chapter 24-postpartum complications

Question 1

The perinatal nurse’s assessment while caring for a woman in the immediate post birth period reveals that the woman is experiencing profuse bleeding. What is the most likely etiology for her bleeding?
a. Uterine atony
b. Uterine inversion
c. Vaginal hematoma
d. Vaginal laceration

Answer 1

A

Question 2

Which is a primary nursing responsibility when caring for a woman experiencing an obstetrical hemorrhage associated with uterine atony?
a. Establish venous access.
b. Perform fundal massage.
c. Prepare the woman for surgical intervention.
d. Catheterize the bladder.

Answer 2

B

Question 3

Which is the most likely cause of late postpartum hemorrhage (PPH)?
a. Subinvolution of the placental site
b. Defective vascularity of the decidua
c. Cervical lacerations
d. Coagulation disorders

Answer 3

A

Question 4

What woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman being prepared for an emergency Caesarean birth for fetal distress
b. A woman with severe pre-eclampsia on magnesium sulphate whose labour is being induced
c. A multiparous woman with an 8-hour labour
d. A primigravida in spontaneous labour with preterm twins

Answer 4

B

Question 5

What is the initial priority nursing intervention when a nurse observes profuse postpartum bleeding?
a. Call the woman’s primary health care provider.
b. Administer the standing order for an oxytocic.
c. Palpate the uterus and massage it if it is boggy.
d. Assess maternal blood pressure (BP) and pulse for signs of hypovolemic shock.

Answer 5

C

Question 6

What is the most objective and least invasive assessment of adequate organ perfusion and oxygenation when caring for a postpartum woman experiencing hemorrhagic shock?
a. Absence of cyanosis in the buccal mucosa
b. Cool, dry skin
c. Diminished restlessness
d. Urinary output of at least 30 mL/hr

Answer 6

D

Question 7

Which is one of the first symptoms of puerperal infection to assess for in the postpartum woman?
a. Fatigue continuing for longer than 1 week
b. Pain with voiding
c. Profuse vaginal bleeding with ambulation
d. Temperature of 38.6° C

Answer 7

D

Question 8

The perinatal nurse assisting with establishing lactation is aware that which action can minimize acute mastitis?
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

Answer 8

B

Question 9

Which statement is true with regard to postpartum hemorrhage (PPH)?
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 Caesarean 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.

Answer 9

D

Question 10

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. What should the nurse suspect, and then what should the nurse implement to confirm the diagnosis?
a. Disseminated intravascular coagulation; ask for laboratory tests.
b. von Willebrand disease; note whether bleeding times have been extended.
c. Thrombophlebitis; use real-time and colour Doppler ultrasound.
d. Coagulopathies; draw blood for laboratory analysis.

Answer 10

C

Question 11

What postpartum hemorrhage (PPH) conditions are considered medical emergencies that require immediate treatment?
a. Inversion of the uterus and hypovolemic shock
b. Hypotonic uterus and coagulopathies
c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura
d. Uterine atony and disseminated intravascular coagulation

Answer 11

A

Question 12

What infection is contracted mostly by mothers who are breastfeeding and usually occurs after the first postpartum week?
a. Endometritis
b. Wound infections
c. Mastitis
d. Urinary tract infections

Answer 12

C

Question 13

What medication should the nurse expect to see ordered first for the patient with von Willebrand disease who experiences a postpartum hemorrhage?
a. Cryoprecipitate
b. Factor VIII and von Willebrand factor (vWf)
c. Desmopressin
d. Hemabate

Answer 13

C

Question 14

The nurse should be aware that a pessary would be most effective in the treatment of which disorder?
a. Cystocele
b. Uterine prolapse
c. Rectocele
d. Stress urinary incontinence

Answer 14

B

Question 15

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems and sensations of bearing down and of something in her vagina. Which would the nurse suspect that the patient most likely is experiencing?
a. Pelvic relaxation
b. Cystocele
c. Uterine displacement
d. Genital fistulas

Answer 15

B

Question 16

The symptoms of mild-to-moderate urinary incontinence (UI) can be successfully decreased by a number of strategies. Which 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

Answer 16

B

Question 17

What is one of the main concerns when a woman is diagnosed with postpartum depression (PPD) without psychotic features?
a. She may have outbursts of anger.
b. She may neglect her hygiene.
c. She may harm her infant.
d. She may lose interest in her husband.

Answer 17

C

Question 18

What should the nurse know to provide adequate postpartum care to the patient experiencing postpartum depression (PPD) without psychotic features?
a. PPD means that the woman is experiencing the baby blues. In addition, she has a visit with a counsellor or psychologist.
b. PPD is more common among older, White women because they have higher expectations.
c. PPD is distinguished by irritability, severe anxiety, and panic attacks.
d. PPD will disappear on its own without outside help.

