Deck 28: The Woman with a Postpartum Complication

Question 1

A woman delivered a 9-lb,10-oz baby 1 hour ago.When you arrive to perform her 15-minute assessment,she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood.What is your first action?

A) Call for help.
B) Assess the fundus for firmness.
C) Take her blood pressure.
D) Check the perineum for lacerations.

Answer 1

Assess the fundus for firmness.

Question 2

A multiparous woman is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant.Her fundus is boggy,lochia is heavy,and vital signs are unchanged.The nurse has the woman void and massages her fundus,but her fundus remains difficult to find,and the rubra lochia remains heavy.What action should the nurse take next?

A) Continue to massage the fundus.
B) Notify the provider.
C) Recheck vital signs.
D) Insert an indwelling urinary catheter.

Answer 2

Notify the provider.

Question 3

The patient who is being treated for endometritis is placed in Fowler's position because it

A) promotes comfort and rest.
B) facilitates drainage of lochia.
C) prevents spread of infection to the urinary tract.
D) decreases tension on the reproductive organs.

Answer 3

facilitates drainage of lochia.

Question 4

A postpartum patient is at increased risk for postpartum hemorrhage if she delivers a(n)

A) 5-lb, 2-oz infant with outlet forceps.
B) 6.5-lb infant after a 2-hour labor.
C) 7-lb infant after an 8-hour labor.
D) 8-lb infant after a 12-hour labor.

Question 5

The perinatal nurse is caring for a woman in the immediate postbirth period.Assessment reveals that the woman is experiencing profuse bleeding.The most likely etiology for the bleeding is

A) uterine atony.
B) uterine inversion.
C) vaginal hematoma.
D) vaginal laceration.

Question 6

Which measure may prevent mastitis in the breastfeeding mother?

A) Initiating early and frequent feedings
B) Nursing the infant for 5 minutes on each breast
C) Wearing a tight-fitting bra
D) Applying ice packs before feeding

Question 7

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests

A) uterine atony.
B) lacerations of the genital tract.
C) perineal hematoma.
D) infection of the uterus.

Question 8

The nurse should expect medical intervention for subinvolution to include

A) oral methylergonovine maleate (Methergine) for 48 hours.
B) oxytocin intravenous infusion for 8 hours.
C) oral fluids to 3000 mL/day.
D) intravenous fluid and blood replacement.

Question 9

When caring for a postpartum woman experiencing hypovolemic shock,the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is

A) absence of cyanosis in the buccal mucosa.
B) cool, dry skin.
C) diminished restlessness.
D) decreased urinary output.

Question 10

If nonsurgical treatment for late postpartum hemorrhage is ineffective,which surgical procedure is appropriate to correct the cause of this condition?

A) Hysterectomy
B) Laparoscopy
C) Laparotomy
D) D&C

Question 11

Nursing measures that help prevent postpartum urinary tract infection include which of the following?

A) Promoting bed rest for 12 hours after delivery
B) Discouraging voiding until the sensation of a full bladder is present
C) Forcing fluids to at least 3000 mL/day
D) Encouraging the intake of orange, grapefruit, or apple juice

Question 12

Early postpartum hemorrhage is defined as signs and symptoms of hypovolemia with which of the following descriptions of blood loss?

A) Cumulative blood loss >1000 mL in the first 24 hours after the birth process.
B) 750 mL in the first 24 hours after vaginal delivery
C) Cumulative blood loss >1000 mL in the first 48 hours after the birth process
D) 1500 mL in the first 48 hours after cesarean delivery

Question 13

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by

A) subinvolution of the uterus.
B) defective vascularity of the decidua.
C) cervical lacerations.
D) coagulation disorders.

Question 14

The nurse knows that a measure for preventing late postpartum hemorrhage is to

A) administer broad-spectrum antibiotics.
B) inspect the placenta after delivery.
C) manually remove the placenta.
D) pull on the umbilical cord to hasten the delivery of the placenta.

Question 15

Which woman is at greatest risk for early postpartum hemorrhage?

A) A primiparous woman being prepared for an emergency cesarean birth for fetal distress
B) A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
C) A multiparous woman with an 8-hour labor
D) A primigravida in spontaneous labor with preterm twins

Question 16

One of the first symptoms of puerperal infection to assess for in the postpartum woman is

A) fatigue continuing for longer than 1 week.
B) pain with voiding.
C) profuse vaginal bleeding with ambulation.
D) temperature of 38° C (100.4° F) or higher after 24 hours.

Question 17

The mother-baby nurse must be able to recognize what sign of thrombophlebitis?

A) Visible varicose veins
B) Positive Homans sign
C) Local tenderness, heat, and swelling
D) Pedal edema in the affected leg

Question 18

What instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications?

