Deck 39: The Postpartum Family at Risk

Question 1

A postpartal patient recovering from deep vein thrombosis is being discharged. What areas of teaching on self-care and anticipatory guidance should the nurse discuss with the patient?

A) Avoid crossing the legs.
B) Avoid prolonged standing or sitting.
C) Take frequent walks.
D) Take a daily aspirin dose of 650 mg.
E) Avoid long car trips.

Answer 1

Avoid crossing the legs.
Avoid prolonged standing or sitting.
Take frequent walks.

Question 2

The postpartum patient is concerned about mastitis because she experienced it with her last baby. Preventive measures the nurse can teach include:

A) Wearing a tight-fitting bra.
B) Limiting feedings to q.i.d.
C) Frequent breastfeeding.
D) Forcing fluids.

Answer 2

Frequent breastfeeding.

Question 3

Which findings would indicate the presence of a perineal wound infection?

A) Redness
B) Edema
C) Vaginal bleeding
D) Warmth
E) Purulent drainage

Answer 3

Redness
Edema
Warmth
Purulent drainage

Question 4

A postpartum patient reports sharp, shooting pains in her nipple during breastfeeding and flaky, itchy skin on her breasts. The nurse suspects:

A) Nipple soreness.
B) Engorgement.
C) Mastitis.
D) Letdown reflex.

Question 5

The home health nurse is visiting a new mother whose baby was delivered by emergency cesarean after a car accident. The mother seems dazed, irritable, and unaware of her surroundings. She tells the nurse she has had trouble sleeping. The nurse would suspect that the mother has:

A) Post-traumatic stress disorder.
B) Postpartum blues.
C) Postpartum psychosis.
D) Disenfranchised grief.

Question 6

The most appropriate nursing diagnosis for a patient with postpartum deep vein thrombosis is:

A) Fluid Volume excess related to tissue edema.
B) Sleep Pattern Disturbance related to tissue hypoxia.
C) Risk for Infection related to obstructed venous return.
D) Altered Tissue Perfusion related to obstructed venous return.

Question 7

A patient is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications?

A) Methergine
B) Stadol
C) Misoprostol
D) Betamethasone

Question 8

The nurse is assessing a patient who has been diagnosed with an early postpartum hemorrhage. Which findings would the nurse expect?

A) A boggy fundus that does not respond to massage
B) Small clots and a moderate amount of lochia rubra on the pad
C) Decreased pulse and increased blood pressure
D) Hematoma formation or bulging/shiny skin in the perineal area
E) Rise in the level of the fundus of the uterus

Question 9

The patient has experienced a postpartum hemorrhage at 6 hours postpartum. After controlling the hemorrhage, the patient's partner asks what would cause a hemorrhage. How should the nurse respond?

A) "Sometimes the uterus relaxes and excessive bleeding occurs."
B) "The blood collected in the vagina and poured out when your partner stood up."
C) "Bottle-feeding prevents the uterus from getting enough stimulation to contract."
D) "The placenta had embedded in the uterine tissue abnormally."

Question 10

The postpartum patient states that she doesn't understand why she can't enjoy being with her baby. The nurse is concerned about:

A) Postpartum psychosis.
B) Postpartum infection.
C) Postpartum depression.
D) Postpartum blues.

Question 11

The nurse is calling patients at 4 weeks postpartum. The patient who should be seen immediately is the patient who:

A) Describes feeling sad all the time.
B) Reports hearing voices talking about the baby.
C) States she has no appetite and wants to sleep all day.
D) Says she needs a refill on her sertraline (Zoloft) next week.

Question 12

To prevent the spread of infection, the nurse teaches the postpartum patient to:

A) Address pain early.
B) Change peripads frequently.
C) Avoid overhydration.
D) Report symptoms of uterine cramping.

