OB Exam 4

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? 100 mL 250 mL 300 mL 500 mL

500 mL Explanation: Postpartum hemorrhage is defined as a blood loss of greater than 500 mL after a vaginal birth or more than 1,000 mL after a cesarean birth.

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.

A client presents to her postpartum appointment with vague reports. The nurse suspects postpartum depression based on which assessment finding? feels like eating all the time lack of pleasure over 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, cry a lot, exhibit a lack of energy and motivation, experience a lack of pleasure, changes in appetite, sleep, or weight, withdraw from friends and family, feel negatively toward her baby, or shows lack of interest in her baby.

A postpartum client with a history of deep vein thrombosis is being discharged on anticoagulant therapy. The nurse teaches the client about the therapy and measures to reduce her risk for bleeding. Which statement by the client indicates the need for additional teaching? "If my lochia increases, I need to call my health care provider." "I should brush my teeth vigorously to stimulate the gums." "I need to avoid using any aspirin-containing products." "If I get a cut, I need to apply direct pressure for about 5 minutes or more."

"I should brush my teeth vigorously to stimulate the gums." Explanation: The client is at risk for bleeding and as such should gently brush her teeth with a soft toothbrush to prevent injury. An increase in lochia warrants notification of the health care provider. Aspirin and aspirin-containing products should be avoided. If the client experiences a cut that bleeds, she should apply direct pressure to the site for 5 to 10 minutes.

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.

What postpartum client should the nurse monitor most closely for signs of a postpartum infection? A client who had a nonelective cesarean birth A primaparous 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.

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

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.

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

It is discovered that a new mother has developed a puerperal infection. What is the most likely expected outcome that the nurse will identify for this client related to this condition? Client's temperature remains below 100.4° F or 38° C orally. Fundus remains firm and midline with progressive descent. Client maintains a urinary output greater than 30 mL per hour. Lochia discharge amount is 6 inches or less on a perineal pad in 1 hour.

Client's temperature remains below 100.4° F or 38° C orally. Explanation: As fever would accompany a puerperal infection, a likely expected outcome would be to reduce the client's temperature and keep it in a normal range. The other expected outcomes do not pertain as directly to puerperal infection as does the reduced temperature.

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 beta-hemolytic streptococci (GBS) Staphylococcus aureus Streptococcus pyogenes

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 administers methylergonovine 0.2 mg to a postpartal woman with uterine subinvolution. Which assessment should the nurse make prior to administering the medication? Her urine output is over 50 mL/h. Her blood pressure is below 140/90 mm Hg. She can walk without experiencing dizziness. Her hematocrit level is over 45%.

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

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

Massaging the fundus firmly 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. Ergotrate 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 palpates a postpartal woman's fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding? The uterine placement is normal. The uterus is filling up with blood. The bladder is distended. There is an infection inside the uterus.

The bladder is distended. Explanation: If a postpartal client's bladder becomes full, the client's uterus is displaced to the side. The client should be taught to void on demand to prevent the uterus from becoming soft and increasing the flow of lochia.

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

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.

The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders? drop in estrogen and progesterone levels after birth lack of social support from family or friends medications used during labor and birth preexisting conditions in the client

drop in estrogen and progesterone levels after birth Explanation: Plummeting levels of estrogen and progesterone immediately after birth can contribute to postpartum mood disorders. It is believed that the greater the change in these hormone levels between pregnancy and postpartum, the greater the change for developing a mood disorder. Lack of support, medications, and preexisting conditions may contribute but are not the main etiology.

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

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.

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 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? "If you don't attempt to void, I'll need to catheterize you." "It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness." "I'll contact your health care provider." "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.

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. "I am sad because I am not spending as much time with my toddler now that my newborn is here." "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." "The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider."

"The newborn is not really mine emotionally, since I was never pregnant and do not have children." "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." "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 internvention. 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 pscyhosis. 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 is caring for a client within the first four hours after her cesarean birth. Which nursing intervention would be most appropriate to prevent thrombophlebitis? 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 two 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 a 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.

