Maternal and Child Nursing - Postpartum Care

7/30/2019 Maternal and Child Nursing - Postpartum Care

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Prepared by: Dennis N. Muoz, PT, RN, RM, MANc

MATERNAL AND CHILDNURSING

(POSTPARTUM CARE)


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1) Which of the following SITUATIONs is morelikely to predispose a patient to postpartumhemorrhage?

a. Birth of a 3,175-g (7lb) infantb. Birth of twinsc. Prolonged first stage of labor

d. Pregnancy-induced hypertension


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2) Postpartum hemorrhage can causehypovolemic shock. The following findingsare associated with hypovolemic shock.Which findings would the nurse see last in the

cascade of events associated withhypovolemic shock?

a. Decreased blood pressure

b. A perineal pad soaked within 15 minutesc. Increased pulse rated. Patient beginning to act anxious or exhibit

air hunger


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3) If a postpartum patient is experiencinghypovolemic shock resulting from uterineatony, the nurse recognizes that the mostimportant diagnosis is:

a. Fluid volume deficit related to excessiveblood loss

b. Risk for infection related to decreased

resistance compensatory mechanismsc. Fear related to uncertainty of outcomed. Anxiety related to lack of knowledge

about complications and treatments


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4) Suzanne Mays, a gravid 1 para 1001, has vaginallydelivered a full-term infant without complications. After the

first postpartum day, she tells the postpartum nurse thatshes afraid that something is wrong because shesperspiring and urinating more than normal. Hertemperature is 100.0F (37.8C). The nurse shouldappropriately reply:

a. Youre probably responding to an infection in yourbody; Ill call the doctor and report your symptomsb. Your temperature is slightly elevated. You could havean infection. Ill call the doctor to report your

temperaturec. Its common to perspire and urinate a lot afterchildbirth; your body is getting rid of the excess fluid

that was used in pregnancyd. Im surprised youre urinating a lot because you dont

have other signs of diabetes


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5) During a childbirth preparation class, thenurse explains that in the postpartum period,the process whereby the uterus shrinks to its

prepregnancy state is called:

a. Involutionb. Puerperium

c. Uterine atonyd. Lochia rubra


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6) To provide safe, effective care, the nurse mustrecognize that in a postpartum woman,subinvolution can be caused by:

a. Pregnancy-induced hypertensionb. Preterm vaginal deliveryc. Uterine infectiond. Mastitis


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7) The nurse assessing the homeostatic status of apostpartum woman should recognize which of the

following statements as correct?

a. A slow trickle of blood from the vagina cancause as much harm as a greater

outpouringb. Hematomas in the vulvar area are alwaysresolved by the use of ice packs and arent a

source of potential hemorrhagec. A uterine fundus that remains boggy isnt

potential threat to the patients safetyd. The patient who loses an estimated 300 ml

of blood in a vaginal delivery is usually acandidate for a blood transfusion


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8) The nurse is are that periodic relaxation and

contraction of the uterine muscles cause painsand cramping after birth. Which of the followingpatients is more likely to experience severepain after giving birth?

a. A gravid 1 para 1001 patient whosbottle-feeding

b. A gravid 2 para 2002 patient whos

bottle-feedingc. A gravid 3 para 1103 patient whosbottle-feeding

d. A gravid 2 para 1001 patient whos

bottle-feeding


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SITUATION: Barbara Shrader is a 22-year oldgravid 1 who vaginally delivered her firstinfant. The vaginal delivery wasuncomplicated.

Question: 9 to 11 SITUATION


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9) One hour after delivery, which of the followingfindings would the nurse expect in a patientwho didnt have complication?

a. Boggy uterus; heavy amount of lochiarubra with small cloths

b. Boggy uterus; moderate amount oflochia serosa

c. Firm uterus; heavy amount of lochiarubra with small clots

d. Firm uterus; scant amount og lochiaserosa


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10) Before assessing the position of Mrs.Shraders uterine fundus the nurse should:

a. Ask the patient to drink fluid to fill herbladder

b. Position of Mrs. Shrader bed at 45degrees

c. Ask Mrs. Shrader to empty her bladderd. Ask Mrs. Shrader to refrain from drinking

fluids for 30 minutes for the assessments


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11) Its now 24 hours since Mrs. Shradersdelivery, in accordance with the normalinvolution process, the nurse should locateMrs. Shraders fundus in which of the followingposition?

a. Midline, 1 cm above the umbilicusb. Midline, 1 cm below the umbilicusc. Deviated to the right, 2 cm above the

umbilicusd. Midline, 3 cm below the umbilicus


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SITUATION: Darleen Stepanski is a gravid 2par 1001 that experience a prolonged secondstage of labor but finally delivered to thepostpartum unit?

