OB PrepU Chapter 22

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? a. Shock b. Dehydration c. Normal vital signs d. Infection

d. Infection

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

b. 1000 mL

The LPN has reported that uterine massage is ineffective on a client. The nurse anticipates the health care provider will prescribe which medication to address this issue? a. Penicillin b. Digoxin c. Oxytocin d. Ibuprofen

c. Oxytocin

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

b. Assess for pedal edema.

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

b. Assessment of the perineal pad

The nursing instructor is leading a discussion exploring the various conditions that can result in postpartum hemorrhage. The instructor determines the session is successful when the students correctly choose which condition is most frequently the cause of postpartum hemorrhage? a. Disseminated intravascular coagulation b. Perineal lacerations c. Hematoma d. Uterine atony

d. Uterine atony

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? a. Call the woman's health care provider. b. Initiate Ringer's lactate infusion. c. Assess the woman's fundus. d. Assess the woman's vital signs.

c. Assess the woman's fundus.

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? a. "If my lochia increases, I need to call my health care provider." b. "I should brush my teeth vigorously to stimulate the gums." c. "I need to avoid using any aspirin-containing products." d. "If I get a cut, I need to apply direct pressure for about 5 minutes or more."

b. "I should brush my teeth vigorously to stimulate the gums."

A nurse is a caring for a postpartum client. What instruction should the nurse provide to the client as a precautionary measure to prevent thromboembolic complications? a. Refrain from elevating legs above heart level. b. Avoid sitting in one position for long periods of time. c. Try to relax with pillows under knees. d. Avoid performing any deep-breathing exercises.

b. Avoid sitting in one position for long periods of time.

When teaching a postpartum client about possible complications following the birth, which would be the best information to include? a. Alteration in normal maternal hormonal function b. Interference with the maternal-newborn attachment process c. Delayed development of the newborn d. Ineffectiveness of breastfeeding

b. Interference with the maternal-newborn attachment process

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? a. Assess her blood pressure. b. Palpate her fundus. c. Have her turn to her left side. d. Assess her perineum.

b. Palpate her fundus.

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

c. She should continue to breastfeed; mastitis will not infect the neonate.

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

d. uterine atony

A nurse is assessing a client with postpartal hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply. a. Assess the client's uterine tone. b. Get a pad count. c. Assess deep tendon reflexes. d. Monitor the client's vital signs. e. Assess the client's skin turgor.

a. Assess the client's uterine tone. b. Get a pad count. d. Monitor the client's vital signs.

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: a. "I should drink more so I don't get dehydrated." b. "He has to do the deep breathing exercises with me." c. "At least I don't have to give up smoking for this one." d. "Using passive range-of-motion exercises in bed sounds easy enough."

c. "At least I don't have to give up smoking for this one."

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

d. "It's not uncommon after birth for you to have a full bladder even though you can't sense the fullness."

The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? a. 750 mL b. 300 mL c. 1000 mL d. 500 mL

d. 500 mL

The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? a. Wear sterile gloves when assessing the pad and perineum. b. Place the client in a supine position with her arms overhead for the examination of her breasts and fundus. c. Perform the examination as quickly as possible. d. Instruct the client to empty her bladder before the examination.

d. Instruct the client to empty her bladder before the examination.

The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. How should the nurse respond? a. Frequent feeding b. Complete emptying of the breast c. Use of breast pumps d. Pierced nipple

d. Pierced nipple

A client presents to the clinic with her 3-week-old infant reporting general flu-like symptoms and a painful right breast. Assessment reveals temperature 101°8F (38.8°C) and the right breast nipple with a movable mass that is red and warm. Which instruction should the nurse prioritize for this client? a. Complete the full course of antibiotic prescribed, even if you begins to feel better. b. Use NSAIDs, warm showers, and warm compresses to relieve discomfort. c. Breastfeed or otherwise empty your breasts at least every 3 hours. d. Increase your fluid intake to ensure that you will continue to produce adequate milk.

a. Complete the full course of antibiotic prescribed, even if you begins to feel better.

The nurse is providing care for a postpartum client who has been diagnosed with a perineal infection and who is being treated with antibiotics. What is the nurse's most appropriate intervention? a. Encourage fluid intake. b. Provide several small meals daily rather than three larger meals. c. Encourage the client to limit mobility. d. Administer antacids with each dose of antibiotics.

a. Encourage fluid intake.

