Chapter 16: Nursing Management During the Postpartum Period

A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 66 beats per minute. Which of these actions should the nurse take?

Document the finding, as it is a normal finding at this time.

A client who has just given birth to a healthy newborn required an episiotomy. Which action would the nurse implement immediately after birth to decrease the client's pain from the

procedure?

Apply an ice pack to the site.

A postpartum client has a fourth-degree perineal laceration. The nurse would expect which medication to be prescribed?

docusate

A nurse is observing a new mother interacting with her newborn. Which statement would alert the nurse to the potential for impaired bonding between mother and newborn?

"He looks like a frog to me."

After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention?

frequent scant voidings

A primipara client who is bottle feeding her baby begins to experience breast engorgement on

her third postpartum day. Which instruction by the nurse would be most appropriate to aid in

relieving her discomfort?

"Apply ice packs to your breasts to reduce the amount of milk being produced."

The nurse administers Rho(D) immune globulin to an Rh-negative client after birth of an Rh-positive newborn based on the understanding that this drug will prevent her from:

developing Rh sensitivity.

Which factor in a client's history would alert the nurse to an increased risk for postpartum hemorrhage?

uterine atony, placenta previa, operative procedures

When teaching parents about their newborn, the nurse describes the development of a close emotional attraction to a newborn by the parents during the first 30 to 60 minutes after birth. The nurse refers to this process by which term?

bonding

A nurse is reviewing the policies of a facility related to bonding and attachment with newborns. Which practice would the nurse identify as needing to be changed?

offering round-the-clock nursery care for all infants

A nurse is preparing a couple and their newborn for discharge. Which instructions would be most appropriate for the nurse to include in discharge teaching?

demonstrating comfort measures to quiet a crying infant

When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure?

early parent-infant contact following birth

Which method would be most effective in evaluating the parents' understanding about their newborn's care?

Observe the parents performing the procedures.

A postpartum woman is having difficulty voiding for the first time after giving birth. Which action would be least effective in helping to stimulate voiding?

placing her hand in a basin of cool water

The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which action would be a priority?

placing the call light within her reach

A nurse is reviewing the medical record of a postpartum client. The nurse identifies that the woman is at risk for a postpartum infection based on which information? Select all that apply.

history of diabetes

hemoglobin level 10 mg/dL

placenta requiring manual extraction

A nurse is completing a postpartum assessment. Which finding would alert the nurse to a

potential problem?

temperature of 101° F (38.3° C)

The nurse is assessing a postpartum client's lochia and finds that there is about a 4-inch stain on the perineal pad. The nurse interprets this finding as indicating which amount of blood loss?

10 to 25 mL

The nurse is assessing a postpartum client's lochia and finds that there is about a 4-inch stain

on the perineal pad. The nurse documents this finding as which description?

light

When reviewing the medical record of a postpartum client, the nurse notes that the client has

experienced a third-degree laceration. The nurse understands that the laceration extends to which area?

through the anal sphincter muscle

A nurse is observing a postpartum client interacting with her newborn and notes that the mother is engaging with the newborn in the en face position. Which behavior would the nurse be

observing?

mother making eye-to-eye contact with the newborn

After teaching a group of nurses during an in-service program about risk factors associated with postpartum hemorrhage, the nurse determines that the teaching was successful when the group identifies which risk factors? Select all that apply.

placenta previa

hydramnios

labor augmentation

A postpartum woman who is breastfeeding tells the nurse that she is experiencing nipple pain. After teaching the woman about possible suggestions, the nurse determines that more teaching is needed when the woman makes which statement?

"I apply glycerin-based gel to my nipples."

A nurse is developing a teaching plan about sexuality and contraception for a postpartum woman who is breastfeeding. Which information would the nurse most likely include? Select all that apply.

possible experience of fluctuations in sexual interest

use of a water-based lubricant to ease vaginal discomfort

possibility of increased breast sensitivity during sexual activity

After teaching a postpartum woman about breastfeeding, the nurse determines that the teaching was successful when the woman makes which statement?

"I should wash my hands before starting to breastfeed."

A postpartum woman who is bottle-feeding her newborn asks the nurse, "About how much should my newborn drink at each feeding?" The nurse responds by saying that to feel satisfied, the newborn needs which amount at each feeding?

2 to 4 ounces

A nurse is observing a postpartum woman and her partner interact with the their newborn. The nurse determines that the parents are developing parental attachment with their newborn when they demonstrate which behavior? Select all that apply.

identify common features between themselves and the newborn

make direct eye contact with the newborn

A nurse is conducting a class for pregnant women who are in their third trimester. The nurse is reviewing information about the emotional changes that occur in the postpartum period, including postpartum blues and postpartum depression. After reviewing information about postpartum blues, the group demonstrates understanding when they make which statement about this condition?

"Getting some outside help for housework can lessen feelings of being overwhelmed."

After teaching parents about their newborn, the nurse determines that the teaching was successful when they identify which concept as reflecting the enduring nature of their relationship, one that involves placing the infant at the center of their lives and finding their own way to assume the parental identity?

commitment

A woman gave birth to a healthy term neonate today at 1330. It is now 1430 and the nurse has completed the client's assessment. At which time would the nurse next assess the client?

