OB CH22 PREPU

Which condition should the nurse look for in the client's history that may explain an increase in the severity of afterpains? primiparity diabetes bottle-feeding multiple gestation

multiple gestation Explanation: Multiple gestation, breastfeeding, multiparity, and conditions that cause overdistention of the uterus will increase the intensity of afterpains. Bottle-feeding and diabetes aren't directly associated with increasing severity of afterpains, unless the client has delivered a macrosomic neonate.

A client who gave birth 5 hours ago has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? Notify the health care provider. Begin an IV infusion of Ringer's lactate solution. Assess the fundus. Assess vital signs.

Assess the fundus. Explanation: The best safeguard against uterine atony is to palpate the fundus at frequent intervals to be assured that the uterus is remaining contracted. If bleeding persists, then a vital signs assessment and notification to the health care provider may be indicated. An intravenous infusion might be prescribed if bleeding continues.

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 within which time frame after birth? 3 months 4 months 2 months 5 months

3 months Explanation: Postpartum psychosis generally surfaces within 3 months of giving birth.

One of the primary assessments a nurse makes every day is for postpartum hemorrhage. What does the nurse assess the fundus for? Consistency, location, and place Content, lochia, place Consistency, shape, and location Location, shape, and content

Consistency, shape, and location Explanation: Assess the fundus for consistency, shape, and location. Remember that the uterus should be firm, in the midline, and decrease 1 cm each postpartum day.

The nurse is planning interventions to prevent the onset of urinary retention in a postpartum client. Why are these interventions needed? Frequent partial voiding never relieves the bladder pressure. Catheterization at the time of delivery reduces bladder tonicity. Decreased bladder sensation results from edema because of the pressure of birth. Mild dehydration causes a concentrated urine volume in the bladder.

Decreased bladder sensation results from edema because of the pressure of birth. Explanation: Urinary retention occurs when there is inadequate bladder emptying. After childbirth, bladder sensation for voiding is decreased because of bladder edema caused by the pressure of birth. Frequent partial voiding can lead to bladder overdistention. Catheterization at the time of delivery will not reduce bladder tone. Dehydration will not cause urinary retention but an overall reduction in urine volume.

The nurse is administering methylergonovine 0.2 mg to a postpartum client with uterine subinvolution. Which assessment will the nurse need to make prior to administering the medication? if urine output is higher than 50 ml/h if blood pressure is lower than 140/90 mm Hg if the client can walk without experiencing dizziness if hematocrit level is higher than 45%

if blood pressure is lower than 140/90 mm Hg Explanation: Methylergonovine elevates blood pressure. It is important to assess that it is not already elevated before administration.

The nurse is caring for a postpartum client with diabetes who has developed an infection. The nurse is aware that infections in clients with diabetes tend to be more severe and can quickly lead to complications. Which complication should the nurse assess this client for? anemia ketoacidosis respiratory alkalosis respiratory acidosis

ketoacidosis Explanation: Clients with diabetes who become pregnant tend to become sicker and develop illnesses more quickly than pregnant clients without diabetes. Severe infections in diabetes can lead to diabetic ketoacidosis. Anemia, respiratory acidosis, and respiratory alkalosis aren't generally associated with infections in diabetic clients.

Two weeks after giving birth, a birthing parent is feeling sad, hopeless, and guilty because they cannot take care of the infant and partner. The birthing parent is tired but cannot sleep and has isolated themselves from family and friends. Which should the nurse prioritize for assessment? postpartum depression lack of partner support maladjustment to parenting postpartum blues

postpartum depression Explanation: Feeling sad; coping poorly; being overwhelmed; being fatigued, but unable to sleep; and withdrawing for social interactions are signs of postpartum depression. Signs of postpartum blues are similar, but less severe and seen within the first week after birth. It is normal for new birthing parents to feel overwhelmed and unable to care for their partner as they did prior to the pregnancy. There is no evidence of lack of partner support in this situation.

A postpartum woman is prescribed an antibiotic because of endometritis. Her breastfed infant should be observed particularly for which of the following? irritability and loss of appetite decreased sleep levels and increased appetite jaundice that does not respond to phototherapy signs of oral candidiasis (thrush) and easy bruising

signs of oral candidiasis (thrush) and easy bruising Explanation: An antibiotic can lead to overgrowth of fungal organisms; it can also lead to underproduction of vitamin K and difficulty with blood clotting.

Which factor might result in a decreased supply of breast milk in a postpartum client? A. Frequent feedings B. Maternal diet high in Vitamin C C. An alcoholic drink D. Supplemental feedings with formula

supplemental feedings with formula Explanation: Routine formula supplementation may interfere with establishing an adequate milk volume because decreased stimulation to the client's nipples affects hormonal levels and milk production. Vitamin C levels haven't been shown to influence milk volume. One drink containing alcohol generally tends to relax the client, facilitating letdown. Excessive consumption of alcohol may block letdown of milk to the infant, though supply isn't necessarily affected. Frequent feedings are likely to increase milk production.

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? 1000 ml 250 ml 750 ml 500 ml

1000 ml Explanation: Postpartum hemorrhage is defined as blood loss of 500 ml or more after a vaginal birth and 1000 ml or more after a cesarean birth.

A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? 500 ml 750 ml 1000 ml 250 ml

1000 ml Explanation: Postpartum hemorrhage is defined as blood loss of 500 ml or more after a vaginal birth and 1000 ml or more after a cesarean birth.

A 29-year-old postpartum client is receiving anticoagulant therapy for deep venous thrombophlebitis. The nurse should include which instruction in her discharge teaching? Avoid iron replacement therapy. Avoid over-the-counter (OTC) salicylates. Wear knee-high stockings when possible. Shortness of breath is a common adverse effect of the medication.

Avoid over-the-counter (OTC) salicylates. Explanation: Discharge teaching should include informing the client to avoid OTC salicylates, which may potentiate the effects of anticoagulant therapy. Iron will not affect anticoagulation therapy. Restrictive clothing should be avoided to prevent the recurrence of thrombophlebitis. Shortness of breath should be reported immediately because it may be a symptom of pulmonary embolism.

The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. A. "I am sad because I am not spending as much time with my toddler now that my newborn is here." B. "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." C. "The newborn is not really mine emotionally, since I was never pregnant and do not have children." D. "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." E. "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

C. "The newborn is not really mine emotionally, since I was never pregnant and do not have children." D. "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." E. "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider." Explanation: Postpartum psychosis is a serious and emergent condition in which the new mother has lost touch with reality and needs immediate psychiatric intervention. Visual hallucinations such as seeing the newborn's thoughts projected on her phone is a sign of postpartum psychosis. Denying the pregnancy or that the newborn is hers is a sign of postpartum psychosis. The delusion that her milk is poisoned is a sign of postpartum psychosis. Being concerned about time with the toddler is a sign of postpartum blues or possibly depression. Reaching out for family to visit is a positive coping skill.

The nurse notes that a client's uterus, which was firm after the fundal massage, has become boggy again. Which intervention would the nurse do next? Perform vigorous fundal massage for the client. Check for bladder distention, while encouraging the client to void. Use semi-Fowler position to encourage uterine drainage. Offer analgesics prescribed by health care provider.

Check for bladder distention, while encouraging the client to void. Explanation: If the nurse finds a previously firm fundus to be relaxed, displaced, and boggy, the nurse should assess for bladder distention and encourage the woman to void or initiate catheterization as indicated. Emptying a full bladder facilitates uterine contraction and decreased bleeding. The nurse should not perform vigorous fundal massage. Excessive massage leads to overstimulation of uterine muscle, resulting in excessive bleeding. The nurse should place the client in a semi-Fowler position to encourage uterine drainage in the client with postpartum endometritis. The nurse should offer analgesics as prescribed by the health care provider to minimize perineal discomfort in clients experiencing postpartum lacerations.

