Question 1

The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider? Select all that apply.

Accepted Answer

A) Foul-smelling lochia can indicate an infection and requires medical attention. B) Hot, red, painful breasts may suggest mastitis, a condition that also necessitates medical intervention. E) Frequent, painful urination could be a sign of a urinary tract infection, which requires treatment.

Question 2

The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take?

Accepted Answer

The presence of discoloration and tenderness in the perineal area could indicate hematoma formation, which requires immediate evaluation by the healthcare provider. Continuing to apply ice or relieving pressure may not address the underlying issue, and monitoring vital signs may not provide enough information for the nurse to intervene appropriately.

Question 3

The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply.

Accepted Answer

Increases in maternal age, prepregnancy obesity, cesarean deliveries, and preexisting chronic medical conditions are all recognized risk factors for severe maternal morbidity. Inability to pay for healthcare could also indirectly contribute to SMM if it leads to limited access to prenatal care or delays in seeking medical attention.

Question 4

The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room?

Accepted Answer

Collecting blood in calibrated, under-buttocks drapes is a recommended method for estimating postpartum blood loss by several organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO). This method allows for more accurate measurement and documentation of blood loss. Asking the patient how many peripads she considered to be "soaked" may be subjective and unreliable, placing a basin at the foot of the delivery table may underestimate blood loss, and relying on the primary health care provider's estimate alone may be inconsistent and inaccurate.

Question 5

The nurse is providing care for a patient who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this patient?

Accepted Answer

Postpartum psychosis is a serious condition that requires immediate hospitalization in a psychiatric unit for the safety of the mother and her newborn. Prescriptions for antidepressant/antipsychotic drugs and prescribed neonate visits may be included in the medical management. Discharge to home with 24-hour observation in place is not sufficient for the level of care needed for postpartum psychosis.

Question 6

The nurse in a labor and delivery department carefully assesses postpartum patients for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign evaluation?

Accepted Answer

Changes in blood pressure may not be an immediate sign of hemorrhage, which can make it difficult to identify the risk of hemorrhage through vital sign evaluation. Other signs such as increased vaginal bleeding and changes in uterine tone may be more reliable indicators.

Question 7

The nurse is aware the greatest source of bleeding during childbirth occurs following detachment of the placenta. Which physiological change takes place immediately after the expulsion of the placenta to decrease the amount of blood loss?

Accepted Answer

Contractions of the uterine myometrium take place immediately after the expulsion of the placenta. These contractions compress blood vessels in the uterus, reducing bleeding and promoting the formation of blood clots to prevent further bleeding. Factors VIII complex and platelet activity also play a role in preventing bleeding, but they do not decrease blood loss immediately after the expulsion of the placenta. Fibrin formation also contributes to clotting, but it does not occur immediately after the expulsion of the placenta.

Question 8

The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient?

Accepted Answer

Carboprost-tromethamine is used to manage postpartum hemorrhage, which is a risk in precipitous births and multiparous patients. Methylergonovine is contraindicated due to the patient's history of hypertension.

Question 9

The nurse continues to monitor a patient after a vaginal delivery with an estimated blood loss of 1,000 mL. Which assessment finding does the nurse recognize as requiring Stage 3 hemorrhage protocol?

Accepted Answer

Development of abnormal vital signs is a key indicator of Stage 3 hemorrhage protocol. Increased restlessness and requests for water are common early signs of blood loss, but severe pain may be related to other factors such as uterine contractions or perineal trauma.

Question 10

The labor and delivery unit nurses are adopting methods to reduce the number of women who develop postpartum depression. Research from Dennis and Dowswell (2013) provides evidence-based suggestions regarding beneficial interventions. Which suggestions do the nurses consider? Select all that apply.

Accepted Answer

Research by Dennis and Dowswell (2013) supports interventions such as telephone-based peer support, interpersonal psychotherapy, and professionally based postpartum home visits as effective methods for reducing the incidence of postpartum depression. These interventions focus on providing support, therapy, and professional guidance to new mothers, which can help in identifying and managing symptoms of postpartum depression.

Question 11

A postpartum patient informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the patient's medical record and associates which risk factors related to a possible urinary tract infection (UTI)? Select all that apply.

Accepted Answer

The answer of A postpartum patient informs the nurse of...

Question 12

The nurse is assessing a patient who is 36 hours postpartum following a cesarean delivery. Which findings cause the nurse to conclude that a wound infection is developing? Select all that apply.

Accepted Answer

The answer of The nurse is assessing a patient who...

Question 13

The nurse on a postpartum unit observes a patient who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The patient states, "I think that my baby is deformed inside and we have to fix him." Which risk factor is most strongly related to possible postpartum psychosis (PPP)?

Accepted Answer

The answer of The nurse on a postpartum unit observes...

Question 14

The nurse is preparing discharge teaching for a postpartum patient who exhibits signs and symptoms of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management?

Accepted Answer

The nurse should provide information about medication therapy, including how to take prescribed antibiotics and any pain medications, to manage the infection and associated pain effectively.

Question 15

The nurse is closely monitoring a patient who is postpartum and at risk for PPH. Which assessment finding will cause the nurse to contact the primary care provider immediately?

Accepted Answer

A peripad weighing 100 g within 15 minutes indicates excessive bleeding, suggesting potential postpartum hemorrhage, which requires immediate medical attention.

Question 16

The lactation nurse takes a phone call from a mother who is breastfeeding her 2-month-old infant. The mother reports an area of redness and warmth on the breast and a painful burning sensation when breastfeeding. Which statement by the nurse is correct if mastitis is suspected?

Accepted Answer

Continuing to breastfeed will help clear up the condition because it helps to empty the breast and remove bacteria. It is important for the mother to ensure that the baby is latching correctly and that the breast is being fully emptied during each feeding. The mother may also need to take antibiotics if the infection does not improve with breastfeeding and self-care measures. Nipple shields may also be used if the pain is severe. Pumping and throwing away milk should only be done if the mother is unable to breastfeed due to the pain, but continuing to breastfeed is preferred. Cracked nipples should be treated with lanolin or other recommended creams and do not require stopping breastfeeding. The baby did not give the mother an infection; the infection is typically caused by bacteria that enter the breast tissue through a crack in the nipple.

Question 17

The nurse is providing postpartum care for a patient after a vaginal delivery. Which assessment finding causes the nurse to suspect endometritis from beta-hemolytic streptococcus?

Accepted Answer

The answer of The nurse is providing postpartum care for...

Question 18

The nurse is collecting information during a follow-up OB appointment with a patient who delivered 3 months ago. The patient reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply.

Accepted Answer

The answer of The nurse is collecting information during a...

Quiz 14: High-Risk Postpartum Nursing Care