The nurse observes an ambulating postpartal woman limping and avoiding putting pressure on her right leg. Which assessments should the nurse prioritize in this client? Bend the knee and palpate the calf for pain. Ask the client to raise the foot and draw a circle. Blanch a toe, and count the seconds it takes to color again. Assess for warmth, erythema, and pedal edema.

Assess for warmth, erythema, and pedal edema. Explanation: This client is demonstrating potential symptoms of DVT, but is avoiding putting pressure on the leg and limping when ambulating. DVT manifestations are caused by inflammation and obstruction of venous return and can be assessed by the presence of calf swelling, warmth, erythema, tenderness, and pedal edema. The client would not need to bend the knee to assess for pain in the calf. Asking the client to raise her toe and draw a circle is assessing reflexes, and blanching a toe is assessing capillary refill (which may be affected by the DVT but is not indicative of a DVT).

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 is monitoring the woman who is 1 hour postpartum and notes on assessment the uterine fundus is boggy, to the right, and approximately 2 cm above the umbilicus. The nurse would conclude this is most likely related to which potential complication? Urinary infection Excessive bleeding A ruptured bladder Bladder distention

Bladder distention Explanation: The displacement of the uterus to one side is suggestive of bladder distension. The bladder should be emptied and then fundal massage instituted to encourage the uterus to contract and stop the excessive bleeding. If the uterus was in the midline, then this would be related solely to uterine bleeding. It's important to ensure the bladder is empty before starting the fundal massage to ensure the uterus will stay contracted. A urinary infection would be noted to cause burning on urination. A ruptured bladder would be indicative of hematuria as well as pelvic pain.

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

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.

A postpartal woman is developing thrombophlebitis in her right leg. Which assessment should the nurse no longer use to assess for thrombophlebitis? Assess for reddness and warmth. Ask about increased pain with weight bearing. Ask if she has pain or tenderness in the lower extremities. Dorsiflex her right foot and ask if she has pain in her calf.

Dorsiflex her right foot and ask if she has pain in her calf. Explanation: A positive Homans' sign (pain in the upper calf upon dorsiflexion) is not a definitive diagnostic sign as it is insensitive and nonspecific and is no longer recommended as an indicator of DVT. That is because calf pain can also be caused by other conditions. Ask the woman if she has pain or tenderness in the lower extremities and assess for reddness and warmth and if she has increased pain when she ambulates or bears weight.

Which nursing diagnosis would be most appropriate for a client with a postpartum hematoma? Impaired urinary elimination Ineffective tissue perfusion Deficient fluid volume Impaired tissue integrity

Impaired urinary elimination Explanation: Due to the nature and location of a postapartum hematoma, impaired urinary elimination would be the best choice. Urination is impaired from swelling. Ineffective tissue perfusion and impaired tissue integrity are nursing diagnoses associated with postpartum lacerations. Deficient fluid volume is a nursing diagnoses associated with postpartum hemorrhage. In addition to risk for injury and pain, another appropriate nursing diagnosis would be risk for impaired urinary elimination related to pressure from the hematoma on urinary structures.

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.

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? Breast yeast Mastitis Plugged milk duct Engorgement

Mastitis Explanation: Mastitis usually occurs 2 to 3 weeks after birth and is noted to be unilateral. Assessment should reveal a localized reddened area which is warm and painful to palpation. The scenario described is not indicative of a plugged milk duct or engorgement. Yeast is not recognized to cause mastitis.

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 - 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.

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 nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and she frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition? postpartum psychosis postpartum blues postpartum depression postpartum panic disorder

Postpartum psychosis - 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 infant, 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 her life is rapidly tumbling out of control. The client thinks of herself 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 characteristics of postpartum blues.

The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about mastitis. What would be the nurse's best response? Risk factors include breast pumps. Risk factors include nipple piercing. Risk factors include complete emptying of the breast. Risk factors include frequent feeding.

