Chapter 23: Postpartum Complications My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 23: Postpartum Complications

Test Bank 

MULTIPLE CHOICE

1. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:

a. Uterine atony.
b. Uterine inversion.
c. Vaginal hematoma.
d. Vaginal laceration.

ANS: A

Feedback
A Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage.
B Uterine inversion may lead to hemorrhage, but it is not the most likely source of this patients bleeding. Furthermore, 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.
C A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding.
D A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

DIF:Cognitive Level: ComprehensionREF:725

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

2. To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features:

a. Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist.
b. Is more common among older, Caucasian women because they have higher expectations.
c. Is distinguished by irritability, severe anxiety, and panic attacks.
d. Will disappear on its own without outside help.

ANS: C

Feedback
A PPD even without psychotic features is more serious and persistent than postpartum baby blues.
B PPD is more common among younger mothers and African-American mothers.
C PPD is also characterized by spontaneous crying long after the usual duration of the baby blues.
D Most women need professional help to get through PPD, including pharmacologic intervention.

DIF:Cognitive Level: ComprehensionREF:741

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

3. The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by:

a. Subinvolution of the placental site.
b. Defective vascularity of the decidua.
c. Cervical lacerations.
d. Coagulation disorders.

ANS: A

Feedback
A Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments.
B Although defective vascularity of the decidua may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.
C Although cervical lacerations may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.
D Although coagulation disorders may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.

DIF:Cognitive Level: ComprehensionREF:726

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

4. The nurse should be aware that a pessary would be most effective in the treatment of what disorder?

a. Cystocele
b. Uterine prolapse
c. Rectocele
d. Stress urinary incontinence

ANS: B

Feedback
A A pessary is not used for the treatment of cystoceles.
B A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position.
C A pessary is not used for the treatment of rectoceles.
D A pessary is not used to treat stress urinary incontinence.

DIF:Cognitive Level: KnowledgeREF:740

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

5. One of the first symptoms of puerperal infection to assess for in the postpartum woman is:

a. Fatigue continuing for longer than 1 week.
b. Pain with voiding.
c. Profuse vaginal bleeding with ambulation.
d. Temperature of 38 C (100.4 F) or higher on 2 successive days starting 24 hours after birth.

ANS: D

Feedback
A Fatigue would be a late finding associated with infection.
B Pain with voiding may indicate a urinary tract infection, but it is not typically one of the earlier symptoms of infection.
C Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.
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 10 postpartum days, starting 24 hours after birth.

DIF:Cognitive Level: ComprehensionREF:735

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

6. The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by:

a. Washing the nipples and breasts with mild soap and water once a day.
b. Using proper breastfeeding techniques.
c. Wearing a nipple shield for the first few days of breastfeeding.
d. Wearing a supportive bra 24 hours a day.

ANS: B

Feedback
A Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection.
B Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples.
C Wearing a nipple shield does not prevent mastitis.
D Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.

DIF:Cognitive Level: ComprehensionREF:736

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

7. Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance:

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 doctors tend to overestimate the amount of blood loss.
d. Traditionally PPH has been classified as early or late with respect to birth.

ANS: D

Feedback
A Unfortunately PPH can occur with little warning and often is recognized only after the mother has profound symptoms.
B Traditionally a 500-ml blood loss after a vaginal birth and a 1000-ml blood loss after a cesarean birth constitute PPH.
C Medical personnel tend to underestimate blood loss by as much as 50% in their subjective observations.
D Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH.

DIF:Cognitive Level: KnowledgeREF:724

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

8. A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect:

a. Disseminated intravascular coagulation.
b. von Willebrand disease.
c. Thrombophlebitis.
d. Coagulopathies.

ANS: C

Feedback
A Pain and tenderness in the extremities, which show warmth, redness, and hardness, likely indicate thrombophlebitis. DIC would present much differently.
B Pain and tenderness in the extremities, which show warmth, redness, and hardness, likely indicate thrombophlebitis. Von Willebrand disease is an inherited bleeding disorder.
C Pain and tenderness in the extremities, which show warmth, redness, and hardness, likely indicate thrombophlebitis.
D Pain and tenderness in the extremities, which show warmth, redness, and hardness, likely indicate thrombophlebitis. Idiopathic purpura and von Willebrand disease are coagulopathies.

DIF:Cognitive Level: AnalysisREF:733

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

9. When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is:

a. Absence of cyanosis in the buccal mucosa.
b. Cool, dry skin.
c. Diminished restlessness.
d. Urinary output of at least 30 ml/hr.

ANS: D

Feedback
A The assessment of the buccal mucosa for cyanosis can be subjective in nature.
B The presence of cool, pale, clammy skin would be an indicative finding associated with hemorrhagic shock.
C Hemorrhagic shock is associated with lethargy, not restlessness.
D Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion.

