Chapter 23: Conditions Occurring after Delivery
The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? 1 100 mL 2 250 mL 3 300 mL 4 500 mL
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A woman presents to the clinic at 1-month postpartum and reports her left breast has a painful, reddened area. On assessment, the nurse discovers a localized red and warm area. The nurse predicts the client has developed which disorder? 1 Breast yeast 2 Mastitis 3 Plugged milk duct 4 Engorgement
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The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? 1 Attachment, lochia color, complete blood cell count 2 Blood pressure, pulse, reports of dizziness 3 Degree of responsiveness, respiratory rate, fundus location 4 Height, level of orientation, support systems
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Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? 1 hemoglobin level of 12 g/dL 2 uterine atony 3 thrombophlebitis 4 moderate amount of lochia rubra
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Which manifestation would alert the nurse to suspect that a postpartum client has septic pelvic thrombophlebitis (SPT)? 1 Lower back pain 2 Pain in lower abdomen 3 Uterine cramping 4 Recurrent vaginal infection
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A nurse is caring for a client who gave birth vaginally 2 hours ago. What postpartum complication can the nurse assess within the first few hours following birth? 1 postpartal infection 2 postpartal blues 3 postpartal hemorrhage 4 postpartum depression
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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? 1 prophylactic heparin administration 2 compression stockings 3 early ambulation 4 warm compresses
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A postpartum client has continuous seepage of blood from the vagina. Upon nursing assessment, the nurse confirms a firm uterus, 1 cm below the umbilicus. The nurse increases her nursing assessment to include assessment for which? 1 Retained placental fragments 2 A urinary tract infection 3 A cervical laceration 4 Uterine atony
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Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which condition? 1 retained placental fragments 2 hypertension 3 thrombophlebitis 4 uterine subinvolution
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The nurse is assessing a client 48 hours postpartum and notes on assessment: temperature 101.2oF (38.4oC), HR 82, RR 18, BP 125/78 mm Hg. The nurse should suspect the vital signs indicate which potential situation? 1 Dehydration 2 Normal vital signs 3 Infection 4 Shock
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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? 1 Escherichia coli 2 group beta-hemolytic streptococci (GBS) 3 Staphylococcus aureus 4 Streptococcus pyogenes
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A multipara client develops thrombophlebitis after birth. Which assessment findings would lead the nurse to intervene immediately? 1 dyspnea, diaphoresis, hypotension, and chest pain 2 dyspnea, bradycardia, hypertension, and confusion 3 weakness, anorexia, change in level of consciousness, and coma 4 pallor, tachycardia, seizures, and jaundice
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A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? 1 Uterine protrusion into the vagina 2 Uterine bleeding present 3 Foul smelling lochia 4 Pain in the lower abdomen
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A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first? 1 Venous duplex ultrasound of the right leg 2 Transthoracic echocardiogram 3 Venogram of the right leg 4 Noninvasive arterial studies of the right leg
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A woman who gave birth to a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which condition does the nurse believe is causing this experience? 1 postpartum baby blues 2 postpartum anxiety 3 postpartum reaction 4 postpartum depression
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An Rh positive client vaginally gives birth to a 6 lb, 10 oz (3,005 g) neonate after 17 hours of labor. Which condition puts this client at risk for infection? 1 length of labor 2 maternal Rh status 3 method of birth 4 size of the neonate
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Manual manipulation was used to reposition the uterus of a client who experienced uterine inversion. Which medication would the nurse administer as prescribed after repositioning? 1 oxytoxic agent 2 magnesium sulfate 3 indomethacin 4 nifedipine
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On a follow-up visit to the clinic, a nurse suspects that a postpartum client is experiencing postpartum psychosis. Which finding would most likely lead the nurse to suspect this condition? 1 delusional beliefs 2 feelings of anxiety 3 sadness 4 insomnia
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Which intervention would be helpful to a bottle-feeding client who is experiencing hard or engorged breasts? 1 applying ice 2 restricting fluids 3 applying warm compresses 4 administering bromocriptine
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A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? 1 Check the lochia. 2 Assess the temperature. 3 Monitor the pain level. 4 Assess the fundal height.
