Chapter 28: The Woman with a Postpartum Complication My Nursing Test Banks

Chapter 28: The Woman with a Postpartum Complication

Test Bank

MULTIPLE CHOICE

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

a.

Ill stay in bed for the first 3 days after my baby is born.

b.

Ill keep my legs elevated with pillows.

c.

Ill sit in my rocking chair most of the time.

d.

Ill put my support stockings on every morning before rising.

ANS: D

Feedback

A

As soon as possible, the woman should ambulate frequently.

B

The mother should avoid knee pillows because they increase pressure on the popliteal space.

C

Sitting in a chair with legs in a dependent position causes pooling of blood in the lower extremities.

D

Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning.

PTS: 1 DIF: Cognitive Level: Application REF: p. 675

OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

2. 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 was 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; however, 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 667

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

3. The nurse knows that a measure for preventing late postpartum hemorrhage is to

a.

Administer broad-spectrum antibiotics.

b.

Inspect the placenta after delivery.

c.

Manually remove the placenta.

d.

Pull on the umbilical cord to hasten the delivery of the placenta.

ANS: B

Feedback

A

Broad-spectrum antibiotics will be given if postpartum infection is suspected.

B

If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage.

C

Manual removal of the placenta increases the risk of postpartum hemorrhage.

D

The placenta is usually delivered 5 to 30 minutes after birth of the baby without pulling on the cord. That can cause uterine inversion.

PTS: 1 DIF: Cognitive Level: Application REF: p. 670

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

4. A multiparous woman 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 woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. The nurse should

a.

Continue to massage the fundus.

b.

Notify the physician.

c.

Recheck vital signs.

d.

Insert a Foley catheter.

ANS: B

Feedback

A

The uterine muscle can be overstimulated by massage, leading to uterine atony and rebound hemorrhage.

B

Treatment of excessive bleeding requires the collaboration of the physician and the nurses. Do not leave the patient alone.

C

The nurse should call the clinician while a second nurse rechecks the vital signs.

D

The woman has voided successfully, so a Foley catheter is not needed at this time.

PTS: 1 DIF: Cognitive Level: Application REF: p. 672

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

5. Early postpartum hemorrhage is defined as a blood loss greater than

a.

500 mL in the first 24 hours after vaginal delivery

b.

750 mL in the first 24 hours after vaginal delivery

c.

1000 mL in the first 48 hours after cesarean delivery

d.

1500 mL in the first 48 hours after cesarean delivery

ANS: A

Feedback

A

The average amount of bleeding after a vaginal birth is 500 mL.

B

The average amount of bleeding after a vaginal birth is 500 mL.

C

Early postpartum hemorrhage occurs in the first 24 hours, not 48 hours. Blood loss after a cesarean averages 1000 mL.

D

Early postpartum hemorrhage is within the first 24 hours. Late postpartum hemorrhage is 48 hours and later.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 666

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

6. A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she feels all wet underneath. You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action?

a.

Call for help.

b.

Assess the fundus for firmness.

c.

Take her blood pressure.

d.

Check the perineum for lacerations.

ANS: B

Feedback

A

The first action should be to assess the fundus.

B

Firmness of the uterus is necessary to control bleeding from the placental site. The nurse should first assess for firmness and massage the fundus as indicated.

C

Assessing blood pressure is an important assessment with a bleeding patient, but the top priority is to control the bleeding. This is done by first assessing the fundus for firmness.

D

If bleeding continues in the presence of a firm fundus, lacerations may be the cause.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 667-668

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

a.

Uterine atony

b.

Lacerations of the genital tract

c.

Perineal hematoma

d.

Infection of the uterus

ANS: B

Feedback

A

The fundus is not firm with uterine atony.

B

Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction.

C

A hematoma would be internal. Swelling and discoloration would be noticed, but bright bleeding would not be.

D

With an infection of the uterus there would be an odor to the lochia and systemic symptoms such as fever and malaise.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 669

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

8. A postpartum patient is at increased risk for postpartum hemorrhage if she delivers 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

ANS: B

Feedback

A

This woman is at risk for lacerations because of the forceps.

B

A rapid (precipitous) labor and delivery may cause exhaustion of the uterine muscle and prevent contraction.

C

This is a normal labor progression. Less than 3 hours is rapid and can produce uterine muscle exhaustion.

D

This is a normal labor progression. Less than 3 hours is a rapid delivery and can cause the uterine muscles not to contract.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 667 | Box 28-1

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

9. What instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications?

a.

Palpate the fundus daily to ensure that it is soft.

b.

Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.

c.

Report any decrease in the amount of brownish red lochia.

d.

The passage of clots as large as an orange can be expected.

ANS: B

Feedback

A

The fundus should stay firm.

B

An increase in lochia or a return to bright red bleeding after the lochia has become pink indicates a complication.

C

The lochia should decrease in amount.

D

Large clots after discharge are a sign of complications and should be reported.

PTS: 1 DIF: Cognitive Level: Application REF: p. 670

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

10. Which woman is at greatest risk for early postpartum hemorrhage?

a.

A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress

b.

A woman with severe preeclampsia on magnesium sulfate whose labor is being induced

c.

A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor

d.

A primigravida in spontaneous labor with preterm twins

ANS: B

Feedback

A

Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH.

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.

C

Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH.

D

Although many causes and risk factors are associated with PPH, this scenario does not pose risk factors or causes of early PPH.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 667 | Box 28-1

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

11. When caring for a postpartum woman experiencing hypovolemic 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.

Decreased urinary output

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 is an indicative finding associated with hypovolemic shock.

C

Hypovolemic shock is associated with lethargy, not restlessness.

D

Hemorrhage may result in hypovolemic 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.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 671

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

12. The nurse should expect medical intervention for subinvolution to include

a.

Oral methylergonovine maleate (Methergine) for 48 hours

b.

Oxytocin intravenous infusion for 8 hours

c.

Oral fluids to 3000 mL/day

d.

Intravenous fluid and blood replacement

ANS: A

Feedback

A

Methergine provides long-sustained contraction of the uterus.

B

Oxytocin provides intermittent contractions.

C

There is no correlation between dehydration and subinvolution.

D

There is no indication that excessive blood loss has occurred.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 668

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

13. If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition?

a.

Hysterectomy

b.

Laparoscopy

c.

Laparotomy

d.

D&C

ANS: D

Feedback

A

Hysterectomy is not indicated for this condition. A hysterectomy is the removal of the uterus.

B

Laparoscopy is not indicated for this condition. A laparoscopy is the insertion of an endoscope through the abdominal wall to examine the peritoneal cavity.

C

Laparotomy is not indicated for this condition. A laparotomy is a surgical incision into the peritoneal cavity to explore the peritoneal cavity.

D

D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 670

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

14. The mother-baby nurse must be able to recognize what sign of thrombophlebitis?

a.

Visible varicose veins

b.

Positive Homans sign

c.

Local tenderness, heat, and swelling

d.

Pedal edema in the affected leg

ANS: C

Feedback

A

Varicose veins may predispose the woman to thrombophlebitis, but are not a sign.

B

A positive Homans sign may be caused by a strained muscle or contusion.

C

Tenderness, heat, and swelling are classic signs of thrombophlebitis that appear at the site of the inflammation.

D

Edema may be more involved than pedal.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 674

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

15. Which nursing measure is appropriate to prevent thrombophlebitis in the recovery period after a cesarean birth?

a.

Roll a bath blanket and place it firmly behind the knees.

b.

Limit oral intake of fluids for the first 24 hours.

c.

Assist the patient in performing gentle leg exercises.

d.

Ambulate the patient as soon as her vital signs are stable.

ANS: C

Feedback

A

The blanket behind the knees will cause pressure and decrease venous blood flow.

B

Limiting oral intake will produce hemoconcentration, which may lead to thrombophlebitis.

C

Leg exercises and passive range of motion promote venous blood flow and prevent venous stasis while the patient is still on bed rest.

D

The patient may not have full return of leg movements, and ambulating is contraindicated.

PTS: 1 DIF: Cognitive Level: Application REF: p. 675

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

16. 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 is a late finding associated with infection.

B

Pain with voiding may indicate a UTI, 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 678

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

17. The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage is most likely caused by

a.

Subinvolution of the uterus

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. Recognized causes of subinvolution included retained placental fragments and pelvic infection.

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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 670

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

18. The patient who is being treated for endometritis is placed in Fowlers 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

ANS: B

Feedback

A

This may not be the position of comfort, but it does allow for drainage.

B

Lochia and infectious material are eliminated by gravity drainage.

C

Hygiene practice aids in preventing the spread of infection to the urinary tract.

D

The position is to aid in the drainage of lochia and infectious material.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 679

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

19. Nursing measures that help prevent postpartum urinary tract infection include

a.

Promoting bed rest for 12 hours after delivery

b.

Discouraging voiding until the sensation of a full bladder is present

c.

Forcing fluids to at least 3000 mL/day

d.

