Chapter 18: Postpartum Maternal Complications Foundations of Maternal-Newborn & Women's Health Nursing, 7th Edition
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Which statement by a postpartum patient indicates that further teaching regarding thrombus formation is unnecessary?
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."
d.
"I'll put my support stockings on every morning before rising."
The nurse understands that late postpartum hemorrhage may 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.
b.
inspecting the placenta after birth.
A multiparous patient 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 patient void and massages her fundus; however, 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.
c.
Notify the health care provider.
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.
b.
750 mL within 24 hours after a vaginal birth.
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.
d.
lacerations of the genital tract.
A postpartum patient 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.
b.
6.5-lb infant after a 2-hour labor.
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.
d.
oral methylergonovine maleate (Methergine) for 48 hours.
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)
d.
Dilation and curettage (D&C)
A positive sign of thrombophlebitis includes
a.
visible varicose veins.
b.
positive Homans sign.
c.
pedal edema in the affected leg.
d.
local tenderness, heat, and swelling.
d.
local tenderness, heat, and swelling.
Which nursing measure would be most appropriate to prevent thrombophlebitis in the recovery period following a cesarean birth?
a.
Limit the patient's oral intake of fluids for the first 24 hours.
b.
Assist the patient in performing leg exercises every 2 hours.
c.
Ambulate the patient as soon as her vital signs are stable.
d.
Roll a bath blanket and place it firmly behind the patient's knees.
b.
Assist the patient in performing leg exercises every 2 hours.
Which temperature indicates the presence of postpartum infection?
a.
37.5°C (99.6°F) in the first 48 hours
b.
37.7°C (100°F) for 2 days postpartum
c.
38°C (100.4°F) in the first 24 hours
d.
38.2°C (100.8°F) on the second and third postpartum days
d.
38.2°C (100.8°F) on the second and third postpartum days
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.
a.
possible infection.
The patient who is being treated for endometritis is placed in the Fowler position because this position
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.
b.
facilitates drainage of lochia.
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 grapefruit juice and carbonated beverages.
d.
discouraging voiding until the sensation of a full bladder is present.
a.
forcing fluids to at least 3000 mL/day.
Which measure may prevent mastitis in a breastfeeding patient?
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.
c.
Initiating early and frequent feedings.
A patient 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 through 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.
b.
Organisms that cause mastitis are not passed through the milk.
The nurse suspecting a uterine infection in a postpartum patient should assess the
a.
episiotomy site.
b.
odor of the lochia.
c.
abdomen for distention.
d.
pulse and blood pressure.
b.
odor of the lochia.
Following a difficult vaginal birth of a singleton pregnancy, the patient 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 37.6°C (99.8°F), pulse 90 beats/minute, respirations 20 breaths per minute, 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 analog
d.
Increase in parenteral fluids
c.
Administration of prostaglandin analog
Following a vaginal birth, a patient has lost a significant amount of blood and is starting to experience signs of hypovolemic shock. Which clinical signs would be consistent with this 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
b.
Compensatory response of tachycardia and decreased pulse pressure
A patient 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 patient 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 patient and reassess in 15 minutes. Initiate frequent vital sign assessments.
b.
initiate a rapid response intervention.
A postpartum patient 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
c.
Lentils
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.
d.
breath sounds.
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.
b.
assess the perineal and vaginal areas.
Prior to ambulating the patient whose admission hemoglobin level was 10.2 g/dL to the bathroom, 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.
c.
dangle her on the side of the bed.
If a late postpartum hemorrhage is documented on a patient 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.
d.
on the second postpartum day.
Which patient data received during report should the nurse recognize as being at risk for postpartum complications?
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
a.
Gravida 5, para 5
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.
b.
blood pressure.
To evaluate the desired response of methylergonovine (Methergine), the nurse would assess the patient's
a.
uterine tone.
b.
pain level.
c.
blood pressure.
d.
last voiding.
a.
uterine tone.
as you receive a report, which assessment finding should you recognize as an indication 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.
Patient requested pain medication twice during last shift
c.
Bright red continuous trickle of blood from vagina
The nurse observes the patient as she ambulates to the bathroom. Which clinical finding might 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
c.
Stiffness of right leg
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 patient on bed rest, with the affected leg elevated.
d.
place the patient on bed rest, with the affected leg elevated.
If the nurse suspects a pulmonary embolism in the patient 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/minute.
c.
position the patient in a supine position with the head of the bed flat.
d.
monitor pulse oximetry for decreased oxygen saturation.
b.
apply O2 via tight face mask at 8 to 10 L/minute.
To prevent infection of the reproductive tract, the nurse should instruct the patient 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.
b.
cleanse the perineum from front to back.
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.
a.
Massage the fundus of the uterus.
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
a.
Insufficient emptying
c.
Supplementing feedings
d.
Blisters on both nipples
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
a.
Anemia
c.
Exhaustion
d.
Postpartum infection
e.
Failure to attach to her infant
Note 
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