Deck 5: Postpartum

Question 1

A nurse midwife is receiving a client who has just delivered a healthy baby girl through vaginal birth. No complications were noted during labor. In the immediate postpartum period, the nurse midwife assesses the client's vital signs:

A)Every 15 minutes during the first hour, every 30 minutes for the next 2 hours, every hour for the next 2 to 6 hours, and then every 4 hours for the next 24 hours.
B)Every 15 minutes during the first 30 minutes, every 30 minutes for the next 2 hours, every hour for the next 4 hours, and then every 4 hours for the next 24 hours.
C)Every 30 minutes for the first hour, every hour for the next 2 hours, every 2 hours for the next 4 hours, and then every 8 hours for the next for the next 24 hours.
D)Every 30 minutes for the first hour, every hour for the next 2 hours, every 4 hours for the next 16 hours, and then every 8 hours for the next 24 hours.

Answer 1

Every 15 minutes during the first hour, every 30 minutes for the next 2 hours, every hour for the next 2 to 6 hours, and then every 4 hours for the next 24 hours.

Question 2

An 18-year-old client is pregnant for the first time. A few weeks before her due date, the client informs the nurse midwife that she has decided to breastfeed her baby after birth. As a part of the teaching plan, the nurse midwife informs the client that she need to needs to add some calories to her current RDA to ensure sufficient milk production. If the pre-pregnancy RDA of the client is 2,200 calories per day and her pregnancy RDA is 2,500 calories per day, the client's RDA during the lactation period is:

A)2,800 calories per day.
B)3,000 calories per day.
C)2,200 calories per day.
D)2,700 calories per day.

Answer 2

3,000 calories per day.

Question 3

A nurse midwife is monitoring a client who gave birth to a healthy baby girl 8 hours ago. No complications were noted during labor. The client has a temperature of 100.4 °F. Which of the following is the next action of the nurse midwife?

A)Instruct the client to increase her oral fluid intake.
B)Assess the uterine tone.
C)Administer an antipyretic.
D)Assess the number of sanitary pads used for the past 8 hours.

Answer 3

Instruct the client to increase her oral fluid intake.

Question 4

A nurse midwife is managing the care of a client who gave birth to her first baby 12 hours ago. Analgesia was administered during labor. The nurse midwife teaches the client to assume which of the following positions to encourage uterine involution?

A)Side-lying position
B)Trendelenburg position
C)Prone position
D)Knee-to-chest position

Question 5

A client who gave birth to a healthy baby girl 8 hours ago tells a nurse midwife that she gets dizzy and lightheaded every time she attempts to ambulate. No complications were noted during labor. Which of the following is the most effective intervention for the client?

A)Assist the client to left side-lying position.
B)Instruct the client to sit on the edge of the bed and dangle her legs before getting up to ambulate.
C)Order for hemoglobin and hematocrit tests.
D)Instruct the client to use an assistive walking device when ambulating.

Question 6

A nurse midwife is assessing four clients who recently gave birth through vaginal delivery. A part of the examination is measuring the fundal height. Which of the following clients needs further evaluation?

A)A client who gave birth 24 hours ago; the fundus is 1 fingerbreadth below the umbilicus.
B)A client who gave birth one hour ago; the fundus is at the level of the umbilicus.
C)A client who gave birth 72 hours ago; the fundus is 2 cm below the umbilicus.
D)A client who gave birth 10 days ago; the fundus is non-palpable.

Question 7

A nurse midwife is about to perform a fundal assessment on a client who gave birth to a 7-pound female newborn. Which of the following nursing interventions is the most appropriate when preparing the client for fundal assessment?

A)Offer 1 to 2 glasses of water.
B)Assist the client in assuming the lithotomy position.
C)Instruct the client to void.
D)Assist the client in assuming a modified Sims position.

Question 8

A nurse midwife is managing the care of a postpartum client who was anemic during labor. The client gave birth to a 7-pound baby girl 24 hours ago through vaginal birth. On assessment, the nurse midwife suspects that the client has puerperal infection. Which of the following findings supports this diagnosis?

A)Soaked 8 perineal pads within the last 24 hours
B)Heart rate of 80 beats per minute
C)Red lochia with a foul odor
D)A body temperature of 100.4 ºF

Question 9

A nurse midwife is managing the care of a 25-year-old client who just delivered a set of twins. Which of the following interventions is the priority action of the nurse midwife during the immediate postpartum period?

