Obstetrician Chapter 22: Nursing Management of the Postpartum Woman at Risk Exam Questions and Answers with Explanations 2021/2022

A 35-year-old G2, P2 client presents to her postpartum appointment with vague complaints. The nurse suspects postpartum depression after the client expresses all except which of the following? a)Feels like eating all the time b)Change in sleep c)Appears detached from infant d)Lack of energy and motivation After teaching a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful? a)"Postpartum psychosis usually appears soon after the woman comes home." b)"Postpartum psychosis usually involves psychotropic drugs but not hospitalization." c)"Postpartum depression develops gradually, appearing within the first 6 weeks." d)"Postpartum blues usually resolves by the fourth or fifth postpartum day." The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount? a)250mL b)300mL c)100mL d)500mL Which of the following assessments would lead you to believe a postpartal woman is developing a urinary complication? a) Her perineum is obviously edematous on inspection. b) At 8 hours postdelivery she has voided a total of 100 mL in four small voidings. c) She has voided a total of 1000 mL in two voidings, each spaced 1 hour apart. d) She tells you she is extremely thirsty. Which of the following would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis? a) Activated partial thromboplastin time b) Prothrombin time c) Platelet level d) Fibrinogen level A nurse is assigned to care for a client with a uterine prolapse. Which of the following would be most important for the nurse to assess when determining the severity of the prolapse? a) Uterine bleeding present b) Foul smelling lochia c) Pain in the lower abdomen d) Uterine protrusion into the vagina On the third day postpartum, which temperature is internationally defined as a postpartal infection? a) 99.6°F (37.5°C) b) 100.4°F (38°C) c) 102.4°F (39.1°C) d) 104.2°F (40.1°C) The nurse is assessing the breast of a woman who is 1 month postpartum. The woman is complaining of a painful area on one breast with a red area. The nurse notes a local area on one breast, red and warm to touch. Which of the following should the nurse suspect is the potential diagnosis? a) Mastitis b) Engorgement c) Plugged milk duct d) Breast yeast A postpartal woman calls you into her room because she is having a very heavy lochia flow containing large clots. Your first action would be to a) Assess her blood pressure. b) Palpate her fundus. c) Have her turn to her left side. d) Assess her perineum. A postpartal woman is developing a thrombophlebitis in her right leg. Which of the following assessments would you make to detect this? a) Ask her to raise her foot and draw a circle. b) Dorsiflex her right foot and ask if she has pain in her calf. c) Bend her knee and palpate her calf for pain. d) Blanch a toe and count the seconds it takes to color again. Which situation should concern the nurse treating a postpartum client within a few days of delivery? a) The client would like to watch the nurse give the baby her first bath b) The client feels empty since she delivered the neonate c) The client would like the nurse to take her baby to the nursery so she can sleep d) The client is nervous about taking the baby home When monitoring a postpartum client 2 hours after delivery, the nurse notices heavy bleeding with large clots. Which response is most appropriate initially? a) Administering ergonovine (Ergotrate) b) Massaging the fundus firmly c) Notifying the primary health care provider d) Performing bimanual compressions Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? a) Applying warm compresses b) Administering bromocriptine (Parlodel) c) Restricting fluids d) Applying ice The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? a) Symptoms include fever, chills, malaise, and localized breast tenderness b) The most common pathogen is group A beta-hemolytic streptococci c) Mastitis usually develops in both breasts of a breast-feeding client d) A breast abscess is a common complication of mastitis A nurse is assessing vital signs for a postpartum patient 48 hours after delivery. The vital signs are: T 101.2°F; HR 82; RR 18; BP 125/78. How will the nurse interpret the vital signs? a) Shock b) Normal vital signs c) Infection d) Dehydration When assessing the patient for postpartum hemorrhage the nurse monitors which of the following every hour? a) Vital signs b) Complete blood count c) Urine volume excreted d) Pad count In which time period would the nurse most likely expect a client who has delivered twins to experience late postpartum hemorrhage? a) 24 to 48 hours after delivery b) 6 weeks to 3 months after delivery c) 24 hours to 6 weeks after delivery d) 6 weeks to 6 months after delivery Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? a) Moderate amount of lochia rubra b) Uterine atony c) Thrombophlebitis d) Hemoglobin level of 12 g/dl Jerry, who is hypertensive and who received corticosteroids during pregnancy, delivered by cesarean and subsequently developed endometritis. Her incision is red, warm, and very sensitive to touch, and she remains febrile despite antibiotic therapy. What is the most important aspect of post hospital care to teach her? a) Proper perineal care b) Wound care and hand washing c) Use of warm compresses and sitz baths d) Strict adherence to antibiotic therapy A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? a) Obtain a clean-catch urine specimen b) Administer amoxicillin, as prescribed c) Encourage her to drink large amounts of fluid d) Suggest that she take an oral analgesic On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? a) Assess the woman's fundus. b) Begin an IV infusion of Ringer's lactate solution. c) Call the woman's health care provider. d) Assess the woman's vital signs. When assessing a postpartum patient who was diagnosed with a cervical laceration which has been repaired, what sign should the nurse report as a possible development of hypovolemic shock? a) Decreased respiratory rate b) Warm and flushed skin c) Elevated blood pressure d) Weak and rapid pulse A client has had a cesarean birth. Which of the following amounts of blood loss would the nurse document as a postpartum hemorrhage in this client? a) 250 ml. b) 750 ml. c) 500 ml. d) 1000 ml. Which of the following behaviors exhibited by a 4-hour postpartum woman requires further interventions by the nurse? a) Returns her son to the nursery because of fatigue. b) Absent verbalization about the birthing process. c) Cuddles her son close to her while feeding. d) Tells visitors about her son and the labor. Which of the following instructions should the nurse offer a client as primary preventive measures to prevent mastitis? a) Avoid massaging the breast area b) Apply cold compresses to the breast c) Avoid frequent breastfeeding d) Perform handwashing before breastfeeding Which recommendation should be given to a client with mastitis who's concerned about breast-feeding her neonate? a) She should continue to breast-feed; mastitis won't infect the neonate b) She should supplement feeding with formula until the infection resolves c) She should stop breast-feeding until completing the antibiotic d) She shouldn't use analgesics because they aren't compatible with breastfeeding A nurse discovers a perineal hematoma in a woman who has recently given birth. Which of the following interventions should the nurse make in this case? (Select all that apply.) a) Perform fundal massage b) Administer methotrexate c) Estimate the size of the hematoma and report it d) Apply an ice pack to the site e) Administer an antibiotic f) Administer a mild analgesic as prescribed A nurse is assigned to care for a client with deep vein thrombosis who has to undergo anticoagulation therapy. Which of the following instructions should the nurse offer the client as a caution when the client receives anticoagulation therapy? a) Sit with legs crossed over each other b) Refrain from performing any leg exercises c) Avoid products containing aspirin d) Avoid prolonged straining during defecation Two weeks after their baby is born, Tom calls to report that his wife Sylvia is behaving strangely. She is extremely talkative and energetic and he has not observed her sleeping for more than an hour or two at a time. She is also forgetting to eat and neglecting her appearance, but worse, she seems to barely be aware of the baby's needs and appears surprised when Tom asks her about the child, "As if," Tom says, "she's forgotten that we even have a baby!" You tell him to bring her in right away, because you suspect Sylvia is suffering from what condition?