Questions 12 to 14 refer to this SITUATION


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12) Thirty minutes after birth, the nurseassesses Mrs. Stepankis fundus and lochiaflow and notes an increased amount of lochiarubra and a few large clots. The uterine fundus

reains midline and firm. What should the nursesuspect as a possible cause of this bleeding?

a. Inadequate amount of oxytocin in the I.V

fluidsb. Prolonged second stage of laborc. Primiparous statusd. Retained placental fragments


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13) Uterine atony, a condition in which theuterus is unable to maintain a state of firness,is a common cause of hemorrhage in the

postpartum period. In providing patient carefor Mrs. Stepanski, the nurse is aware thatuterine atony can result from:

a. Hypertensionb. Cervical and vaginal tearsc. Urinary retentiond. Endometritis


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14) It has been since Mrs. Stepanskis initial

voiding and the nurse assess her fundus to be3 cm above the umbilicus and deviated to theright side. The nurse has an order tocatheterize this patient if shes unable to void.

Mrs. Stepanski walks to the bathroom and isable to urinate. The nurse should expect tocatheterize the patient if she measures:

a. 100ml of urineb. 350ml of urinec. 400ml of urined. 500ml of urine


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SITUATION: Marjorie Sloan is a 28-year-oldprimigrabida who vaginally delivered a full-

term infant with a forceps-assisted deliveryand midline episiotomy. An ice pack is appliedto the perineum to decrease swelling andpain.

Question 15 to 17 refers to this SITUATION.


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15) Six hours after being on the postpartumunit, Mrs. Sloan complains of excruciatingperineal and rectal pain and a feeling offullness in the vaginal area. The nurse maysuspect the cause of the pain to be related to:

a. Vaginal hematomab. Hemorrhoidc. Episiotomyd. Full bladder


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16) In performing a nursing assessment of Mrs.Sloans episiotomy, the nurse would

especially assess for:

a. Discomfort and rednessb. Discharge and odorc. Edema and approximation

d. Swelling and color


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17) In performing a routine fundal assessment,the nurse finds Mrs. Sloans fundus to be

boggy. The nurse should first:

a. Call the doctorb. Massage the fundus

c. Assess lochia flowd. Start methylergonovine as ordered


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SITUATION: Carole Soccer,a 28-year-oldmultipara, vaginally delivered a term infant.

Her amniotic membranes were ruptured for 12hours before her admission. She experienceda prolonged first stage of labor and receivedlumbar epidural anesthetic and a midline

episiotomy.



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18) The nurse prepares the nursing plan of

care and recognizes that Mrs. Soccer is athigh risk for infection related to:

a. Leukocytosis 20,000/lb. 99.6F (37.5C) temperaturec. Pulse rate 76 beat/minuted. Midline episiotomy


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19) During the nursing assessment, which of thefollowing findings in Mrs. Soccer would beindicative of dehydration related to prolongedlabor?

a. Temperature 100.1F (37.8C)b. Pulse rate 80beats/minutec. Leukocytosis 20,000/ld. Blood pressure 140/90


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20) When preparing a plan of care for Mrs.

Soccer, the nurse recognizes that the leastappropriate diagnosis is related to:

a. Impaired skin integrity related to

episiotomyb. Pain related to uterine contraction and

episiotomyc. Anxiety related to parenting

responsibilities and family adaptationd. Impaired gas exchange related to pulse

rate of 80 beats/minute


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21) Mrs. Soccer has been diagnosed with apuerperal (postpartum) infection. Which of thefollowing events most likely contributes todevelopment of a puerperal infection?

a. Prolonged first stage of labor (more than12 hours)b. Prolonged rupture of membranes

(more than 24 hours)c. Midline episiotomyd. Multiparity status


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SITUATION: Collette Holmes is a 35-year-oldmultigravida who delivered a full-term infant

via cesarean section because of a breechpresentation.