A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurse's priority for this client? Check the lochia. Assess the temperature. Monitor the pain level. Assess the fundal height.

Check the lochia. Explanation: 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 deficiency of von Willebrand factor, and impairment of platelet adhesion. A fever of 100.4° F (38° C) after the first 24 hours following birth and pain indicate infection. A client with a postpartum fundal height that is higher than expected may have subinvolution of the uterus.

Which practice would the nurse recommend to a client who has had a cesarean delivery? Frequent douching after she's discharged Side-rolling exercises Sit-ups for 2 weeks postoperatively Coughing and deep-breathing exercises

Coughing and deep-breathing exercises Explanation: As for any postoperative client, coughing and deep-breathing exercises should be taught to keep the alveoli open and prevent infection. Frequent douching isn't recommended and is contraindicated in clients who have just given birth. Sit-ups at 2 weeks postpartum could potentially damage the healing of the incision. Side-rolling exercises aren't an accepted medical practice.

The nurse is caring for a client who has been diagnosed with a deep vein thrombosis. Which assessment finding should the nurse prioritize and report immediately? Calf pain Pyrexia Edema Dyspnea

Dyspnea Explanation: A DVT is often suspected when an individual with an increased risk develops calf pain, pyrexia, and edema in one lower extremity. After the individual has been positively diagnosed with a DVT, any signs of dyspnea should be suspect of possible pulmonary embolism and should be handled as an emergency. The RN and/or primary care provider should be notified immediately so emergent care can be started, as this is often fatal.

A postpartum client saturates a peripad in 30 minutes. What is the nurse's first action in this situation? Encourage the client to void. Massage the fundus. Take a blood pressure. Call the provider.

Massage the fundus. Explanation: When a client has heavy bleeding, the first action is to massage the fundus to stimulate it to contract and to control the amount of blood loss. The blood pressure will not change immediately and will not help to control the bleeding. If the fundal position is deviated, the nurse would palpate the bladder and if full, would encourage the client to void. The provider needs to be called, but not until the nurse has addressed the client's most urgent need.

Upon examination of a postpartal client's perineum, the nurse notes a large hematoma. The client does not report any pain, and lochia is dark red and moderate in amount. Which factor would most likely contribute to the nurse not discovering the perineal hematoma prior to the examination? The client is receiving oral pain medications. The client had an episiotomy. The client has a distended bladder. The client has a history of epidural anesthesia.

The client has a history of epidural anesthesia. Explanation: If a client has an epidural, her sensation of pain is decreased, so nurses cannot rely on client reports of pain as a symptom of a perineal hematoma. The nurse should always inspect the perineum to determine if there is a hematoma present. Having an episiotomy, having a distended bladder, or taking oral pain medications would have no effect on a perineal hematoma.

The nurse is performing a focused assessment on a client who is 2 days postpartum. The client reports pelvic pain, chills, profuse dark, foul-smelling lochia with blood clots. The client states, "my bleeding before was light and now it is heavy." Vital signs: temperature, 99.5°F (37.5°C); heart rate, 102 beats/min; blood pressure, 100/66 mm Hg. Complete the following sentence(s) by choosing from the lists of options. The nurse suspects the client has......evidenced by..... and....

The nurse suspects the client has retained fragments of placenta as evidenced by pelvic pain and profuse dark lochia with blood clots

A postpartum client is recovering from the birth and emergent repair of a cervical laceration. Which sign on assessment should the nurse prioritize and report to the health care provider? Warm and flushed skin Weak and rapid pulse Elevated blood pressure Decreased respiratory rate

Weak and rapid pulse Explanation: Excessive hemorrhage puts the client at risk for hypovolemic shock. Signs of impending shock include a weak and rapid pulse, decreased blood pressure, tachypnea, and cool and clammy skin. These findings should be reported immediately to the health care provider so that proper intervention for the client may be instituted.

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? a client who had a nonelective cesarean birth a primiparous client who had a vaginal birth a client who had an 8-hour labor a client who conceived following fertility treatments

a client who had a nonelective cesarean birth Explanation: The major risk factor for postpartum infection is a nonelective cesarean birth. Antepartum risk factors include history of infection; history of chronic conditions, such as diabetes, anemia, or poor nutrition; infections of the genital tract; smoking; and obesity. The other listed factors are not noted risk factors for infection.

The nurse suspects that a mother who delivered her infant 2 weeks ago is experiencing postpartum depression. What is the first line of treatment for this client? telling the client that she has no need to be depressed scheduling electroconvulsive therapy administrating a selective serotonin reuptake inhibitor talking to the client and reassuring her that she will feel better soon

administrating a selective serotonin reuptake inhibitor Explanation: Selective serotonin reuptake inhibitors are the first-line drugs for postpartum depression and will help the new mother cope with the stresses of motherhood. They are also safe for breastfeeding mothers. Electroconvulsive therapy is used on women who are not responsive to medications. Minimizing the importance of the depression is counterproductive and not supportive of the mother.

Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts? applying ice restricting fluids applying warm compresses administering bromocriptine

applying ice Explanation: Women who do not breastfeed often experience moderate to severe engorgement and breast pain when no treatment is applied. Ice promotes comfort by decreasing blood flow (vasoconstriction), numbing the area, and discouraging further letdown of milk. Restricting fluids does not reduce engorgement and should not be encouraged. Warm compresses will promote blood flow and hence, milk production, worsening the problem of engorgement. Bromocriptine has been removed from the market for lactation suppression.

Which measurement best describes postpartum hemorrhage? blood loss of 600 ml, occurring at least 24 hours after birth blood loss of 400 ml, occurring at least 24 hours after birth blood loss of 800 ml, occurring at least 24 hours after birth blood loss of 1,000 ml, occurring at least 24 hours after birth

blood loss of 1,000 ml, occurring at least 24 hours after birth Explanation: Postpartum hemorrhage involves blood loss in excess of 1,000 mL within the first 24 hours of delivery.

The nurse is caring for a postpartum client with uterine atony. Bladder drainage and massage have been ineffective. Oxytocin IV has been given but has been ineffective in maintaining uterine tone. Which medication does the nurse anticipate being prescribed as the next choice? misoprostol heparin tranexamic acid carboprost tromethamine

carboprost tromethamine Explanation: If oxytocin is not effective at maintaining tone, carboprost tromethamine, a prostaglandin F2-alpha derivative, or methylergonovine maleate, an ergot compound, both given intramuscularly, are the next possible options. Additional options include misoprostol, a prostaglandin E1 analogue, administered rectally to decrease postpartum hemorrhage or ranexamic acid to decrease bleeding. Heparin would increase bleeding and would not be used.

