Chapter 24 - Postpartum Complications

The perinatal nurse’s assessment while caring for a patient in the immediate postpartum period reveals that the patient 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

a. Uterine atony

Which is a primary nursing responsibility when caring for a patient experiencing an obstetrical hemorrhage associated with uterine atony?

a. Establish venous access.

b. Perform fundal massage.

c. Prepare the patient for surgical intervention.

d. Catheterize the bladder.

b. Perform fundal massage.

A perinatal nurse caring for the postpartum patient understands that late postpartum hemorrhage (PPH) is most likely caused by

a. subinvolution of the placental site.

b. defective vascularity of the decidua.

c. cervical lacerations.

d. coagulation disorders.

a. subinvolution of the placental site.

Which patient is at greatest risk for early postpartum hemorrhage (PPH)?

a. A primiparous patient being prepared for an emergency Caesarean birth for fetal distress

b. A patient with severe pre-eclampsia on magnesium sulphate whose labour is being induced

c. A multiparous patient with an 8-hour labour

d. A primigravida in spontaneous labour with preterm twins

b. A patient with severe pre-eclampsia on magnesium sulphate whose labour is being induced

What is the initial priority nursing intervention when a nurse observes profuse postpartum bleeding?

a. Call the patient’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.

c. Palpate the uterus and massage it if it is boggy.

What is the most objective and least invasive assessment of adequate organ perfusion and oxygenation when caring for a postpartum patient 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

d. Urinary output of at least 30 mL/hr

Which is one of the first symptoms of puerperal infection to assess for in the postpartum patient?

a. Fatigue continuing for longer than 1 week

b. Pain with voiding

c. Profuse vaginal bleeding with ambulation

d. Temperature of 38.6C

d. Temperature of 38.6C

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

b. Using proper breastfeeding techniques

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance

a. PPH is easy to recognize early; after all, the patient 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 primary or secondary.

d. traditionally PPH has been classified as primary or secondary.

A patient who has recently given birth states they have pain and tenderness in their 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; ask for ultrasound examination.

d. Coagulopathies; draw blood for laboratory analysis.

c. Thrombophlebitis; ask for ultrasound examination.

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

a. Inversion of the uterus and hypovolemic shock

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

c. Mastitis

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

c. Desmopressin

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Many patients experience a perinatal mood disorder (PMD). Which statement regarding PMD is essential for the nurse to be aware of when attempting to formulate a nursing plan?

a. PPD symptoms are consistently severe.

b. This syndrome affects only new mothers.

c. PPD can easily go undetected.

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

c. PPD can easily go undetected.

A patient gave birth to a 4500 g baby 1 hour ago. When completing the patient’s 15-minute assessment, they tell a nurse that they “feels all wet underneath.” The nurse discovers that both pads are completely saturated and that the patient is lying in a 10 cm-diameter puddle of blood. What is the nurse’s first action?

a. Call for help.

b. Assess the fundus for firmness.

c. Take their blood pressure.

d. Check the perineum for lacerations.

b. Assess the fundus for firmness.

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.

b. lacerations of the genital tract.

What is one of the main concerns when a patient is diagnosed with postpartum depression (PPD)?

a. They may have outbursts of anger.

b. They may neglect their hygiene.

c. They may harm their infant.

d. They may lose interest in their partner.

c. They may harm their infant.

What should the nurse know to provide adequate postpartum care to the patient experiencing postpartum depression (PPD)?

a. PPD means that the patient is experiencing the baby blues. In addition, she has avisit with a counsellor or psychologist.

b. PPD is more common among older, White patients because they have higher expectations.

c. PPD is distinguished by irritability and labile mood swings.

d. PPD will disappear on its own without outside help.

c. PPD is distinguished by irritability and labile mood swings.

To provide adequate postpartum care, a nurse should be aware that postpartum psychosis

a. is more likely to occur in patients with more than two children.

b. is rarely delusional and then is usually about someone trying to harm her (the mother).

c. although serious, is not likely to need psychiatric hospitalization.

d. may include bipolar disorder (formerly called “manic depression”).

d. may include bipolar disorder (formerly called “manic depression”).

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 patients.

d. Realize that this is a common occurrence that affects many patients.

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.

d. They refer to the dead infant in the past tense.

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.

d. Expressing to the parents that you are sorry for their loss.

