Deck 16: Caring for the Woman Experiencing Complications During the Postpartal Period

Question 1

A perinatal clinic nurse develops concerns about a postpartum woman and her infant at the first well-baby checkup.The nurse has assessed several risk factors for depression.Which action by the nurse is most appropriate?

A) Administer the Edinburgh Postnatal Depression Scale.
B) Contact Children and Family Services or Child Protective Services.
C) Notify the Visiting Nurses Association and request a home visit.
D) Provide information and teaching on the postpartum blues.

Answer 1

Administer the Edinburgh Postnatal Depression Scale.

Question 2

The perinatal nurse administers heparin as ordered to the postpartum woman with newly diagnosed deep vein thrombosis.The patient asks about the purpose of the medication.Which response by the nurse is best?

A) Assists with breakdown of the thromboses
B) Decreases clotting time and circulatory clotting factors
C) Prevents extension of the clot and new clot formation
D) Prevents the formation of any new clots only

Answer 2

Prevents extension of the clot and new clot formation

Question 3

A nurse is caring for a patient who has excessive blood loss post-delivery from uterine atony.The perinatal nurse notifies the health-care provider while another nurse performs uterine massage.Which medication does the nurse anticipate to be given as the priority?

A) Carboprost (Hemabate)
B) Ergonovine (Ergotrate)
C) Methylergonovine (Methergine)
D) Oxytocin (Pitocin)

Answer 3

Oxytocin (Pitocin)

Question 4

A nurse is assessing a woman who had a postpartum hemorrhage treated with fundal massage and oxytocin (Pitocin).Which assessment finding would require the nurse to intervene immediately?

A) Mean arterial pressure of 58 mm Hg
B) Pain of 4 on a pain scale of 1 (least amount) to 10 (most amount) 1 hour after the pain medication was administered
C) Used perineal pad weight of +80 g in 2 hours
D) Urinary bladder nondistended, no urge to void

Question 5

The clinic nurse sees a patient and her infant in the clinic for their 2-week follow-up visit.The woman appears to be tired,her clothes and hair appear unwashed,and she does not make eye contact with her infant.Which question would be most appropriate for the nurse to ask?

A) "Do you have help at home?"
B) "Is there anything wrong with your son?"
C) "Tell me about the first few days at home."
D) "What has happened? You look awful!"

Question 6

A postpartum woman has a deep vein thrombosis.The patient states,"I feel anxious and have some pain in my chest." The patient's respiratory rate is 28 breaths per minute.The perinatal nurse should prepare to respond to which of the following conditions?

A) Amniotic fluid embolus
B) Myocardial infarction
C) Pulmonary edema
D) Pulmonary embolus

Question 7

A perinatal nurse receives reports from the nurse aide on four patients who all gave birth within the last 4 hours.Which patient should the nurse assess first?

A) Blood loss of 850 mL during cesarean birth
B) Exhausted mother wanting only to rest after childbirth
C) Pulse consistently ranges from 82 to 90 beats/minute
D) Systolic blood pressure change from 132 to 110 mm Hg

Question 8

A patient is being dismissed after giving birth and having a hematoma drained in the
Operating room.What action by the patient best indicates to the nurse that outcomes for the diagnosis of risk for altered attachment have been met?

A) Asks partner to hold the baby so she can sleep
B) Holds and comforts the infant when fussy
C) Makes eye contact with the infant
D) States that her mother will help with infant care

Question 9

The perinatal nurse routinely screens pregnant women for postpartum depression.Which woman does the nurse screen as the priority?

A) Adolescent
B) Age 35 years or older
C) Ambivalent at first visit
D) First pregnancy

Question 10

The perinatal nurse teaches the postpartum woman about warning signs regarding the development of postpartum infection.The nurse teaches that fever and which of the following symptoms need to be assessed by a health-care provider?

A) Breast engorgement
B) Diarrhea
C) Emotional lability
D) Uterine tenderness

Question 11

A nursing student is preparing to give a pregnant woman heparin for a deep vein thrombosis (DVT).The student questions the dose,as it is higher than what the student has given to other patients.What response by the perinatal nurse is most appropriate?

A) Have the student hold the dose and double-check the order with the provider.
B) Inform the student that physiological changes in pregnancy require higher doses.
C) Remind the student that large doses are needed to dissolve the existing clot.
D) Tells the student to administer the dose and check results of the next laboratory draw.

Question 12

A postpartum woman has a deep vein thrombosis.The patient states,"I feel anxious and have some pain in my chest." The patient's respiratory rate is 28 breaths per minute.After calling for help,which action by the perinatal nurse takes priority?

