Deck 21: Postpartum Complications

Question 1

A woman delivered a 9-lb,10-ounce 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.

Answer 1

Assess the fundus for firmness.

Question 2

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

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

Answer 2

Mastitis

Question 3

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.

Answer 3

A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor is being induced.

Question 4

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 after birth 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 after birth hemorrhage is:

A) cryoprecipitate.
B) factor VIII and vWf.
C) desmopressin.
D) hemabate.

Question 5

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 6

The first and most important nursing intervention when a nurse observes profuse after birth 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 7

With shortened hospital stays,new mothers are often discharged before they begin to experience symptoms of the baby blues or after birth 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 after birth 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

Early after birth 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 9

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 10

One of the first symptoms of puerperal infection to assess for in the after birth 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 two successive days starting 24 hours after birth.

Question 11

To provide adequate after birth 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").

Question 12

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 13

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 14

To provide adequate after birth 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 15

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 16

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 17

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 18

When caring for a after birth 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 19

The perinatal nurse caring for the after birth 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 20

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 21

Which instruction 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 22

MATCHING
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

Question 23

If nonsurgical treatment for late after birth 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 24

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

A) After birth depression
B) After birth psychosis
C) After birth bipolar disorder
D) After birth blues

Question 25

MATCHING
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 26

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

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

Question 27

MATCHING
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 28

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) posttraumatic stress disorder (PTSD).
D) obsessive-compulsive disorder (OCD).

Question 29

MATCHING
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 30

MATCHING
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