N164 | Exam 3 Review (Sherpath)

Which type of hematoma is most common in vaginal births and is visible from the outside?

a) Vaginal

b) Vulvar

c) Cervical

d) Retroperitoneal

b) Vulvar

--> visible to the outside

--> painful to the touch

--> caused by tissue breakdown during a vaginal birth

Which conditions are risk factors for uterine atony? Select all that apply.

a) Primiparous birth

b) Polyhydramnios

c) Precipitous birth

d) Fetal macrosomia

e) Chorioamnionitis

b) Polyhydramnios

d) Fetal macrosomia

e) Chorioamnionitis

After a vaginal delivery, an estimated blood loss greater than _____ mL would indicate a diagnosis of a postpartum hemorrhage.

500

--> PPH is defined as blood loss >500 mL after a vaginal birth and >1000 mL after a cesarean birth

A nurse is monitoring a new mother in the postpartum period for signs of hemorrhage. Which sign, if noted in the mother, indicates excessive blood loss?

a) An increase in the pulse from 88 to 110 beats/min

b) A blood pressure change from 130/88 to 124/80 mm Hg

c) An increase in the respiratory rate from 18 to 20 breaths/min

d) A change in the O2 saturation from 99% to 96%

a) An increase in the pulse from 88 to 110 beats/min

--> tachycardia is one of the early signs of hypovolemic shock

--> a change in pulse rate >20 beats/min would be a concern for the nurse

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage (PPH). Before administration of this medication, which nursing assessment is the priority?

a) Deep tendon reflexes

b) Uterine tone

c) Amount of lochia

d) Blood pressure

d) Blood pressure

--> Methylergonovine maleate is more likely to cause the DBP to rise when given

--> it is contraindicated in a patient with high BP

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 the fundus remains difficult to find, and the rubra lochia remains heavy. Which action would the nurse take next?

a) Continue to vigorously massage the fundus.

b) Notify the health care provider.

c) Recheck vital signs.

d) Insert a Foley catheter.

b) Notify the health care provider.

--> because the patient has a boggy uterus, heavy lochia, had a precipitous delivery, and delivered a large newborn, the treatment requires notification of the health care provider

--> the patient with these signs of PPH should not be left alone

In the fourth stage of labor, the nurse recognizes that a full bladder increases the risk for which postpartum complication?

a) Retained placenta

b) Boggy uterus

c) Infection

d) Shock

b) Boggy uterus

--> a full bladder displaces the uterus and prevents contraction of the uterus

--> uterine atony is the primary cause of postpartum hemorrhage (PPH)

When caring for a patient with a postpartum hemorrhage, which interventions would the nurse initiate to improve the patient's status? Select all that apply.

a) Insertion of an indwelling catheter

b) Fundal massage

c) Pad count

d) Administration of tocolytic drugs

e) Intravenous (IV) fluid replacement

a) Insertion of an indwelling catheter

b) Fundal massage

e) Intravenous (IV) fluid replacement

The nurse understands that which action after the birth of the newborn can prevent a postpartum hemorrhage?

a) Administration of broad-spectrum antibiotics

b) Inspection of the placenta

c) Manual removal of the placenta after birth

d) Pulling on the umbilical cord to hasten delivery of the placenta

b) Inspection of the placenta

--> if a portion of the placenta is missing, the healthcare provider can explore the uterus, locate the missing fragments, and remove the potential cause of a postpartum hemorrhage (PPH)

On assessment, the postpartum nurse notes a firm fundus, bright red blood oozing from the vagina, and a saturated perineal pad. What diagnosis would the nurse expect based on these assessment findings?

a) Vaginal hematoma

b) Placenta accreta

c) Vaginal laceration

d) Uterine inversion

c) Vaginal laceration

--> a vaginal laceration that was not discovered or repaired after a vaginal delivery would create an oozing of blood that is typically bright red (frank) in color

The nurse understands that which conditions are risks for a uterine inversion? Select all that apply.

a) Precipitous delivery

b) Short umbilical cord

c) Polyhydramnios

d) Fundal implantation of the placenta

e) Prolonged labor

b) Short umbilical cord

d) Fundal implantation of the placenta

e) Prolonged labor

Which risk factor places a woman at risk for subinvolution of the uterus?