A) Administer oxygen.
B) Document the findings.
C) Take a full set of vital signs.
D) Prepare to give pain medication.

Question 13

The perinatal nurse is aware that a key factor contributing to suboptimal outcomes for pregnant women and their families is which of the following?

A) Decreased knowledge regarding signs and symptoms of complications
B) Delayed communication between health-care provider call groups
C) Lack of family and other social support during pregnancy
D) Suboptimal nursing resources to provide care during labor and birth

Question 14

A postpartum patient is ready for discharge from the hospital with her baby.She describes having some "sad feelings" after her last baby.The perinatal nurse explains that she should seek help in which situation?

A) After 2 weeks of continuous sad feelings
B) After 3 weeks of continuous sad feelings
C) After 1 month of continuous sad feelings
D) After 6 weeks of continuous sad feelings

Question 15

A patient has been transferred to an intensive care unit (ICU)after experiencing a pulmonary embolus.The patient is stable 24 hours later,but will remain in the unit for another day or two.At this time,the priority for the perinatal nurse is to provide the family with information about infant care and what other action?

A) Advocate for infant visitation and breast pumping in the ICU if desired by the patient.
B) Give the family information about the hospital policies and procedures, including visiting hours.
C) Provide information about follow-up with her family physician after discharge from the hospital.
D) Educate the family and patient about the patient's risk for future deep vein thrombosis.

Question 16

A postpartum patient is hemorrhaging despite receiving several medications and fundal massage.What action by the nurse takes priority?

A) Begin weighing all used perineal pads.
B) Obtain informed consent for surgery.
C) Place the woman on her left side.
D) Switch the IV solution to dextrose.

Question 17

The perinatal nurse accurately defines postpartum hemorrhage to a group of nursing students by including a decrease in hematocrit levels from prebirth to postbirth by which percentage?

A) 5%
B) 8%
C) 10%
D) 15%

Question 18

A G2 TPAL 2002 patient experienced a precipitous birth 90 minutes ago.Her infant weighed 4,200 g,and a repair of a second-degree laceration was needed following the birth.The nurse assesses that the patient's uterus is boggy and deviated to the right.The patient's vaginal bleeding has increased.Which action by the nurse takes priority?

A) Assess the vital signs, including blood pressure and pulse.
B) Call the health-care provider to examine the woman now.
C) Massage the uterine fundus with continual lower-segment support.
D) Measure and document each used perineal pad to assess blood loss.

Question 19

Approximately 8 hours ago,a woman gave birth after 2.5 hours of pushing.She required an episiotomy and an assisted birth (forceps).The perinatal nurse assesses a slight bulge in the perineum and the presence of ecchymosis to the right of the episiotomy.The area feels "full" and is approximately 4 cm in diameter.The patient describes this area as "tender." What intervention does the nurse anticipate for this situation?

A) Application of ice
B) Exploratory surgery
C) Incision and drainage
D) Sitz bath every 12 hours

Question 20

The perinatal nurse recognizes that which common organism is responsible for postpartum infection manifesting with scant,odorless lochia?

A) Beta-hemolytic streptococcus
B) Chlamydia trachomatis
C) Escherichia coli
D) Treponema pallidum

Question 21

A woman is being treated for endometritis after a cesarean birth.To prevent a possible complication,what action by the nurse is best?

A) Encourage the woman to empty her bladder every 4 hours.
B) Instruct the woman to monitor her temperature at home.
C) Prepare the woman to have cultures of her lochia taken.
D) Teach her to splint her abdominal incision when coughing.

Question 22

As a member of the health-care team,the perinatal nurse finds it helpful following a maternal emergency,such as a postpartum hemorrhage,to engage in which of the following activities?

A) A family meeting to encourage communication and understanding
B) Debriefing with the other staff members involved in the patient's care
C) Health-promoting behaviors such as adequate sleep and exercise
D) Review of the case to determine any fault in the care provided
E) Time off to resolve any conflict with other staff members

Question 23

A woman with postpartum depression is in the perinatal clinic for follow-up.The health-care provider tells the nurse that the patient will be prescribed a tricyclic antidepressant.The nurse will instruct the patient about which medication?

A) Fluoxetine (Prozac)
B) Pamelor (Nortriptyline)
C) Sertraline (Zoloft)
D) Venlafaxine (Effexor)

Question 24

A woman with a deep vein thrombosis (DVT)is receiving IV heparin therapy.Which nursing diagnosis does the nurse address as the priority?

