Deck 23: Postpartum Complications

Question 1

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance:

A) PPH is easy to recognize early; after all, the woman is bleeding.
B) Traditionally it takes more than 1000 ml of blood after vaginal birth and 2500 ml after cesarean birth to define the condition as PPH.
C) If anything, nurses and doctors tend to overestimate the amount of blood loss.
D) Traditionally PPH has been classified as early or late with respect to birth.

Answer 1

Traditionally PPH has been classified as early or late with respect to birth.

Question 2

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect:

A) Disseminated intravascular coagulation.
B) von Willebrand disease.
C) Thrombophlebitis.
D) Coagulopathies.

Answer 2

Thrombophlebitis.

Question 3

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:

A) Establish venous access.
B) Perform fundal massage.
C) Prepare the woman for surgical intervention.
D) Catheterize the bladder.

Answer 3

Perform fundal massage.

Question 4

The nurse should be aware that a pessary would be most effective in the treatment of what disorder?

A) Cystocele
B) Uterine prolapse
C) Rectocele
D) Stress urinary incontinence

Question 5

The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by:

A) Washing the nipples and breasts with mild soap and water once a day.
B) Using proper breastfeeding techniques.
C) Wearing a nipple shield for the first few days of breastfeeding.
D) Wearing a supportive bra 24 hours a day.

Question 6

When caring for a postpartum woman experiencing hemorrhagic 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) Urinary output of at least 30 ml/hr.

Question 7

With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to:

A) Stay home and avoid outside activities to ensure adequate rest.
B) Be certain that you are 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.

Question 8

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 on 2 successive days starting 24 hours after birth.

Question 9

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features:

A) Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist.
B) Is more common among older, Caucasian women because they have higher expectations.
C) Is distinguished by irritability, severe anxiety, and panic attacks.
D) Will disappear on its own without outside help.

Question 10

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, 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 11

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 12

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks after delivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the patient with von Willebrand disease who experiences a postpartum hemorrhage is:

A) Cryoprecipitate.
B) Factor VIII and vWf.
C) Desmopressin.
D) Hemabate.

Question 13

Medications used to manage postpartum hemorrhage (PPH) include (choose all that apply):

A) Pitocin.
B) Methergine.
C) Terbutaline.
D) Hemabate.
E) Magnesium sulfate.

Question 14

Abnormal adherence of the placenta occurs for reasons unknown. Attempts to remove the placenta in the usual manner are unsuccessful, and laceration and perforation of the uterine wall may result, putting the woman at risk for severe PPH and infection. Placental adherence may be partial or complete. Which is not a recognized degree of placental attachment?

A) Placenta accreta
B) Placenta previa
C) Placenta increta
D) Placenta percreta

Question 15

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

A) Subinvolution of the placental site.
B) Defective vascularity of the decidua.
C) Cervical lacerations.
D) Coagulation disorders.

Question 16

The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the patient to use first?

A) Pelvic floor support devices
B) Bladder training and pelvic muscle exercises
C) Surgery
D) Medications

Question 17

____________________ is the most common cause of postpartum infection.