1 The nurse should assess the client for prolonged bleeding time. von Willebrand disease is a congenital bleeding disorder, inherited as an autosomal dominant trait, that is characterized by a prolonged bleeding time,
A client who gave birth to twins 6 hours ago becomes restless and nervous. Her blood pressure falls from 130/80 mm Hg to 96/50 mm Hg. Her pulse drops from 80 to 56 bpm. She was induced earlier in the day and experienced abruptio placentae. Based on this information, what postpartum complication would the nurse expect is happening? 1 infection 2 hemorrhage 3 fluid volume overload 4 pulmonary emboli
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Which of the following would indicate to the nurse that a postpartal client is experiencing uterine prolapse? 1 Rubra-colored lochia 2 Upper vagina appearing beefy red 3 Blood in the urine 4 Malodorous vaginal discharge
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A client develops mastitis 3 weeks after giving birth. What part of client self-care is emphasized as most important? 1 Administer antibiotic medication for the full 10 days even if she begins to feel better 2 Use NSAIDs, warm showers, and warm compresses to relieve her discomfort 3 Breastfeed or otherwise empty her breasts every 1 to 2 hours 4 Increase her fluid intake to ensure that she will continue to produce adequate milk
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Which recommendation should be given to a client with mastitis who is concerned about breast-feeding her neonate? 1 She should stop breast-feeding until completing the antibiotic. 2 She should supplement feeding with formula until the infection resolves. 3 She should not use analgesics because they are not compatible with breast-feeding. 4 She should continue to breast-feed; mastitis will not infect the neonate.
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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? 1 an inverted nipple on the affected breast 2 no breast milk in the affected breast 3 an ecchymotic area on the affected breast 4 hardening of an area in the affected breast
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The nurse is assessing vital signs on the client and notes a normal blood pressure along with an elevated pulse when the patient moves from a lying to a standing or sitting position. What would this indicate? 1 Delayed labor 2 Overhydration 3 Arrested labor 4 Low fluid volume
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The nurse is teaching a discharge session to a group of postpartum clients. When asked how long to expect the bleeding, which time frame should the nurse point out? 1 For 6 weeks 2 On and off for 2 to 3 weeks 3 Stops in 1 to 2 weeks 4 In approximately 10 days
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Your patient delivered six hours ago. She calls you to her room complaining of pain "deep inside." You medicate her per orders with no relief attained. You check her vital signs and find they are markedly different then when the CNA charted them 30 minutes ago. What would you suspect? 1 Late postpartum hemorrhage 3 Early postpartum hemorrhage 4 Uterine laceration 4 Pelvic hematoma
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A postpartal woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this? 1 Bend her knee, and palpate her calf for pain. 2 Ask her to raise her foot and draw a circle. 3 Blanch a toe, and count the seconds it takes to color again. 4 Assess for pedal edema.
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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? 1 oxytocin 2 methylergonovine 3 carboprost 4 nifedipine
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A postpartum woman is prescribed oxytocin to stimulate the uterus to contract. Which action would be most important for the nurse to do? 1 Administer the drug as an IV bolus injection. 2 Give as a vaginal or rectal suppository. 3 Piggyback the IV infusion into a primary line. 4 Withhold the drug if the woman is hypertensive.
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A nurse teaches a postpartum woman about her risk for thromboembolism. The nurse determines that additional teaching is required when the woman identifies which as a factor that increases her risk? 1 increase in clotting factors 2 vessel damage 3 immobility 4 increase in red blood cell production
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A client arrives in the emergency department accompanied by her husband and new 10-week-old infant, crying, confused, and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear approximately when? 1 within 3 months of giving birth 2 within 4 months of giving birth 3 within 2 months of giving birth 4 within 5 months of giving birth
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A postpartal patient is receiving heparin as treatment for thrombophlebitis. What should the nurse instruct the patient about breast-feeding during this time? 1 Breast-feeding can continue. 2 The baby will need weekly blood work. 3 The effect of anticoagulants is counteracted by infant gastric juices. 4 All anticoagulants pass in breast milk so breastfeeding will have to stop.
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A postpartum patient has a swollen area of purplish discoloration in the perineal area that is 5 cm in diameter. Which nursing diagnosis should the nurse use to plan care for this patient? 1 Acute pain 2 Risk for injury 3 Risk for infection 4 Ineffective peripheral tissue perfusion
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A postpartum woman has a history of von Willenbrand disease (vWD). The client is being prepared for discharge, and a referral for health care follow up is made to assess for potential postpartum hemorrhage. The nurse understands that this client is at greatest risk for hemorrhage during which time during the postpartum period? 1 first 3 days 2 first week 3 first month 4 first 6 weeks
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After teaching a postpartum client about postpartum blues, the nurse determines that the teaching was effective when the client makes which statement? 1 "If the symptoms last more than a few days, I need to call my doctor." 2 "I might feel like laughing one minute and crying the next." 3 "I'll need to take medication to treat the anxiety and sadness." 4 "I should call this support line only if I hear voices."
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A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition? 1 hyperglycemia 2 hypertension 3 hypovolemia 4 hypothyroidism
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