Deck 28: Postpartum Maternal Complications

Question 1

Which measure may prevent mastitis in a breastfeeding client?

A) Wearing a tight-fitting bra
B) Applying ice packs prior to feeding
C) Initiating early and frequent feedings
D) Nursing the infant for 5 minutes on each breast

Answer 1

Initiating early and frequent feedings

Question 2

Which temperature indicates the presence of postpartum infection?

A) 99.6° F in the first 48 hours
B) 100° F for 2 days postpartum
C) 100.4° F in the first 24 hours
D) 100.8° F on the second and third postpartum days

Answer 2

100.8° F on the second and third postpartum days

Question 3

A multiparous client is admitted to the postpartum unit after a rapid labor and birth of a 4000-g infant. Her fundus is boggy, lochia is heavy, and vital signs are unchanged. The nurse has the client void and massages her fundus, but the fundus remains difficult to find and the rubra lochia remains heavy. Which action should the nurse take next?

A) Recheck vital signs.
B) Insert a Foley catheter.
C) Notify the health care provider.
D) Continue to massage the fundus.

Answer 3

Notify the health care provider.

Question 4

If nonsurgical treatment for subinvolution is ineffective, which surgical procedure is appropriate to correct the cause of this condition?

A) Hysterectomy
B) Laparoscopy
C) Laparotomy
D) Dilation and curettage (D&C)

Question 5

The client who is being treated for endometritis is placed in the Fowler position because it:

A) promotes comfort and rest.
B) facilitates drainage of lochia.
C) prevents spread of infection to the urinary tract.
D) decreases tension on the reproductive organs.

Question 6

Which statement by a postpartum client indicates that further teaching is not needed regarding thrombus formation?

A) "I'll keep my legs elevated with pillows."
B) "I'll sit in my rocking chair most of the time."
C) "I'll stay in bed for the first 3 days after my baby is born."
D) "I'll put my support stockings on every morning before rising."

Question 7

Which instruction should be included in the discharge teaching plan to assist the client in recognizing early signs of complications?

A) Palpate the fundus daily to ensure that it is soft.
B) Report any decrease in the amount of brownish red lochia.
C) The passage of clots as large as an orange can be expected.
D) Notify the health care provider of any increase in the amount of lochia or a return to bright red bleeding.

Question 8

A white blood cell (WBC) count of 35,000 cells/mm³ on the morning of the first postpartum day indicates:

A) possible infection.
B) normal WBC limit.
C) serious infection.
D) suspicion of a sexually transmitted disease.

Question 9

Early postpartum hemorrhage is defined as a blood loss greater than:

A) 500 mL within 24 hours after a vaginal birth.
B) 750 mL within 24 hours after a vaginal birth.
C) 1000 mL within 48 hours after a cesarean birth.
D) 1500 mL within 48 hours after a cesarean birth.

Question 10

A postpartum client would be at increased risk for postpartum hemorrhage if she delivered a(n):

A) 5-lb, 2-oz infant with outlet forceps.
B) 6.5-lb infant after a 2-hour labor.
C) 7-lb infant after an 8-hour labor.
D) 8-lb infant after a 12-hour labor.

Question 11

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:

A) uterine atony.
B) perineal hematoma.
C) infection of the uterus.
D) lacerations of the genital tract.

Question 12

Following a vaginal birth, a client has lost a significant amount of blood and is starting to experience signs of hypovolemic shock. Which clinical signs would be consistent with this clinical diagnosis?

A) Decrease in blood pressure, with an increase in pulse pressure
B) Compensatory response of tachycardia and decreased pulse pressure
C) Decrease in heart rate and an increase in respiratory effort
D) Flushed skin

Question 13

The nurse knows that late postpartum hemorrhage can be prevented by:

A) manually removing the placenta.
B) inspecting the placenta after birth.
C) administering broad-spectrum antibiotics.
D) pulling on the umbilical cord to hasten the birth of the placenta.

Question 14

The nurse should expect medical intervention for subinvolution to include:

A) oral fluids to 3000 mL/day.
B) intravenous fluid and blood replacement.
C) oxytocin intravenous infusion for 8 hours.
D) oral methylergonovine maleate (Methergine) for 48 hours.

Question 15

A sign of thrombophlebitis is:

A) visible varicose veins.
B) positive Homans sign.
C) pedal edema in the affected leg.
D) local tenderness, heat, and swelling.

