Chapter 33: Postpartum Complications
MULTIPLE CHOICE
1. A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the client is experiencing profuse bleeding. What is the most likely cause for this
bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration
ANS: A
Uterine atony is significant hypotonia of the uterus and is the leading cause of postpartum
hemorrhage. Uterine inversion may lead to hemorrhage; however, it is not the most likely
source of this client’s bleeding. Further, if the woman were experiencing a uterine inversion,
it would be evidenced by the presence of a large, red, rounded mass protruding from the
introitus. A vaginal hematoma may be associated with hemorrhage. However, the most
likely clinical finding for vaginal hematoma is pain, not the presence of profuse bleeding. A
vaginal laceration should be suspected if vaginal bleeding continues in the presence of a
firm, contracted uterine fundus.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
NURSINGTB.COM
2. What is the primary nursing responsibility when caring for a client who is experiencing an
obstetric hemorrhage associated with uterine atony?
a. Establishing venous access
b. Performing fundal massage
c. Preparing the woman for surgical intervention
d. Catheterizing the bladder
ANS: B
The initial management of excessive postpartum bleeding is a firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention, fundal
massage is the initial intervention. The woman may need surgical intervention to treat her
postpartum hemorrhage, but the initial nursing intervention is to assess the uterus. After
uterine massage, the nurse may want to catheterize the client to eliminate any bladder
distention that may be preventing the uterus from properly contracting.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
3. What is the most common reason for late postpartum hemorrhage (PPH)?
a. Subinvolution of the uterus
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders
, ANS: A
Late PPH may be the result of subinvolution of the uterus. Recognized causes of
subinvolution include retained placental fragments and pelvic infection. Although defective
vascularity, cervical lacerations, and coagulation disorders of the decidua may also cause
PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or
retained placental fragments.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
4. Which client is at greatest risk for early postpartum hemorrhage (PPH)?
a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean
birth for fetal distress
b. Woman with severe preeclampsia on magnesium sulfate whose labor is being
induced
c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
d. Primigravida in spontaneous labor with preterm twins
ANS: B
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a
smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous
woman being prepared for an emergency cesarean birth for fetal distress, a multiparous
woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do
not indicate risk factors or causes of early PPH.
PTS: 1 DIF:N CRognIitivG
e LevB.
elC
: AnMalyze
TOP: Nursing Process: PlanUninS
g N T MSC: Client Needs: Physiologic Integrity
5. The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which
observation indicates or would confirm this diagnosis?
a. Absence of cyanosis in the buccal mucosa
b. Cool, dry skin
c. Calm mental status
d. Urinary output of at least 30 ml/hr
ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation during
which the perfusion of body organs may become severely compromised, and death may
occur. The presence of adequate urinary output indicates adequate tissue perfusion. The
assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool, pale,
clammy skin is associated with hemorrhagic shock. Hemorrhagic shock is associated with
lethargy, not restlessness.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
6. The most effective and least expensive treatment of puerperal infection is prevention. What
is the most important strategy for the nurse to adopt?
a. Large doses of vitamin C during pregnancy
, b. Prophylactic antibiotics
c. Strict aseptic technique by all health care personnel
d. Limited protein and fat intake
ANS: C
Strict adherence by all health care personnel to aseptic techniques during childbirth and the
postpartum period is extremely important and the least expensive measure to prevent
infection. Good nutrition to control anemia is a preventive measure. Increased iron intake
assists in preventing anemia. Antibiotics may be administered to manage infections; they are
not a cost-effective measure to prevent postpartum infection. Limiting protein and fat intake
does not help prevent anemia or prevent infection.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
7. What is one of the initial signs and symptoms of puerperal infection in the postpartum
client?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal lochia with ambulation
d. Temperature of 38° C (100.4° F) or higher on 2 successive days
ANS: D
Postpartum or puerperal infection is any clinical infection of the genital canal that occurs
within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the
United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2
successive days of the first N
1U RSstpa
0 po INrtum
GT B.C M 24 hours after birth. Fatigue is a late
days,Ostarting
finding associated with infection. Pain with voiding may indicate a urinary tract infection
(UTI), but it is not typically one of the earlier symptoms of infection. Profuse lochia may be
associated with endometritis, but it is not the first symptom associated with infection.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
8. Nurses need to understand the basic definitions and incidence data regarding post-partum
hemorrhage (PPH). Which statement regarding this condition is most accurate?
a. PPH is easy to recognize early; after all, the woman is bleeding.
b. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml
after cesarean birth to define the condition as PPH.
c. If anything, nurses and physicians tend to overestimate the amount of blood loss.
d. Traditionally, PPH has been classified as early PPH or late PPH with respect to
birth.