Risk factors include nipple piercing. 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.

A woman arrives at the office for her 4-week postpartal visit. Her uterus is still enlarged and soft, and lochial discharge is still present. Which 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.

Which recommendation should be given to a client with mastitis who is concerned about breast-feeding her neonate? She should stop breast-feeding until completing the antibiotic. She should supplement feeding with formula until the infection resolves. She should not use analgesics because they are not compatible with breast-feeding. She should continue to breast-feed; mastitis will not infect the neonate.

She should continue to breast-feed; mastitis will not infect the neonate. Explanation: The client with mastitis should be encouraged to continue breast-feeding while taking antibiotics for the infection. No supplemental feedings are necessary because breast-feeding does not need to be altered and actually encourages resolution of the infection. Analgesics are safe and should be administered as needed.

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? The most common pathogen is group A beta-hemolytic streptococci. 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. 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.

Which situation should concern the nurse treating a postpartum client within a few days of birth? The client is nervous about taking the baby home. The client feels empty since she gave birth to the neonate. The client would like to watch the nurse give the baby her first bath. The client would like the nurse to take her baby to the nursery so she can sleep.

The client feels empty since she gave birth to the neonate. Explanation: A client experiencing postpartum blues may say she feels empty now that the infant is no longer in her uterus. She may also verbalize that she feels unprotected now. The other options are considered normal and would not be cause for concern. Many first-time mothers are nervous about caring for their neonates by themselves after discharge. New mothers may want a demonstration before doing a task themselves. A client may want to get some uninterrupted sleep, so she may ask that the neonate be taken to the nursery.

Which instruction would the nurse include in the teaching plan for a postpartal client with a history of thromboembolism to reduce the risk of a recurrence? Refrain from performing leg exercises. Wear support hose or antiembolic stockings. Flex the muscles at the groin. Avoid pressure on the thigh muscles.

Wear support hose or antiembolic stockings - When caring for a postpartal client with a history of a thromboembolic disorder, the nurse should instruct the client to wear support hose or antiembolic stockings. The nurse should instruct the client specifically to perform leg exercises such as flexion and extension of the feet and pushing the back of the knees into the mattress and then flexing slightly. The nurse should instruct the client to refrain from flexing the muscles at the groin, and the nurse should instruct the client to avoid pressure at the back of the knees, not on the thigh muscles.

A nurse is assigned to care for a client with lacerations. The nurse knows that which factor would be the most likely cause of lacerations of the genital tract? history of hypertension birth of a large newborn excessive traction on umbilical cord development of endometritis

birth of a large newborn Explanation: The nurse knows that lacerations of the genital tract may occur with the birth of a large infant. Other risk factors for lacerations include forceps or vacuum birth, precipitous second stage, and rapid expulsion. Scarring from prior gynecologic or birth events and vulvar, perineal, or vaginal varicosities increase the incidence of lacerations. When the client experiences excessive traction on the umbilical cord coupled with rapid expulsion of the uterine contents, it leads to uterine inversion and not lacerations of the genital tract. Endometritis is the primary cause of postpartum infections; it is not known to lead to lacerations of the genital tract.

A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. inability to concentrate loss of confidence manifestations of mania decreased interest in life bizarre behavior

inability to concentrate loss of confidence decreased interest in life Explanation: The nurse should monitor the client for symptoms such as inability to concentrate, loss of confidence, and decreased interest in life to verify the presence of postpartum depression. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis.

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? hemoglobin level of 12 g/dL uterine atony thrombophlebitis moderate amount of lochia rubra

uterine atony Explanation: Multiparous women typically experience a loss of uterine tone due to frequent distentions of the uterus from previous pregnancies. As a result, this client is also at higher risk for hemorrhage. Thrombophlebitis does not increase the risk of hemorrhage during the postpartum period. The hemoglobin level and lochia flow are within acceptable limits.