What options for saying goodbye would the nurse want to discuss with a patient 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 patient 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.

c. Ask the patient if she would like to see and hold her baby after birth.

A patient experienced a miscarriage at 10 weeks of gestation and had a dilation and curettage (D&C). They state they are just fine and want to go home as soon as possible. While a nurse is assessing their responses to their loss, they tell you that they had purchased some baby things and had picked out a name. On the basis of your assessment of the responses, what nursing intervention would the nurse do first?

a. Ready them for discharge.

b. Notify pastoral care to offer them a blessing.

c. Ask them if they would like to see what was obtained from their D&C.

d. Ask them what name they had picked out for their baby.

d. Ask them what name they had picked out for their baby.

A patient is diagnosed with having a stillborn. At first, they appear stunned by the news, cry a little, and then asks a nurse to call their mother. What is the phase of bereavement the patient is experiencing?

a. Anticipatory grief

b. Acute distress

c. Intense grief

d. Reorganization

b. Acute distress

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.

c. Make sure the parents themselves approve the final decisions.

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

b. Numbness or lack of response

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?”

b. The parents are discussing sex and a future pregnancy, even if they have not sorted out their feelings yet.

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

d. Grandparents

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.

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.

Which should the nurse be aware of with regard to helping parents with their decision making about an autopsy?

a. Autopsies may be important in answering the question “Why?”

b. Autopsies must be done within a few hours after birth.

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 birth.

a. Autopsies may be important in answering the question “Why?”

Complicated bereavement

a. occurs when, in multiple births, one child dies, and the other or others live.

b. is a state in which the parents are ambivalent, as with an abortion.

c. is an extremely intense grief reaction that persists for a long time.

d. is felt by the family of adolescent mothers who lose their babies.

c. is an extremely intense grief reaction that persists for a long time.

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.

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.

Which medication can be used to manage postpartum hemorrhage (PPH)?

a. Coumadin

b. Methylergonovine

c. Terbutaline

d. Magnesium sulphate

b. Methylergonovine

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

a. Yoga

Which instruction 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 primary health care provider 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.

b. Notify the primary health care provider of any increase in the amount of lochia or a return to bright red bleeding.

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

a. Hysterectomy

b. Laparoscopy

c. Laparotomy

d. D&C

d. D&C

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

d. Postpartum blues

Anxiety disorders are common mental disorders that affect patients. While providing care to the perinatal patient, a nurse should be aware that one of these disorders is likely to be triggered by the process of labour and birth. This disorder is

a. phobias.

b. panic disorder.

c. posttraumatic stress disorder (PTSD).

d. obsessive-compulsive disorder (OCD).

c. posttraumatic stress disorder (PTSD).

Which are risk factors for postpartum hemorrhage (PPH)? (Select all that apply.)

a. Twin pregnancy

b. Preterm birth

c. Magnesium sulphate administration during labour

d. Mother’s first labour and birth

e. Forceps-assisted birth

f. Oxytocin-induced labour

A, C, E, F

a. Twin pregnancy, c. Magnesium sulphate administration during labour, e. Forceps-assisted birth, f. Oxytocin-induced labour

Which are considered unusual placental adherences? (Select all that apply.)

a. Placenta previa

b. Placenta accrete

c. Placenta increta

d. Placenta abruption

e. Retained placental fragments

f. Placenta percreta

B, C, F

b. Placenta accrete, c. Placenta increta, f. Placenta percreta

Which are adverse effects that the nurse needs to be aware of when caring for a patient with a postpartum hemorrhage (PPH) who is being administrated carboprost tromethamine? (Select all that apply.)

a. Hypothermia

b. Bradycardia

c. Hypotension

d. Nausea

e. Diarrhea

f. Headache

D, E, F

d. Nausea, e. Diarrhea, f. Headache

Which are administration guidelines for the use of methylergonovine when managing postpartum hemorrhage (PPH)? (Select all that apply.)

a. Contraindication to its use is pre-eclampsia.

b. Water intoxication is a common adverse effect.

c. Withhold drug if maternal BP is >130/85.

d. Nausea and vomiting are adverse effects.

e. It is not to be administered to patients with asthma.

A, D

a. Contraindication to its use is pre-eclampsia., d. Nausea and vomiting are adverse effects.