PrepU: Chapter 22: Nursing Management of the Postpartum Woman at Risk

The nurse observes an ambulating postpartum 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. Assess for warmth, erythema, and pedal edema. Blanch a toe, and count the seconds it takes to color again. Ask the client to raise the foot and draw a circle.

Assess for warmth, erythema, and pedal edema.

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

Perform handwashing before breastfeeding.

Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps birth that resulted in lacerations 4 hours ago. What should the nurse do next? Assess for uterine contractions. Obtain the client's vital signs. Change the client's peri-pad. Have the client void.

Assess for uterine contractions.

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? "What time did you last change your pad?" "When did you last void?" "Are you in any pain with your bleeding?" "How much blood was on the two pads?"

"How much blood was on the two pads?"

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

Check the lochia.

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.

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 subinvolution uterine atony

uterine atony

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

applying ice

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. She is over her interest in her baby. lack of pleasure extreme periods of elation

lack of pleasure

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 500 ml 750 ml 250 ml

1000 ml

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

500 mL

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. Assess the woman's fundus. Call the woman's health care provider.

Assess the woman's fundus.

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? Breastfeed or otherwise empty your breasts at least every 3 hours. Increase your fluid intake to ensure that you will continue to produce adequate milk. Use NSAIDs, warm showers, and warm compresses to relieve discomfort. Complete the full course of antibiotic prescribed, even if you begin to feel better.

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

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

Oxytocin

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 bizarre behavior manifestations of mania loss of confidence decreased interest in life

inability to concentrate loss of confidence decreased interest in life

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: postpartum blues. postpartum depression. maladjustment to parenting. lack of partner support.

postpartum depression.

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? moderate amount of lochia rubra uterine atony thrombophlebitis hemoglobin level of 12 g/dl (120 g/L)

uterine atony

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."

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 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." "I'll contact your health care provider." "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."

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

Assessment of the perineal pad

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. Her perineum is obviously edematous on inspection. She says she is extremely thirsty. She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart.

At 8 hours postdelivery she has voided a total of 100 mL in four small voidings.

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

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

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

a client who had a nonelective cesarean birth

A nurse is caring for a client who has had an intrauterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulation? Select all that apply. acute renal failure bleeding gums hypertension lochia less than usual tachycardia

bleeding gums tachycardia acute renal failure

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? Mastitis Engorgement Plugged milk duct Breast yeast

Mastitis

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? Use of breast pumps Pierced nipple Complete emptying of the breast Frequent feeding

Pierced nipple

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 talking to the client and reassuring her that she will feel better soon scheduling electroconvulsive therapy administrating a selective serotonin reuptake inhibitor

administrating a selective serotonin reuptake inhibitor

While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect? hematoma uterine inversion laceration uterine atony

laceration

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 size of the neonate method of birth

length of labor

Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects? seizures uterine hyperstimulation headache flushing

seizures

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

The client has a history of epidural anesthesia.

A postpartum client who was discharged home returns to the primary health care facility after 2 weeks with reports of fever and pain in the breast. The client is diagnosed with mastitis. What education should the nurse give to the client for managing and preventing mastitis? Perform handwashing before and after breastfeeding. Discontinue breastfeeding to allow time for healing. Discourage manual compression of breast for expressing milk. Avoid hot or cold compresses on the breast.

Perform handwashing before and after 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? The uterus is filling up with blood. The bladder is distended. The uterine placement is normal. There is an infection inside the uterus.

The bladder is distended.