tears or fragments left inside may indicate an accessory lobe or placenta accreta. These can lead to profuse hemorrhage because the uterus is unable to contract fully. Administering antibiotics would be appropriate for preventing infection, not postpartum hemorrhage. Manual removal of the placenta or excessive traction on the umbilical cord can lead to uterine inversion, which in turn would result in hemorrhage.

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which finding? A. bruising on arms and legs B. moderate lochia serosa C. nonpalpable fundus D. fever

moderate lochia serosa explanation: Subinvolution is usually identified at the woman's postpartum examination 4 to 6 weeks after birth. The clinical picture includes a postpartum fundal height that is higher than expected, with a boggy uterus; the lochia fails to change colors from red to serosa to alba within a few weeks. Normally, at 4 to 6 weeks, lochia alba or no lochia would be present and the fundus would not be palpable. Thus evidence of lochia serosa suggests subinvolution. Bruising would suggest a coagulopathy. Fever would suggest an infection.

A nurse is reviewing a journal article on the causes of postpartum hemorrhage. Which condition would the nurse most likely find as the most common cause? A. uterine inversion B. uterine atony C. cervical or vaginal lacerations D. labor augmentation

uterine atony explanation: The most common cause of postpartum hemorrhage is uterine atony, failure of the uterus to contract and retract after birth. The uterus must remain contracted after birth to control bleeding from the placental site. Labor augmentation is a risk factor for postpartum hemorrhage. Lacerations of the birth canal and uterine inversion may cause postpartum hemorrhage, but these are not the most common cause.

As part of an inservice program to a group of home health care nurses who care for postpartum women, a nurse is describing postpartum depression. The nurse determines that the teaching was successful when the group identifies that this condition becomes evident at which time after birth of the newborn? A. within the first 2 weeks B. in approximately 1 month C. in the first week D. within the first 6 weeks

within the first 6 weeks "Postpartum depression develops gradually, appearing within the first 6 weeks."