Question 1

The nurse is assisting a multiparous postpartum woman to the bathroom for the first time since her delivery 3 hours ago. When the client stands up, blood runs down her legs and pools on the floor. The client turns pale and feels weak. Which is the priority nursing action?

Accepted Answer

Helping the client back to bed to check her fundus is the priority nursing action. This scenario suggests postpartum hemorrhage, a common and serious complication after childbirth. The fundus (top of the uterus) should be firm to help control bleeding by compressing the blood vessels. A soft or boggy fundus can indicate uterine atony, a leading cause of postpartum hemorrhage, requiring immediate attention to prevent severe blood loss.

Question 2

The nurse conducts discharge teaching for a postpartum client who is diagnosed with deep vein thrombosis (DVT). Which statements indicate accurate understanding of the information presented? Select all that apply.

Accepted Answer

Supportive stockings help prevent further clot formation. Bleeding gums can indicate a side effect of anticoagulants like Coumadin, requiring medical attention. Elevating legs helps reduce swelling and improve circulation.

Question 3

A postpartum multipara is breastfeeding her new baby. The client states that she developed mastitis with her first child, and asks if there is something she can do to prevent mastitis this time. Which response by the nurse is most appropriate?

Accepted Answer

Massaging the breasts on a daily basis and unblocking any ducts that feel hardened can help prevent mastitis. This is because mastitis often occurs from milk stasis due to a blocked duct, and massaging can help prevent this from happening. The other options (B, C, D) are not necessarily helpful or accurate.

Question 4

The nurse is assessing a postpartum client who is 36 hours post delivery. Which findings cause the nurse to suspect a reproductive tract infection? Select all that apply.

Accepted Answer

A temperature of 38.0°C (100.4°F) or higher, foul-smelling lochia, and uterine tenderness are all signs of a reproductive tract infection. Leg edema and erythema may be signs of a deep vein thrombosis or clot, while breast engorgement is a common postpartum occurrence and not typically indicative of an infection.

Question 5

Which assessment data support the nurse's suspicion that a postpartum client has mastitis? Select all that apply.

Accepted Answer

The answer of Which assessment data support the nurse's suspicion...

Question 6

Which method of initial assessment would best indicate whether a postpartum client is experiencing a urinary complication?

Accepted Answer

Calculation of urine output is the best method of initial assessment to determine if a postpartum client is experiencing a urinary complication such as urinary retention or urinary tract infection. A decreased urine output may indicate urinary retention, while increased output may indicate infection or other issues. Urine pH and specific gravity may provide relevant information, but are not the best methods for initial assessment of urinary complications. Calculation of intake alone does not provide enough information to determine if the client is experiencing a urinary complication.

Question 7

The nurse is reviewing the medical record for a postpartum client. Which findings would necessitate the need for the nurse to monitor the client closely for the development of thrombophlebitis? Select all that apply.

Accepted Answer

A history of diabetes mellitus, being a current smoker, and laboratory values indicating anemia are risk factors for thrombophlebitis. Diabetes can affect blood flow and clotting, smoking increases the risk of blood clots, and anemia can affect circulation and oxygenation, all contributing to a higher risk of thrombophlebitis.

Question 8

The nurse is conducting discharge instruction for a postpartum client. Which client response indicates accurate understanding of when to notify the healthcare provider?

Accepted Answer

This response indicates accurate understanding of when to notify the healthcare provider as continuing pain despite taking prescribed analgesics may be a sign of possible complications such as infection. While the other options may also require healthcare provider notification, option B is the most critical.

Question 9

The postpartum client is diagnosed with thrombophlebitis in the right leg. Which assessment finding requires immediate intervention by the nurse?

Accepted Answer

Chest pressure may be a sign of a pulmonary embolism, a serious complication of thrombophlebitis. Immediate intervention, such as calling for emergency assistance and administering oxygen, may be necessary. Acute pain, redness, and edema are common findings in thrombophlebitis and should be addressed, but they do not indicate an immediate threat to the client's life.

Question 10

The nurse is providing care to a postpartum client 24 hours after delivery who has been diagnosed with metritis. Which response by the nurse is accurate when the client asks what made her sick?