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? a. Staphylococcus aureus b. Escherichia coli c. group B streptococcus (GBS) d. Streptococcus pyogenes (group A strep)

a. Staphylococcus aureus

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

a. The client feels empty since she gave birth to the neonate.

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? a. "I will stop breastfeeding until I finish my antibiotics." b. "I can continue breastfeeding my infant, but it may be somewhat uncomfortable." c. "When breastfeeding, it is recommended to begin nursing on the infected breast first." d. "I am able to pump my breast milk for my baby and throw away the milk."

b. "I can continue breastfeeding my infant, but it may be somewhat uncomfortable."

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? a. Urinary infection b. Bladder distention c. Excessive bleeding d. A ruptured bladder

b. Bladder distention

The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? a. Height, level of orientation, support systems b. Blood pressure, pulse, reports of dizziness c. Degree of responsiveness, respiratory rate, fundus location d. Attachment, lochia color, complete blood cell count

b. Blood pressure, pulse, reports of dizziness

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? a. nifedipine b. oxytocin agent c. indomethacin d. magnesium sulfate

b. oxytocin agent

In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status? a. "Are you in any pain with your bleeding?" b. "What time did you last change your pad?" c. "How much blood was on the two pads?" d. "When did you last void?"

c. "How much blood was on the two pads?"

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? a. Perform vigorous fundal massage for the client. b. Use semi-Fowler position to encourage uterine drainage. c. Check for bladder distention, while encouraging the client to void. d. Offer analgesics prescribed by health care provider.

c. Check for bladder distention, while encouraging the client to void.

A client is diagnosed with a postpartum infection. The nurse is most correct to provide which instruction? a. Apply ice to the perineum to decrease pain of a perineal infection. b. Change the perineal pad every 3 to 4 hours to decrease the uterine infection. c. Finish all antibiotics to decrease a genital tract infection. d. Drink plenty of fluids to decrease a bladder infection.

c. Finish all antibiotics to decrease a genital tract infection.

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

c. Perform handwashing before breastfeeding.

The nurse palpates a postpartum 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? a. The uterine placement is normal. b. The uterus is filling up with blood. c. The bladder is distended. d. There is an infection inside the uterus.

c. The bladder is distended.

A nurse is caring for a client who has just given birth. What is the best method for the nurse to assess this client for postpartum hemorrhage? a. by assessing blood pressure b. by monitoring hCG titers c. by frequently assessing uterine involution d. by assessing skin turgor

c. by frequently assessing uterine involution

The nurse reviews the history of a postpartum woman, G3, P3 and notes it is positive for obesity and smoking. The nurse would be especially alert for the development of signs and symptoms of which complication in this client? a. postpartum hemorrhage b. metritis c. deep venous thrombosis d. uterine atony

c. deep venous thrombosis

The nurse is caring for a woman who experienced a vaginal birth 6 hours prior. The health care provider is concerned the woman may have retained placental tissue. What assessment finding would alert the nurse to further assess the client for complications of retained placental tissue? a. The client's blood pressure is 160/78 mm Hg with a base line of 102/62 mm Hg. b. The client reports perineal discomfort and burning pain. c. The client states being slightly nauseated and having no appetite since giving birth. d. The client's pulse is 130 beats/min at rest and base line was 98 beat/min.

d. The client's pulse is 130 beats/min at rest and base line was 98 beat/min.

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? a. lack of social support from family or friends b. medications used during labor and birth c. preexisting conditions in the client d. drop in estrogen and progesterone levels after birth

d. drop in estrogen and progesterone levels after birth

Two weeks after giving birth, a woman is feeling sad, hopeless, and guilty because she cannot take care of the infant and partner. The woman is tired but cannot sleep and has isolated herself from family and friends. The nurse recognizes that this client is exhibiting signs of: a. maladjustment to parenting. b. postpartum blues. c. lack of partner support. d. postpartum depression.

d. postpartum depression.

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

b. massaging the fundus firmly

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? a. The client has a history of epidural anesthesia. b. The client had an episiotomy. c. The client has a distended bladder. d. The client is receiving oral pain medications.

a. The client has a history of epidural anesthesia.

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

a. applying ice

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. a. inability to concentrate b. bizarre behavior c. loss of confidence d. decreased interest in life e. manifestations of mania

a. inability to concentrate c. loss of confidence d. decreased interest in life

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? a. postpartum psychosis b. postpartum depression c. postpartum blues d. postpartum panic disorder

a. postpartum psychosis