DIF:Cognitive Level: AnalysisREF:732

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

10. The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild-to-moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the patient to use first?

a. Pelvic floor support devices
b. Bladder training and pelvic muscle exercises
c. Surgery
d. Medications

ANS: B

Feedback
A Pelvic floor support devices, also known as pessaries, come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection.
B Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women.
C Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site.
D Pharmacologic therapy includes serotonin-norepinephrine uptake inhibitors or vaginal estrogen therapy. These are not the first action a nurse should recommend.

DIF:Cognitive Level: ApplicationREF:739

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

11. When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may:

a. Have outbursts of anger.
b. Neglect her hygiene.
c. Harm her infant.
d. Lose interest in her husband.

ANS: C

Feedback
A Although this symptom is attributable to PPD, the major concern would be the potential to harm herself or her infant.
B Although this symptom is attributable to PPD, the major concern would be the potential to harm herself or her infant.
C Thoughts of harm to ones self or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention.
D Although this symptom is attributable to PPD, the major concern would be the potential to harm herself or her infant.

DIF:Cognitive Level: ComprehensionREF:742

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Diagnosis

12. A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:

a. Establish venous access.
b. Perform fundal massage.
c. Prepare the woman for surgical intervention.
d. Catheterize the bladder.

ANS: B

Feedback
A Although this may be a necessary intervention, the initial intervention would be fundal massage.
B The initial management of excessive postpartum bleeding is firm massage of the uterine fundus.
C The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus.
D After uterine massage, the nurse may want to catheterize the patient to eliminate any bladder distention that may be preventing the uterus from contracting properly.

DIF:Cognitive Level: ApplicationREF:726

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

13. Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks after delivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the patient with von Willebrand disease who experiences a postpartum hemorrhage is:

a. Cryoprecipitate.
b. Factor VIII and vWf.
c. Desmopressin.
d. Hemabate.

ANS: C

Feedback
A Cryoprecipitate may be used; however, because of the risk of possible donor viruses, other modalities are considered safer.
B Treatment with plasma products such as factor VIII and vWf are an acceptable option for this patient. Because of the repeated exposure to donor blood products and possible viruses, this is not the initial treatment of choice.
C Desmopressin is the primary treatment of choice. This hormone can be administered orally, nasally, and intravenously. This medication promotes the release of factor VIII and vWf from storage.
D Although the administration of this prostaglandin is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the patient who presents with a bleeding disorder.

DIF:Cognitive Level: ApplicationREF:733

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

14. With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to:

a. Stay home and avoid outside activities to ensure adequate rest.
b. Be certain that you are the only caregiver for your baby to facilitate infant attachment.
c. Keep feelings of sadness and adjustment to your new role to yourself.
d. Realize that this is a common occurrence that affects many women.

ANS: D

Feedback
A Although it is important for the mother to obtain enough rest, she should not distance herself from family and friends. Her spouse or partner can communicate the best visiting times so the new mother can obtain adequate rest. It is also important that she not isolate herself at home during this time of role adjustment.
B Even if breastfeeding, other family members can participate in the infants care. If depression occurs, the symptoms can often interfere with mothering functions and this support will be essential.
C The new mother should share her feelings with someone else. It is also important that she not overcommit herself or think she has to be superwoman. A telephone call to the hospital warm line may provide reassurance with lactation issues and other infant care questions. If symptoms continue, a referral to a professional therapist may be necessary.
D If the new mother experiences symptoms of the baby blues, it is important that she be aware that this is nothing to be ashamed of. As many as 13% of new mothers experience similar symptoms.

DIF:Cognitive Level: ApplicationREF:741

OBJ:Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

15. Abnormal adherence of the placenta occurs for reasons unknown. Attempts to remove the placenta in the usual manner are unsuccessful, and laceration and perforation of the uterine wall may result, putting the woman at risk for severe PPH and infection. Placental adherence may be partial or complete. Which is not a recognized degree of placental attachment?

a. Placenta accreta
b. Placenta previa
c. Placenta increta
d. Placenta percreta

ANS: B

Feedback
A Placenta accreta is slight penetration of the myometrium by placental trophoblast.
B Placenta previa is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. The placenta is not adhered to the myometrium.
C Placenta increta is deep penetration of the myometrium by the placenta.
D Placenta percreta is perforation of the uterus by the placenta.

DIF:Cognitive Level: ComprehensionREF:725

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

MULTIPLE RESPONSE

1. Medications used to manage postpartum hemorrhage (PPH) include (choose all that apply):

a. Pitocin.
b. Methergine.
c. Terbutaline.
d. Hemabate.
e. Magnesium sulfate.

ANS: A, B, D

Feedback
Correct These medications are all used to manage PPH.
Incorrect These medications are tocolytics; relaxation of the uterus causes or worsens PPH.

DIF:Cognitive Level: ComprehensionREF:727

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

COMPLETION

1. ____________________ is the most common cause of postpartum infection.

ANS:

Endometritis

Endometritis usually begins as a localized infection at the placental site; however, it can spread to the entire endometrium. Incidence is higher after a cesarean birth. Assessment may reveal fever, chills, nausea, fatigue, lethargy, pelvic pain, uterine tenderness, or foul smelling lochia.

DIF:Cognitive Level: ComprehensionREF:735

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

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