ATI Maternal Newborn Nursing Edition
10, Unit 3 Postpartum Nursing Care
Questions and answers 100% Correct
1. A nurse is performing a fundal assessment for a client who is 2 days postpartum and
observes the perennial pad for lochia. She notes the pad to be saturated
approximately 12 cm with lochia that is bright red and contains small clots. Which of
the following findings should the nurse document?
a. moderate lochia rubra
b. Excessive blood loss
c. light lochia rubra
d. Scant lochia serosa
- Answer-a
a. CORRECT: the client has moderate lochia rubra containing small clots,
which is an expected finding for the second day postpartum.
b.. Excessive blood loss is saturation of a perineal pad in 15 min or less or
pooling of blood under the client's buttocks.
c. light lochia rubra is a perineal pad that is saturated less than 10 cm with
lochia.
d. scant lochia serosa (less than 2.5 cm on perineal pad) is pinkish brown in
color and serosanguineous in consistency. it occurs on day 4 to 12 following
delivery."
2. During ambulation to the bathroom, a postpartum client experiences a gush of dark
red blood that soon stops. on assessment, a nurse finds the uterus to be firm,
midline, and at the level of the umbilicus. Which of the following findings should the
nurse interpret this data as being?
a. Evidence of a possible vaginal hematoma
b. an indication of a cervical or perineal laceration
c. A normal postural discharge of lochia
d. Abnormally excessive lochia rubra flow
- Answer-c
, ATI Maternal Newborn Nursing Edition
10, Unit 3 Postpartum Nursing Care
Questions and answers 100% Correct
a. a client who has a vaginal hematoma is expected to report excessive pain
or vaginal pressure.
b. Excessive spurting of bright red blood from the vagina indicates a possible
cervical or perineal laceration.
c. CORRECT: lochia typically trickles from the vaginal opening but flows more
steadily during uterine contractions. massaging the uterus or ambulation can
result in a gush of lochia with the expression of clots and dark blood that has
been pooled in the vagina, but it should soon decrease back to a trickle of
bright red lochia in the early puerperium.
d. Excessive blood loss consists of one pad saturated in 15 min or less or the
pooling of blood under the buttocks, which is not affected by the client's
postural changes."
3. A nurse is completing postpartum discharge teaching to a client who had no
immunity to varicella and was given varicella vaccine. Which of the following
statements by the client indicates understanding of the teaching?
a. “I will need to use contraception for 3 months before considering pregnancy."
b. “I need a second vaccination at my postpartum visit."
c. “I was given the vaccine because my baby is o-positive."
d. “I will be tested in 3 months to see if i have developed immunity." –
Answer- b
a. a client is instructed to not get pregnant for 1 month following
administration of varicella vaccine.
b. CORRECT: a second varicella immunization is needed at 4 to 8 weeks
following delivery by clients who had no history of immunity.
c. rho(d) immune globulin is administered to a Rh-negative mother who has
an Rh-positive newborn.
10, Unit 3 Postpartum Nursing Care
Questions and answers 100% Correct
1. A nurse is performing a fundal assessment for a client who is 2 days postpartum and
observes the perennial pad for lochia. She notes the pad to be saturated
approximately 12 cm with lochia that is bright red and contains small clots. Which of
the following findings should the nurse document?
a. moderate lochia rubra
b. Excessive blood loss
c. light lochia rubra
d. Scant lochia serosa
- Answer-a
a. CORRECT: the client has moderate lochia rubra containing small clots,
which is an expected finding for the second day postpartum.
b.. Excessive blood loss is saturation of a perineal pad in 15 min or less or
pooling of blood under the client's buttocks.
c. light lochia rubra is a perineal pad that is saturated less than 10 cm with
lochia.
d. scant lochia serosa (less than 2.5 cm on perineal pad) is pinkish brown in
color and serosanguineous in consistency. it occurs on day 4 to 12 following
delivery."
2. During ambulation to the bathroom, a postpartum client experiences a gush of dark
red blood that soon stops. on assessment, a nurse finds the uterus to be firm,
midline, and at the level of the umbilicus. Which of the following findings should the
nurse interpret this data as being?
a. Evidence of a possible vaginal hematoma
b. an indication of a cervical or perineal laceration
c. A normal postural discharge of lochia
d. Abnormally excessive lochia rubra flow
- Answer-c
, ATI Maternal Newborn Nursing Edition
10, Unit 3 Postpartum Nursing Care
Questions and answers 100% Correct
a. a client who has a vaginal hematoma is expected to report excessive pain
or vaginal pressure.
b. Excessive spurting of bright red blood from the vagina indicates a possible
cervical or perineal laceration.
c. CORRECT: lochia typically trickles from the vaginal opening but flows more
steadily during uterine contractions. massaging the uterus or ambulation can
result in a gush of lochia with the expression of clots and dark blood that has
been pooled in the vagina, but it should soon decrease back to a trickle of
bright red lochia in the early puerperium.
d. Excessive blood loss consists of one pad saturated in 15 min or less or the
pooling of blood under the buttocks, which is not affected by the client's
postural changes."
3. A nurse is completing postpartum discharge teaching to a client who had no
immunity to varicella and was given varicella vaccine. Which of the following
statements by the client indicates understanding of the teaching?
a. “I will need to use contraception for 3 months before considering pregnancy."
b. “I need a second vaccination at my postpartum visit."
c. “I was given the vaccine because my baby is o-positive."
d. “I will be tested in 3 months to see if i have developed immunity." –
Answer- b
a. a client is instructed to not get pregnant for 1 month following
administration of varicella vaccine.
b. CORRECT: a second varicella immunization is needed at 4 to 8 weeks
following delivery by clients who had no history of immunity.
c. rho(d) immune globulin is administered to a Rh-negative mother who has
an Rh-positive newborn.