Answer 18

C

Question 19

What should the nurse be aware of to provide adequate postpartum care for the woman experiencing postpartum psychosis?
a. Postpartum psychosis is more likely to occur in women after the birth of their first child.
b. Postpartum psychosis is rarely delusional and then usually about someone trying to harm her (the mother).
c. Although serious, postpartum psychosis is not likely to require psychiatric hospitalization.
d. Postpartum psychosis is most commonly associated with bipolar disorder.

Answer 19

D

Question 20

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 in self-care activities to help prevent postpartum depression. What is the most accurate statement as related to these activities?
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.

Answer 20

D

Question 21

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action would indicate that the family had begun to grieve for the dead infant?
a. They refer to the two live infants as twins.
b. They ask about the dead triplet’s current status.
c. They bring in play clothes for all three infants.
d. They refer to the dead infant in the past tense.

Answer 21

D

Question 22

What is the basis for the most appropriate statement that the nurse can make to young bereaved parents?
a. Indicating that the parents now have an angel in heaven.
b. Expressing to the parents that the nurse understands how they feel.
c. Pointing out to them that they are young and will have future opportunities to be parents.
d. Expressing to the parents that you are sorry for their loss.

Answer 22

D

Question 23

What options for saying goodbye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?
a. The nurse shouldn’t discuss any options at this time; there is plenty of time after the baby is born.
b. Ask the mother if she would like a picture taken of her baby after birth.
c. Ask the woman if she would like to see and hold her baby after birth.
d. Assist the family in deciding what funeral home is to be notified after the baby is born.

Answer 23

C

Question 24

A woman experienced a miscarriage at 10 weeks of gestation and had a dilation and curettage (D&C). She states that she is just fine and wants to go home as soon as possible. While you are assessing her responses to her loss, she tells you that she had purchased some baby things and had picked out a name. On the basis of your assessment of her responses, what nursing intervention would you use first?
a. Ready her for discharge.
b. Notify pastoral care to offer her a blessing.
c. Ask her if she would like to see what was obtained from her D&C.
d. Ask her what name she had picked out for her baby.

Answer 24

D

Question 25

A woman is diagnosed with having a stillborn. At first, she appears stunned by the news, cries a little, and then asks you to call her mother. What is the phase of bereavement the woman is experiencing?
a. Anticipatory grief
b. Acute distress
c. Intense grief
d. Reorganization

Answer 25

B

Question 26

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What should the nurse’s role be?
a. Take over as much as possible to relieve the pressure.
b. Encourage grandparents to take over.
c. Make sure the parents themselves approve the final decisions.
d. Leave them alone to work things out.

Answer 26

C

Question 27

During a follow-up visit, which would the nurse expect not to observe if the parents have progressed to the second stage or phase of grieving?
a. Guilt, particularly in the mother
b. Numbness or lack of response
c. Bitterness or irritability
d. Fear and anxiety, especially about getting pregnant again

Answer 27

B

Question 28

Which would signify that grieving parents had progressed to the reorganization/recovery phase a year after their loss?
a. The parents say they feel no pain.
b. The parents are discussing sex and a future pregnancy, even if they have not sorted out their feelings yet.
c. The parents have abandoned those moments of bittersweet grief.
d. The parents’ questions have progressed from “Why?” to “Why us?”

Answer 28

B

Question 29

The nurse caring for a family during a loss might notice that survivor guilt sometimes is felt at the death of an infant by which family member?
a. Siblings
b. Mother
c. Father
d. Grandparents

Answer 29

D

Question 30

When helping the mother, father, and other family members actualize the loss of the infant, what should the nurse do?
a. Use the words lost or gone rather than dead or died.
b. Make sure that the family understands that it is important to name the baby.
c. If the parents choose to visit with the baby, apply powder and lotion to the baby and wrap the infant in a pretty blanket.
d. Set a firm time for ending the visit with the baby so the parents know when to let go.

Answer 30

C

Question 31

Which should the nurse be aware of with regard to helping parents with their decision making about an autopsy?
a. Autopsies are important in answering the question “Why?”
b. Autopsies must be done within a few hours after delivery.
c. The type of autopsy is from head to toe with no possibility of optional types such as excluding the head.
d. The decision for an autopsy needs to be done within 4 hours of delivery.

Answer 31

A

Question 32

What should the nurse be aware of with regard to organ donation after an infant’s death?
a. Federal law requires organ donation.
b. Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience.
c. The most common donation is the infant’s kidneys.
d. Corneas can be donated if the infant was either stillborn or alive, as long as the pregnancy went full term.

Answer 32

B

Question 33

In helping bereaved parents cope and move on, nurses should keep in mind which of the following?
a. A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.
b. When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies.
c. No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions.
d. In emergency situations nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

Answer 33

A

Question 34

Which medication can be used to manage postpartum hemorrhage (PPH)?
a. Coumadin
b. Methylergonovine
c. Terbutaline
d. Magnesium sulphate

Answer 34

B

Question 35

Which is a possible alternative or complementary therapy for postpartum depression (PPD) for breastfeeding mothers?
a. Yoga
b. Motherwort
c. St. John’s wort
d. Wine consumption

Answer 35

A