Question 1

A postpartal patient recovering from deep vein thrombosis is being discharged. What areas of teaching on self-care and anticipatory guidance should the nurse discuss with the patient?

Accepted Answer

The nurse should instruct the patient to avoid crossing the legs, avoid prolonged standing or sitting, and take frequent walks to promote circulation and prevent further clot formation. Taking aspirin or avoiding long car trips are not standard recommendations for all patients recovering from DVT.

Question 2

The postpartum patient is concerned about mastitis because she experienced it with her last baby. Preventive measures the nurse can teach include:

Accepted Answer

The most effective preventive measure for mastitis is frequent breastfeeding, which helps to keep milk flowing and prevent milk stasis. Wearing a tight-fitting bra can actually increase the risk of mastitis by compressing milk ducts. Limiting feedings to q.i.d. (four times a day) is not enough to maintain milk flow and can also increase the risk of mastitis. Forcing fluids does not have a direct effect on preventing mastitis.

Question 3

Which findings would indicate the presence of a perineal wound infection?

Accepted Answer

Redness, edema, warmth, and purulent drainage are classic signs of infection. Vaginal bleeding is not typically associated with wound infection.

Question 4

A postpartum patient reports sharp, shooting pains in her nipple during breastfeeding and flaky, itchy skin on her breasts. The nurse suspects:

Accepted Answer

The symptoms described suggest possible mastitis, which is an infection in the breast tissue that can cause painful, shooting sensations during breastfeeding as well as itching and flakiness on the skin. Nipple soreness and engorgement may also occur, but typically do not include these additional symptoms. Letdown reflex, while a normal physiological process during breastfeeding, would not cause sharp, shooting pains or skin irritation.

Question 5

The home health nurse is visiting a new mother whose baby was delivered by emergency cesarean after a car accident. The mother seems dazed, irritable, and unaware of her surroundings. She tells the nurse she has had trouble sleeping. The nurse would suspect that the mother has:

Accepted Answer

The mother's symptoms of dazedness, irritability, and trouble sleeping suggest post-traumatic stress disorder, which can occur following a traumatic event such as a car accident and emergency cesarean delivery. Postpartum blues typically involve mood swings, weepiness, and mild depression and usually resolve within a few weeks. Postpartum psychosis is a rare but serious condition that involves delusions, hallucinations, and confusion. Disenfranchised grief refers to grief that is not acknowledged or socially accepted, such as the loss of a same-sex partner.

Question 6

The most appropriate nursing diagnosis for a patient with postpartum deep vein thrombosis is:

Accepted Answer

Postpartum deep vein thrombosis results in obstructed venous return, leading to altered tissue perfusion. This can cause pain, edema, and decreased mobility in the affected limb. Therefore, Altered Tissue Perfusion related to obstructed venous return is the most appropriate nursing diagnosis for this patient. The other options are not directly related to the pathophysiology of deep vein thrombosis.

Question 7

A patient is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications?

Accepted Answer

Methergine and Misoprostol are medications used to manage postpartum hemorrhage. Methergine helps by contracting the uterus, and Misoprostol is a prostaglandin that also aids in uterine contraction.

Question 8

The nurse is assessing a patient who has been diagnosed with an early postpartum hemorrhage. Which findings would the nurse expect?

Accepted Answer

The answer of The nurse is assessing a patient who...

Question 9

The patient has experienced a postpartum hemorrhage at 6 hours postpartum. After controlling the hemorrhage, the patient's partner asks what would cause a hemorrhage. How should the nurse respond?

Accepted Answer

Uterine atony, where the uterus fails to contract effectively, is a common cause of postpartum hemorrhage.

Question 10

The postpartum patient states that she doesn't understand why she can't enjoy being with her baby. The nurse is concerned about:

Accepted Answer

The patient's statement suggests that she may be experiencing postpartum depression, which is a common condition affecting new mothers. Symptoms include difficulty bonding with the baby, feelings of sadness, guilt, and hopelessness, and loss of interest in activities that were once enjoyable. It is important for the nurse to assess the patient for other signs and symptoms of depression and to provide appropriate interventions and referrals as needed.

Question 11

The nurse is calling patients at 4 weeks postpartum. The patient who should be seen immediately is the patient who:

Accepted Answer

Hearing voices is a symptom of postpartum psychosis, which is a medical emergency and requires immediate attention. The other options describe symptoms of postpartum depression, which should be addressed but are not as urgent as hearing voices.