Which change best describes the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications? the same as during pregnancy increased decreased the same as before pregnancy

decreased Explanation: The placenta produces the hormone human placental lactogen, an insulin antagonist. After birth, the placenta, the major source of insulin resistance, is gone. Insulin needs decrease and women with type 1 diabetes may need only one-half to two-thirds of the prenatal insulin dose during the first few postpartum days. Blood glucose levels should be monitored and insulin dosages adjusted as needed. The client should be

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

dyspnea, diaphoresis, hypotension, and chest pain Explanation: Sudden unexplained shortness of breath and reports 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 clinical pathway is being used to coordinate care for a postpartum client who had an uncomplicated vaginal delivery of an 8-lb, 2-oz (3,693-g) neonate over an intact perineum 24 hours ago. While planning care for this client, the registered nurse collaborates with the licensed practical nurse to achieve which priority outcome in the next 8 hours? administering a rubella vaccination if the client isn't immune encouraging the client to demonstrate an ability to breastfeed the neonate completing an initial sitz bath encouraging high fiber foods to achieve a soft bowel movement

encouraging the client to demonstrate an ability to breastfeed the neonate Explanation: With an uncomplicated vaginal birth, the average client will be hospitalized for 48 hours or less. By 24 hours postpartum, it's important for the client to start demonstrating the ability to care for her neonate. The first bowel movement occurs on average 2 to 3 days postpartum. The rubella vaccine is given, when indicated, on the day of discharge. This client delivered over an intact perineum, and although a sitz bath can provide comfort, it isn't a priority.

About 10 days following birth, a new mother visits her primary care provider with localized symptoms of redness, swelling, warmth, and a hard, inflamed vessel in one leg. The nurse should suspect which condition? mastitis subinvolution uterine atony femoral thrombophlebitis

femoral thrombophlebitis Explanation: A woman experiencing a femoral thrombophlebitis will usually have unilateral localized symptoms such as redness, swelling, warmth, and a hard, inflamed vessel in the affected leg. Symptoms for thrombophlebitis usually present about 10 days after birth. Symptoms of uterine atony are a soft fundus and hemorrhage from the vagina. Symptoms of mastitis, infection of the breast, include a painful, swollen, reddened breast; fever; and scant breast milk. Symptoms of subinvolution include an enlarged, soft uterus and lochial discharge.

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? postpartum infection postpartum blues postpartum hemorrhage postpartum depression

postpartum hemorrhage Explanation: Early postpartum hemorrhage can be assessed within the first few hours following birth. Postpartum infection may be noticed as a rise in temperature after the first 24 hours following birth. Postpartum blues and postpartum depression are emotional disorders noticed much later, in the days to weeks following birth.

A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? uterine prolapse uterine contraction uterine atony uterine subinvolution

uterine atony Explanation: Fundal massage is performed for uterine atony, which is failure of the uterus to contract and retract after birth. The nurse would place the gloved dominant hand on the fundus and the gloved nondominant hand on the area just above the symphysis pubis. Using a circular motion, the nurse massages the fundus with the dominant hand. Then the nurse checks for firmness and, if firm, applies gentle downward pressure to express clots that may have accumulated. Finally, the nurse assists the woman with perineal care and applying a new perineal pad.

The nurse is concerned that a postpartum client with a cervical laceration is developing hypovolemic shock. What did the nurse assess in this client? elevated blood pressure weak and rapid pulse warm and flushed skin decreased respiratory rate

weak and rapid pulse Explanation: If the loss of blood is extremely copious, a woman will quickly begin to exhibit symptoms of hypovolemic shock such as a weak and rapid pulse. The skin will be pale and clammy, and the blood pressure will fall. Respiratory rate will be increased and shallow.

After teaching a class of pregnant women on ways to decrease the postpartum complication of thrombotic conditions, the nurse recognizes more teaching is needed when one of the participants states: "At least I don't have to give up smoking for this one." "Using passive range-of-motion exercises in bed sounds easy enough." "I should drink more so I don't get dehydrated." "He has to do the deep breathing exercises with me."

"At least I don't have to give up smoking for this one." Explanation: Preventing thrombotic conditions is an important aspect of postpartum care and proper nursing management. There are many simple measures that can be utilized: encouraging leg exercises and walking; using intermittent sequential compression devices; stopping smoking to reduce or prevent vascular vasoconstriction; using compression stockings; performing passive range-of-motion exercises while in bed; using postoperative deep breathing exercises to improve venous return; and increasing fluid intake to prevent dehydration.

The nurse is administering a postpartum woman an antibiotic for mastitis. Which statement by the mother indicates that she understood the nurse's explanation of care? "I will stop breastfeeding until I finish my antibiotics." "I am able to pump my breast milk for my baby and throw away the milk." "I can continue breastfeeding my infant, but it may be somewhat uncomfortable." "When breastfeeding, it is recommended to begin nursing on the infected breast first."

"I can continue breastfeeding my infant, but it may be somewhat uncomfortable." Explanation: Breastfeeding on antibiotics for mastitis is fine, and the mother is encouraged to empty the infected breast to prevent milk stasis. However, the nurse should prepare the mother for the process being somewhat painful because the breast is tender. It is recommended to start the infant nursing on the uninvolved breast first as vigorous sucking may increase the mother's pain. Unless contraindicated by the antibiotic, the breast milk will be stored for later if the mother needs to pump her breasts; she does not need to throw the milk away.

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? "I will make handprints and footprints of the baby for you to keep." "I know you are hurting, but you can have another baby in the future." "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" "Have you named your baby yet? I would like to know your baby's name."

"I know you are hurting, but you can have another baby in the future." Explanation: Parents who have experienced a stillborn need support from the nursing staff. Statements by the nurses need to be therapeutic for the grieving parents. Statements that offer false hope or diminish the value of the stillborn child cause the parents pain. Telling them that they can have another child is both thoughtless and hurtful.

A postpartum woman is being discharged with anticoagulant therapy for treatment of deep vein thrombosis. After teaching the woman about this therapy, the nurse determines that the teaching was successful based on which statement? "I need to apply pressure to any cut for 5 to 10 minutes." "It's okay for me to use a regular razor to shave my legs." "I should avoid taking acetaminophen if I have a headache." "The medicine will make my stools turn black."

"I need to apply pressure to any cut for 5 to 10 minutes." Explanation: Anticoagulant therapy increases the woman's risk for bleeding. The statement about applying pressure to a cut would be correct. The woman should use an electric razor for shaving and avoid aspirin-containing products while on anticoagulant therapy. Black stools are not expected but indicate bleeding and should be reported.

The nurse is instructing a postpartum client on observations to report to the health care provider that could signify retained placental fragments. Which client statement indicates that teaching has been effective? "If the drainage changes from clear to bright red, I am to call the doctor." "I will have large amount of vaginal drainage for at least several months." "An elevated temperature is normal during the first few weeks after delivery." "My drainage will fluctuate between bright red and dark red for several weeks."

"If the drainage changes from clear to bright red, I am to call the doctor." Explanation: Because the hemorrhage from retained fragments may be delayed until after the client is home, instruct to observe the color of lochia and to report any tendency for the discharge to change from lochia serosa or alba back to rubra. The client will not have large amounts of drainage for several months. An elevated temperature indicates an infection. The drainage should not fluctuate between bright and dark red and could indicate retained placental fragments.

A client who gave birth vaginally 16 hours ago states she does not need to void at this time. The nurse reviews the documentation and finds that the client has not voided for 7 hours. Which response by the nurse is indicated? "I'll contact your health care provider." "It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness." "If you don't attempt to void, I'll need to catheterize you." "I'll check on you in a few hours."

"It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness." Explanation: After a vaginal birth, the client should be encouraged to void every 4 to 6 hours. As a result of anesthesia and trauma, the client may be unable to sense the filling bladder. It is premature to catheterize the client without allowing her to attempt to void first. There is no need to contact the care provider at this time as the client is demonstrating common adaptations in the early postpartum period. Allowing the client's bladder to fill for another 2 to 3 hours might cause overdistention.

