obstetric nursing: postpartum

A new mother received epidural anesthesia during labor and had a forceps delivery after pushing 2 hours. At 6 hours PP, her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse immediately plans to:

prepare the client for surgery

A nurse is providing instructions to a mother who has been diagnosed with mastitis. Which of the following statements if made by the mother indicates a need for further teaching?

"I need to stop breastfeeding until this condition resolves."

On completing a fundal assessment, the nurse notes the fundus is situated on the client's left abdomen. Which of the following actions is appropriate? Ask the client to empty her bladder Straight catheterize the client immediately Call the client's health provider for direction Straight catheterize the client for half of her uterine volume

1. A full bladder may displace the uterine fundus to the left or right side of the abdomen. Catheterization is unnecessary invasive if the woman can void on her own.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is one day postpartum. An expected finding would be: Soft, non-tender; colostrum is present Leakage of milk at let down Swollen, warm, and tender upon palpation A few blisters and a bruise on each areola

1. Breasts are essentially unchanged for the first two to three days after birth. Colostrum is present and may leak from the nipples.

Which of the following behaviors characterizes the PP mother in the taking in phase? Passive and dependant Striving for independence and autonomy Curious and interested in care of the baby Exhibiting maximum readiness for new learning

1. During the taking in phase, which usually lasts 1-3 days, the mother is passive and dependent and expresses her own needs rather than the neonate's needs. The taking hold phase usually lasts from days 3-10 PP. During this stage, the mother strives for independence and autonomy; she also becomes curious and interested in the care of the baby and is most ready to learn.

Which of the following factors might result in a decreased supply of breast milk in a PP mother? Supplemental feedings with formula Maternal diet high in vitamin C An alcoholic drink Frequent feedings

1. Routine formula supplementation may interfere with establishing an adequate milk volume because decreased stimulation to the mother's nipples affects hormonal levels and milk production.

53) Parents can facilitate the adjustment of their other children to a new baby by: Having the children choose or make a gift to give to the new baby upon its arrival home Emphasizing activities that keep the new baby and other children together Having the mother carry the new baby into the home so she can show the other children the new baby Reducing stress on other children by limiting their involvement in the care of the new baby

1. Special time should be set aside just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability without overwhelming them.

A nurse performs an assessment on a client who is 4 hours PP. The nurse notes that the client has cool, clammy skin and is restless and excessively thirsty. The nurse prepares immediately to: Assess for hypovolemia and notify the health care provider Begin hourly pad counts and reassure the client Begin fundal massage and start oxygen by mask Elevate the head of the bed and assess vital signs

1. Symptoms of hypovolemia include cool, clammy, pale skin, sensations of anxiety or impending doom, restlessness, and thirst. When these symptoms are present, the nurse should further assess for hypovolemia and notify the health care provider.

During the 3rd PP day, which of the following observations about the client would the nurse be most likely to make? The client appears interested in learning about neonatal care The client talks a lot about her birth experience The client sleeps whenever the neonate isn't present The client requests help in choosing a name for the neonate.

1. The third to tenth days of PP care are the "taking-hold" phase, in which the new mother strives for independence and is eager for her neonate. The other options describe the phase in which the mother relives her birth experience.

Methergine or pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client's medical history? Peripheral vascular disease Hypothyroidism Hypotension Type 1 diabetes

1. These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.

When performing a postpartum check, the nurse should: Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum Assist the woman into a supine position with her arms above her head and her legs extended for the examination of her abdomen Instruct the woman to avoid urinating just before the examination since a full bladder will facilitate fundal palpation Wash hands and put on sterile gloves before beginning the check

1. While the supine position is best for examining the abdomen, the woman should keep her arms at her sides and slightly flex her knees in order to relax abdominal muscles and facilitate palpation of the fundus. The bladder should be emptied before the check. A full bladder alters the position of the fundus and makes the findings inaccurate. Although hands are washed before starting the check, clean (not sterile) gloves are put on just before the perineum and pad are assessed to protect from contact with blood and secretions.

Which of the following findings would be expected when assessing the postpartum client? Fundus 1 cm above the umbilicus 1 hour postpartum Fundus 1 cm above the umbilicus on postpartum day 3 Fundus palpable in the abdomen at 2 weeks postpartum Fundus slightly to the right; 2 cm above umbilicus on postpartum day 2

1. Within the first 12 hours postpartum, the fundus usually is approximately 1 cm above the umbilicus. The fundus should be below the umbilicus by PP day 3. The fundus shouldn't be palpated in the abdomen after day 10.

A nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. Select all instructions that would be included on the list. Take the prescribed antibiotics until the soreness subsides. Wear supportive bra Avoid decompression of the breasts by breastfeeding or breast pump Rest during the acute phase Continue to breastfeed if the breasts are not too sore.

2, 4, and 5. Mastitis are an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3 L a day, and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. Continued decompression of the breast by breastfeeding or pumping is important to empty the breast and prevent formation of an abscess.