A) Altered family processes
B) Pain
C) Risk for injury
D) Self-care deficit

Question 25

A woman is being taken to the operating room later in the day for incision and drainage of a large perineal hematoma.What action by the nurse is most important to meet the patient's psychosocial needs?

A) Administer a preoperative sedative to calm her.
B) Allow the woman to make choices when possible.
C) Introduce the patient to the nursery staff.
D) Reassure the patient that hematomas heal quickly.

Question 26

A nurse is teaching a postpartum patient about preventing infection after discharge.What action by the patient indicates that she needs additional teaching?

A) Allows milk to dry on her nipples after nursing
B) Removes her peri-pad from back to front
C) Sprays water from the peri-bottle from front to back
D) Washes her hands prior to using the bathroom

Question 27

A nurse is caring for a patient on heparin for a deep vein thrombosis (DVT)and realizes that the patient has received an overdose of the medication.When contacting the physician,what orders does the nurse anticipate?

A) Laboratory draw for PT/INR; administer protamine sulfate.
B) Laboratory draw for PT/INR; administer vitamin K.
C) Laboratory draw for aPTT; administer protamine sulfate.
D) Laboratory draw for aPTT; administer vitamin K.

Question 28

As part of a research study on deep vein thrombosis (DVT),a perinatal nurse is collecting blood samples in women at highest risk for factor V Leiden mutation.Which woman would the nurse approach as the priority?

A) African American
B) Asian American
C) Caucasian American
D) Hispanic American

Question 29

The nursing faculty member who is explaining uterine atony to nursing students informs them of risk factors contributing to this condition.Which factors would place a woman at higher risk of uterine atony?

A) Forceps-assisted birth
B) Trial of labor after a prior cesarean birth
C) Multi-fetal gestation
D) Oxytocin labor induction
E) Use of magnesium sulfate

Question 30

A postpartum woman is in the perinatal clinic for a routine follow-up visit with her new infant.The patient seems agitated by the questions the nurse is asking and often looks up at the ceiling apprehensively.What action by the nurse is best?

A) Ask the woman if she is hearing voices.
B) Assess the woman's sleep and nutrition.
C) Determine if the woman has any support.
D) Take the baby to another room for assessment.

Question 31

A woman with postpartum depression resists treatment,saying: "Who cares if I'm depressed? It only affects me." What response by the nurse is best?

A) "Don't you think your family would like you to get treatment?"
B) "Infants of depressed mothers have delayed development."
C) "You may harm your baby if your depression is not treated."
D) "We care that you are depressed and want you to feel better."

Question 32

A postpartum woman is about to be dismissed with her baby when she reveals to the nurse that she is homeless and has nowhere to go.What action by the nurse is most appropriate?

A) Call Child Protective Services to come get the infant.
B) Enlist social work to find a shelter that will take them.
C) Remove the infant and take him to the newborn nursery.
D) Tell the patient that the baby cannot be dismissed without a home.

Question 33

A postpartum woman who had a cesarean birth complains of warmth and pain in one of her calves.Which assessment should the nurse perform as the priority?

A) Bilateral calf circumference
B) Homans' sign on both legs
C) Lung sounds and oxygen saturation
D) Pedal and popliteal pulses

Question 34

A postpartum woman presents to the perinatal clinic complaining of extreme breast tenderness and an inability to express milk on the left side when breastfeeding.What nonpharmacological comfort measure does the nurse teach this patient?

A) Application of either warm or cold packs
B) Expression of milk every 1-2 hours
C) Ice and elevation of the breast when sitting
D) Menthol-based lotion to draw the heat out

Question 35

A nursing student who once lived in the southwest was overheard making disparaging comments about Hispanic immigrants,stating: "They only come here for free medical care." What response by the nursing faculty member is best?

A) "Most immigrants do not come here for free health care at all."
B) "Research actually shows that most immigrants come to find work."
C) "That is a downfall of the Patient Protection and Affordable Care Act."
D) "Why are you only picking one ethnic group about whom to make this statement?"

Question 36

A patient was discharged from the hospital on warfarin sodium (Coumadin)and is now in the perinatal clinic for follow-up.Which of the following would best indicate to the nurse that goals for discharge teaching have been met?

A) Chooses aspirin for pain relief
B) Eats large salads three times a week
C) Patient INR of 2.5
D) Patient aPTT of 2 times normal

Question 37

A woman had a cesarean birth after a prolonged trial of labor.When assessing the patient,the nurse notes the patient is lethargic,has a pulse of 130 beats/minute,and states: "I'm glad I have so little lochia; I'm too tired to change my pad." What action by the nurse is most appropriate?

