Deck 23: Postpartum Complications

Question 1

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems and sensations of bearing down and of something in her vagina. The nurse would realize that the client most likely is suffering from:

A)Pelvic relaxation.
B)Cystoceles and/or rectoceles.
C)Uterine displacement.
D)Genital fistulas.

Answer 1

Cystoceles and/or rectoceles.

Question 2

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.

Answer 2

Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.

Question 3

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.

Answer 3

Harm her infant.

Question 4

To provide adequate postpartum care,the nurse should be aware that postpartum depression (PPD) with psychotic features:

A)Is more likely to occur in women with more than two children.
B)Is rarely delusional and then usually about someone trying to harm her (the mother).
C)Although serious,is not likely to need psychiatric hospitalization.
D)May include bipolar disorder (formerly called "manic depression").

Question 5

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 client with von Willebrand disease who experiences a postpartum hemorrhage is:

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

Question 6

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.

Question 7

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.

Question 8

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 9

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 10

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 11

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 12

What woman is at greatest risk for early postpartum hemorrhage (PPH)?

A)A primiparous woman (G 2 P 1 0 0 1) 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 (G 3 P 2 0 0 2) with an 8-hour labor
D)A primigravida in spontaneous labor with preterm twins

Question 13

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:

A)Call the woman's primary health care provider.
B)Administer the standing order for an oxytocic.
C)Palpate the uterus and massage it if it is boggy.
D)Assess maternal blood pressure and pulse for signs of hypovolemic shock.

Question 14

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 15

What PPH conditions are considered medical emergencies that require immediate treatment?

A)Inversion of the uterus and hypovolemic shock
B)Hypotonic uterus and coagulopathies
C)Subinvolution of the uterus and idiopathic thrombocytopenic purpura
D)Uterine atony and disseminated intravascular coagulation

Question 16

According to Beck's studies,what risk factor for postpartum depression is likely to have the greatest effect on the woman's condition?

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

Question 17

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 18

What infection is contracted mostly by first-time mothers who are breastfeeding?

A)Endometritis
B)Wound infections
C)Mastitis
D)Urinary tract infections

Question 19

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 client to use first?

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

Question 20

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 __________ and should confirm the diagnosis by ___________.

A)Disseminated intravascular coagulation;asking for laboratory tests
B)von Willebrand disease;noting whether bleeding times have been extended
C)Thrombophlebitis;using real-time and color Doppler ultrasound
D)Coagulopathies;drawing blood for laboratory analysis

Question 21

The most appropriate statement that the nurse can make to bereaved parents is:

A)"You have an angel in heaven."
B)"I understand how you must feel."
C)"You're young and can have other children."
D)"I'm sorry."

Question 22

Nurses who want to help parents with their decision making about an autopsy or who may be required to be involved in seeking consent for autopsies should be aware that:

A)Autopsies not specifically covered by insurance or done under the jurisdiction of the medical examiner's office can be very expensive.
B)Autopsies must be done within a few hours after delivery.
C)In the current litigious society more autopsies are performed than in the past.
D)Most parents who refuse the examination regret it later.

Question 23

Complicated bereavement:

A)Occurs when,in multiple births,one child dies,and the other or others live.
B)Is a state in which the parents are ambivalent,as with an abortion.
C)Is an extremely intense grief reaction that persists for a long time.
D)Is felt by the family of adolescent mothers who lose their babies.

Question 24

When helping the mother,father,and other family members actualize the loss of the infant,nurses should:

A)Use the words lost or gone rather than dead or died.
B)Make sure that the family understands that it is important to name the baby.
C)If the parents choose to visit with the baby,apply powder and lotion to the baby and wrap the infant in a pretty blanket.
D)Set a firm time for ending the visit with the baby so the parents know when to let go.

Question 25

____________________ is the most common postpartum infection.

Question 26

A woman experienced a miscarriage at 10 weeks of gestation and had a dilation and curettage (D&C). She states that she is just fine and wants to go home as soon as possible. While you are assessing her responses to her loss,she tells you that she had purchased some baby things and had picked out a name. On the basis of your assessment of her responses,what nursing intervention would you use first?

