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By frequently assessing uterine involution
(see full question) A nurse is caring for a client who has just undergone delivery. What is the best method for the nurse to assess this client for postpartum hemorrhage?
Wound care and hand washing
(see full question) Jerry, who is hypertensive and who received corticosteroids during pregnancy, delivered by cesarean and subsequently developed endometritis. Her incision is red, warm, and very sensitive to touch, and she remains febrile despite antibiotic therapy. What is the most important aspect of post hospital care to teach her?
Oxytoxic agent
(see full question) Manual manipulation was used to reposition the uterus of a client who experienced uterine inversion. Which of the following would the nurse administer as ordered after repositioning?
Postpartum depression develops gradually, appearing within the first 6 weeks."
After teaching a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful?
Assess for uterine contractions
Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps delivery which resulted in lacerations 4-hours ago. What should the nurse do next? You selected: Have the client void Incorrect
Risk for impaired urinary elimination
Which nursing diagnosis would be most appropriate for a client with a postpartum hematoma?
Uterine atony
(see full question) Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage?
Length of labor
An Rh-positive client vaginally delivers a 6-lb, 10-oz neonate after 17 hours of labor. Which condition puts this client at risk for infection?
A woman with diabetes who has delivered vaginally and develops tachycardia and a fever of 101.7°F (38.8°C) on the third postpartum day. The next day, she appears ill; fever is 102.9°F (39.3°C); WBC is 31,500 cells/mm3; blood cultures are negative.
Which woman should you suspect of having endometritis?
: Massaging the fundus firmly
(see full question) When monitoring a postpartum client 2 hours after delivery, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially?
Have the client rest with the extremity elevated
A nurse is caring for a 38-year-old overweight client 24-hours post cesarean delivery. The client is reporting calf tenderness. Which should the nurse do first?
Lacerations.
The nurse assesses the patient who is one hour postpartum and observes a heavy steady gush of bright red blood from the vagina in the presence of a firm fundus. Select the most likely cause of the signs and symptoms.
Escherichia coli
The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse most likely expect the culture to reveal?
100.4°F (38°C)
(see full question) On the third day postpartum, which temperature is internationally defined as a postpartal infection?
Infection
A nurse is assessing vital signs for a postpartum patient 48 hours after delivery. The vital signs are: T 101.2°F; (38.4°C) HR 82 beats/min.; RR 18 breaths/min.; BP 125/78 mmHg. How will the nurse interpret the vital signs?
Bleeding gums • Tachycardia • Acute renal failure
(see full question) A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation? Select all that apply.
Administration of platelet transfusions as ordered
(see full question) A nurse is caring for a client with idiopathic thrombocytopenic purpura (ITP). Which intervention should the nurse perform first?
: Staphylococcus aureus
The nurse is teaching a client with newly diagnosed mastitis about her condition. The nurse would inform the client that she most likely contracted the disorder from which organism?
Her uterus is at the level of the umbilicus.
Which assessment on the third postpartal day would make you evaluate a woman as having uterine subinvolution?
Take an oral contraceptive daily
(see full question) A nurse is caring for a postpartum client who has been treated for deep vein thrombosis (DVT). Which order would the nurse question?
: Palpate her fundus.
(see full question) A postpartal woman calls you into her room because she is having a very heavy lochia flow containing large clots. Your first action would be to
Risk for fatigue related to chronic bleeding due to subinvolution
(see full question) A woman arrives at the office for her 4-week postpartal visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which of the following is the most likely nursing diagnosis for this patient?
Oxytocin
(see full question) The nurse has attempted to massage a boggy uterus to firm state without success. The next intervention the nurse should anticipate is the administration of what medication?
Cervical laceration
(see full question) The nurse is assisting with a birth, and the client has just delivered the placenta. Suddenly bright red blood gushes from the vagina. The nurse recognizes that which of the following is the most likely cause of this postpartum hemorrhage?
"Try applying warm compresses to your breasts to encourage the milk to be released."
Which of the following instructions would the nurse include in the teaching plan for a postpartum woman with mastitis?
The client feels empty since she delivered the neonate
Which situation should concern the nurse treating a postpartum client within a few days of delivery?
Steadily decreasing volume of urine
You are caring for a woman who is receiving IV antibiotics and supportive care for endometritis. Which of the following findings should you report as soon as you notice it?
Postpartum psychosis
(see full question) A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which of the following conditions?
24 hours to 12 weeks after delivery
(see full question) In which time period would the nurse most likely expect a client who has delivered twins to experience late postpartum hemorrhage?
Assess client's uterine tone • Monitor client's vital signs • Get a pad count
A nurse is assessing a client with postpartal hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply.
Infection
A nurse is assessing vital signs for a postpartum patient 48 hours after delivery. The vital signs are: Temp 101.2°F (38.4°C); HR 82 beats/min.; RR 18 breaths/min.; BP 125/78 mmHg. How will the nurse interpret the vital signs?
Cardiovascular disease
A nurse is assigned to care for a client experiencing early postpartum hemorrhage. The nurse is required to administer the prescribed methylergonovine maleate intramuscularly to the client. Which of the following conditions would the nurse identify as necessitating the cautious administration of this drug?
To breast-feed or otherwise empty her breasts every 1 to 2 hours
Brenda develops mastitis 3 weeks after delivery. What part of self-care do you tell her is most important? You selected: To take her antibiotic medication for the full 10 days even if she begins to feel better sooner Incorrect
Avoid over-the-counter (OTC) salicylates
(see full question) A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instructions in her discharge teaching?
Uterine atony
(see full question) A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition?
Consistency of the fundus
(see full question) A nurse has just received a client from the surgical suite following a cesarean birth. The report given reveals the client has received magnesium sulfate for management of preeclampsia just before the emergency surgery. The nurse should monitor the client for adverse effects from the magnesium sulfate by checking which parameter?
Assess client's uterine tone • Monitor client's vital signs • Get a pad count
(see full question) A nurse is assessing a client with postpartal hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply.
Laceration of the cervix
(see full question) Uterine atony, or the inability of the uterus to effectively contract, has four major causes. What is one of them?