Encouraging the intake of orange, grapefruit, or apple juice

ANS: C

Feedback

A

The woman should be encouraged to ambulate early.

B

With pain medications, trauma to the area, and anesthesia, the sensation of a full bladder may be decreased. She needs to be encouraged to void frequently.

C

Adequate fluid intake of 2500 to 3000 ml/day prevents urinary stasis, dilutes urine, and flushes out waste products.

D

Juices such as cranberry juice can discourage bacterial growth.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 680

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

20. Which measure may prevent mastitis in the breastfeeding mother?

a.

Initiating early and frequent feedings

b.

Nursing the infant for 5 minutes on each breast

c.

Wearing a tight-fitting bra

d.

Applying ice packs before feeding

ANS: A

Feedback

A

Early and frequent feedings prevent stasis of milk, which contributes to engorgement and mastitis.

B

Five minutes does not adequately empty the breast. This will produce stasis of the milk.

C

A firm-fitting bra will support the breast, but not prevent mastitis. The breast should not be bound.

D

Warm packs before feeding will increase the flow of milk.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 680

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

21. A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that

a.

The infant is protected from infection by immunoglobulins in the breast milk.

b.

The infant is not susceptible to the organisms that cause mastitis.

c.

The organisms that cause mastitis are not passed to the milk.

d.

The organisms will be inactivated by gastric acid.

ANS: C

Feedback

A

The mother is just producing the immunoglobulin from this infection, so it is not available for the infant.

B

Because of an immature immune system, infants are susceptible to many infections. However, this infection is in the breast tissue and is not excreted in the breast milk.

C

The organisms are localized in the breast tissue and are not excreted in the breast milk.

D

The organism will not get into the infants gastrointestinal system.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 681

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

22. If the nurse suspects a uterine infection in the postpartum patient, she should assess the

a.

Pulse and blood pressure

b.

Odor of the lochia

c.

Episiotomy site

d.

Abdomen for distention

ANS: B

Feedback

A

The pulse may be altered with an infection, but the odor of the lochia will be an earlier sign and more specific.

B

An abnormal odor of the lochia indicates infection in the uterus.

C

The infection may move to the episiotomy site if proper hygiene is not followed.

D

The abdomen becomes distended usually because of a decrease of peristalsis, such as after cesarean section.

PTS: 1 DIF: Cognitive Level: Application REF: p. 682

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

23. Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth?

a.

Postpartum depression

b.

Postpartum psychosis

c.

Postpartum bipolar disorder

d.

Postpartum blues

ANS: D

Feedback

A

Postpartum depression is not the normal worries (blues) that many new mothers experience. Many caregivers believe that postpartum depression is underdiagnosed and underreported.

B

Postpartum psychosis is a rare condition that usually surfaces within 3 weeks of delivery. Hospitalization of the woman is usually necessary for treatment of this disorder.

C

Bipolar disorder is one of the two categories of postpartum psychosis, characterized by both manic and depressive episodes.

D

Postpartum blues or baby blues is a transient self-limiting disease that is believed to be related to hormonal fluctuations after childbirth.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 683

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

24. When a woman is diagnosed with postpartum psychosis, 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 outbursts of anger is a symptom is attributable to PPD, the major concern would be the potential of harm to herself or to her infant.

B

Neglect of personal hygiene is symptom is attributable to PPD; however, the major concern would be the potential of harm to herself or to 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 patient is likely to lose interest in her spouse, the major concern is the potential of harm to herself or to her infant.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 684

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

25. According to Becks studies, what risk factor for postpartum depression (PPD) is likely to have the greatest effect on the womans condition?

a.

Prenatal depression

b.

Single-mother status

c.

Low socioeconomic status

d.

Unplanned or unwanted pregnancy

ANS: A

Feedback

A

Depressive symptoms during pregnancy or previous ppd are strong predictors for subsequent episodes of PPD.

B

Single-mother status is a small-relation predictor for PPD.

C

Low socioeconomic status is a small-relation predictor for PPD.

D

An unwanted pregnancy may contribute to the risk for PPD; however, it does not pose as great an effect as prenatal depression.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 685

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

26. Anxiety disorders are the most common mental disorders that affect women. While providing care to the maternity patient, the nurse should be aware that one of these disorders is likely to be triggered by the process of labor and birth. This disorder is

a.

A phobia

b.

Panic disorder

c.

Posttraumatic stress disorder (PTSD)

d.

Obsessive-compulsive disorder (OCD)

ANS: C

Feedback

A

Phobias are irrational fears that may lead a person to avoid certain objects, events, or situations.