A)Administer pain medications.
B)Encourage the client to void every 2 hours.
C)Apply warm compress to perineum.
D)Assess fundal tone and height.

Question 10

A nurse midwife is assessing four clients who recently gave birth to healthy newborns through vaginal delivery. All of the clients had uncomplicated labors. Which of the following clients needs further evaluation?

A)A postpartum client who has a temperature of 100.4 °F. The client gave birth 24 hours ago.
B)A postpartum client who soaked 8 perineal pads in the past 24 hours. The client gave birth 24 hours ago.
C)A postpartum client who complains of uterine pain every time she breastfeeds her newborn. The client gave birth 48 hours ago.
D)A postpartum client with clots larger than 1 cm across in the red lochia. The client gave birth 48 hours ago.

Question 11

A nurse midwife is assessing the fundal tone and height of a client who gave birth to a healthy baby boy 24 hours ago. After obtaining the vital signs, the nurse midwife notes that the fundus is at the level of the umbilicus. Which of the following is the next action of the nurse midwife?

A)Document the findings as normal.
B)Obtain the vital signs every 15 to 30 minutes.
C)Initiate fundal massage.
D)Administer oxytocin.

Question 12

A client who gave birth two days ago informs the nurse midwife that she has not had a bowel movement since the delivery of her child. The client had a vaginal birth. Which of the following statements made by the nurse midwife is the most appropriate in this situation?

A)"Bowel elimination usually returns a week after birth. Increase your fluid intake to prevent constipation."
B)"Bowel elimination usually returns 5 to 7 days after birth. Ambulate and increase your fiber intake to prevent constipation."
C)"Bowel elimination usually returns within the first 24 hours. Stay here and I will notify your physician."
D)"Bowel elimination usually occurs within 2 to 3 days after birth. Increase your fiber intake to relieve constipation."

Question 13

A nurse midwife is managing the care of a 25-year-old postpartum client who gave birth 18 hours ago. No complications were noted during the labor process. The newborn is brought to the client for feeding and to have the mother and child bond for the night. The client says, "I'm too tired. Please get her back to the nursery, just for tonight. I need to get some sleep." Which of the following is the most appropriate action of the nurse midwife?

A)Create a teaching plan for the mother that focuses on breast feeding.
B)Encourage the client to join a parenting skill class.
C)Accept the client's behavior as an indication that she is in the taking-in phase.
D)Accept the client's behavior as an indication that she is in the taking-hold phase.

Question 14

A nurse midwife is assessing a postpartum client for signs of deep venous thrombosis. To elicit Homan's sign, the nurse midwife:

A)Instructs the client to extend her legs flat on the bed, grasps the foot being tested and moves it downward.
B)Instructs the client to extend her legs flat on the bed, grasps the foot being tested and dorsiflexes it forward.
C)Instructs the client to lie flat on the bed with both legs extended and raises one leg at a time.
D)Instructs the client to lie flat on the bed and places both legs on two pillows for 15 minutes.

Question 15

A client gave birth to a baby girl 24 hours ago at 39 weeks' gestation. The child was delivered through cesarean section, and no complications were noted during labor. The client has three older kids, including a set of twins. The twins were born at 38 weeks' gestation, and the youngest child was born at 35 weeks' gestation. The client was pregnant 11 years ago but had a miscarriage on the 18th week of her pregnancy. About 5 years ago, she got pregnant, but the pregnancy was terminated at 25 weeks' gestation. Based on the client's history, she is accurately classified as:

A)G4 P4314
B)G5 P5214
C)G5 P5314
D)G4 P5313

Question 16

A nurse midwife is managing the care of a postpartum client who has a history of thrombophlebitis. On assessment, the nurse midwife suspects pulmonary embolus. Which of the following symptoms would not support this diagnosis?

A)Sharp chest pain
B)Confusion
C)Cyanosis
D)Bradycardia

Question 17

A postpartum client has type 1 diabetes. The client gave birth 24 hours ago. During the immediate postpartum period, which of the following statements is the most accurate about her insulin needs?

