MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING Chapter 17 After Delivery: A Case-Based Approach

MATERNITY NEWBORN AND WOMEN’S HEALTH NURSING Chapter 17 After Delivery: A Case-Based Approach 2 | Page 1. What is the first sign of hypovolemic shock from postpartum hemorrhage? a. Cold, clammy skin b. Tachycardia c. Hypotension d. Decreased urinary output - ANSWER-ANS: B Tachycardia is usually the first sign of inadequate blood volume. 2. Although the nurse has massaged the uterus every 15 minutes, it remains flaccid, and the patient continues to pass large clots. What does the nurse recognize these signs indicate? a. Uterine atony b. Uterine dystocia c. Uterine hypoplasia d. Uterine dysfunction - ANSWER-ANS: A Atony describes a lack of normal muscle tone. If the uterus is atonic, then muscle fibers are flaccid and will not compress bleeding vessels. 3. What should the nurses first action be when postpartum hemorrhage from uterine atony is suspected? a. Teach the patient how to massage the abdomen and then get help. b. Start IV fluids to prevent hypovolemia and then notify the registered nurse. c. Begin massaging the fundus while another person notifies the physician. d. Ask the patient to void and reassess fundal tone and location. - ANSWER-ANS: C When the uterus is boggy, the nurse should immediately massage it until it becomes firm. 4. The nurse assesses a boggy uterus with the fundus above the umbilicus and deviated to the side. What should the nurses next assessment be? a. Fullness of the bladder b. Amount of lochia c. Blood pressure d. Level of pain - ANSWER-ANS: A 3 | Page Bladder distention can cause uterine atony. The uterus is massaged to firmness and then the bladder is emptied. 5. Massage and putting the infant to the breast of a postpartum patient have been ineffective in controlling a boggy uterus. What will the nurse anticipate might be ordered by the physician? a. Ritodrine b. Magnesium sulfate c. Oxytocin d. Bromocriptine - ANSWER-ANS: C Oxytocin (Pitocin) is the most common drug ordered to control uterine atony 6. A 4-week postpartum patient with mastitis asks the nurse if she can continue to breastfeed. What is the nurses most helpful response? a. Stop breastfeeding until the infection clears. b. Pump the breasts to continue milk production, but do not give breast milk to the infant. c. Begin all feedings with the affected breast until the mastitis is resolved. d. Breastfeeding can continue unless there is abscess formation. - ANSWER-ANS: D The woman with mastitis can continue to breastfeed unless an abscess forms. 7. A woman had a vaginal delivery two days ago and is preparing for discharge. What will the nurse plan to teach the woman to report to help prevent postpartum complications? a. Fever b. Change in lochia from red to white c. Contractions d. Fatigue and irritability - ANSWER-ANS: A Increased temperature is a sign of infection. The other choices are normal in the postpartum period. 8. One day after discharge, the postpartum patient calls the clinic complaining of a reddened area on her lower leg, temperature elevation of 37 C (99.8 F), rust-colored lochia, and sore breasts. What does the nurse suspect from these symptoms? a. Phlebitis