Accepted Answer

Group beta strep (GBS) is a common cause of postpartum infections such as metritis. It is important for the client to understand the cause of her infection in order to prevent future occurrences and to facilitate healing. Incorrect information or vague responses may cause confusion and anxiety for the client.

Question 11

The charge nurse is reviewing the plan of care for maternal clients currently admitted for postpartum care. During the course of the medical record review, which intervention requires immediate consideration for revision?

Accepted Answer

Heparin's anticoagulant effect is monitored using the activated partial thromboplastin time (aPTT) rather than the prothrombin time (PT), which is used to monitor warfarin therapy. This indicates a need for immediate revision in the plan of care.

Question 12

A client is experiencing excessive bleeding immediately after the birth of her newborn. After increasing the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse anticipates which prescriptions from the healthcare provider? Select all that apply.

Accepted Answer

Methylergonovine maleate (Methergine) and misoprostol (Cytotec) are both used for postpartum hemorrhage and are often prescribed when increasing IV fluids and oxytocin do not stop the bleeding. Butorphanol tartrate (Stadol), fentanyl (Duragesic), and betamethasone (Diprolene) are not indicated for postpartum hemorrhage.

Question 13

The nurse is conducting teaching for a postpartum client who is approaching discharge. Which topics will the nurse include in the educational session regarding the prevention of postpartum hemorrhage? Select all that apply.

Accepted Answer

The answer of The nurse is conducting teaching for a...

Question 14

The nurse is revising the care plan of a postpartum client who develops mastitis. Which nursing diagnosis is most appropriate for inclusion in this client's updated plan of care?

Accepted Answer

The answer of The nurse is revising the care plan...

Question 15

The nurse is planning care for a postpartum client. Which data in the client's history increase the risk for postpartum depression? Select all that apply.

Accepted Answer

Bipolar disorder, PMDD, and recent relocation to a new city are risk factors for postpartum depression due to mental health history and significant life changes.

Question 16

The postpartum client who delivered a newborn 2 days ago develops endometritis. Which entry in the medical record would the nurse expect to find when reviewing the client's history?

Accepted Answer

Endometritis is an infection in the lining of the uterus and can occur after childbirth, especially after a cesarean birth. The history of arrest of dilation indicates a greater likelihood of the need for a cesarean birth, increasing the risk for postpartum infections including endometritis.

Question 17

The postpartum client presents to the maternity clinic with complaints of urinary urgency and dysuria 3 days after hospital discharge. Which statement is most important for the nurse to make?

Accepted Answer

The most important statement to make in this situation is to instruct the client to void into a sterile cup without touching the inside of the cup. This will allow for a clean catch urine sample to be obtained for testing and diagnosis of a possible urinary tract infection.

Question 18

The nurse is assessing a postpartum client's risk for early postpartum hemorrhage. Which findings in the client's health history place this client at an increase risk for early postpartum hemorrhage? Select all that apply.

Accepted Answer

Grand multiparity (having had five or more previous births) and oxytocin induction of labor are risk factors for early postpartum hemorrhage. Microsomia (low birth weight) and African American heritage may increase the risk of postpartum hemorrhage, but not specifically early postpartum hemorrhage. Anorexia nervosa is not a known risk factor for postpartum hemorrhage.

Question 19

The nurse is performing wellness checks for postpartum clients after hospital discharge via the telephone. Which client should be seen immediately?

Accepted Answer

This client is showing signs of postpartum psychosis and needs immediate evaluation and treatment by a healthcare provider. The other options indicate postpartum depression, which is a serious concern, but not as urgent as psychosis. The client with a history of depression needs a refill on her medication and should be seen in a timely manner but is not an urgent priority.

Question 20

The maternal nurse educator is conducting a presentation for antepartum clients describing the identification and care of women diagnosed with postpartum psychiatric disorders. Which information should the maternal nurse educator include in the teaching content?

Accepted Answer

Referring a woman with a history of postpartum depression to a mental health professional for counseling and biweekly visits postpartum is appropriate to provide preventive care. However, the prevalence rate of postpartum depression is not as high as mentioned in option A, and the duration of the disorder is not limited to 6 weeks as stated in option B. Option D describes the diagnostic criteria for post-traumatic stress disorder, which may occur postpartum but is not specific to postpartum psychiatric disorders.

Quiz 30: The Postpartum Family at Risk