Chapter 22 - Nursing Care of the Family During the Postpartum Period

What is the most likely cause of postpartum hemorrhage in a multiparous patient (G3T2P0A0L2) who gave birth 4 hours ago to a 4300 g newborn after augmentation of labour with oxytocin?

a. Retained placental fragments

b. Unrepaired vaginal lacerations

c. Uterine atony

d. Puerperal infection

c. Uterine atony

On examining a patient who gave birth 5 hours ago, the nurse finds that the patient has completely saturated a perineal pad within 15 minutes. What is the nurse’s initial response?

a. Begin an intravenous (IV) infusion of Ringer’s lactate solution.

b. Assess the patient’s vital signs.

c. Call the patient’s primary health care provider.

d. Massage the patient’s fundus.

d. Massage the patient’s fundus.

A patient gave birth vaginally to a 4400 g infant yesterday. The primary health care provider has written orders for perineal ice packs, use of a sitz bath TID, and a stool softener. What information is most closely correlated with these orders?

a. The patient is a G2T2P0A0L2.

b. The patient had a vacuum-assisted birth.

c. The patient received epidural anaesthesia.

d. The patient has had an episiotomy.

d. The patient has had an episiotomy.

The laboratory results for a postpartum patient are as follows: blood type, A; Rh status, positive; rubella titre, 1:8 (EIA 0.6); hematocrit, 30%. How would the nurse best interpret these data?

a. Rubella vaccine should be given.

b. A blood transfusion is necessary.

c. Rh immune globulin is necessary within 72 hours of birth.

d. A Kleihauer-Betke test should be performed.

a. Rubella vaccine should be given.

A patient gave birth 48 hours ago to a healthy newborn. They have decided to bottle-feed. During the assessment, a nurse notices that both of the patient’s breasts are swollen, warm, and tender on palpation. Which information should the nurse offer the patient?

a. Run warm water on her breasts during a shower.

b. Apply ice to the breasts for comfort.

c. Express small amounts of milk from the breasts to relieve pressure.

d. Wear a loose-fitting bra to prevent nipple irritation.

b. Apply ice to the breasts for comfort.

A 25-year-old multiparous patient gave birth to an infant 1 day ago. Today their partner brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the partner asks for help with warming the soup so that his wife can eat it. What is the basis of the nurse’s most appropriate response?

a. Asking the patient if they did not like the lunch that was served to them.

b. Checking with the patient that they have obtained permission from their health care provider to consume seaweed soup.

c. Asking the partner what the soup contains.

d. Offering to warm the soup up in the microwave for the patient.

d. Offering to warm the soup up in the microwave for the patient.

A primiparous patient is to be discharged from the hospital tomorrow with their newborn. Which behaviour indicates a need for further intervention by the nurse before the patient can be discharged?

a. The patient leaves the infant on the bed while taking a shower.

b. The patient continues to hold and cuddle their infant after feeding the newborn.

c. The patient reads a magazine while the infant sleeps.

d. The patient changes the infant’s diaper and shows the nurse the contents of the diaper.

a. The patient leaves the infant on the bed while taking a shower.

What would prevent early discharge of a postpartum patient?

a. Afterpains when breastfeeding

b. Birth at 38 weeks of gestation

c. Has voided 130 mL since birth

d. Episiotomy that shows slight redness and edema, is dry and approximated

c. Has voided 130 mL since birth

Which finding could prevent early discharge of a newborn at 12 hours of age?

a. Birth weight of 3000 g

b. One meconium stool since birth

c. Voided, clear, pale urine three times since birth

d. Infant breastfed once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast

d. Infant breastfed once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast

Which is the primary influence for shorter postpartum hospital stays?

a. Desire for a family-centred experience

b. Budget-driven decision

c. Hospitals

d. The federal government

a. Desire for a family-centred experience

How long should the nurse teach the patient who is not breastfeeding to wear a well-fitted support bra to suppress lactation in the postpartum period?

a. 24 hours

b. 48 hours

c. 72 hours

d. 7 days

c. 72 hours

Which patient should receive Rh immune globulin?

a. Rh+, sensitized

b. Rh+, not sensitized

c. Rh–, sensitized

d. Rh–, not sensitized

d. Rh–, not sensitized

In the recovery room, if a patient is asked either to raise their legs (knees extended) off the bed or to flex their knees, place their feet flat on the bed, and raise their buttocks well off the bed, most likely they are being tested to see whether they

a. have recovered from epidural or spinal anesthesia.

b. have hidden bleeding underneath them.

c. have regained some flexibility.

d. is a candidate to go home after 6 hours.

a. have recovered from epidural or spinal anesthesia.

If a patient is at risk for thrombus and is not ready to ambulate, nurses may intervene by performing a number of interventions. Which intervention should the nurse avoid?

a. Putting the patient in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots.

b. Having the patient flex, extend, and rotate their feet, ankles, and legs.

c. Having the patient sit in a chair.

d. Notifying the health care provider if there is pain and redness in leg.

c. Having the patient sit in a chair.