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22) The nurse recognizes that which of thefollowing events would be the most importantcontribution to the prevention ofthromboembolism?

a. Increasing oral fluid intakeb. Providing oxygen therapyc. Administering pain medications as

neededd. Encouraging frequent ambulation


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23) Mrs. Holes is in a hypercoagulable stateimmediately after birth. To determine Mrs.Holmes risk of developing thrombophlebitisin the postpartum period, the nurse shouldassess:

a. The condition of the I.V. site

b. For Homans signc. The lungs for adventitious soundsd. Deep tendon reflexes


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24) The nurse should be aware that in theusual treatment of thrombophlebitis, its mostimportant to:

a. Administer pain medications as neededb. Encourage frequent ambulationc. Encourage increased oral intaked. Avoid rubbing or massaging the affected

leg


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25) Pulmonary embolism is a rare event

postpartum but carries a high mortality rate.Its usually caused by a thrombus fragment

thats carried by venous circulation to the

right side of the heart. The pulmonary artery is

obstructed; therefore, blood isnt carried tothe lungs. The nurse should be aware that akey symptom of pulmonary embolism is:

a. Hypertensionb. Chest painc. Diuresisd. Bradycardia


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26) The risk of postpartum thromboembolismoccurs because of a physiologic increase in:

a. Coagulation factorsb. Heart ratec. Diuresis

d. Blood pressure


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27) Mrs. Holmes has been kept nothing bymouth for the surgery and remains nothing bymouth on the postpartum floor. At the end ofthe first postpartum day, Mrs. Holmes statesshe would like some water and custard to eat.The nurse tells the patient that shell be

allowed food and drink when:

a. Her vital signs are stableb. Her I.V. fluids are discontinuedc. 24 hours have passed since the operationd. The nurse is able to assess bowel sounds


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SITUATION: Brenda Gillano is a 32-year-oldprimigravida who vaginally delivered a full-term infant without complications. She statesthat she would like to take a nap but allowsthe nurse to take vital signs and performs an

assessment.



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28) According to Reva Rubin, the nurserecognizes that Mrs. Gillano is experiencingwhat phase?

a. Postpartum phaseb. Taking-in phasec. Taking-hold phased. Letting-go phase


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29) According to Reva Rubin, the best time toteach a postpartum patient about maternaland infant care is during which of thefollowing pahse?

a. Postpartum phaseb. Taking-in phasec. Taking-hold phase

d. Letting-go phase


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SITUATION: Ling Poh, a 24-year-old

gravid 1 para 1001, vaginally delivereda full-term infant without complicationsexcept for a midline episiotomy.

Questions 30 to 35 refer to thisSITUATION


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30) To prevent swelling and discomfort of theperineal site immediately after delivery, thenurse caring for Mrs. Poh should:

a. Set up the portable sitz bath for thepatients use

b. Apply an ice bag to the perineal area for

30 minutesc. Assist the patient on the bedpan and

squirt warm water over the perineal aread. Apply dry heat therapy to the perineal area


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31) The nurse instructs Mrs. Poh on perinealcare. Mrs. Poh asks the nurse why she mustsquirt warm water over her perineal area afterevery urination and defecation. The nurse

states that the most important reason toperform perineal care is to:

a. Prevent infection

b. Promote comfortc. Encourage clean hygienic practicesd. Promote bladder functioning


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32) In preparing a sitz bath for Mrs. Poh, thenurse should remember that normal watertemperature should be maintained at:

a. 98F(34.7C)b. 99F (37.2C)c. 101F (38.3C)

d. 106F (41.1C)