Question 13

A patient had a cesarean birth 3 days ago. She has tenderness, localized heat, and redness of the left leg. She is afebrile. As a result of these symptoms, the nurse recognizes that the patient will most likely be:

A) Encouraged to ambulate freely.
B) Given aspirin 650 mg by mouth.
C) Given Methergine IM.
D) Placed on bed rest.

Question 14

The postpartum multipara is breastfeeding her new baby. The patient states that she developed mastitis with her first child, and asks whether there is something she can do to prevent mastitis this time. The best response of the nurse is:

A) "Massage your breasts on a daily basis, and if you find a hardened area, massage it towards the nipple to unblock that duct."
B) "Most first-time moms experience mastitis. It is really quite unusual for a woman having her second baby to get it again."
C) "Apply cabbage leaves to any areas that feel thickened or firm to relieve the swelling."
D) "Take your temperature once a day. This will help you to pick up the infection early, before it becomes severe."

Question 15

The nurse is caring for a postpartum patient who is at risk for developing early postpartum hemorrhage. What interventions would be included in the plan of care to detect this complication?

A) Weigh perineal pads if the patient has a slow, steady, free flow of blood from the vagina.
B) Massage the uterus every 2 hours.
C) Maintain vascular access.
D) Obtain blood specimens for hemoglobin and hematocrit.
E) Encourage the patient to void if the fundus is displaced upward or to one side.

Question 16

The charge nurse is assessing several postpartum patients. Which patient has the greatest risk for postpartum hemorrhage?

A) The patient who was overdue and delivered vaginally
B) The patient who delivered by scheduled cesarean delivery
C) The patient who had oxytocin augmentation of labor
D) The patient who delivered vaginally at 36 weeks

Question 17

Which method of assessment would best indicate whether a patient has a urinary complication?

A) Urine pH
B) Calculation of output
C) Urine-specific gravity
D) Calculation of intake

Question 18

The nurse is caring for a postpartum patient who had an estimated blood loss of 500 ml following a vaginal birth. What is the best clinical measure of the patient's actual blood loss?

A) The clinical estimation of blood loss at time of birth
B) A decrease in the hematocrit of 10 points between the time of admission and the time of postbirth
C) The amount of saturation of the linens during and after the birth
D) A decrease in blood pressure and increase in pulse after birth

Question 19

The nurse is assisting a multiparous woman to the bathroom for the first time since her delivery 3 hours ago. When the patient stands up, blood runs down her legs and pools on the floor. The patient turns pale and feels weak. The first action of the nurse is to:

A) Assist the patient to empty her bladder.
B) Help the patient back to bed to check the fundus.
C) Assess her blood pressure and pulse.
D) Begin an IV of lactated Ringer's solution.

Question 20

Which relief measure would be most appropriate for a postpartum patient with superficial thrombophlebitis?

A) Urge ambulation.
B) Apply ice to the leg.
C) Elevate the affected limb.
D) Massage her calf.

Question 21

The patient delivered by cesarean birth 3 days ago and is being discharged. Which statement should the nurse include in the discharge teaching?

A) "If your incision becomes increasingly painful, call the doctor."
B) "It is normal for the incision to ooze greenish discharge in a few days."
C) "Increasing redness around the incision is a part of the healing process."
D) "A fever is to be expected because you had a surgical delivery."

Question 22

The nurse is preparing a community education class on healthy pregnancy. Which statements should be included?

A) Eating a well-balanced diet helps prevent pregnancy complications.
B) Stress management and support systems are important in pregnancy.
C) Prenatal care can be obtained at any point in the pregnancy.
D) Complications during a prior pregnancy do not recur.
E) Exercising regularly facilitates feeling better in pregnancy.

Question 23

The postpartum patient who delivered 2 days ago has developed endometritis. Which entry would the nurse expect to find in this patient's chart?

A) "Cesarean birth performed secondary to arrest of dilation."
B) "Rupture of membranes occurred 2 hours prior to delivery."
C) "External fetal monitoring used throughout labor."
D) "The patient has history of pregnancy-induced hypertension."