ANS: D
MULTIPLE CHOICE
1. A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the client is experiencing profuse bleeding. What is the most likely cause for this
bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration
ANS: A
Uterine atony is significant hypotonia of the uterus and is the leading cause of postpartum
hemorrhage. Uterine inversion may lead to hemorrhage; however, it is not the most likely
source of this client’s bleeding. Further, if the woman were experiencing a uterine inversion,
it would be evidenced by the presence of a large, red, rounded mass protruding from the
introitus. A vaginal hematoma may be associated with hemorrhage. However, the most
likely clinical finding for vaginal hematoma is pain, not the presence of profuse bleeding. A
vaginal laceration should be suspected if vaginal bleeding continues in the presence of a
firm, contracted uterine fundus.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
NURSINGTB.COM
2. What is the primary nursing responsibility when caring for a client who is experiencing an
obstetric hemorrhage associated with uterine atony?
a. Establishing venous access
b. Performing fundal massage
c. Preparing the woman for surgical intervention
d. Catheterizing the bladder
ANS: B
The initial management of excessive postpartum bleeding is a firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention, fundal
massage is the initial intervention. The woman may need surgical intervention to treat her
postpartum hemorrhage, but the initial nursing intervention is to assess the uterus. After
uterine massage, the nurse may want to catheterize the client to eliminate any bladder
distention that may be preventing the uterus from properly contracting.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity
3. What is the most common reason for late postpartum hemorrhage (PPH)?
a. Subinvolution of the uterus
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders
, ANS: A
Late PPH may be the result of subinvolution of the uterus. Recognized causes of
subinvolution include retained placental fragments and pelvic infection. Although defective
vascularity, cervical lacerations, and coagulation disorders of the decidua may also cause
PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or
retained placental fragments.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
4. Which client is at greatest risk for early postpartum hemorrhage (PPH)?
a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean
birth for fetal distress
b. Woman with severe preeclampsia on magnesium sulfate whose labor is being
induced
c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor
d. Primigravida in spontaneous labor with preterm twins
ANS: B
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a
smooth muscle relaxant, thereby contributing to uterine relaxation and atony. A primiparous
woman being prepared for an emergency cesarean birth for fetal distress, a multiparous
woman with an 8-hour labor, and a primigravida in spontaneous labor with preterm twins do
not indicate risk factors or causes of early PPH.
PTS: 1 DIF:N CRognIitivG
e LevB.
elC
: AnMalyze
TOP: Nursing Process: PlanUninS
g N T MSC: Client Needs: Physiologic Integrity
5. The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which
observation indicates or would confirm this diagnosis?
a. Absence of cyanosis in the buccal mucosa
b. Cool, dry skin
c. Calm mental status
d. Urinary output of at least 30 ml/hr
ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation during
which the perfusion of body organs may become severely compromised, and death may
occur. The presence of adequate urinary output indicates adequate tissue perfusion. The
assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool, pale,
clammy skin is associated with hemorrhagic shock. Hemorrhagic shock is associated with
lethargy, not restlessness.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
6. The most effective and least expensive treatment of puerperal infection is prevention. What
is the most important strategy for the nurse to adopt?
a. Large doses of vitamin C during pregnancy
, b. Prophylactic antibiotics
c. Strict aseptic technique by all health care personnel
d. Limited protein and fat intake
ANS: C
Strict adherence by all health care personnel to aseptic techniques during childbirth and the
postpartum period is extremely important and the least expensive measure to prevent
infection. Good nutrition to control anemia is a preventive measure. Increased iron intake
assists in preventing anemia. Antibiotics may be administered to manage infections; they are
not a cost-effective measure to prevent postpartum infection. Limiting protein and fat intake
does not help prevent anemia or prevent infection.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning
MSC: Client Needs: Safe and Effective Care Environment
7. What is one of the initial signs and symptoms of puerperal infection in the postpartum
client?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal lochia with ambulation
d. Temperature of 38° C (100.4° F) or higher on 2 successive days
ANS: D
Postpartum or puerperal infection is any clinical infection of the genital canal that occurs
within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the
United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2
successive days of the first N
1U RSstpa
0 po INrtum
GT B.C M 24 hours after birth. Fatigue is a late
days,Ostarting
finding associated with infection. Pain with voiding may indicate a urinary tract infection
(UTI), but it is not typically one of the earlier symptoms of infection. Profuse lochia may be
associated with endometritis, but it is not the first symptom associated with infection.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
8. Nurses need to understand the basic definitions and incidence data regarding post-partum
hemorrhage (PPH). Which statement regarding this condition is most accurate?
a. PPH is easy to recognize early; after all, the woman is bleeding.
b. Traditionally, it takes more than 1000 ml of blood after vaginal birth and 2500 ml
after cesarean birth to define the condition as PPH.
c. If anything, nurses and physicians tend to overestimate the amount of blood loss.
d. Traditionally, PPH has been classified as early PPH or late PPH with respect to
birth.
ANS: D