Question 16

The nurse expecting a uterine infection in a postpartum client should assess the:

A) episiotomy site.
B) odor of the lochia.
C) abdomen for distention.
D) pulse and blood pressure.

Question 17

Following a difficult vaginal birth of a singleton pregnancy, the client starts bleeding heavily. Clots are expressed and a Foley catheter is inserted to empty the bladder because the uterine fundus is soft and displaced laterally from midline. Vital signs are 99.8° F, pulse 90 beats/min, respirations 20 breaths/min, and BP 130/90 mm Hg. Which pharmacologic intervention is indicated?

A) Oxytocin (Pitocin) to be administered in a piggyback solution
B) Administration of methylergonovine (Methergine)
C) Administration of prostaglandin analogue
D) Increase in parenteral fluids

Question 18

Nursing measures that help prevent postpartum urinary tract infection include:

A) forcing fluids to at least 3000 mL/day.
B) promoting bed rest for 12 hours after birth.
C) encouraging the intake of orange, grapefruit, or apple juice.
D) discouraging voiding until the sensation of a full bladder is present.

Question 19

Which nursing measure would be appropriate to prevent thrombophlebitis in the recovery period following a cesarean birth?

A) Limit the client's oral intake of fluids for the first 24 hours.
B) Assist the client in performing leg exercises every 2 hours.
C) Ambulate the client as soon as her vital signs are stable.
D) Roll a bath blanket and place it firmly behind the client's knees.

Question 20

A client with mastitis is concerned about breastfeeding while she has an active infection. Which is an appropriate response by the nurse?

A) Organisms will be inactivated by gastric acid.
B) Organisms that cause mastitis are not passed to the milk.
C) The infant is not susceptible to the organisms that cause mastitis.
D) The infant is protected from infection by immunoglobulins in the breast milk.

Question 21

If a late postpartum hemorrhage is documented on a client who delivered 3 days ago, the nurse recognizes that this hemorrhage occurred:

A) on the first postpartum day.
B) during recovery phase of labor.
C) during the third stage of labor.
D) on the second postpartum day.

Question 22

Which client data received during report should the nurse recognize as being a postpartum risk factor?

A) Gravida 5, para 5
B) Labor duration of 4 hours
C) Infant weight greater than 3800 g
D) Epidural anesthesia for labor and birth

Question 23

The nurse recognizes that infection may be present in her postpartum client when the client exhibits a temperature of:

A) 100.0° F during the first 36 hours postpartum.
B) 100.8° F twice in the first 24 hours postpartum.
C) 99.6° F on the first postpartum day and 100.4 on the second.
D) 100.4° F on the second postpartum day and 100.8° F on the fourth.

Question 24

As you receive a report, which assessment finding should you recognize as indicative of a vaginal laceration?

A) Fundus firm at the umbilicus
B) Pulse of 90 bpm, blood pressure of 110/78 mm Hg
C) Bright red continuous trickle of blood from vagina
D) Client requested pain medication twice during last shift

Question 25

Which data collected during your assessment may indicate a vaginal wall hematoma?

A) Firm uterus at U-1
B) Pulse rate of 110 bpm
C) Moderate lochia
D) Soreness of perineum

Question 26

To determine an adverse response to carboprost tromethamine (Hemabate), the nurse should frequently assess:

A) temperature.
B) lochial flow.
C) fundal height.
D) breath sounds.

Question 27

For the client diagnosed with endometritis, the nurse recognizes that the client should be positioned in the:

A) prone position.
B) side-lying position.
C) Fowler position.
D) supine position with the head flat.

Question 28

Which labor and birth information on the client would suggest an increased risk for hemorrhage?

A) Precipitous birth after a 12-hour labor
B) Cesarean birth of an infant weighing 8 lb, 4 oz
C) Vaginal birth of 7-lb infant after a 2-hour labor
D) Vaginal birth of 6-lb infant after a 7-hour labor

Question 29

To evaluate the desired response of methylergonovine (Methergine), the nurse would assess the client's:

A) uterine tone.
B) pain level.
C) blood pressure.
D) last voiding.