After the nurse teaches a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful? "Postpartum psychosis usually appears soon after the woman comes home." "Postpartum depression develops gradually, appearing within the first 6 weeks." "Postpartum psychosis usually involves psychotropic drugs but not hospitalization." "Postpartum blues usually resolves by the 4th or 5th postpartum day."

"Postpartum depression develops gradually, appearing within the first 6 weeks." Explanation: Postpartum depression usually has a more gradual onset, becoming evident within the first 6 weeks postpartum. Postpartum blues usually peaks on the 4th to 5th postpartum day and resolves by the 10th day. Postpartum psychosis generally surfaces within 3 weeks of giving birth. Treatment typically involves hospitalization for up to several months. Psychotropic drugs are almost always a part of treatment, along with individual psychotherapy and support group therapy.

A health care provider is discussing the results of a recent sonogram with the client. A new diagnosis of uterine displacement is made. Which statement indicates a need for further teaching? "My bladder can enter into my vagina if the muscles of the vagina are weak." "You thought that I had a problem when doing my pelvic examination." "Kegel exercises may help strengthen my perineal muscles and decrease stress incontinence." "To eliminate the source of the problem, my uterus will have to be removed."

"To eliminate the source of the problem, my uterus will have to be removed." Explanation: When caring for a client experiencing a uterine displacement, the nurse should assess for urinary incontinence, dysmenorrhea, low back pain, infertility, recurrent vaginal infections, dyspareunia, varicose veins, and aching legs. When the client states that surgery is required to remove the uterus, this is not accurate. Only if there is extensive weakening with a cystocele (bladder) or rectocele would surgical intervention be needed. Removing the uterus is not the first option for treatment. Kegel exercises are often encouraged. A pelvic examination can identify uterine displacement.

Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis? "Stop breastfeeding until the pain and swelling subside." "You'll need to take this medication to stop the milk from being produced." "Try applying warm compresses to your breasts to encourage the milk to be released." "Limit the amount of fluid you drink so your breasts don't get much fuller."

"Try applying warm compresses to your breasts to encourage the milk to be released." Explanation: Warm compresses promote the let-down reflex, encouraging the milk to be released. They also provide comfort. With mastitis, breastfeeding is encouraged to empty the breasts and reverse milk stasis and to maintain the milk supply. Lactation is not suppressed. Fluid intake is important to ensure adequate milk supply. In addition, fluid intake is important when infection is present.

The nurse is providing education to a postpartum woman who has developed a uterine infection. Which statement by the woman indicates that further instruction is needed? "I will change my perineal pad regularly to remove the infected drainage." "I will take frequent walks around my home to promote drainage." "When I am sleeping or lying in bed, I should lie flat on my back." "If my abdomen becomes firm, or if I don't urinate as much, I need to call the doctor."

"When I am sleeping or lying in bed, I should lie flat on my back." Explanation: With a uterine infection, the client needs to be in a semi-Fowler position to facilitate drainage and prevent the infection from spreading. Changing the perineal pads regularly; walking to promote drainage; and contacting the doctor if her uterus becomes rigid (or if she notes a decrease in urinary output) are all correct actions.

The nurse is assigned to care for a postpartum client with a deep vein thrombosis (DVT) who is prescribed anticoagulation therapy. Which statement will the nurse include when providing education to this client? "It is appropriate for you to sit with your legs crossed over each other." "It is expected for you to have minimal blood in your urine during therapy." "You need to avoid medications which contain acetylsalicylic acid." "You can breastfeed your newborn while taking any anticoagulation medication."

"You need to avoid medications which contain acetylsalicylic acid." Explanation: The nurse should caution the client to avoid products containing acetylsalicylic acid, or aspirin, and other nonsteroidal anti-inflammatory medications while on anticoagulation therapy. These medications inhibit the synthesis of clotting factors and can further prolong clotting time and precipitate bleeding. The nurse should instruct the client to avoid crossing the legs as a preventive measure. Hematuria is not expected and indicates internal bleeding. The client would be instructed to notify the primary health care provider for any prolonged bleeding. The client may not be able to breastfeed while taking anticoagulation medications. Warfarin is not thought to be excreted in breastmilk; however, most medications are excreted in breast milk. Therefore, breastfeeding is generally not recommended for the client on anticoagulation therapy.

The nurse is caring for several postpartum clients and notes various warning signs that are concerning. Which client should the nurse suspect is developing endometritis? A. A woman with a history of infection and smoking, temperature 101°F (38.3°C) on the fourth postpartum day; reports severe perineal pain; edges of the episiotomy have separated. B. An obese woman with temperature 100.4°F (38°C) at 12 hours after birth; lochia is moderate; negative vaginal cultures. C. A woman with diabetes, vaginal birth, HR 110, temperature 101.7°F (38.7°C) on the third postpartum day. The next day, appears ill; temperature now 102.9°F (39.3°C); WBC 31,500/mm3; negative blood cultures. D. A woman with PROM before birth; reports severe burning with urination, malaise and severe temperature spikes on the 7th postpartum day. WBC is 21,850/mm3; temperature 101°F (38.3°C); skin pale and clammy.

A woman with diabetes, vaginal birth, HR 110, temperature 101.7°F (38.7°C) on the third postpartum day. The next day, appears ill; temperature now 102.9°F (39.3°C); WBC 31,500/mm3; negative blood cultures. Explanation: Endometritis is an infection of the endometrium of the uterus. Clinical manifestations include a fever of 100.4°F (38°C) or higher, usually between the 2nd and 10th day after delivery; tachycardia, chills, anorexia, and general malaise; client may also report abdominal cramping and pain. Reports of severe perineal pain and signs of fever and separation of the episiotomy edges would be suspicious for a wound infection. An elevated temperature of up to 100.4°F (38°C) within the first 24 hours is a normal response to the birthing process. Reports of severe burning on urination accompanied by fever and malaise would be suspicious of a UTI.

A nurse is assessing a client with postpartum 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. A. Assess the client's uterine tone. B. Monitor the client's vital signs. C. Assess the client's skin turgor. D. Get a pad count. E. Assess deep tendon reflexes.

A. Assess the client's uterine tone. B. Monitor the client's vital signs. D. Get a pad count. Explanation: A nurse should evaluate the efficacy of IV oxytocin therapy by assessing the uterine tone, monitoring vital signs, and getting a pad count. Assessing the skin turgor and assessing deep tendon reflexes are not interventions applicable to administration of oxytocin.

Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply. A. placental abruption (abruptio placentae) B. severe preeclampsia C. septicemia D. isoimmunization E. ectopic pregnancy

A. placental abruption (abruptio placentae) B. severe preeclampsia C. septicemia Explanation: DIC is not itself a specific illness; rather it is always a secondary diagnosis that occurs as a complication of placental abruption, anaphylactoid syndrome of pregnancy, intrauterine fetal death with prolonged retention of the fetus, acute fatty liver of pregnancy, severe preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), septicemia, and postpartum hemorrhage.

What is a risk factor for developing a postpartum infection? Select all that apply. A. type 1 diabetes B. thin build C. prolonged labor D. cesarean birth E. rupture of membranes at time of birth

A. type 1 diabetes C. prolonged labor D. cesarean birth Explanation: Several risk factors make it more likely for a postpartum woman to develop a wound infection. They include prolonged labor, prolonged ruptured membranes, obesity, history of chronic illnesses such as diabetes or hypertension, and a surgical incision from a cesarean birth. Hematomas and chorioamnionitis are also contributory factors.

The nurse is caring for a mother within the first four hours after a cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis in the mother? Roll a bath blanket or towel and place it firmly behind the knees. Limit oral intake of fluids for the first 24 hours to prevent nausea. Assist client in performing leg exercises every 2 hours. Ambulate the client as soon as her vital signs are stable.

