Question 1

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

Accepted Answer

One possible complication of endometritis is dehiscence of incisions,such as from a cesarean birth or an episiotomy.Teaching the woman to firmly splint the incision when she coughs will add support and decrease the likelihood of this occurring.Taking one's temperature and collecting cultures do not prevent a complication; these are used for monitoring and diagnosing.Emptying the bladder is unrelated.

Question 2

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?

Accepted Answer

After the crisis has passed and immediate interventions have been completed,a debriefing of the healthcare team's response to the situation can be helpful as a learning opportunity.It is important to note the family's response to the unforeseen events and to include them,as appropriate,in the discussion.Because most families expect childbirth to be uneventful,a postpartum hemorrhage can provoke widely differing emotional responses.The prudent and compassionate clinician will take the time to let both the patient and the family express their feelings and affirm their concerns.Taking care of oneself is always helpful to decrease stress.The other actions are not helpful.

Question 3

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?

Accepted Answer

Pamelor is a tricyclic antidepressant.Prozac and Zoloft are selective serotonin reuptake inhibitors (SSRIs).Effexor is a serotonin-norepinephrine reuptake inhibitor (SNRI).

Question 4

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

Accepted Answer

Heparin has many side effects,including a risk for bleeding.The patient on IV heparin is at high risk for injury.The other diagnoses are important,but safety takes priority.

Question 5

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?

Accepted Answer

Patients with postpartum complications often feel a lack of control.Allowing the woman to make choices whenever possible helps her regain her sense of control.Giving a sedative is merely masking the problem.Reassuring the woman may be important to do but is not the best response.Introducing the patient to the nursery staff would be a good action if that staff will be caring for the baby while the patient is in the operating room,but it is not the best option.

Question 6

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

Accepted Answer

Removing the peri-pad from back to front increases the likelihood of contaminating the vaginal area with organisms from the rectal area.The other actions are appropriate.

Question 7

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?

Accepted Answer

Heparin therapy is monitored with the aPTT (activated partial thromboplastin time).The antidote for heparin is protamine sulfate.PT (prothrombin time)and INR (international normalized ratio)are used to monitor warfarin sodium therapy,although in many places INR is totally replacing the PT.Vitamin K is the antidote to warfarin.

Question 8

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?

Accepted Answer

Approximately 5-7% of North American Caucasians,2% of Hispanics,and 1% of African Americans have the factor V Leiden mutation.Asians do not have this gene and are not at risk for this mutation.

Question 9

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?

Accepted Answer

Multiple factors increase the risk of uterine atony,including trauma during birth from forceps or vacuum devices; uterine overdistention from multi-fetal gestation,hydramnios,or macrosomia; and the use of both oxytocin and magnesium sulfate.(Other risk factors can be found in Box 16-1.)A trial of labor after a prior cesarean birth is not a risk factor for uterine atony.

Question 10

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?

Accepted Answer

This woman may be displaying signs of postpartum psychosis,which include hallucinations,delusions,agitation,confusion,disorientation,sleep disturbances,suicidal and homicidal thoughts,and a loss of touch with reality.The most specific question the nurse can ask is about hallucinations because the woman is looking up at the ceiling.Many new mothers have sleep disturbances,so this would not be the priority question to ask.Assessing the woman's social support is not a priority.Taking the infant away from the mother would only be needed if the infant were in immediate danger,and this action may agitate the woman further.The nurse should alert others,remain with the mother,and conduct further assessments.

Question 11

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?

Accepted Answer

Infants of mothers with depression are more likely to have delays in psychosocial and development and may be fussier than infants whose mothers are not depressed.Giving the woman factual information about a consequence of untreated depression may help her make a decision about treatment.The other statements are emotionally manipulative and are likely to induce guilt.

Question 12

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?

Accepted Answer

Caring for homeless women requires sensitivity and creativity.The best action by the nurse is to collaborate with social services to find a shelter that takes new moms and their infants.The other actions are unnecessary and will contribute to the woman's distrust of the health-care system.

Question 13

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?

Accepted Answer

Several clinical manifestations exist for DVT,including pain,calf tenderness,and leg swelling.The nurse can also assess warmth,redness,and possibly a palpable cord.The most accurate assessment is to measure and compare calf circumference; a 2-cm or greater increase on the painful side is an objective finding for DVT.Homans' sign is an assessment for DVT but may be inaccurate in as many as 50% of patients with DVT.Pulses may or may not be decreased,and the popliteal pulse is difficult to find in most patients.Because the patient did not complain of respiratory problems,listening to lung sounds and obtaining a pulse oximeter measurement is not the priority.

Question 14

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?

Accepted Answer

This woman has the manifestations of mastitis and will be treated with antibiotics and analgesics.Comfort measures include applying either warm or cold packs to the breasts.If the woman wishes to continue breastfeeding,she should empty her breasts every 2-4 hours.Elevation and menthol-based lotions are not warranted.

Question 15

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?

Accepted Answer

Recent research showed that most undocumented Hispanic immigrants in Texas came to find work as their primary reason.This response is best because it offers factual information and is professional in tone.The Patient Protection and Affordable Care Act does not provide health coverage for undocumented migrants and prohibits them from buying private insurance from the state-sponsored exchanges.

Question 16

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?

Accepted Answer

Warfarin therapy is monitored with the PT and INR,and in many places,the INR has replaced the PT.A therapeutic INR is 2-3.5.This patient's INR is therapeutic.Aspirin can potentiate the risk of bleeding when taken with warfarin.Green leafy vegetables contain vitamin K,which can counteract warfarin.The patient should eat a consistent amount of foods containing vitamin K and not binge occasionally.The aPTT is used to monitor heparin therapy.

Question 17

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?

Accepted Answer

Signs of puerperal infection include tachycardia,malaise,uterine tenderness,and subinvolution.Lochia can be heavy and foul smelling or scant and odorless,depending on the offending organism.The nurse should take a full set of vital signs,perform a complete assessment,and notify the health-care provider.

Question 18

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?

Accepted Answer

Although all options are possibilities,this woman has several risk factors for being a victim of intimate partner abuse (unplanned pregnancy,victim of child abuse,marital instability).The nurse should first assess for this (intimate partner abuse)before considering the other situations.

Question 19

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

Accepted Answer

To correctly assess for a perineal hematoma,assist the woman to a side-lying position and gently lift the upper buttock.Ask the patient to bear down and assess for full or bulging tissue,blue discoloration of tissue,and tenderness.

Question 20

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?

Accepted Answer

St.John's wort has been used to treat depression but cannot be taken with SSRIs because of the possibility of the patient developing a serious condition known as serotonin syndrome.This herb can also increase the side effects associated with SSRIs.The other statements are appropriate.

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