B

Panic disorders include episodes of intense apprehension, fear, and terror. Symptoms may manifest themselves as palpitations, chest pain, choking, or smothering.

C

In PTSD, women perceive childbirth as a traumatic event. They have nightmares and flashbacks about the event, anxiety, and avoidance of reminders of the traumatic event.

D

OCD symptoms include recurrent, persistent, and intrusive thoughts. The mother may repeatedly check and recheck her infant once he or she is born, even though she realizes that this is irrational. OCD is best treated with medications.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 684

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

27. To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD)

a.

Is the baby blues plus the woman 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 pervasive sadness that lasts at least 2 weeks

d.

Will disappear on its own without outside help

ANS: C

Feedback

A

PPD is more serious and persistent than postpartum baby blues.

B

PPD is more common among younger mothers and African-American mothers.

C

PPD is characterized by a persistent depressed state. The woman is unable to feel pleasure or love although she is able to care for her infant. She often experiences generalized fatigue, irritability, little interest in food and sleep disorders.

D

Most women need professional help to get through PPD, including pharmacologic intervention.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 683

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

28. 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 in order 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 that the new mother can obtain adequate rest. It is also important that she not isolate herself at home by herself 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 feel as though she has to be superwoman. A telephone call to the hospital warm line may provide reassurance with lactation issues and other infant care questions. Should symptoms continue, a referral to a professional therapist may be necessary.

D

Should the new mother experience symptoms of the baby blues, it is important that she be aware that this is nothing to be ashamed of.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 685-686

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. Medications used to manage postpartum hemorrhage include (select all that apply)

a.

Pitocin

b.

Methergine

c.

Terbutaline

d.

Hemabate

e.

Magnesium sulfate

ANS: A, B, D

Feedback

Correct

Pitocin, Methergine, and Hemabate are all used to manage PPH.

Incorrect

Terbutaline and magnesium sulfate are tocolytics; relaxation of the uterus causes or worsens PPH.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 668

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

COMPLETION

1. The nurse is in the process of assessing the comfort level of her postpartum patient. Excess bleeding is not obvious; however, the new mother complains of deep, severe pelvic pain. The registered nurse (RN) has noted both skin and vital sign changes. This patient may have formed a(n) ________.

ANS:

hematoma

Hematomas occur as a result of bleeding into loose connective tissue while the overlying tissue remains intact. A hematoma can develop after either a spontaneous or an instrumental vaginal delivery when blood vessels are injured. They are most likely to occur in the vulvar, vaginal, or retroperitoneal areas. The nurse should examine the vulva for a bulging mass or skin discoloration and intervene as necessary.

PTS: 1 DIF: Cognitive Level: Application REF: p. 669

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

2. _______________ is the most common postpartum infection.

ANS:

Endometritis

Endometritis usually begins as a localized infection at the placental site; however, can spread to involve the entire endometrium. Assessment for signs of endometritis may reveal a fever, elevated pulse, chills, anorexia, fatigue, pelvic pain, uterine tenderness or foul-smelling profuse lochia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 679

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

3. Of all pregnant women being treated for depression, approximately one-third have a first occurrence during pregnancy. All pregnant and postpartum women should be screened for perinatal mood disorders by using the _________ Postnatal Depression Scale.

ANS:

Edinburgh

The 10-item Edinburgh Postnatal Depression Scale accurately identifies depression in pregnant and postpartum women.

PTS: 1 DIF: Cognitive Level: Application REF: p. 685

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

TRUE/FALSE

1. Should a postpartum complication such as hemorrhage occur, the nursing staff will spring into action to ensure that patient safety needs are met. This level of activity is very reassuring to both the new mother and her family members as they can see that the patient is receiving the best care. Is this statement true or false?

ANS: F

On the contrary, the unusual activity of the hospital staff may make the mother and her family very anxious. Keeping the family informed is one of the most effective ways of reducing unnecessary anxiety. A comment such as, I know that all of this activity must be frightening. She is bleeding a little more than we would like, and we are doing several things at once would be very helpful.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 673

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

2. Pulmonary embolism (PE) is a serious complication of deep vein thrombosis (DVT) and the leading cause of maternal mortality. As many as 15% to 25% of all DVTs lead to PEs if not recognized and treated. Is this statement true or false?

ANS: T

This statement is correct. PE occurs with fragments of a blood clot dislodge and are carried to the lungs. Treatment is aimed at dissolving the clot and maintaining pulmonary circulation. Oxygen is used to decrease hypoxia, and narcotic analgesics are given to reduce pain and apprehension.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 674

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

Leave a Reply