Deck 22: Nursing Management of the Postpartum Woman at Risk

Question 1

Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which of the following?

A) Retained placental fragments
B) Hypertension
C) Thrombophlebitis
D) Uterine subinvolution

Answer 1

Thrombophlebitis

Question 2

As part of an inservice program, a nurse is describing a transient, self-limiting mood disorder that affects mothers after childbirth. The nurse correctly identifies this as postpartum:

A) Depression
B) Psychosis
C) Bipolar disorder
D) Blues

Answer 2

Blues

Question 3

A woman who is 2 weeks postpartum calls the clinic and says, "My left breast hurts." After further assessment on the phone, the nurse suspects the woman has mastitis. In addition to pain, the nurse would assess for which of the following?

A) An inverted nipple on the affected breast
B) No breast milk in the affected breast
C) An ecchymotic area on the affected breast
D) Hardening of an area in the affected breast

Answer 3

Hardening of an area in the affected breast

Question 4

A group of students are reviewing the causes of postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as the most common cause?

A) Labor augmentation
B) Uterine atony
C) Cervical or vaginal lacerations
D) Uterine inversion

Question 5

A multipara client develops thrombophlebitis after delivery. Which of the following would alert the nurse to the need for immediate intervention?

A) Dyspnea, diaphoresis, hypotension, and chest pain
B) Dyspnea, bradycardia, hypertension, and confusion
C) Weakness, anorexia, change in level of consciousness, and coma
D) Pallor, tachycardia, seizures, and jaundice

Question 6

A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which of the following in the mother and the newborn?

A) Infection
B) Hemorrhage
C) Trauma
D) Hypovolemia

Question 7

When assessing the postpartum woman, the nurse uses indicators other than pulse rate and blood pressure for postpartum hemorrhage based on the knowledge that:

A) These measurements may not change until after the blood loss is large
B) The body's compensatory mechanisms activate and prevent any changes
C) They relate more to change in condition than to the amount of blood lost
D) Maternal anxiety adversely affects these vital signs

Question 8

The nurse is assessing a woman with abruption placentae who has just given birth. The nurse would be alert for which of the following?

A) Severe uterine pain
B) Board-like abdomen
C) Appearance of petechiae
D) Inversion of the uterus

Question 9

A nurse is assessing a postpartum woman. Which finding would cause the nurse to be most concerned?

A) Leg pain on ambulation with mild ankle edema
B) Calf pain with dorsiflexion of the foot.
C) Perineal pain with swelling along the episiotomy
D) Sharp stabbing chest pain with shortness of breath

Question 10

A woman experiencing postpartum hemorrhage is ordered to receive a uterotonic agent. Which of the following would the nurse least expect to administer?

A) Oxytocin
B) Methylergonovine
C) Carboprost
D) Terbutaline

Question 11

Which of the following would be most appropriate when massaging a woman's fundus?

A) Place the hands on the sides of the abdomen to grasp the uterus.
B) Use an up-and-down motion to massage the uterus.
C) Wait until the uterus is firm to express clots.
D) Continue massaging the uterus for at least 5 minutes.

Question 12

After teaching a woman with a postpartum infection about care after discharge, which client statement indicates the need for additional teaching?

A) "I need to call my doctor if my temperature goes above 100.4° F."
B) "When I put on a new pad, I'll start at the back and go forward."
C) "If I have chills or my discharge has a strange odor, I'll call my doctor."
D) "I'll point the spray of the peribottle so the water flows front to back."

Question 13

A nurse suspects that a postpartum client is experiencing postpartum psychosis. Which of the following would most likely lead the nurse to suspect this condition?

A) Delirium
B) Feelings of anxiety
C) Sadness
D) Insomnia

Question 14

A postpartum woman is diagnosed with metritis. The nurse interprets this as an infection involving which of the following? (Select all that apply.)

A) Endometrium
B) Decidua
C) Myometrium
D) Broad ligament
E) Ovaries
F) Fallopian tubes

Question 15

A group of nursing students are reviewing information about mastitis and its causes. The students demonstrate understanding of the information when they identify which of the following as the most common cause?

A) E. coli
B) S. aureus
C) Proteus
D) Klebsiella

Question 16

A home health care nurse is assessing a postpartum woman who was discharged 2 days ago. The woman tells the nurse that she has a low-grade fever and feels "lousy." Which of the following findings would lead the nurse to suspect metritis? (Select all that apply.)

A) Lower abdominal tenderness
B) Urgency
C) Flank pain
D) Breast tenderness
E) Anorexia

Question 17

A postpartum client comes to the clinic for her routine 6-week visit. The nurse assesses the client and suspects that she is experiencing subinvolution based on which of the following?

A) Nonpalpable fundus
B) Moderate lochia serosa
C) Bruising on arms and legs
D) Fever

Question 18

Assessment of a postpartum client reveals a firm uterus with bright-red bleeding and a localized bluish bulging area just under the skin at the perineum. The woman also is complaining of significant pelvic pain and is experiencing problems with voiding. The nurse suspects which of the following?

A) Hematoma
B) Laceration
C) Bladder distention
D) Uterine atony

Question 19

A postpartum woman is ordered to receive oxytocin to stimulate the uterus to contract. Which of the following would be most important for the nurse to do?

A) Administer the drug as an IV bolus injection.
B) Give as a vaginal or rectal suppository.
C) Piggyback the IV infusion into a primary line.
D) Withhold the drug if the woman is hypertensive.

Question 20

Assessment of a postpartum woman experiencing postpartum hemorrhage reveals mild shock. Which of the following would the nurse expect to assess? (Select all that apply.)

A) Diaphoresis
B) Tachycardia
C) Oliguria
D) Cool extremities
E) Confusion

Question 21

A group of students are reviewing risk factors associated with postpartum hemorrhage. The students demonstrate understanding of the information when they identify which of the following as associated with uterine tone? (Select all that apply.)

A) Rapid labor
B) Retained blood clots
C) Hydramnios
D) Operative birth
E) Fetal malpostion

Question 22

A nurse is massaging a postpartum client's fundus and places the nondominant hand on the area above the symphysis pubis based on the understanding that this action:

A) Determines that the procedure is effective
B) Helps support the lower uterine segment
C) Aids in expressing accumulated clots
D) Prevents uterine muscle fatigue

Question 23

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which of the following would the nurse include as the most cost-effective method for prevention?

A) Prophylactic heparin administration
B) Compression stocking
C) Early ambulation
D) Warm compresses

Question 24

A postpartum woman who developed deep vein thrombosis is being discharged on anticoagulant therapy. After teaching the woman about this treatment, the nurse determines that additional teaching is needed when the woman states which of the following?

A) "I will use a soft toothbrush to brush my teeth."
B) "I can take ibuprofen if I have any pain."
C) "I need to avoid drinking any alcohol."
D) "I will call my health care provider if my stools are black and tarry."

Question 25

The nurse is developing a discharge teaching plan for a postpartum woman who has developed a postpartum infection. Which of the following would the nurse most likely include in this teaching plan? (Select all that apply.)

A) Taking the prescribed antibiotic until it is finished
B) Checking temperature once a week
C) Washing hands before and after perineal care
D) Handling perineal pads by the edges
E) Directing peribottle to flow from back to front

Question 26

A nurse is assessing a postpartum client who is at home. Which statement by the client would lead the nurse to suspect that the client may be developing postpartum depression?

A) "I just feel so overwhelmed and tired."
B) "I'm feeling so guilty and worthless lately."
C) "It's strange, one minute I'm happy, the next I'm sad."
D) "I keep hearing voices telling me to take my baby to the river."