Ambulate the client as soon as her vital signs are stable. Explanation: The best prevention for thrombophlebitis is ambulation as soon as possible after recovery. Ambulation requires blood movement throughout the cardiovascular system, decreasing thrombophlebitis risks. Placing a bath blanket behind the knees interrupts circulation and could cause a thrombus. Fluids are encouraged not limited. Leg exercises may put strain on the abdominal incision.

A postpartum woman is developing a thrombophlebitis in her right leg. Which assessments would the nurse make to detect this? Blanch a toe, and count the seconds it takes to color again. Assess for pedal edema. Bend her knee, and palpate her calf for pain. Ask her to raise her foot and draw a circle.

Assess for pedal edema. Explanation: Calf swelling, erythema, warmth, tenderness, and pedal edema may be noted and are caused by an inflammatory process and obstruction of venous return.

The nurse is monitoring a client who is 5 hours postpartum and notes her perineal pad has become saturated in approximately 15 minutes. Which action should the nurse prioritize? Initiate Ringer's lactate infusion. Assess the woman's vital signs. Call the woman's health care provider. Assess the woman's fundus.

Assess the woman's fundus. Explanation: The nurse should prioritize assessing the uterine fundus to eliminate it as a source of the bleeding. Assessing the vital signs would be the next step, especially if the massage is ineffective, to determine if the client is becoming unstable. The nurse would then alert the RN or health care provider about the increased bleeding and/or unstable vital signs. The LPN would not initiate an IV infusion without an order from the health care provider but should be prepared to do so, if it is ordered.

The nurse notes uterine atony in the postpartum client. Which assessment is completed next? Assessment of bowel function Assessment of the lung fields Assessment of the perineal pad Assessment of laboratory data

Assessment of the perineal pad Explanation: Uterine atony is a cause of postpartum hemorrhage due to the inability of the uterus to contract effectively. Assessment of the perineal pad for the characteristics and amount of bleeding is essential. It is important to monitor all postpartum women for excessive bleeding because two-thirds of the women who experience postpartum hemorrhage have no risk factors. Assessment of bowel and bladder function is routine in a postpartum assessment but not included in concerns for hemorrhage. Assessment of the lungs and any laboratory work is common but not as high of a concern.

Which assessment would lead the nurse to believe a postpartum woman is developing a urinary complication? At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. She says she is extremely thirsty. Her perineum is obviously edematous on inspection.

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. Explanation: Postpartum women who void in small amounts may be experiencing bladder overflow from retention.

The nurse is conducting discharge teaching with a postpartum woman. What would be an important instruction for this client? Call her caregiver if amount of lochia decreases. Call her caregiver if lochia moves from serosa to alba. Call her caregiver if lochia moves from serosa to rubra. Call her caregiver if lochia moves from rubra to serosa.

Call her caregiver if lochia moves from serosa to rubra. Explanation: Most cases of late postpartum hemorrhage occur after the woman leaves the health care or birthing facility. Therefore, client education before discharge about expected changes and danger signs and symptoms is crucial. Instruct the woman to call her primary care provider if she experiences any signs of infection, such as fever greater than 100.4°F (38°C), chills, or foul-smelling lochia. She should also report lochia that increases (versus decreasing) in amount, or reversal of the pattern of lochia (i.e., moves from serosa back to rubra).

The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal? Staphylococcus aureus Escherichia coli Gardnerella vaginalis Klebsiella pneumoniae

Escherichia coli Explanation: E. coli is the most common causative organism for urinary tract infections. S. aureus is the most common causative organism for mastitis. G. vaginalis is a common cause of metritis. K. pneumoniae is a common cause of endometritis, but some species of Klebsiella may cause urinary tract infections.

The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal? Staphylococcus aureus Escherichia coli Klebsiella pneumoniae Gardnerella vaginalis

Escherichia coli Explanation: E. coli is the most common causative organism for urinary tract infections. S. aureus is the most common causative organism for mastitis. G. vaginalis is a common cause of metritis. K. pneumoniae is a common cause of endometritis, but some species of Klebsiella may cause urinary tract infections.

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? Dehydration Normal vital signs Infection Shock

Infection Explanation: Temperatures elevated above 100.4° F (38° C) 24 hours after birth are indicative of possible infection. All but the temperature for this client are within normal limits, so they are not indicative of shock or dehydration.

The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? Place the client in a supine position with their arms overhead for the examination. Instruct the client to empty their bladder before the obstetric examination. Maintain client privacy and perform the obstetric examination quickly. Wear sterile gloves when assessing the pad for lochia and the perineum.

Instruct the client to empty their bladder before the obstetric examination. Explanation: An empty bladder facilitates the examination of the fundus. The client should be in a supine position with their arms at the sides and their knees bent. The arms-overhead position is unnecessary. Clean gloves should be used when assessing the perineum; sterile gloves are not necessary. The postpartum examination should not be done quickly. The nurse can take this time to teach the client about the changes in their body after birth.

The nurse assesses the client who is 1 hour postpartum and discovers a heavy, steady trickle of bright red blood from the vagina in the presence of a firm fundus. Which potential cause should the nurse question and report to the RN or primary care provider? Perineal hematoma Laceration Uterine atony Infection of the uterus

Laceration Explanation: A steady trickle of blood with a firm uterus is more likely to occur from a laceration rather than from the uterine atony. This type of bleeding is usually bright red in color rather than the dark red color of lochia. A perineal hematoma presents as a bulging, swollen mass on the perineum. Uterine infection typically presents with a foul smelling discharge.

What medication would the nurse administer to a client experiencing uterine atony and bleeding leading to postpartum hemorrhage? Oxytocin Magnesium sulfate Domperidone Calcium gluconate

Oxytocin Explanation: Oxytocin causes the uterus to contract to improve uterine tone and reduce bleeding. Magnesium sulfate is administered to clients with preeclampsia or eclampsia or hypertension problems. Domperidone is used to increase lactation in women. Calcium gluconate is an antagonist used in clients experiencing side effects of magnesium sulfate.

The nurse is monitoring several postpartum women for potential complications related to the birthing process. Which assessment should a nurse prioritize on an hourly basis? Complete blood count Vital signs Pad count Urine volume excreted

Pad count Explanation: The way to monitor for bleeding every hour is to assess pads and percentage of the pad saturated by blood in the previous hour. It would not be necessary to do a complete blood count every hour, nor hourly urines. Vital signs are not typically taken every hour.

The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize? Assess her blood pressure. Palpate her fundus. Have her turn to her left side. Assess her perineum.

Palpate her fundus. Explanation: The nurse should assess the status of the uterus by palpating the fundus and determining its condition. If it is boggy, the nurse would then initiate fundal massage to help it contract and encourage the passage of the lochia and any potential clots that may be in the uterus. Assessing the blood pressure and assessing her perineum would follow if indicated. It would be best if the woman is in the semi-Fowler position to allow gravity to help the lochia to drain from the uterus. The nurse would also ensure the bladder was not distended.

Which instruction should the nurse offer a client as primary preventive measures to prevent mastitis? Avoid massaging the breast area. Avoid frequent breastfeeding. Perform handwashing before breastfeeding. Apply cold compresses to the breast.

Perform handwashing before breastfeeding. Explanation: As a primary preventive measure to prevent mastitis, the nurse should instruct the client to perform good handwashing before breastfeeding. The nurse should instruct the client to frequently breastfeed to prevent engorgement and milk stasis. If the breast is distended before feeding, the nurse should instruct the client to apply cold (not warm) moist heat to the breast. Gently massaging the affected area of the breast also helps.

