Deck 21: Postpartum Complications

Question 1

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

Answer 1

Bladder training and pelvic muscle exercises

Question 2

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 is 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").

Answer 2

May include bipolar disorder (formerly called "manic depression").

Question 3

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.

Answer 3

Uterine atony.

Question 4

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 5

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 6

Which 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 who is receiving magnesium sulfate and 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 7

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 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

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 10

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

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

Question 11

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 12

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 13

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 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

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 16

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 17

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 18

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 19

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.

Question 20

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 21

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 22

Early postpartum hemorrhage is defined as a blood loss greater than:

A)500 mL in the first 24 hours after vaginal delivery.
B)750 mL in the first 24 hours after vaginal delivery.
C)1000 mL in the first 48 hours after cesarean delivery.
D)1500 mL in the first 48 hours after cesarean delivery.

Question 23

A woman delivered a 9-lb,10-oz baby 1 hour ago.When you arrive to perform her 15-minute assessment,she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood.What is your first action?

A)Call for help.
B)Assess the fundus for firmness.
C)Take her blood pressure.
D)Check the perineum for lacerations.

Question 24

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

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

Question 25

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 26

The nurse caring for a family during a loss may 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 27

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 28

A mother with mastitis is concerned about breastfeeding while she has an active infection.The nurse should explain that:

A)The infant is protected from infection by immunoglobulins in the breast milk.
B)The infant is not susceptible to the organisms that cause mastitis.
C)The organisms that cause mastitis are not passed to the milk.
D)The organisms will be inactivated by gastric acid.

Question 29

Which instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications?

A)Palpate the fundus daily to ensure that it is soft.
B)Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.
C)Report any decrease in the amount of brownish red lochia.
D)The passage of clots as large as an orange can be expected.

Question 30

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 31

Anxiety disorders are the most common mental disorders that affect women.While providing care to the maternity patient,the nurse should be aware that one of these disorders is likely to be triggered by the process of labor and birth.This disorder is:

A)Phobias.
B)Panic disorder.
C)Post-traumatic stress disorder (PTSD).
D)Obsessive-compulsive disorder (OCD).

Question 32

If nonsurgical treatment for late postpartum hemorrhage is ineffective,which surgical procedure is appropriate to correct the cause of this condition?

A)Hysterectomy
B)Laparoscopy
C)Laparotomy
D)D&C

Question 33

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 34

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 whether 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 35

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:

A)Uterine atony.
B)Lacerations of the genital tract.
C)Perineal hematoma.
D)Infection of the uterus.

Question 36

Which 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 37

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 38

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

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

Question 39

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of circulatory status can be done with noninvasive monitoring. Please match the type of noninvasive assessment that the RN would perform with the appropriate clinical manifestation or body system.

Pulse oximetry

A)Palpation
B)Auscultation
C)Inspection
D)Observation
E)Measurement

Question 40

Which condition is a transient,self-limiting mood disorder that affects new mothers after childbirth?

A)Postpartum depression
B)Postpartum psychosis
C)Postpartum bipolar disorder
D)Postpartum blues

Question 41

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of circulatory status can be done with noninvasive monitoring. Please match the type of noninvasive assessment that the RN would perform with the appropriate clinical manifestation or body system.

Heart sounds

A)Palpation
B)Auscultation
C)Inspection
D)Observation
E)Measurement

Question 42

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of circulatory status can be done with noninvasive monitoring. Please match the type of noninvasive assessment that the RN would perform with the appropriate clinical manifestation or body system.

Skin color,temperature,turgor

A)Palpation
B)Auscultation
C)Inspection
D)Observation
E)Measurement

Question 43

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of circulatory status can be done with noninvasive monitoring. Please match the type of noninvasive assessment that the RN would perform with the appropriate clinical manifestation or body system.

Arterial pulses

A)Palpation
B)Auscultation
C)Inspection
D)Observation
E)Measurement

Question 44

PPH may be sudden and result in rapid blood loss. The nurse must be alert to the symptoms of hemorrhage and hypovolemic shock and be prepared to act quickly to minimize blood loss. Astute assessment of circulatory status can be done with noninvasive monitoring. Please match the type of noninvasive assessment that the RN would perform with the appropriate clinical manifestation or body system.

Presence or absence of anxiety

A)Palpation
B)Auscultation
C)Inspection
D)Observation
E)Measurement