a) Chorioamnionitis

b) Forceful traction of the umbilical cord

c) Vacuum extraction

d) Precipitous delivery

a) Chorioamnionitis

--> pelvic infections, including chorioamnionitis, place a woman at risk for subinvolution

A nurse is caring for the following labor patients. Which patients would the nurse be prepared to monitor closely for signs of postpartum hemorrhage (PPH)? Select all that apply.

a) G1 P0000, delivered a 29-week fetal demise vaginally after 8 hours in labor

b) G2 P1001, delivered a 4200-g neonate vaginally after 4 hours of labor

c) G2 P0010, delivered a 3750-g neonate by cesarean section for breech presentation

d) G4 P3003, delivered a 3500-g neonate by cesarean section with a placenta accreta

e) G3 P0200, delivered a 3900-g neonate vaginally after 36 hours in labor

b) G2 P1001, delivered a 4200-g neonate vaginally after 4 hours of labor

d) G4 P3003, delivered a 3500-g neonate by cesarean section with a placenta accreta

e) G3 P0200, delivered a 3900-g neonate vaginally after 36 hours in labor

A woman, 1 day postpartum, is being carefully monitored after a significant postpartum hemorrhage (PPH). Which finding would the nurse report to the health care provider?

a) Urine output of 160 mL for the past 8 hours

b) Weight loss of 2 lb since delivery

c) Pulse rate of 68 beats/min

d) Fundus firm at the umbilicus

a) Urine output of 160 mL for the past 8 hours

--> oliguria (urine output

A woman delivered a 9-lb, 10-oz baby 1 hour ago. When the nurse arrives to perform the 15-minute assessment, the patient says that she "feels all wet underneath." The nurse discovers that both perineal pads are completely saturated and that the patient is lying in a 6-inch-diameter puddle of blood. After calling for help, which action would the nurse take next?

a) Assess the fundus for firmness.

b) Estimate the blood loss by weighing the perineal pads.

c) Check the perineum for lacerations.

d) Manually remove any contents in the uterus.

a) Assess the fundus for firmness.

--> firmness of the uterus is necessary to control bleeding from the placental site

--> the nurse should first attempt to firm the fundus through firm, but not vigorous, massage

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 the patient's fundus remains difficult to find and the lochia remains bright red and heavy. Which action would the nurse take next?

a) Vigorously massage the fundus

b) Notify the health care provider

c) Recheck the vital signs

d) Insert an indwelling catheter

b) Notify the health care provider

The nurse understands that an early postpartum hemorrhage is defined as an estimated blood loss greater than _____ mL in the first 24 hours after a vaginal delivery.

500

The nurse recognizes that a steady trickle of bright red blood from the vagina in the presence of a firm fundus may indicate which condition?

a) Uterine atony

b) Retained placenta

c) Infection of the uterus

d) A laceration within the genital tract

d) A laceration within the genital tract

--> undetected lacerations bleed slowly and continuously until repaired with sutures

--> bleeding from lacerations is uncontrolled by uterine contractions, and it is typically bright red

Which postpartum infection is the most common?

a) Mastitis

b) Wound infection

c) Endometritis

d) Urinary tract infection (UTI)

c) Endometritis

--> can affect up to 15% of women who have cesarean births in the U.S.

Which situations are common risk factors for developing mastitis? Select all that apply.

a) Bottle feeding

b) Cracked nipples

c) Wearing an underwire bra

d) Breast implants

e) Abrupt weaning of the infant

b) Cracked nipples

c) Wearing an underwire bra

e) Abrupt weaning of the infant

A fever equal or above _____°F for 2 or more consecutive days should be reported to the health care provider for evaluation of a postpartum infection.

100.4

Which task would the nurse teach the postpartum woman to perform to prevent a urinary tract infection (UTI)?

a) Apply antibiotic ointment to the urethra daily.

b) Change the perineal pad at each voiding.

c) Void at least every hour during the postpartum period.

d) Spray the perineum with a povidine-iodine solution after voiding.

b) Change the perineal pad at each voiding.

