Chapter 28: Postpartum Maternal Complications
MULTIPLE CHOICE
1. Which statement by a postpartum client indicates that further teaching is not needed regarding
thrombus formation?
a. “I’ll keep my legs elevated with pillows.”
b. “I’ll sit in my rocking chair most of the time.”
c. “I’ll stay in bed for the first 3 days after my baby is born.”
d. “I’ll put my support stockings on every morning before rising.”
ANS: D
Venous congestion begins as soon as the client stands up. The stockings should be applied
before she rises from the bed in the morning. The client should avoid knee pillows because
they increase pressure on the popliteal space. Sitting in a chair with legs in a dependent
position causes pooling of blood in the lower extremities. As soon as possible, the client
should ambulate frequently.
PTS: 1 DIF: Cognitive Level: Application REF: 607
OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
2. The nurse knows that late postpartum hemorrhage can be prevented by:
a. manually removing the placenta.
b. inspecting the placenta after birth.
c. administering broad-spectrum antibiotics.
d. pulling on the umbilical cord to hasten the birth of the placenta.
ANS: B
If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing
fragments, and remove the potential cause of late postpartum hemorrhage. Manual removal of
the placenta increases the risk of postpartum hemorrhage. Broad-spectrum antibiotics will be
given if postpartum infection is suspected. The placenta is usually delivered 5 to 30 minutes
after birth of the baby without pulling on the cord. That can cause uterine inversion.
PTS: 1 DIF: Cognitive Level: Application REF: 602
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Physiologic Integrity
3. A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000-
g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has
the client void and massages her fundus, but the fundus remains difficult to find and the rubra
lochia remains heavy. Which action should the nurse take next?
a. Recheck vital signs.
b. Insert a Foley catheter.
c. Notify the health care provider.
d. Continue to massage the fundus.
ANS: C
, Treatment of excessive bleeding requires the collaboration of the health care provider and the
nurses. Do not leave the client alone. The nurse should call the clinician while a second nurse
rechecks the vital signs. The client has voided successfully, so a Foley catheter is not needed
at this time. The uterine muscle can be overstimulated by massage, leading to uterine atony
and rebound hemorrhage.
PTS: 1 DIF: Cognitive Level: Application REF: 604
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Physiologic Integrity
4. Early postpartum hemorrhage is defined as a blood loss greater than:
a. 500 mL within 24 hours after a vaginal birth.
b. 750 mL within 24 hours after a vaginal birth.
c. 1000 mL within 48 hours after a cesarean birth.
d. 1500 mL within 48 hours after a cesarean birth.
ANS: B
The average amount of bleeding after a vaginal birth is 500 mL. Early postpartum hemorrhage
occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL. Late
postpartum hemorrhage is 48 hours and later.
PTS: 1 DIF: Cognitive Level: Understanding REF: 598
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity
5. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
a. uterine atony.
b. perineal hematoma.
c. infection of the uterus.
d. lacerations of the genital tract.
ANS: D
Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is
uncontrolled by uterine contraction. The fundus would not be firm with uterine atony. A
hematoma would be internal. Swelling and discoloration would be noticed, but bright
bleeding would not be. With an infection of the uterus, there would be an odor to the lochia
and systemic symptoms such as fever and malaise.
PTS: 1 DIF: Cognitive Level: Understanding REF: 601
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity
6. A postpartum client would be at increased risk for postpartum hemorrhage if she delivered
a(n):
a. 5-lb, 2-oz infant with outlet forceps.
b. 6.5-lb infant after a 2-hour labor.
c. 7-lb infant after an 8-hour labor.
d. 8-lb infant after a 12-hour labor.
ANS: B
MULTIPLE CHOICE
1. Which statement by a postpartum client indicates that further teaching is not needed regarding
thrombus formation?
a. “I’ll keep my legs elevated with pillows.”
b. “I’ll sit in my rocking chair most of the time.”
c. “I’ll stay in bed for the first 3 days after my baby is born.”
d. “I’ll put my support stockings on every morning before rising.”
ANS: D
Venous congestion begins as soon as the client stands up. The stockings should be applied
before she rises from the bed in the morning. The client should avoid knee pillows because
they increase pressure on the popliteal space. Sitting in a chair with legs in a dependent
position causes pooling of blood in the lower extremities. As soon as possible, the client
should ambulate frequently.
PTS: 1 DIF: Cognitive Level: Application REF: 607
OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance
2. The nurse knows that late postpartum hemorrhage can be prevented by:
a. manually removing the placenta.
b. inspecting the placenta after birth.
c. administering broad-spectrum antibiotics.
d. pulling on the umbilical cord to hasten the birth of the placenta.
ANS: B
If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing
fragments, and remove the potential cause of late postpartum hemorrhage. Manual removal of
the placenta increases the risk of postpartum hemorrhage. Broad-spectrum antibiotics will be
given if postpartum infection is suspected. The placenta is usually delivered 5 to 30 minutes
after birth of the baby without pulling on the cord. That can cause uterine inversion.
PTS: 1 DIF: Cognitive Level: Application REF: 602
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Physiologic Integrity
3. A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000-
g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has
the client void and massages her fundus, but the fundus remains difficult to find and the rubra
lochia remains heavy. Which action should the nurse take next?
a. Recheck vital signs.
b. Insert a Foley catheter.
c. Notify the health care provider.
d. Continue to massage the fundus.
ANS: C
, Treatment of excessive bleeding requires the collaboration of the health care provider and the
nurses. Do not leave the client alone. The nurse should call the clinician while a second nurse
rechecks the vital signs. The client has voided successfully, so a Foley catheter is not needed
at this time. The uterine muscle can be overstimulated by massage, leading to uterine atony
and rebound hemorrhage.
PTS: 1 DIF: Cognitive Level: Application REF: 604
OBJ: Nursing Process Step: Implementation
MSC: Client Needs: Physiologic Integrity
4. Early postpartum hemorrhage is defined as a blood loss greater than:
a. 500 mL within 24 hours after a vaginal birth.
b. 750 mL within 24 hours after a vaginal birth.
c. 1000 mL within 48 hours after a cesarean birth.
d. 1500 mL within 48 hours after a cesarean birth.
ANS: B
The average amount of bleeding after a vaginal birth is 500 mL. Early postpartum hemorrhage
occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL. Late
postpartum hemorrhage is 48 hours and later.
PTS: 1 DIF: Cognitive Level: Understanding REF: 598
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity
5. A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:
a. uterine atony.
b. perineal hematoma.
c. infection of the uterus.
d. lacerations of the genital tract.
ANS: D
Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is
uncontrolled by uterine contraction. The fundus would not be firm with uterine atony. A
hematoma would be internal. Swelling and discoloration would be noticed, but bright
bleeding would not be. With an infection of the uterus, there would be an odor to the lochia
and systemic symptoms such as fever and malaise.
PTS: 1 DIF: Cognitive Level: Understanding REF: 601
OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity
6. A postpartum client would be at increased risk for postpartum hemorrhage if she delivered
a(n):
a. 5-lb, 2-oz infant with outlet forceps.
b. 6.5-lb infant after a 2-hour labor.
c. 7-lb infant after an 8-hour labor.
d. 8-lb infant after a 12-hour labor.
ANS: B