Question 12

To prevent the spread of infection, the nurse teaches the postpartum patient to:

Accepted Answer

Changing peripads frequently can help prevent the growth of bacteria and reduce the risk of infection. Addressing pain early, avoiding overhydration, and reporting symptoms of uterine cramping are also important in postpartum care, but they do not directly address the spread of infection.

Question 13

A patient had a cesarean birth 3 days ago. She has tenderness, localized heat, and redness of the left leg. She is afebrile. As a result of these symptoms, the nurse recognizes that the patient will most likely be:

Accepted Answer

The patient is exhibiting signs of a possible deep vein thrombosis (DVT) which is a potential complication following cesarean birth. As a result, the patient should be placed on bed rest until further evaluation and treatment can be initiated. Ambulation could potentially dislodge a clot and worsen the condition. Aspirin is not the appropriate medication for DVT and Methergine is used to prevent postpartum hemorrhage, not for DVT.

Question 14

The postpartum multipara is breastfeeding her new baby. The patient states that she developed mastitis with her first child, and asks whether there is something she can do to prevent mastitis this time. The best response of the nurse is:

Accepted Answer

Massaging the breasts on a daily basis and unblocking any ducts that feel hardened or blocked will help prevent the development of mastitis. This method helps to increase milk flow and reduce the risk of milk stasis, which can lead to inflammation and infection. It is important to encourage the patient to continue breastfeeding frequently and to ensure that the baby is properly positioned and latched onto the breast.

Question 15

The nurse is caring for a postpartum patient who is at risk for developing early postpartum hemorrhage. What interventions would be included in the plan of care to detect this complication?

Accepted Answer

Weighing perineal pads and obtaining blood specimens for hemoglobin and hematocrit are interventions that would be included in the plan of care to detect early postpartum hemorrhage.

Question 16

The charge nurse is assessing several postpartum patients. Which patient has the greatest risk for postpartum hemorrhage?

Accepted Answer

Oxytocin augmentation of labor is a major risk factor for postpartum hemorrhage as it can lead to overstimulation of the uterus and poor contraction of the blood vessels within the uterus. Patients who are overdue or deliver prematurely may also be at an increased risk for postpartum hemorrhage, but it is not as significant as the risk associated with oxytocin augmentation. Patients who deliver by scheduled cesarean delivery typically have a lower risk for postpartum hemorrhage as the delivery is controlled and the uterus can be well-contracted during the procedure.

Question 17

Which method of assessment would best indicate whether a patient has a urinary complication?

Accepted Answer

Calculation of output would be the best method to determine if a patient has a urinary complication. The amount of urine produced can indicate if there is a blockage or other issue with the urinary system. Urine pH and urine-specific gravity can indicate other issues, but they are not specific to urinary complications. Calculation of intake is important for overall fluid balance, but does not specifically indicate urinary complications.

Question 18

The nurse is caring for a postpartum patient who had an estimated blood loss of 500 ml following a vaginal birth. What is the best clinical measure of the patient's actual blood loss?

Accepted Answer

A decrease in hematocrit of 10 points between admission and post-birth indicates a significant loss of blood volume and is the most accurate measure of blood loss. Clinical estimation of blood loss can be inaccurate, as can saturation of linens since not all blood loss is captured on linens. Blood pressure and pulse changes can be due to other factors as well.

Question 19

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

Accepted Answer

The patient is experiencing postpartum hemorrhage, which can be life-threatening. The first action of the nurse should be to check the fundus for firmness to ensure that the uterus is contracting appropriately. If the fundus is not firm, the nurse should massage the uterus or administer medications as ordered, and notify the healthcare provider immediately. Assessing blood pressure and pulse and starting an IV may be necessary interventions, but they are not the first priority in this situation. Assisting the patient to empty her bladder may also be necessary, but addressing the postpartum hemorrhage takes precedence.

Question 20

Which relief measure would be most appropriate for a postpartum patient with superficial thrombophlebitis?

Accepted Answer

Elevating the affected limb helps reduce swelling and promotes venous return, which is appropriate for managing superficial thrombophlebitis.

Quiz 39: The Postpartum Family at Risk