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to “mother the mother.” What does this expression refer to?

a. Formally initializing individualized care by confirming the patient’s and infant’s identification (ID) numbers on their respective wrist bands

b. Teaching the mother to check the identity of any person who comes to remove the baby from the room

c. Including other family members in the teaching of self-care and child care

d. Nurturing the patient by providing encouragement and support as she takes on the many tasks of motherhood

d. Nurturing the patient by providing encouragement and support as she takes on the many tasks of motherhood

What is the most common cause of excessive blood loss after childbirth?

a. Vaginal or vulvar hematomas

b. Unrepaired lacerations of the vagina or cervix

c. Failure of the uterine muscle to contract firmly

d. Retained placental fragments

c. Failure of the uterine muscle to contract firmly

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. What does this activity indicate that the nurse is doing?

a. Improving the accuracy of blood loss estimation, which usually is a subjective assessment

b. Determining which pad is best

c. Demonstrating that other nurses usually underestimate blood loss

d. Indicating to the nurse supervisor that one of them needs some time off

a. Improving the accuracy of blood loss estimation, which usually is a subjective assessment

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the patient empty their bladder spontaneously as soon as possible. Which would be the last intervention that the nurse would implement?

a. Pouring water from a squeeze bottle over the patient’s perineum

b. Placing oil of peppermint in a bedpan under the patient

c. Asking the health care provider to prescribe analgesics

d. Inserting a sterile catheter

d. Inserting a sterile catheter

If a patient is at risk for thrombus and is not ready to ambulate, which intervention should the nurse perform?

a. Put on antiembolic stockings (TED hose).

b. Have them avoid leg exercises.

c. Have them sit in a chair.

d. Keep their legs flat; do not elevate.

a. Put on antiembolic stockings (TED hose).

 Which does a nurse understand is true with regard to rubella and Rh issues?

a. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.

b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1 month after vaccination.

c. Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant.

d. Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1 month after vaccination.

When does planning for discharge officially begin?

a. At the time of admission to the nurse’s unit

b. When the infant is presented to the mother at birth

c. During the first visit with the health care provider in the unit

d. When the take-home information packet is given to the couple

a. At the time of admission to the nurse’s unit

A nurse prevents overdistention of the bladder and urinary retention in a postpartum patient in order to prevent

a. after birth hemorrhage and eclampsia.

b. fever and increased blood pressure.

c. after birth hemorrhage and urinary tract infection.

d. urinary tract infection and uterine rupture.

c. after birth hemorrhage and urinary tract infection.

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

a. Notify the primary health care provider of an impending hemorrhage.

b. Assess the blood pressure and pulse.

c. Evaluate the lochia.

d. Assist the patient in emptying their bladder.

d. Assist the patient in emptying their bladder.

When caring for a new postpartum patient, a nurse is aware that the best measure to prevent abdominal distention after a Caesarean birth is

a. rectal suppositories.

b. early and frequent ambulation.

c. tightening and relaxing abdominal muscles.

d. carbonated beverages.

b. early and frequent ambulation.

The nurse caring for a postpartum patient understands that breast engorgement is caused by

a. overproduction of colostrum.

b. accumulation of milk in the lactiferous ducts and glands.

c. hyperplasia of mammary tissue.

d. congestion of veins and lymphatics.

d. congestion of veins and lymphatics.

During a phone follow-up conversation with a woman who is 4 days’ after birth, the woman tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let down. I seem to cry for no reason!” The nurse would recognize that the woman is experiencing

a. taking-in.

b. postpartum depression (PPD).

c. postpartum blues.

d. attachment difficulty.

c. postpartum blues.

The postpartum patient who continually repeats the story of their labour, birth, and recovery experience is

a. providing others with her knowledge of events.

b. making the birth experience “real.”

c. taking hold of the events leading to her labour and birth.

d. accepting their response to labour and birth.

b. making the birth experience “real.”

A primigravida patient who had an emergency Caesarean birth 3 days ago is scheduled for discharge. As a nurse prepares the patient for discharge, the patient begins to cry. The nurses initial action should be to

a. assess her for pain.

b. point out how lucky they are to have a healthy baby.

c. explain that they are experiencing after birth blues.

d. allow them time to express their feelings.

d. allow them time to express their feelings.

A man calls the nurse’s station and states that his partner, who gave birth 2 days ago, is happy one minute and crying the next. The man says, “She was never like this before the baby was born.” The nurse’s initial response could be to

a. tell him to ignore the mood swings, as they will go away.

b. reassure him that this behaviour is normal.

c. advise him to get immediate psychological help for her.

d. instruct him in the signs, symptoms, and duration of after birth blues.

b. reassure him that this behaviour is normal.

Which should the nurse be concerned about with regard to potential psychosocial complications during a 6-week postpartum mother and baby checkup? (Select all that apply.)

a. The mother discusses their labour and birth experience excessively.

b. The mother views themselves as ugly and is not able to look at themselves in a mirror.

c. The mother has not given the baby a name.

d. The mother has a partner who reacts very positively about the baby.

e. The mother expresses disappointment over the baby’s gender.

f. The mother believes that their baby is more attractive and clever than any others.

B, C, E