A) Assess the amount of lochia on the peri-pad.
B) Cluster the nursing care given to allow uninterrupted sleep.
C) Have the woman get up and attempt to void.
D) Take a full set of vital signs and call the provider.

Question 38

A perinatal nurse is conducting an initial interview and assessment on a new patient in her first trimester of an unplanned pregnancy.The nurse discovers the patient was a victim of child abuse and her husband has left her and returned several times.The nurse should assess this patient for what other issue as the priority?

A) Financial concerns
B) Homelessness
C) Intimate partner abuse
D) Social isolation

Question 39

A nurse is assessing a patient for a perineal hematoma.Which action by the nurse is most appropriate?

A) Assist the woman to a knee-chest position with head down.
B) Have the patient lie supine and place her legs in frog-leg position.
C) Place the patient in a side-lying position and lift the upper buttock.
D) Turn the woman side to side and lift the upper leg each time.

Question 40

A woman with postpartum depression is being treated with a selective serotonin
Reuptake inhibitor (SSRI).What statement by the patient requires further action by the nurse?

A) "Adding St. John's wort has really helped my depression."
B) "I have started using aromatherapy and it helps a little."
C) "Increasing my calcium intake seems to have a positive effect."
D) "My baby seemed sleepier so I stopped breastfeeding him."

Question 41

A woman is hospitalized emergently for postpartum psychosis.For which of the following does the nurse prepare the patient as initial treatment?

A) Amphetamine and dextroamphetamine (Adderall)
B) Electroconvulsive therapy (ECT)
C) Lithium (Lithobid)
D) Chlorpromazine (Thorazine)
E) Diazepam (Valium)

Question 42

A postpartum woman who had a prolonged labor presents to the clinic complaining of abdominal pain,high fevers with chills,and back pain.The nurse notes the patient's heart rate is 142 beats/minute,and her abdomen is tender with hypoactive bowel sounds.The patient will be admitted,and when giving report to the hospital nurse,the clinic nurse advises that the patient will probably receive what initial treatment?

A) Antibiotics
B) Coumadin
C) Forced fluids
D) Heparin
E) Ibuprofen (Motrin)

Question 43

The nursing faculty member explains to a class of nursing students the risk factors for developing postpartum depression (PPD).Which of the following does the faculty include?

A) Financial stress
B) Isolation
C) Low self-esteem
D) Stay-at-home mother
E) Unplanned pregnancy

Question 44

A nurse manager in the perinatal clinic wants to begin screening male partners for risk factors for committing intimate partner abuse.What risk factors does the manager include on the new screening form?

A) Confidence
B) Low income
C) Male-dominant family structure
D) Unemployment
E) Young age

Question 45

A woman is hospitalized after an incision and drainage of a large breast abscess that cultured methicillin-resistant Staphylococcus aureus.What dietary choices indicate that she has understood teaching regarding nutrition and wound healing?

A) Chicken breast
B) Hard-boiled egg
C) Orange slices
D) Spinach
E) Whole-wheat bread

Question 46

The perinatal nurse explains risk factors for hematoma formation to a group of nursing students.What risk factors does the nurse include in the teaching?

A) Cesarean birth
B) Episiotomy
C) Genital tract laceration
D) Multiparity
E) Prolonged second stage of labor

Question 47

A perinatal nurse explains to the nursing student that pregnant women have risk factors for deep vein thrombosis (DVT)as a result of their pregnancy.To which components of Virchow's triad is the nurse referring?

A) Dehydration
B) Hypercoagulability
C) Trauma to veins
D) Vascular distention
E) Venous stasis

Question 48

A postpartum woman has a suspected deep vein thrombosis (DVT).Which diagnostic studies does the nurse prepare the woman to possibly have?

A) Laboratory draw for D-dimer
B) Magnetic resonance imaging (MRI)
C) Venogram
D) Venous duplex ultrasound
E) Ventilation-perfusion (V/Q) scan

Question 49

A perinatal nurse is teaching a woman who is in a violent relationship about safety-promoting behaviors.Which of the following does the nurse include in teaching?

A) Ask neighbors and family not to intervene.
B) Begin hiding money and an extra set of keys.
C) Find and safely store important documents.
D) Photocopy and save utility and rent receipts.
E) Remove weapons or bullets from the home.

Question 50

A woman presents to the emergency department in labor and states that she is homeless and has not had prenatal care.The emergency department nurse explains to the nursing student that homeless women face many challenges to getting prenatal care,including which of the following?

A) Caring for other children
B) Fear of violence
C) Lack of insurance
D) Mistrust of health-care providers
E) Transportation difficulties