Question 24

The patient delivered her 2nd child yesterday, and is preparing to be discharged. She expresses concern to the nurse because she developed an upper urinary tract infection (UTI) after the birth of her first child. Which statement indicates that the patient needs additional teaching about this issue?

A) "If I start to have burning with urination, I need to call the doctor."
B) "Drinking 8 glasses of water each day will help prevent another UTI."
C) "I will remember to wipe from front to back after I move my bowels."
D) "Voiding two or three times per day will help prevent a recurrence."

Question 25

A nurse suspects that a postpartum patient has mastitis. Which data support this assessment?

A) Shooting pain in her nipple during breastfeeding
B) Late onset of nipple pain
C) Pink, flaking, pruritic skin of the affected nipple
D) Nipple soreness when the infant latches on
E) Pain radiating to the underarm area from the breast.

Question 26

The nurse understands that the classic symptom of endometritis in a postpartum patient is:

A) Purulent, foul-smelling lochia.
B) Sawtooth temperature spikes.
C) Profuse vaginal discharge.
D) Uterine tenderness.

Question 27

The postpartum patient who is being discharged from the hospital experienced severe postpartum depression after her last birth. What should the nurse include in the plan of follow-up care for this patient?

A) One visit from a homecare nurse, to take place in 2 days
B) Two visits from a public health nurse over the next month
C) An appointment with a mental health counselor
D) Follow-up with the obstetrician in 6 weeks

Question 28

The nurse suspects that a patient has developed a perineal hematoma. What assessment findings would the nurse have detected to lead to this conclusion?

A) Facial petechiae
B) Large, soft hemorrhoids
C) Tense tissues with severe pain
D) Elevated temperature

Question 29

A postpartum patient with endometritis is being discharged home on antibiotic therapy. The new mother plans to breastfeed her baby. What should the nurse's discharge instruction include?

A) The patient can douche every other day.
B) Sexual intercourse can be resumed when the patient feels up to it.
C) Light housework will provide needed exercise.
D) The baby's mouth should be examined for thrush.

Question 30

Which interventions can the nurse utilize to provide continuity of care for the postpartal patient who experienced a complication and is now ready to return home?

A) Encourage the patient to take advantage of home visits.
B) Make telephone calls as a follow-up to check on the patient and newborn.
C) Provide information about postpartal support groups.
D) Refer to mental health professionals to help screen the patient for any mental health problems as a result of the complications experienced in the hospital.
E) Supply information about postpartal classes designed to meet the specific needs of a variety of families.

Question 31

The postpartum patient has developed thrombophlebitis in her right leg. Which finding requires immediate intervention?

A) The patient reports she had this condition after her last pregnancy.
B) The patient develops pain and swelling in her left lower leg.
C) The patient appears anxious, and describes pressure in her chest.
D) The patient becomes upset that she cannot go home yet.

Question 32

The childbirth educator revises the curriculum to include postpartum depression preventive measures. Topics will include:

A) Encouraging planning in the prenatal period for the postnatal period.
B) Reviewing historical cases of postpartum psychosis with parents.
C) The importance of counseling for all postpartum mothers.
D) Prophylactic administration of Paxil.

Question 33

The postpartum patient is suspected of having acute cystitis. Which symptoms would the nurse expect to see in this patient?

A) High fever
B) Frequency
C) Suprapubic pain
D) Chills
E) Nausea and vomiting

Question 34

The patient delivered vaginally 2 hours ago after receiving an epidural analgesia. She has a slight tingling sensation in both lower extremities, but normal movement. She sustained a second-degree perineal laceration. Her perineum is edematous and ecchymotic. What should the nurse include in the plan of care for this patient?

A) Assist the patient to the bathroom in 2 hours to void.
B) Place a Foley catheter now.
C) Apply warm packs to the perineum three times a day.
D) Allow the patient to rest for the next 8 hours.