A nurse is caring for a client who has just given birth and notes that the client has developed shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and fatigue. The nurse interprets these findings as suggesting which of the following? Peripartum cardiomyopathy Uterine prolapse Hypovolemic shock Postpartum panic disorder

Peripartum cardiomyopathy Explanation: The nurse should know that the client is experiencing peripartum cardiomyopathy. Common presenting symptoms of this condition include shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and fatigue, though it is commonly overlooked. The signs and symptoms associated with hypovolemic shock include hypotension; tachycardia; decreased pulse pressure; cold, pale, clammy skin; cyanosis; oliguria; extreme thirst; apathy; lethargy; and confusion. Postpartum panic disorder is characterized by extreme anxiety, heart palpitations, hot or cold flashes, trembling, restlessness, agitation, and irritability. Uterine prolapse is characterized by dysmenorrhea, irregular periods, low back pain, infertility, recurrent vaginal infections, urinary incontinence, dyspareunia, varicose veins, and aching legs

The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response? Use of breast pumps Pierced nipple Complete emptying of the breast Frequent feeding

Pierced nipple Explanation: Certain risk factors contribute to the development of mastitis. These include inadequate or incomplete breast emptying during feeding or lack of frequent feeding leading to milk stasis; engorgement; clogged milk ducts; cracked or bleeding nipples; nipple piercing; and use of plastic-backed breast pads.

The father of a 2-week-old infant presents to the clinic with his disheveled wife for a postpartum visit. He reports his wife is acting differently, is extremely talkative and energetic, sleeping only 1 or 2 hours at a time (if at all), not eating, and appears to be totally neglecting the infant. The nurse should suspect the client is exhibiting signs and symptoms of which disorder? Postpartum blues Postpartum depression Postpartum psychosis Maladjustment

Postpartum psychosis Explanation: Postpartum psychosis in a client can present with extreme mood changes and odd behavior. Her sudden change in behavior from normal, along with a lack of self-care and care for the infant, are signs of psychosis and need to be assessed by a provider as soon as possible. Postpartum depression affects the woman's ability to function; however, her perception of reality remains intact. Postpartum blues is a transitory phase of sadness and crying common among postpartum women.

A postpartal client is diagnosed with peripartum cardiomyopathy. Which of the following instructions should the nurse offer when caring for this client? Avoid pressure on the breast tissue Consume a high fiber diet and plenty of fluids Refrain from breastfeeding your infant Perform Kegel's exercises

Refrain from breastfeeding your infant Explanation: When caring for a client with peripartum cardiomyopathy, the nurse should instruct the client to refrain from breastfeeding her infant because breastfeeding increases metabolic demands of lactation and the passage of many of the pharmacologic agents used to manage PPCM into breast milk. A nurse should instruct a client to consume a high fiber diet and plenty of fluids when caring for a client with rectocele to avoid constipation. The nurse instructs a client with mastitis to avoid putting pressure on the breast tissue. Kegel exercises are helpful in strengthening the pubococcygeal muscle.

A nurse is caring for a postpartum client whose most recent assessment reveals a large, purplish area of edema on the left side of the perineum. What action will the nurse take? Report the finding promptly to the primary health care provider. Apply an ice pack and reassess in 30 minutes. Provide a hot pack and administer analgesia as prescribed. Document the expected finding and reassess frequently.

Report the finding promptly to the primary health care provider. Explanation: This client's presentation is consistent with a hematoma, which indicates a hemorrhage and which must be treated promptly. Because this is a large hematoma, reporting this change in status is priority. If the hematoma had been small in size, hot and/or cold treatments will likely be used. This is not an expected finding; thus, the nurse needs to intervene.

A woman arrives at the office for her 4-week postpartum visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which nursing diagnosis is most likely for this client? Risk for fatigue related to chronic bleeding due to subinvolution Risk for infection related to microorganism invasion of episiotomy Risk for impaired breastfeeding related to development of mastitis Ineffective peripheral tissue perfusion related to interference with circulation secondary to development of thrombophlebitis

Risk for fatigue related to chronic bleeding due to subinvolution Explanation: Subinvolution is incomplete return of the uterus to its prepregnant size and shape. With subinvolution, at a 4- or 6-week postpartal visit, the uterus is still enlarged and soft. Lochial discharge usually is still present. The symptoms in the scenario are closest to those of subinvolution.

The nurse is caring for a postpartum woman who is diagnosed with endometritis. Which position should the nurse encourage the client to maintain? Flat in bed On her left side Trendelenburg Semi-Fowler

Semi-Fowler Explanation: A semi-Fowler position encourages lochia to drain so it will not become stagnant and cause further infection. Placing the woman flat in bed, on her left side, or in the Trendelenburg position would not accomplish this goal and could result in the infection spreading to other parts of the body.

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? Escherichia coli group B streptococcus (GBS) Staphylococcus aureus Streptococcus pyogenes (group A strep)

Staphylococcus aureus Explanation: The most common cause of mastitis is S. aureus, transmitted from the neonate's mouth. Mastitis is not harmful to the neonate. E. coli, GBS, and S. pyogenes are not associated with mastitis. GBS infection is associated with neonatal sepsis and death.

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? The most common pathogen is group A streptococcus (GAS). A breast abscess is a common complication of mastitis. Mastitis usually develops in both breasts of a breastfeeding client. Symptoms include fever, chills, malaise, and localized breast tenderness.

Symptoms include fever, chills, malaise, and localized breast tenderness. Explanation: Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

A nurse is caring for a postpartum client who has been treated for deep vein thrombosis (DVT). Which prescription would the nurse question? Wear compression stockings. Plan long rest periods throughout the day. Take aspirin as needed. Take an oral contraceptive pill daily.

Take an oral contraceptive pill daily. Explanation: When caring for a client with DVT, the nurse should instruct the client to avoid using oral contraceptives. Cigarette smoking, use of oral contraceptive pills, sedentary lifestyle, and obesity increase the risk for developing DVT. The nurse should encourage the client with DVT to wear compression stockings. The nurse should instruct the client to avoid using products containing aspirin when caring for clients with bleeding, but not for clients with DVT. Prolonged rest periods should be avoided. Prolonged rest involves staying motionless; this could lead to venous stasis, which needs to be avoided in cases of DVT.

The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse? Teach that adequate hydration helps clear the infection quicker. Instruct to use a sit bath while voiding. Advise her to take acetaminophen to ease symptoms. Ask primary care provider to prescribe an analgesic.

Teach that adequate hydration helps clear the infection quicker. Explanation: Adequate hydration is necessary to dilute the bacterial concentration in the urine and aid in clearing the organisms from the urinary tract. Encourage the woman to drink at least 3000 ml of fluid a day, suggesting she drink one glass per hour. Drinking fluid will make the urine acidic, deterring organism growth. The other choices are also options but address the symptoms and not the root cause. The goal should be to rid the body of the infection, not concentrate on counteracting the results of the infection.

The nurse instructs a client on actions to prevent postpartum depression. During a home visit, which observation indicates that instruction has been effective? The client appears disheveled and listless. The client complains of fatigue. The client is chatting on the telephone with a friend. The client is cleaning the kitchen while the baby naps.

The client is chatting on the telephone with a friend. Explanation: Chatting on the phone with friends indicates that the client is not becoming isolated with baby care. This will help prevent the onset of postpartum depression. Fatigue, listlessness, and trying to be perfect with cleaning are observations that could indicate postpartum depression.