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33) Mrs. Poh states that she has difficultysitting down in a chair because of the

discomfort of her episiotomy sutures. Thenurse should advise her to:

a. Bear weight on one side of the buttocks

when sitting in a chairb. Bring her buttocks together before

sitting; then let her full weight down onthe chair

c. Slowly sit down in the chair; bearweight on one side of her buttocks

d. Maintain a rigid posture when sitting inthe chair


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34) Mrs. Poh requests pain medication for

episiotomy discomfort. She has used heranesthetic spray and has had a sitz bath. Thebaby is scheduled to be bottle-fed in30minutes. When should the nurse administer

pain medication?

a. 1 hour after feeding the infantb. 1 hour before feeding the infant

c. Immediately and allow the nursery staffto feed infantd. Immediately and allow the mother to feed

the infant


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35) Mrs. Poh plans to bottle-feed her baby. Toprevent lactation from occurring, the nurse

instruct the patient to:

a. Increase her oral fluid intakeb. Wear a tight-fitting brassiere

c. Allow hot shower water to flow on herchest

d. Place cabbage leaves inside her brassiere


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SITUATION: Rafaela Mendez, aprimigravida, vaginally delivered a4,309-g (9 lb, 8 oz) infant. She had a

midline episiotomy and experienced athird-degree laceration.

Questions 36 to 45 refer to thisSITUATION


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36) The nurse understands that this type of

laceration:

a. Extends into the anterior wall of therectum

b. Extends to the perineal skin and othersuperficial structures

c. Extends into the anal sphincter muscled. Extends into the perineal muscles


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37) The nurse should be aware that Mrs.Mendezs third-degree laceration mayincrease her likelihood of developing:

a. Constipationb. Hypertensionc. Hemorrhaged. Subinvolution


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38) Mrs. Mendez plans to breast-feed her babyand asks the nurse how to clean her breastbefore breast-feeding the baby. The nursestates that to clean her breast before breast-

feeding she should use only:

a. Rubbing alcoholb. Water

c. Soapd. Lotion


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39) The nurse has reviewed the principles and practiceof breast-feeding with Mrs. Mendez. The nurseassesses that the patient understands how tobreast-feed by which of the following statementsfrom Mrs. Mendez?

a. As long as the baby breast-feeds every 2 to 3hours, my milk supply will be adequateb. My baby should breast-feed only for 5

minutes on each side

c. Its OK if my baby feeds only 5 minutes oneach side because shes getting the milk withthe highest fat contentd. If my nipples become sore, I think Ill quit

breast-feeding


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40) Mrs. Mendez has continued to breast-feedher infant every 3 to 4 hours except at night.About 48 hours after delivery, she complainsthat her breasts have become larger, firmer,

and tender. The nurse recognizes that Mrs.Mendez is probably experiencing:

a. Mastitis

b. Engorgementc. Let-down reflexd. Involution


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41) Mrs. Mendez complains that she experiencescramping while shes breast-feeding. The nursestates that this is normal because of a certainhormone thats released during breast-feeding.

That hormone is:

a. Prolactinb. Estrogen

c. Progesteroned. Oxytocin


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42) When Mrs. Mendez is receiving discharge

instructions from the nurse, she asks thenurse when she can resume sexualintercourse. The nurse states that sexualintercourse can be resumed:

a. 6 weeks after giving birthb. With doctor approvalc. When the lochia has stopped

d. At the mans discretion


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43) Mrs. Mendez asks the nurse about the

reliability of breast-feeding as a form ofcontraception. The nurse recognizes thatbreast-feeding as a form of contraception isleast affected by:

a. The age and sex of a full-term newbornb. The amount of time the newborn is on thebreast

c. The use of supplementary formulad. Partial weaning


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44) The nurse is reviewing dischargeinstructions with Mrs. Mendez. Which of thefollowing symptoms is least important incharacterizing postpartum blues?

a. Crying easily and feeling despondentb. Loss of appetite and anxietyc. Altered body image

d. Difficulty sleeping; poor concentration


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45) In reviewing discharge instructions with

Mrs. Mendez, the nurse is aware that a higherincidence of postpartum blues can result

from:

a. Fatigueb. Subinvolutionc. Neonatal jaundiced. Pregnancy-induced hypertension

Documents

Maternal and Child Nursing - Postpartum Care