A) Palpate the fundus daily to ensure that it is soft.
B) Notify the physician of a return to bright red bleeding.
C) Report any decrease in the amount of brownish red lochia.
D) The passage of clots as large as an orange can be expected.

Question 19

Which nursing measure is appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth?

A) Roll a bath blanket and place it firmly behind the knees.
B) Limit oral intake of fluids for the first 24 hours.
C) Assist the patient in performing gentle leg exercises.
D) Ambulate the patient as soon as her vital signs are stable.

Question 20

Which statement by a postpartum woman indicates that teaching about thrombus formation has been effective?

A) "I'll stay in bed for the first 3 days after my baby is born."
B) "I'll keep my legs elevated with pillows."
C) "I'll sit in my rocking chair most of the time."
D) "I'll put my support stockings on every morning before rising."

Question 21

If the nurse suspects a uterine infection in the postpartum patient,she should assess the

A) pulse and blood pressure.
B) odor of the lochia.
C) episiotomy site.
D) abdomen for distention.

Question 22

To provide adequate postpartum care,the nurse should be aware that peripartum depression (PPD)

A) is the "baby blues," plus the woman has a visit with a counselor or psychologist.
B) does not affect the father who can then care for the baby.
C) is distinguished by pervasive sadness that lasts at least 2 weeks.
D) will disappear on its own without outside help.

Question 23

A provider left an order for a woman to have Methylergonovine 0.2 mg IM.The nurse assesses the woman and finds her vital signs to be: temperature 37.9° C (100.2° F),pulse 90 beats/minute,respirations 18 breaths/minute,and blood pressure 152/90 mm Hg.What action by the nurse is most appropriate?

A) Administer acetaminophen first.
B) Check policy for administration.
C) Give the medication as prescribed.
D) Consult with the provider.

Question 24

A home health care nurse is checking on a new mother with signs of obsessive-compulsive disorder.What assessment findings correlate with this condition? (Select all that apply.)

A) Frequently checking on the baby
B) Fear of being alone with the baby
C) Woman states she feels worthless
D) Woman has bought $5,000 worth of toys
E) Mother states birth was very traumatic

Question 25

Which condition is a transient,self-limiting mood disorder that affects new mothers after childbirth?

A) Postpartum depression
B) Postpartum psychosis
C) Postpartum bipolar disorder
D) Postpartum blues

Question 26

A mother with mastitis is concerned about breastfeeding while she has an active infection.The nurse should explain that

A) the infant is protected from infection by immunoglobulins in the breast milk.
B) the infant is not susceptible to the organisms that cause mastitis.
C) the organisms that cause mastitis are not passed to the milk.
D) the organisms will be inactivated by gastric acid.

Question 27

When a woman is diagnosed with postpartum psychosis,one of the main concerns is that she may

A) have outbursts of anger.
B) neglect her hygiene.
C) harm her infant.
D) lose interest in her husband.

Question 28

What risk factor for peripartum depression (PPD)is likely to have the greatest effect on the woman's condition?

A) Personal history of depression
B) Single-mother status
C) Low socioeconomic status
D) Unplanned or unwanted pregnancy

Question 29

What actions can the labor and delivery nurse take to decrease a woman's chance of contracting a puerperal infection? (Select all that apply.)

A) Avoid straight catheterizing the woman unless she cannot void.
B) Keep vaginal examinations to a minimum.
C) Change wet peripads and linens frequently.
D) Maintain the woman on bedrest while laboring.
E) Use good hand hygiene before and after contact with the woman.

Question 30

Medications used to manage postpartum hemorrhage include which of the following? (Select all that apply.)

A) Oxytocin
B) Methergine
C) Terbutaline
D) Hemabate
E) Magnesium sulfate

Question 31

The nurse explain to the student that which of the following factors increase a woman's risk for thrombosis? (Select all that apply.)

A) Use of stirrups for a prolonged period of time
B) Prolonged bedrest during or after labor and delivery
C) Adherence to a strict vegetarian diet
D) Excessive sweating during labor
E) Maternal age greater than 30 years of age

Question 32

A woman just received an injection of carboprost,2500 mcg IM.What actions by the nurse take priority? (Select all that apply.)

A) Assess for nausea and vomiting
B) Assess fetal well-being.
C) Administer acetaminophen for headache.
D) Monitor urine output.
E) Notify the provider immediately.

Question 33

The maternity nurse knows that which disorder can be triggered by a birth the woman views as traumatic?

A) A phobia
B) Panic disorder
C) Posttraumatic stress disorder (PTSD)
D) Obsessive-compulsive disorder (OCD)

Question 34

What teaching does the nurse provide to help new mothers prevent postpartum depression?

A) Stay home and avoid outside activities to ensure adequate rest.
B) Be the only caregiver for your baby to facilitate infant attachment.
C) Keep feelings of sadness and adjustment to your new role to yourself.
D) Realize that this is a common occurrence that affects many women.