A)Ready her for discharge.
B)Notify pastoral care to offer her a blessing.
C)Ask her if she would like to see what was obtained from her D&C.
D)Ask her what name she had picked out for her baby.

Question 27

With regard to organ donation after an infant's death,nurses should be aware that:

A)Federal law requires medical staff to ask the parents about organ donation and then to contact their state's organ procurement organization (OPO) to handle the procedure if the parents agree.
B)Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience.
C)The most common donation is the infant's kidneys.
D)Corneas can be donated if the infant was either stillborn or alive,as long as the pregnancy went full term.

Question 28

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

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

Question 29

In helping bereaved parents cope and move on,nurses should keep in mind that:

A)A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.
B)When pictures of the infant are taken for keepsakes,no close-ups should be taken of any congenital anomalies.
C)No significant differences exist in grieving individuals from various cultures,ethnic groups,and religions.
D)In emergency situations nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

Question 30

The nurse would conclude that grieving parents had progressed to the reorganization/recovery phase during a follow-up visit a year later if:

A)The parents say they feel no pain.
B)The parents are discussing sex and a future pregnancy,even if they have not sorted out their feelings yet.
C)The parents have abandoned those moments of bittersweet grief.
D)The parents' questions have progressed from "Why?" to "Why us?"

Question 31

Possible alternative and complementary therapies for postpartum depression (PPD) for breastfeeding mothers include (choose all that apply):

A)Acupressure.
B)Aromatherapy.
C)St. John's wort.
D)Wine consumption.
E)Yoga.

Question 32

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 33

What options for saying goodbye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?

A)The nurse shouldn't discuss any options at this time;there is plenty of time after the baby is born.
B)"Would you like a picture taken of your baby after birth?"
C)"When your baby is born,would you like to see and hold her?"
D)"What funeral home do you want notified after the baby is born?"

Question 34

The nurse caring for a family during a loss might notice that survival guilt sometimes is felt at the death of an infant by the child's:

A)Siblings.
B)Mother.
C)Father.
D)Grandparents.

Question 35

A woman is diagnosed with having a stillborn. At first,she appears stunned by the news,cries a little,and then asks you to call her mother. The phase of bereavement the woman is experiencing is called:

A)Anticipatory grief.
B)Acute distress.
C)Intense grief.
D)Reorganization.

Question 36

After giving birth to a stillborn infant,the woman turns to the nurse and says,"I just finished painting the baby's room. Do you think that caused my baby to die?" The nurse's best response to this woman is:

A)"That's an old wives' tale;lots of women are around paint during pregnancy,and this doesn't happen to them."
B)"That's not likely. Paint is associated with elevated pediatric lead levels."
C)Silence.
D)"I can understand your need to find an answer to what caused this. What else are you thinking about?"

Question 37

A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist,who informs them of their son's prognosis. When the father sees his son,he says,"He looks just fine to me. I can't understand what all this is about." The most appropriate response by the nurse would be:

A)"Didn't the doctor tell you about your son's problems?"
B)"This must be a difficult time for you. Tell me how you're doing."
C)To stand beside him quietly.
D)"You'll have to face up to the fact that he is going to die sooner or later."

Question 38

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action would indicate that the family had begun to grieve for the dead infant?

A)They refer to the two live infants as twins.
B)They ask about the dead triplet's current status.
C)They bring in play clothes for all three infants.
D)They refer to the dead infant in the past tense.

Question 39

During a follow-up visit,if parents have progressed to the second stage or phase of grieving,the nurse should not expect to see:

A)Guilt,particularly in the mother.
B)Numbness or lack of response.
C)Bitterness or irritability.
D)Fear and anxiety,especially about getting pregnant again.

Question 40

During the initial acute distress phase of grieving,parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. The nurse's role should be to:

A)Take over as much as possible to relieve the pressure.
B)Encourage grandparents to take over.
C)Make sure the parents themselves approve the final decisions.
D)Let them alone to work things out.

Question 41

_________________________ refers to the grief response that occurs with reminders of loss. This typically happens on special anniversary dates of the loss.