The nurse receives a report on a client who gave birth to a healthy neonate 1 hour ago. What data are most important to monitor during the immediate postpartum period for this client? intake and output height of fundus temperature and blood pressure blood glucose level

height of fundus Explanation: A complete obstetric examination should be performed every 15 minutes for the first 1 to 2 hours postpartum. The most important assessment is determining the location of the fundus. It is important to monitor uterine involution and assessment of the amount of lochia. The perineum is assessed, especially if an episiotomy is completed. Pulse and blood pressure provide secondary information to determine if bleeding is present. A blood glucose level must be obtained only if the client has risk factors for an unstable blood glucose level or if the client has symptoms of an altered blood glucose level. Intake and output are followed, but that assessment is not a priority at this time. Some clients have very little intake within the early postpartum period.

The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor? increased vaginal acidity leading to growth of bacteria loss of protection with premature rupture of membranes prolonged labor with multiple vaginal examinations to evaluate progress retained placental fragments

increased vaginal acidity leading to growth of bacteria Explanation: Vaginal acidity is decreased due to the presence of amniotic fluid, blood, and lochia, all of which are alkaline. An alkaline environment encourages the growth of bacteria. With rupture of membranes, the barrier is removed, allowing bacteria to ascend through the internal genital structures. A prolonged labor with multiple vaginal examinations provides opportunities for exposure to organisms, with time for the bacteria to multiply. Retained placental fragments provide an excellent medium for bacterial growth.

A client presents to her postpartum appointment with vague reports. The nurse suspects postpartum depression based on which assessment finding? She feels like eating all the time. lack of pleasure She is over her interest in her baby. extreme periods of elation

lack of pleasure Explanation: Some signs and symptoms of postpartum depression include feeling restless, worthless, guilty, hopeless, moody, sad, overwhelmed; crying a lot; exhibiting a lack of energy and motivation; experiencing a lack of pleasure; changes in appetite, sleep, or weight; withdrawing from friends and family; feeling negatively toward her baby; or showing lack of interest in her baby.

An Rh-positive client gives birth vaginally to a 6 lb, 10 oz (3,005 g) neonate after 17 hours of labor. Which condition puts this client at risk for infection? length of labor maternal Rh status method of birth size of the neonate

length of labor Explanation: The prolonged length of labor places the mother at increased risk for developing an infection. The average size of the neonate, the vaginal birth, and Rh status of the client do not place this mother at increased risk.

When monitoring a postpartum client 2 hours after birth, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? notifying the primary care provider performing bimanual compressions massaging the fundus firmly administering ergonovine

massaging the fundus firmly Explanation: Initial management of excessive postpartum bleeding is firm massage of the fundus and administration of oxytocin. Bimanual compression is performed by a primary health care provider. Ergonovine maleate should be used only if the bleeding does not respond to massage and oxytocin. The primary health care provider should be notified if the client does not respond to fundal massage, but other measures can be taken in the meantime.

The nurse is assessing the breast of a woman who is 1 month postpartum. The woman reports a painful area on one breast with a red area. The nurse notes a local area on one breast to be red and warm to touch. What should the nurse consider as the potential diagnosis? breast yeast mastitis plugged milk duct engorgement

mastitis Explanation: Mastitis usually occurs 2 to 3 weeks after birth and is noted to be unilateral. Mastitis needs to be assessed and treated with antibiotic therapy

A nurse is conducting a class for nurses working in the postpartum unit about ways to reduce the risk of postpartum infections. The nurse determines that the teaching was effective when the group identifies which preventive measure as essential? meticulous handwashing use of clean gloves for invasive procedures unlimited visitation from family and friends fluid intake limitations

meticulous handwashing Explanation: Meticulous handwashing is essential for preventing postpartum infections, including before and after each client care activity. Aseptic technique, not clean gloves, are needed when performing invasive procedures. All visitors should be screened for any signs of active infection to reduce the risk for exposure. Adequate hydration, not fluid limitations, would be appropriate

A nurse is caring for a client in the clinic. The client reports burning during urination for the past few days. Assessment reveals cloudy urine, with the presence of white blood cells (WBCs). Vital signs: temperature, 101.4°F (38.5°C); heart rate, 101 beats/min; blood pressure, 100/64 mm Hg. Complete the following sentence(s) by choosing from the lists of options. The priority actions of the nurse should be to first Select...obtain a cultureadminister antibioticsrecheck the client's temperatureobtain a culture followed by Select...initiate antibioticsencourage intake of fluidsadminister nonsteroidal anti-inflammatory drug (NSAID)initiate antibiotics

obtain a culture initiate antibiotics Explanation: The nurse should first obtain a culture for sensitivity before administering antibiotics. Once the culture has been obtained, the nurse should administer a broad-spectrum antibiotic per provider prescription. Rechecking the client's temperature is not necessary. An antibiotic should not be administered until a culture has been obtained. The priorities for this client would be to first obtain a culture, then administer a broad-spectrum antibiotic. The nurse will encourage fluid intake, but this is not the priority. A nonsteroidal anti-inflammatory drugs (NSAID) can be administered for fever, but the priority is to obtain a culture and start the client on a broad-spectrum antibiotic to start treating the infection.

The nurse is observing a client who gave birth yesterday. Where should the nurse expect to find the top of the client's fundus? below the symphysis pubis at the level of the umbilicus one fingerbreadth below the umbilicus one fingerbreadth above the umbilicus

one fingerbreadth below the umbilicus Explanation: After a client gives birth, the height of her fundus should decrease by about one fingerbreadth (about 1 cm) each day. So by the end of the first postpartum day, the fundus should be one fingerbreadth below the umbilicus. Immediately after birth, the fundus may be above the umbilicus; 6 to 12 hours after birth, it should be at the level of the umbilicus; , 10 days after birth, it should be below the symphysis pubis

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 magnesium sulfate indomethacin nifedipine

oxytocin agent Explanation: The nurse should administer a prescribed oxytocin agent to the client after repositioning the uterine fundus because it causes uterine contractions preventing reinversion and decreasing blood loss. The nurse should administer prescribed medications such as magnesium sulfate, indomethacin, and nifedipine, which are uterine relaxants that help in the repositioning of the uterus. These drugs are administered during the repositioning of the uterus and not after in case of uterine inversion.

Which finding(s) leads the nurse to suspect that a postpartum woman has developed endometritis? Select all that apply. pain on both sides of the abdomen foul-smelling lochia hematuria flank pain leukocytosis

pain on both sides of the abdomen foul-smelling lochia Explanation: Signs and symptoms of endometritis can include lower abdominal tenderness or pain on one or both sides, foul-smelling lochia, elevated temperature, accompanying chills, loss of appetite, and general malaise. Leukocytosis may already be present and related to the birthing process, so it is not of significant value in the puerperium. Hematuria and flank pain would be associated with a urinary tract infection.

Which disorder is described as a transient, self-limiting mood disorder that affects postpartum clients after birth? postpartum blues postpartum psychosis postpartum depression postpartum bipolar disorder

postpartum blues Explanation: Postpartum blues is manifested by mild depressive symptoms of anxiety, irritability, mood swings, tearfulness, increased sensitivity, feelings of being overwhelmed, and fatigue. This disorder is usually self-limiting and requires no formal treatment other than reassurance and validation of the client's experience as well as assistance in caring for oneself and the newborn. Postpartum depression is a major depressive episode associated with birth. Postpartum psychosis is at the severe end of the continuum of postpartum emotional disorders. Bipolar disorder refers to a mood disorder typically involving episodes of depression and mania. It can be first diagnosed during pregnancy or the postpartum period.