Question 30

To prevent infection of the urinary tract, the nurse should instruct the client to:

A) include soft drinks in the total fluid intake.
B) drink grapefruit juice several times a day.
C) perform pericare at least twice during a shift.
D) increase fluid intake to 2500 to 3000 mL/day.

Question 31

A postpartum client has developed deep vein thrombosis (DVT) and treatment with warfarin (Coumadin) has been initiated. Which dietary selection should be modified in view of this treatment regimen?

A) Fresh fruits
B) Milk
C) Lentils
D) Soda

Question 32

If the nurse suspects a pulmonary embolism in the client who suddenly complains of chest pain, she or he should immediately:

A) assess for abnormal breath sounds.
B) apply O2 via tight face mask at 8 to 10 L/min.
C) position the client in a supine position with the head of the bed flat.
D) monitor pulse oximetry for decreased oxygen saturation.

Question 33

A client has been treated with oxytocin (Pitocin) for postpartum hemorrhage. Bleeding has stabilized and slowed down considerably. The peripad in place reveals a moderate amount of bright red blood, with no clots expelled when massaging the fundus. The client now complains of having difficulty breathing. Auscultation of breath sounds reveals adventitious sounds. Based on this clinical presentation, the priority nursing action is to:

A) evaluate intake and output of the past 12 hours following birth.
B) initiate a rapid response intervention.
C) obtain an order from the physician for type and crossmatch of 2 units packed red blood cells (PRBCs).
D) reposition the client and reassess in 15 minutes. Initiate frequent vital sign assessments.

Question 34

To prevent infection of the reproductive tract, the nurse should instruct the client to:

A) change the peripad once per shift.
B) cleanse the perineum from front to back.
C) perform pericare at least twice during the shift.
D) increase fluid intake to 2500 to 3000 mL/day.

Question 35

If a DVT (deep vein thrombosis) is suspected, the nurse should:

A) perform a Homans sign on the affected leg.
B) dorsiflex the foot of the affected leg.
C) palpate the affected leg for edema and pain.
D) place the client on bed rest, with the affected leg elevated.

Question 36

Which observation of your client as she ambulates could indicate development of a DVT (deep vein thrombosis)?

A) Slow gait
B) Shuffling gait
C) Stiffness of right leg
D) Leans on husband for support

Question 37

What data in the client's history should the nurse recognize as being pertinent to a possible diagnosis of postpartum depression?

A) Teenage depression episode
B) Unexpected operative birth
C) Ambivalence during the first trimester
D) Second pregnancy in a 3-year period

Question 38

Before administering methylergonovine (Methergine), the nurse checks the:

A) color of the lochia.
B) blood pressure.
C) location of the fundus.
D) last administration of analgesics.

Question 39

Prior to ambulating the client to the bathroom whose admission hemoglobin level was 10.2 g/dL, the nurse should:

A) request repeat hemoglobin and hematocrit.
B) assess the resting pulse rate.
C) dangle her on the side of the bed.
D) administer the ordered oral analgesic.

Question 40

If the nurse suspects a complication of a low forceps birth labor, she should immediately:

A) administer a strong oral analgesic.
B) assess the perineal and vaginal areas.
C) assess the position of the uterine fundus.
D) review the labor record for duration of second stage.

Question 41

For the patient experiencing a postpartum hemorrhage, the health care provider prescribes methylergonovine (Methergine). What assessment must the nurse perform prior to administering this medication?

A) Heart rate
B) Temperature
C) Blood pressure
D) Respiratory rate

Question 42

The visiting nurse must be aware that women who have had a postpartum hemorrhage are subject to a variety of complications after discharge from the hospital. These include which of the following? (Select all that apply.)

A) Anemia
B) Dehydration
C) Exhaustion
D) Postpartum infection
E) Failure to attach to her infant

Question 43

The nurse notes that the fundus of a postpartum patient is boggy, shifted to the left of the midline, and 2 cm above the umbilicus. What is the nurse's priority action?

A) Massage the fundus of the uterus.
B) Assist the patient out of bed to void.
C) Increase the infusion of oxytocin (Pitocin).
D) Ask another nurse to bring in a straight catheter tray.

Question 44

Which information should the nurse recognize as contributing to mastitis in the breastfeeding mother? (Select all that apply.)

A) Insufficient emptying
B) Feeding every 2 hours
C) Supplementing feedings
D) Blisters on both nipples
E) Alternating breastfeeding positions