The nurse examines a woman one hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: Place her on a bedpan to empty her bladder Massage her fundus Call the physician Administer Methergine 0.2 mg IM which has been ordered prn

2. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm, followed by 3 and 4, especially if the fundus does not become or remain firm with massage. There is no indication of a distended bladder since the fundus is midline and below the umbilicus.

Which of the following physiological responses is considered normal in the early postpartum period? Urinary urgency and dysuria Rapid diuresis Decrease in blood pressure Increase motility of the GI system

2. In the early PP period, there's an increase in the glomerular filtration rate and a drop in the progesterone levels, which result in rapid diuresis. There should be no urinary urgency, though a woman may feel anxious about voiding. There's a minimal change in blood pressure following childbirth, and a residual decrease in GI motility.

Methergine or pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the: Amount of lochia Blood pressure Deep tendon reflexes Uterine tone

2. Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.

On which of the postpartum days can the client expect lochia serosa? Days 3 and 4 PP Days 3 to 10 PP Days 10-14 PP Days 14 to 42 PP

2. On the third and fourth PP days, the lochia becomes a pale pink or brown and contains old blood, serum, leukocytes, and tissue debris. This type of lochia usually lasts until PP day 10. Lochia rubra usually last for the first 3 to 4 days PP. Lochia alba, which contain leukocytes, decidua, epithelial cells, mucus, and bacteria, may continue for 2 to 6 weeks PP

54) A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing the needs of women during this stage, should: Foster an active role in the baby's care Provide time for the mother to reflect on the events of and her behavior during childbirth Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now Promote maternal independence by encouraging her to meet her own hygiene and comfort needs

2. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition. Once they are met, she is more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach.

Which of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications? Increase Decrease Remain the same as before pregnancy Remain the same as during pregnancy

2. 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 only need one-half to two-thirds of the prenatal insulin during the first few PP days.

A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse instructs the mother that she should expect normal bowel elimination to return:

3 days PP

A nurse is assessing a client in the 4th stage if labor and notes that the fundus is firm but that bleeding is excessive. The initial nursing action would be which of the following? Massage the fundus Place the mother in the Trendelenburg's position Notify the physician Record the findings

3.

A nurse is caring for a PP client with a diagnosis of DVT who is receiving a continuous intravenous infusion of heparin sodium. Which of the following laboratory results will the nurse specifically review to determine if an effective and appropriate dose of the heparin is being delivered? Prothrombin time Internationalized normalized ratio Activated partial thromboplastin time Platelet count

3.

Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? Retained placental fragments Urinary tract infection Cervical laceration Uterine atony

3. Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting. Retained placental fragments and uterine atony may cause subinvolution of the uterus, making it soft, boggy, and larger than expected. UTI won't cause vaginal bleeding, although hematuria may be present.

A client is complaining of painful contractions, or afterpains, on postpartum day 2. Which of the following conditions could increase the severity of afterpains? Bottle-feeding Diabetes Multiple gestation Primiparity

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

When making a visit to the home of a postpartum woman one week after birth, the nurse should recognize that the woman would characteristically: Express a strong need to review events and her behavior during the process of labor and birth Exhibit a reduced attention span, limiting readiness to learn Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn Have reestablished her role as a spouse/partner

3. One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage as described in response 3. This stage lasts for as long as 4 to 5 weeks after birth. Responses 1 and 2 are characteristic of the taking-in stage, which lasts for the first few days after birth. Response 4 reflects the letting-go stage, which indicates that psychosocial recovery is complete.

The nurse is about the give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum? Lower than during her pregnancy Higher than during her pregnancy Lower than before she became pregnant Higher than before she became pregnant

3. PP insulin requirements are usually significantly lower than prepregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum.

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: Return to prepregnant weight is usually achieved by the end of the postpartum period Fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3 pound weight loss The expected weight loss immediately after birth averages about 11 to 13 pounds Lactation will inhibit weight loss since caloric intake must increase to support milk production

3. Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 pounds. Weight loss continues during breastfeeding since fat stores developed during pregnancy and extra calories consumed are used as part of the lactation process

Which of the following interventions would be helpful to a breastfeeding mother who is experiencing engorged breasts? Applying ice Applying a breast binder Teaching how to express her breasts in a warm shower Administering bromocriptine (Parlodel)

3. Teaching the client how to express her breasts in a warm shower aids with let-down and will give temporary relief. Ice can promote comfort by vasoconstriction, numbing, and discouraging further letdown of milk.

Which measure would be least effective in preventing postpartum hemorrhage? Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered Encourage the woman to void every 2 hours Massage the fundus every hour for the first 24 hours following birth Teach the woman the importance of rest and nutrition to enhance healing

3. The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Responses 1, 2, and 4 are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.

Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage? Hypertension Cervical and vaginal tears Urine retention Endometritis

3. Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period.

Which type of lochia should the nurse expect to find in a client 2 days PP? Foul-smelling Lochia serosa Lochia alba Lochia rubra

4.

Which of the following responses is most appropriate for a mother with diabetes who wants to breastfeed her infant but is concerned about the effects of breastfeeding on her health? Mothers with diabetes who breast-feed have a hard time controlling their insulin needs Mothers with diabetes shouldn't breastfeed because of potential complications Mothers with diabetes shouldn't breastfeed; insulin requirements are doubled. Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding.

