NURS 129
Chapter 28: The Woman with a Postpartum Complication
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition
MULTIPLE CHOICE
1. Which statement by a postpartum woman indicates that teaching about thrombus
formation has been effective?
a. “I’ll stay in bed for the first 3 days after my baby is born.”
b. “I’ll keep my legs elevated with pillows.”
c. “I’ll sit in my rocking chair most of the time.”
d. “I’ll put my support stockings on every morning before rising.”
ANS: D
Venous congestion begins as soon as the woman stands up. The stockings should be applied
before she rises from the bed in the morning. As soon as possible, the woman should
ambulate frequently. The mother 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.
PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF: p. 607 OBJ: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
2. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the woman is experiencing profuse bleeding. The most likely etiology for
the bleeding is
a. uterine atony.
b. uterine inversion.
c. vaginal hematoma.
d. vaginal laceration.
ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum
hemorrhage. The other situations can cause bleeding but are not the most common cause.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 599 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
3. The nurse knows that a measure for preventing late postpartum hemorrhage is to
a. administer broad-spectrum antibiotics.
b. inspect the placenta after delivery.
c. manually remove the placenta.
d. pull on the umbilical cord to hasten the delivery 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. Broad-spectrum
antibiotics will be given if postpartum infection is suspected. Manual removal of the
placenta increases the risk of postpartum hemorrhage. 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: Knowledge/Remembering
REF: p. 602 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
4. A multiparous woman 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 woman void and massages her fundus, but her fundus remains difficult to
find, and the rubra lochia remains heavy. What action should the nurse take next?
a. Continue to massage the fundus.
b. Notify the provider.
c. Recheck vital signs.
d. Insert an indwelling urinary catheter.
ANS: B
After taking these corrective actions, the nurse should contact the provider and anticipate
collaborative care measures. Another nurse can assess vital signs. Since the woman just
voided, an indwelling catheter is not needed.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 601 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
5. Early postpartum hemorrhage is defined as signs and symptoms of hypovolemia with
which of the following descriptions of blood loss?
a. Cumulative blood loss >1000 mL in the first 24 hours after the birth process.
b. 750 mL in the first 24 hours after vaginal delivery
c. Cumulative blood loss >1000 mL in the first 48 hours after the birth process
d. 1500 mL in the first 48 hours after cesarean delivery
ANS: A
The newest definition of early postpoartum hemorrhage is cumulative blood loss >1000 mL
with signs of hypovolemia within the first 24 hours after the birth process. Hemorrhage after
24 hours is considered late postpartum hemorrhage.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 599 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
6. A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-
minute assessment, she tells you that she “feels all wet underneath.” You discover that
both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of
blood. What is your first action?
a. Call for help.
Chapter 28: The Woman with a Postpartum Complication
McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition
MULTIPLE CHOICE
1. Which statement by a postpartum woman indicates that teaching about thrombus
formation has been effective?
a. “I’ll stay in bed for the first 3 days after my baby is born.”
b. “I’ll keep my legs elevated with pillows.”
c. “I’ll sit in my rocking chair most of the time.”
d. “I’ll put my support stockings on every morning before rising.”
ANS: D
Venous congestion begins as soon as the woman stands up. The stockings should be applied
before she rises from the bed in the morning. As soon as possible, the woman should
ambulate frequently. The mother 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.
PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF: p. 607 OBJ: Nursing Process: Evaluation
MSC: Client Needs: Health Promotion and Maintenance
2. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the woman is experiencing profuse bleeding. The most likely etiology for
the bleeding is
a. uterine atony.
b. uterine inversion.
c. vaginal hematoma.
d. vaginal laceration.
ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum
hemorrhage. The other situations can cause bleeding but are not the most common cause.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 599 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
3. The nurse knows that a measure for preventing late postpartum hemorrhage is to
a. administer broad-spectrum antibiotics.
b. inspect the placenta after delivery.
c. manually remove the placenta.
d. pull on the umbilical cord to hasten the delivery 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. Broad-spectrum
antibiotics will be given if postpartum infection is suspected. Manual removal of the
placenta increases the risk of postpartum hemorrhage. 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: Knowledge/Remembering
REF: p. 602 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
4. A multiparous woman 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 woman void and massages her fundus, but her fundus remains difficult to
find, and the rubra lochia remains heavy. What action should the nurse take next?
a. Continue to massage the fundus.
b. Notify the provider.
c. Recheck vital signs.
d. Insert an indwelling urinary catheter.
ANS: B
After taking these corrective actions, the nurse should contact the provider and anticipate
collaborative care measures. Another nurse can assess vital signs. Since the woman just
voided, an indwelling catheter is not needed.
PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 601 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity
5. Early postpartum hemorrhage is defined as signs and symptoms of hypovolemia with
which of the following descriptions of blood loss?
a. Cumulative blood loss >1000 mL in the first 24 hours after the birth process.
b. 750 mL in the first 24 hours after vaginal delivery
c. Cumulative blood loss >1000 mL in the first 48 hours after the birth process
d. 1500 mL in the first 48 hours after cesarean delivery
ANS: A
The newest definition of early postpoartum hemorrhage is cumulative blood loss >1000 mL
with signs of hypovolemia within the first 24 hours after the birth process. Hemorrhage after
24 hours is considered late postpartum hemorrhage.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 599 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity
6. A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-
minute assessment, she tells you that she “feels all wet underneath.” You discover that
both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of
blood. What is your first action?
a. Call for help.