A nurse is caring for a pregnant client. The client has been diagnosed with uterine fibroids. The nurse knows that which of the following is likely to occur in this client in the postpartum period? urinary tract infection postpartum infections postpartum hemorrhage altered uterine contractility

postpartum hemorrhage Explanation: The nurse should know that a client with uterine fibroids or other uterine anomalies is likely to experience postpartum hemorrhage. Altered uterine contractility is one of the risk factors that will lead to postpartum hemorrhage. Altered uterine contractility does not occur as a result of uterine fibroids. Endometritis is the primary cause of postpartum infections. Postpartum infections are not caused by uterine fibroids. Uterine fibroids are not known to cause urinary tract infections.

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 the client 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 condition? postpartum psychosis postpartum depression postpartum panic disorder postpartum blues

postpartum psychosis Explanation: The client's signs and symptoms suggest that the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the newborn, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that life is rapidly tumbling out of control. The client thinks of oneself as an incompetent parent. Emotional swings, crying easily—often for no reason—and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristic of postpartum blues.

The nurse is performing a focused assessment on a client who is 2 days postpartum. The client reports pelvic pain, chills, profuse dark, foul-smelling lochia with blood clots. The client states, "my bleeding before was light and now it is heavy." Vital signs: temperature, 99.5°F (37.5°C); heart rate, 102 beats/min; blood pressure, 100/66 mm Hg. Complete the following sentence(s) by choosing from the lists of options. The nurse suspects the client has Select...retained fragments of placentapuerperal infectionurinary tract infection (UTI)urinary tract infection (UTI) as evidenced by Select...pelvic paintemperature 99.5°F (37.5°C)heart rate 102 beats/mintemperature 99.5°F (37.5°C) and Select...profuse dark lochia with blood clotsblood pressure 100/66 mm Hgdecreased appetiteprofuse dark lochia with blood clots

retained fragments of placenta pelvic pain profuse dark lochia with blood clots Endometritis is an infection of the uterine lining that may occur on the second to the fifth day postpartum. Signs and symptoms of endometritis include pelvic pain; malodorous dark, profuse lochia; and a low-grade fever. Retained fragments of the placenta can occur when the placenta does not come out whole. The symptoms of retained pieces are delayed and heavy bleeding with clots, foul-smelling vaginal discharge, fever, chills, and feeling sick or flulike. The client would have had severe symptoms 2 days postpartum. Pelvic pain 2 days postpartum may indicate retained fragments of placenta. Foul-smelling lochia 2 days postpartum is a sign of retained fragments of placenta. Signs and symptoms of urinary tract infection (UTI) include dysuria, pelvic pain (cystitis), or costovertebral pain if the infection is in the kidney (pyelonephritis). Signs and symptoms of puerperal infections include flulike symptoms such as high fevers, chills, malaise, and anorexia. A heart rate of 102 beats/min is slightly above average, most likely due to the low-grade fever. Although a temperature of 99.5°F (37.5°C) is a low-grade fever that may occur in endometritis, this is not the best answer. A blood pressure of 100/66 mm Hg has nothing to do with retained placenta fragments. Decreased appetite has nothing to do with retained placenta fragments.

Eight days after birth, the woman notices a return to red lochia. What condition does the nurse anticipate this client is experiencing? retained placental fragments genital tract infection perineal hematoma rupture disseminate intravascular coagulopathy

retained placental fragments Explanation: Late postpartum hemorrhage is usually due to retained placental fragments, which separate from the uterine wall. An intrauterine infection may result from the retained tissue providing a medium for bacterial growth inside the uterus. A perineal hematoma is seen within 24 hours of the birth. If the client has a clotting disorder, bleeding would be a continuous problem and not an acute episode for one day.

Effective nursing management involves many aspects and being aware of subtle changes in the client. Which finding should alert the nurse to a potential infection in the client? temperature of 38°C (100.4°F) or higher after the first 24 hours after birth temperature of 37.5°C (99.5°F) or higher after the first 12 hours after birth temperature of 39°C (102.2°F) or higher after the first 48 hours after birth temperature of 38.5°C (101.3°F) or higher after the first 36 hours after birth

temperature of 38°C (100.4°F) or higher after the first 24 hours after birth Explanation: Postpartum infection is defined as a fever of 38°C or 100.4°F or higher after the first 24 hours after birth, occurring on at least two of the first 10 days after birth, exclusive of the first 24 hours.

The nurse would be alert for which of the following complications when caring for a 38-year-old postpartum client with a history of obesity and diabetes? uterine prolapse thromboembolic complications septic pelvic thrombophlebitis postpartum infections

thromboembolic complications Explanation: The nurse should monitor the client for thromboembolic complications. The risk for thromboembolic complications increase when the client is older than 35, is obese, and has a history of diabetes or a pre-existing cardiovascular disease. Uterine prolapse occurs more commonly in perimenopausal clients. A client diagnosed with a puerperal infection is at increased risk for septic pelvic thrombophlebitis. Endometritis is the primary cause of postpartum infections.

A client who gave birth several hours ago is experiencing postpartum hemorrhage. She had a cesarean birth and received deep, general anesthesia. She has a history of postpartum hemorrhage with her previous births. The blood is a dark red. Which cause of the hemorrhage is most likely in this client? uterine atony cervical laceration retained placental fragment disseminated intravascular coagulation

uterine atony Explanation: Uterine atony, or relaxation of the uterus, is the most frequent cause of postpartum hemorrhage; it tends to occur most often in Asian or Hispanic woman. Conditions that contribute to uterine atony include having received deep anesthesia or analgesia and a prior history of postpartum hemorrhage. A cervical laceration is less likely because the blood is dark, not bright red, and bleeding from such a laceration usually occurs immediately after detachment of the placenta. Disseminated intravascular coagulation is typically associated with premature separation of the placenta, a missed early miscarriage, or fetal death, none of which is evident in this scenario. A retained placental fragment is possible, and could contribute to the atony, but there is no evidence for this in the scenario.

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? a) Uterine bleeding present b) Pain in the lower abdomen c) Foul smelling lochia d) Uterine protrusion into the vagina

uterine protrusion into the vagina Explanation: To determine if the uterine prolapse in the client is mild or severe, the nurse should assess for uterine protrusion of the cervix and uterus into the vagina. As more of the uterus descends, the vagina becomes inverted. Uterine bleeding, foul-smelling lochia, and pain or tenderness in the lower abdomen are all characteristic manifestations of late postpartum hemorrhage.

Which complication is most likely responsible for a late postpartum hemorrhage? uterine subinvolution clotting deficiency perineal laceration cervical laceration

uterine subinvolution Explanation: Late postpartum bleeding is usually the result of subinvolution of the uterus. Retained products of conception or infection commonly cause subinvolution. Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency may have an immediate postpartum hemorrhage if the deficiency is not corrected at the time of birth.

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? venous duplex ultrasound of the right leg transthoracic echocardiogram noninvasive arterial studies of the right leg venogram of the right leg

venous duplex ultrasound of the right leg Explanation: Right calf pain and nonpitting edema may indicate deep vein thrombosis (DVT). Postpartum clients and clients who have had abdominal surgery are at increased risk for DVT. Venous duplex ultrasound is a noninvasive test that visualizes the veins and assesses blood flow patterns. A venogram is an invasive test that utilizes dye and radiation to create images of the veins and wouldn't be the first choice. Transthoracic echocardiography looks at cardiac structures and isn't indicated at this time. Right calf pain and edema are symptoms of venous outflow obstruction, not arterial insufficiency.