A)The insulin needs of the client decrease.
B)The insulin needs of the client increase.
C)The insulin needs of the client are the same as her insulin needs during her pregnancy.
D)The insulin needs of the client are the same as her insulin needs before her pregnancy.

Question 18

A part of the placenta is left inside the client's uterus during the third stage of labor. Which of the following is the most common complication of this condition?

A)Postpartum depression
B)Subinvolution
C)Hemorrhage
D)Infection

Question 19

A client who gave birth to a healthy newborn experiences crying and expresses feelings of sadness and emptiness. The client delivered her baby 3 days ago. The nurse midwife suspects that the client has:

A)Postpartum depression.
B)Postpartum blues.
C)Postpartum psychosis.
D)A normal behavior during the taking-hold phase.

Question 20

A nurse midwife is managing the care of a postpartum client who gave birth to a baby girl two months ago. On assessment, the client informs the nurse midwife that she is hearing voices and that she constantly feels empty. She has a history of clinical depression. Which of the following is the priority action of the nurse midwife?

A)Offer compassion.
B)Protect the client and child from injury.
C)Consider counseling for the client.
D)Administer antidepressants.

Question 21

A client who is due to give birth any time asks the nurse midwife what changes in the reproductive system she should expect after the delivery. Which of the following statements by the nurse midwife is the most appropriate?

A)"After birth, your uterus will weigh about 1,000 grams. By the 6th week after birth, it will weigh around 500 grams."
B)"Your uterus will never completely return to its pre-pregnancy state."
C)"The rate of uterine involution greatly varies from woman to woman."
D)"By the third week after birth, your uterus can no longer be detected by abdominal palpation."

Question 22

Which of the following clients has the greatest risk for delayed uterine involution?

A)A client who gave birth to a 7-pound baby girl.
B)A multiparous client who completed the second stage of labor in 1 ½ hours.
C)A client who voids every 2 hours.
D)A client who gave birth to twins.

Question 23

A nurse midwife is assessing the clients in the unit who gave birth 24 hours ago through vaginal delivery. Which of the following clients are at risk for puerperal infection?
I.A client who ruptured her membranes 12 hours before birth.
II.A client who had internal fetal monitoring during labor.
III.A client with low levels of hemoglobin and hematocrit.
IV.A client who is negative for vaginal infections.

A)I, II and III
B)I and III only
C)I and IV only
D)II, III and IV

Question 24

A nurse midwife is assessing a postpartum client who gave birth through vaginal delivery 18 hours ago. On assessment, the nurse midwife suspects that the client has cervical laceration. Which of the following findings is expected in this condition?

A)Uterine hyperactivity
B)Soft uterus
C)A gush of dark, red blood from the vagina
D)Continuous seepage of bright red blood from the vagina

Question 25

A client develops fever of 102.2 ºF on the third day postpartum. Assessment findings include abdominal tenderness and dark brown lochia. Endometritis is suspected. Which of the following interventions is the most appropriate for the client?

A)Obtain a culture from the perineal pad.
B)Administer an oxytocic agent.
C)Position the client in the side-lying position.
D)Instruct the client to remain in bed until the pain is resolved.

Question 26

A client had a cesarean delivery. The client informs the nurse midwife that she intends to breastfeed her baby. Which of the following instructions is the most effective for a client who wants to breastfeed after a cesarean delivery?

A)"Use the football hold when breastfeeding."
B)"Choose the position that is most comfortable during breastfeeding."
C)"Breast feeding is withheld for the first 12 hours of life."
D)"Breastfeed the newborn every 4 to 8 hours."

Question 27

A nurse midwife is teaching a group of pregnant women about the characteristics of the different types of lochia. Which of the following statements made by one of the women indicates that further teaching is necessary?

A)"Lochia rubra mainly consists of blood."
B)"The lochia consists of blood, mucus and some bacteria."
C)"Lochia serosa occurs 4 to 10 days after birth."
D)"Lochia alba is mainly composed of blood and leukocytes."

Question 28

A nurse midwife is receiving a client who gave birth an hour ago. Which of the following nursing interventions is the priority action of the nurse during the immediate postpartum period?

A)Obtain the client's blood glucose level.
B)Palpate for the height of fundus.
C)Order hemoglobin and hematrocrit tests.
D)Administer oxygen.