4. Breastfeeding has an antidiabetogenic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding mothers are at a higher risk of hypoglycemia in the first PP days after birth because the glucose levels are lower. Mothers with diabetes should be encouraged to breastfeed.

Which of the following complications is most likely responsible for a delayed postpartum hemorrhage? Cervical laceration Clotting deficiency Perineal laceration Uterine Subinvolution

4. Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution. Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn't corrected at the time of delivery.

After expulsion of the placenta in a client who has six living children, an infusion of lactated ringer's solution with 10 units of pitocin is ordered. The nurse understands that this is indicated for this client because: She had a precipitate birth This was an extramural birth Retained placental fragments must be expelled Multigravida's are at increased risk for uterine atony.

4. Multiple full-term pregnancies and deliveries result in overstretched uterine muscles that do not contract efficiently and bleeding may ensue.

52) Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: Tell the woman she can rest after she feeds her baby Recognize this as a behavior of the taking-hold stage Record the behavior as ineffective maternal-newborn attachment Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

4. Response 1 does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking-in stage. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby.

Which of the following findings would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum? Postural hypotension Temperature of 100.4°F Bradycardia — pulse rate of 55 BPM Pain in left calf with dorsiflexion of left foot

4. Responses 1 and 3 are expected related to circulatory changes after birth. A temperature of 100.4°F in the first 24 hours is most likely indicative of dehydration which is easily corrected by increasing oral fluid intake. The findings in response 4 indicate a positive Homan sign and are suggestive of thrombophlebitis and should be investigated further.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: Uses soap and warm water to wash the vulva and perineum Washes from symphysis pubis back to episiotomy Changes her perineal pad every 2 - 3 hours Uses the peribottle to rinse upward into her vagina

4. Responses 1, 2, and 3 are all appropriate measures. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still-open cervix.

Before giving a PP client the rubella vaccine, which of the following facts should the nurse include in client teaching? The vaccine is safe in clients with egg allergies Breast-feeding isn't compatible with the vaccine Transient arthralgia and rash are common adverse effects The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects

4. The client must understand that she must not become pregnant for 3 months after the vaccination because of its potential teratogenic effects. The rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies. The virus is not transmitted into the breast milk, so clients may continue to breastfeed after the vaccination. Transient arthralgia and rash are common adverse effects of the vaccine.

On the first PP night, a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases? Depression phase Letting-go phase Taking-hold phase Taking-in phase

4. The taking-in phase occurs in the first 24 hours after birth. The mother is concerned with her own needs and requires support from staff and relatives. The taking-hold phase occurs when the mother is ready to take responsibility for her care as well as the infants care. The letting-go phase begins several weeks later, when the mother incorporates the new infant into the family unit.

What type of milk is present in the breasts 7 to 10 days PP? Colostrum Hind milk Mature milk Transitional milk

4. Transitional milk comes after colostrum and usually lasts until 2 weeks PP

A nurse in a PP unit is instructing a mother regarding lochia and the amount of expected lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but should never exceed the need for:

8 peripads per day. The average number of peripads is 6 per day.

A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss?

An increase in the pulse from 88 to 102 BPM

A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following?

Ask the mother to urinate and empty her bladder

Select all of the physiological maternal changes that occur during the PP period.

Cervical involution ceases immediately Fundus begins to descend into the pelvis after 24 hours

A nurse is caring for a PP woman who has received epidural anesthesia and is monitoring the woman for the presence of a vulva hematoma. Which of the following assessment findings would best indicate the presence of a hematoma

Changes in vital signs

A postpartum nurse is preparing to care for a woman who has just delivered a healthy newborn infant. In the immediate postpartum period the nurse plans to take the woman's vital signs:

Every 15 minutes during the first hour and then every 30 minutes for the next two hours.

A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.2*F. Which of the following actions would be most appropriate?

Increase hydration by encouraging oral fluids

The nurse is asseterm-3ssing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is:

Indicates the presence of infection

When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which of the following nursing actions is most appropriate?

Notify physician

A nurse is developing a plan of care for a PP woman with a small vulvar hematoma. The nurse includes which specific intervention in the plan during the first 12 hours following the delivery of this client?

Prepare an ice pack for application to the area.

A PP nurse is assessing a mother who delivered a healthy newborn infant by C-section. The nurse is assessing for signs and symptoms of superficial venous thrombosis. Which of the following signs or symptoms would the nurse note if superficial venous thrombosis were present?

enlarged hardened veins

A PP client is being treated for DVT. The nurse understands that the client's response to treatment will be evaluated by regularly assessing the client for: Dysuria, ecchymosis, and vertigo Epistaxis, hematuria, and dysuria Hematuria, ecchymosis, and epistaxis Hematuria, ecchymosis, and vertigo

hematuria, ecchymosis, and epistaxis.

A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which of the following nursing interventions would be most appropriate initially?

massage fundus until firm