--> blood is an excellent medium for bacterial growth

During a home visit, the nurse assesses a woman 2 weeks after a cesarean delivery. Which signs or symptoms would alert the nurse to a possible wound infection? Select all that apply.

a) Purulent drainage on the woman's pants

b) Well-approximated incision

c) Oral temperature of 101°F (38.3°C)

d) Warm incision site

e) Bruising around the incision site

a) Purulent drainage on the woman's pants

c) Oral temperature of 101°F (38.3°C)

d) Warm incision site

Which instruction would the nurse provide to a woman who is breastfeeding and has mastitis?

a) "Limit the amount of time the infant nurses on each breast."

b) "Nurse the infant only on the unaffected breast until it resolves."

c) "Completely empty each breast at each feeding or use a pump."

d) "Wear an underwire bra until the mastitis has subsided."

c) "Completely empty each breast at each feeding or use a pump."

--> this will help avoid engorgement

--> mastitis may occur when breasts are engorged and the milk is static

To assess whether there is any improvement in a patient's dysuria, the nurse would ask which question?

a) "Do you have to urinate at night?"

b) "Do you have blood in your urine?"

c) "Do you have to urinate frequently?"

d) "Do you have pain when you urinate?"

d) "Do you have pain when you urinate?"

Which signs and symptoms are commonly associated with endometritis? Select all that apply.

a) Flank pain

b) Breast tenderness

c) Pelvic pain

d) Excessive lochia

e) Low-grade fever for 24 hours

c) Pelvic pain

d) Excessive lochia

Wound dehiscence is a sign of a wound infection and is characterized by which finding?

a) Separation of the wound site

b) Purulent drainage at the wound site

c) Bleeding at the wound site

d) Edema at the wound site

a) Separation of the wound site

--> wound dehiscence should be reported immediately to a health care provider

The nurse is assessing a 3-day-postpartum breastfeeding woman. Her breasts are firm and warm to the touch. When asked when she last fed the infant, her reply is, "I fed the baby last evening, but I let the nurses feed him in the nursery last night because I needed to rest." Which action would the nurse take to prevent the woman from developing mastitis?

a) Encourage the woman to breastfeed her infant more frequently.

b) Have the woman massage her breasts hourly.

c) Obtain a prescription to culture her expressed breast milk.

d) Take the temperature and pulse rate of the woman.

a) Encourage the woman to breastfeed her infant more frequently.

A nurse on the postpartum unit is caring for several postpartum women. Which woman would the nurse recognize as having the greatest risk for developing a postpartum infection?

a) A woman who experienced a precipitous labor less than 3 hours in duration

b) A woman who has type 1 diabetes and delivered a large-for-gestational-age infant via cesarean section

c) A woman who had a boggy uterus that was not well contracted after delivery

d) A woman who has a first-degree laceration of the perineum

b) A woman who has type 1 diabetes and delivered a large-for-gestational-age infant via cesarean section

A nurse is reviewing discharge teaching with a patient who has a urinary tract infection (UTI). Which statements by the patient indicate understanding of the teaching?

Select all that apply.

a) "I will perform perineal care and apply a perineal pad in a back-to-front direction."

b) "I will drink cranberry and prune juices to make my urine more acidic."

c) "I will drink large amounts of water to flush the bacteria from my urinary tract."

d) "I will go back to breastfeeding after I have finished taking the antibiotic."

e) "I will take analgesics for any discomfort."

c) "I will drink large amounts of water to flush the bacteria from my urinary tract."

e) "I will take analgesics for any discomfort."

_____% of postpartum women experience some form of the "baby blues".

85

Which symptoms are associated with postpartum depression? Select all that apply.

a) Hallucinations

b) Tiredness

c) Changes in diet

d) Issues with sleep

e) Obsessive thoughts

b) Tiredness

c) Changes in diet

d) Issues with sleep

Which symptoms are unique to postpartum psychosis? Select all that apply.

a) Hallucinations

b) Tiredness

c) Changes in diet

d) Attempts at self-harm

e) Paranoia

a) Hallucinations

d) Attempts at self-harm

e) Paranoia

Which statement regarding postpartum depression is essential for the nurse to be aware of when selecting a plan of care?

a) "Postpartum depression symptoms are consistently severe."

b) "This syndrome affects only new mothers."

c) "Postpartum depression can easily go undetected."

d) "Only mental health professionals should teach new parents about this condition.

c) "Postpartum depression can easily go undetected."

--> this is because women may not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt

The nurse determines that screening for risk factors associated with postpartum depression is best started at which point?

a) Before discharge from the hospital

b) As soon after delivery as possible

c) At the 6-week follow-up visit

d) During the third trimester

d) During the third trimester

--> the CDC recommends that health care providers address the issue of postpartum depression during prenatal visits, preferably during the third trimester, to recognize any potential risk factors for postpartum depression and to begin education immediately on prevention and treatment

The nurse in a prenatal clinic understands that which available validated screening tool is most effective in detecting postpartum depression?

a) Depressed Mothers Screening Tool (DMST)

b) Postpartum Depression Rating Scale (PDRS)

c) Edinburgh Postnatal Depression Scale (EPDS)

d) Postpartum Depression Screening Scale (PDSS)

c) Edinburgh Postnatal Depression Scale (EPDS)

--> the most widely used screening tool available to detect postpartum depression

--> given prenatally, the EPDS has been shown to effectively identify women at risk for postpartum depression

Which emotional expressions of "baby blues" are most common?

a) Exhaustion and withdrawal

b) Tearfulness and tiredness

c) Anxiety and hopelessness

d) Paranoia and insomnia

b) Tearfulness and tiredness

Which situations are considered risk factors for a postpartum mood disorder when they are present before the pregnancy? Select all that apply.

a) Low socioeconomic status

b) Strong social support

c) Infertility treatments

d) History of depression

e) 27 years old at time of conception

a) Low socioeconomic status

c) Infertility treatments

d) History of depression

Which characteristic describes sleep disturbances associated with postpartum depression?

a) Unrestful sleep

b) Caused by the baby's presence

c) Excessive sleeping

d) Attributed to the need for nighttime feedings

a) Unrestful sleep

--> there is a different quality to sleep problems in women with postpartum depression

--> it is usual for new mothers to have their sleep interrupted by a crying baby, but women with postpartum depression report that they cannot go to sleep even when the baby is settled and goes to sleep

Which statement by a postpartum woman would require the most immediate attention by the nurse?

a) "I am so tired I do not know how I am going to make it through the day."

b) "I am not hungry. I am going to skip lunch today."

c) "The lactation consultant tried to steal my baby."

d) "I am never going to feel like myself again."

c) "The lactation consultant tried to steal my baby."

--> paranoia and hallucinations could indicate postpartum psychosis, which is a postpartum mood disorder that requires immediate medical attention

Which statement by a maternal home care nurse reflects the correct approach to addressing potential and actual postpartum depression in maternal patients?

a) "We include education about postpartum depression to women if they have a history of depression."

b) "If we suspect a woman may have developed postpartum depression, then we provide specialized education about that topic."

c) "Because emotional disorders and imbalances are a very sensitive subject, we try not to offend patients by routinely bringing up the topic of postpartum depression."

d) "Teaching about postpartum depression is a routine part of education for all pregnant patients."

d) "Teaching about postpartum depression is a routine part of education for all pregnant patients."

Which advice would the nurse provide a woman regarding the "baby blues" and postpartum depression as part of discharge teaching?

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) "Talk about your feelings and seek help if needed."

d) "Keep feelings of sadness and adjustment to your new role to yourself."

c) "Talk about your feelings and seek help if needed."

Infants born prior to completion of which gestational week are considered premature _____?

37

Which characteristics would the nurse expect to observe when caring for a premature newborn? Select all that apply.

a) Small head in proportion to body

b) Scrawny extremities

c) Hypertonicity

d) Smooth, translucent skin

e) Vernix caseosa

b) Scrawny extremities

d) Smooth, translucent skin

e) Vernix caseosa

Which assessment findings are expected in a premature newborn?

Select all that apply.

a) Axillary temperature range of 36.3°C to 36.9°C (97.3°F to 98.4°F)

b) Urine output of 1 mL/kg/hr

c) Respiratory rate <30 breaths/min

d) Weight gain of 15 to 20 g/kg/day

e) Loss of 15% birth weight during first week of life

a) Axillary temperature range of 36.3°C to 36.9°C (97.3°F to 98.4°F)

d) Weight gain of 15 to 20 g/kg/day

e) Loss of 15% birth weight during first week of life

Which assessment finding indicates readiness for nipple feeding in premature newborns?

a) Respiratory rate of 60 breaths/min

b) High gastric residuals

c) Irritability during care

d) Rooting

d) Rooting

--> rooting and sucking on a finger or pacifier are signs of readiness for nipple feeding

Match the method of ventilation with its description.

Description:

- Provides constant distending pressure and promotes lung expansion

- Indicated for respiratory failure, severe apnea, or bradycardia

- Decreases lung barotrauma and volutrauma

Method of Ventilation:

- Conventional mechanical ventilation

- Continuous positive airway pressure

- High-frequency oscillation

Provides constant distending pressure and promotes lung expansion --> Continuous positive airway pressure (CPAP)

Indicated for respiratory failure, severe apnea, or bradycardia --> Conventional mechanical ventilation (CMV)

Decreases lung barotrauma and volutrauma --> High-frequency oscillation (HFO)

Which intervention is most important for preventing infection in premature newborns?

a) Don gloves and gowns for all contact

b) Restricted visitation

c) Hand hygiene

d) Single rooms

c) Hand hygiene

--> the most effective intervention to prevent infection

Which nonpharmacologic interventions are recommended for premature newborns experiencing pain? Select all that apply.

a) Nonnutritive sucking

b) Containment

c) Supine positioning

d) Skin-to-skin contact

e) White noise

a) Nonnutritive sucking

b) Containment

d) Skin-to-skin contact

Which nursing intervention promotes maturation of the intestinal tract and intestinal motility in premature newborns?

a) Bottle feeding

b) Trophic feedings

c) Parenteral nutrition

d) Intermittent bolus gavage feedings

b) Trophic feedings

--> aka minimal enteral feedings

--> just a few milliliters of milk initiated within a few days of life

Which factors contribute to compromised physiologic functioning in premature newborns?

Select all that apply.

a) High surfactant levels

b) Limited brown fat stores

c) Predisposition to hyperglycemia

d) Capillary fragility

e) Minimal maternal immunoglobulin storage

f) Weak or absent gag reflex

b) Limited brown fat stores

d) Capillary fragility

e) Minimal maternal immunoglobulin storage

f) Weak or absent gag reflex

Which respiratory assessment finding is expected in a premature newborn?

a) Central cyanosis

b) Periodic breathing

c) Apnea for 20 seconds

d) Adventitious breath sounds

b) Periodic breathing

--> cessation of breathing for 5 to 10 seconds followed by rapid respirations for 10 to 15 seconds

Which clinical signs are associated with respiratory distress syndrome?

Select all that apply.

a) Dyspnea

b) Abdominal distention

c) Inspiratory crackles

d) Tense fontanel

e) Wheezing

f) Apnea

a) Dyspnea

c) Inspiratory crackles

f) Apnea

Which intervention is associated with reduced length of ventilator support and oxygen therapy in premature newborns?

a) Administration of surfactant

b) Administration of nitric oxide

c) Use of oxygen hood

d) Use of extracorporeal membrane oxygenation (ECMO)

a) Administration of surfactant

--> administered via endotracheal tube

--> has been shown to reduce the length of ventilator support and oxygen therapy and increase survival of premature newborns

Which equipment is most commonly used to promote a neutral thermal environment in premature newborns?

a) Radiant warmer

b) Polyethylene bag

c) Incubator

d) Open crib

c) Incubator

--> used for the majority of premature newborns to provide a neutral thermal environment and minimize heat loss

Which interventions would the nurse implement for a premature newborn with evaporative losses? Select all that apply.

a) Adjust incubator temperature.

b) Change to intermittent gavage feedings.

c) Provide high humidity.

d) Assess blood glucose.

e) Bathe the infant.

a) Adjust incubator temperature.

c) Provide high humidity.

d) Assess blood glucose.

Which interventions would the nurse implement to facilitate parent-infant bond? Select all that apply.

a) Teach containment techniques.

b) Encourage skin-to-skin contact.

c) Include parents in infant care.

d) Encourage rocking and singing.

e) Encourage eye contact with infant.

a) Teach containment techniques.

b) Encourage skin-to-skin contact.

c) Include parents in infant care.