1500

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, ―I‘m bleeding a lot.‖ The most likely cause of after birth hemorrhage in this woman is

uterine atony

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse‘s first action is to

massage the woman‘s fundus.

A woman gave birth vaginally to a 9-lb, 12-ounce girl yesterday. Her 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?

The woman has an episiotomy.

The laboratory results for a after birth woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?

Rubella vaccine should be given

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by

applying ice to the breasts for comfort.

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse‘s most appropriate response is to ask the woman

I‘ll warm the soup in the microwave for you

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice

is inconsistent with the Baby-Friendly Hospital Initiative.

A after birth woman overhears the nurse tell the obstetrics clinician that she has a positive Homans‘ sign and asks what it means. The nurse‘s best response is

You have calf pain when the nurse flexes your foot.

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

has recovered from epidural or spinal anesthesia.

Under the Newborns‘ and Mothers‘ Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of hours after a normal vaginal birth and for hours after a cesarean birth

48; 96

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with

her eldest daughter (the infant‘s sister)

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically, this expression refers to

nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood.

Excessive blood loss after childbirth can have several causes; the most common is

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. This activity indicates that the nurse is trying to

improve 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 woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse could try is

inserting a sterile catheter.

If a woman 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?

Having the patient sit in a chair.

As relates to rubella and Rh issues, nurses should be aware that

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

Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins

at the time of admission to the nurse‘s unit

Postpartal overdistention of the bladder and urinary retention can lead to which complications?

After birth hemorrhage and urinary tract infection

Rho immune globulin will be ordered after birth if which situation occurs?

Mother Rh–, baby Rh+

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

Assist the patient in emptying her bladder

When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is

early and frequent ambulation

The nurse caring for the after-birth woman understands that breast engorgement is caused by

congestion of veins and lymphatics.

The nurse assesses the postpartum client to have moderate lochia rubra with clots. Which nursing intervention would be appropriate?

Assess fundus and bladder status.

The nurse is providing education to the new family. Which question by the nurse is best?

"How have your breastfeedings been going?"

The nurse is preparing to administer postpartum neuraxial morphine to a client who is morbidly obese. For which side effect related to morbid obesity should the nurse monitor?

Respiratory depression

A postpartum client has just received a rubella vaccination. The client demonstrates understanding of the teaching associated with administration of this vaccine when she states which of the following?

"I must avoid getting pregnant for 1 month."

The incidence of complications and discomforts in the first year postpartum is common and women may experience which of the following?Select all that apply.

Pain

Urinary incontinence

Changes in mental health status

Sleep deprivation

A variety of drugs are used either alone or in combination to provide relief of postpartum pain. Which of the following would be an option for pain relief?

Nonsteroidal anti-inflammatory agents

On the 3rd day postpartum, a client who is not breastfeeding experiences engorgement. To relieve her discomfort, the nurse should encourage the client to donwhich of the following?

Apply cold packs to the breasts

The nurse is caring for a client who had a cesarean birth 4 hours ago. Which

interventions would the nurse implement at this time?Select all that apply.

Administer analgesics as needed.

Encourage leg exercises every 2 hours.

Encourage the client to cough and deep-breathe every 2 to 4 hours

Encourage the use of breathing, relaxation, and distraction.

A client who delivered 2 hours ago tells the nurse that she is exhausted and feels

guilty because her friends told her how euphoric they felt after giving birth. How

should the nurse respond?

"Everyone is different, and both responses are normal."

The breastfeeding client asks the nurse about appropriate contraception. What is the

nurse's best response?

"It's possible to get pregnant before your menstrual period returns. Let's talk

about some different options for contraception."

The postpartum client expresses concern about getting back to her prepregnant

shape, and asks the nurse when she will be able to run again. Which statement by

the client indicates that teaching was effective?

"I should see how my energy level is at home, and increase my activity slowly."

The hospital is developing a new maternity unit. What aspects should be included in

the planning of the new unit to best promote family wellness?

A nursing care model based on providing couplet care

Which statement by a nursing student preparing to care for a postpartum lesbian

mother would indicate that the student is prepared for the teaching?

"I will have to adjust some of my discharge instruction for this mother."

A new grandmother comments that when her children were born, they stayed in the

nursery. The grandmother asks the nurse why her daughter's baby stays mostly in

the room instead of the nursery. How should the nurse respond?

"Contact between parents and babies increases attachment."

What is the advantage of a client using a patient-controlled analgesia (P C A)

following a cesarean birth?

The client feels a greater sense of control, and is less dependent on the nursing

staff.

The client having her second child is scheduled for a cesarean birth because the

baby is in a breech presentation. The client states, "I'm wondering what will be

different this time compared with my first birth, which was vaginal." What response is

best?

"You'll be wearing a sequential compression device until you start walking."

The nurse is caring for a client who delivered by cesarean birth. The client received

a general anesthetic. To prevent or minimize abdominal distention, which of the

following would the nurse encourage?Select all that apply.

Leg exercises every 2 hours

Abdominal tightening

Ambulation

A multiparous client delivered her first child vaginally 2 years ago, and delivered an

infant by cesarean yesterday due to breech presentation. Which statement would

the nurse expect the client to make?

"I'm having significantly more pain this time than with my last birth."

The nurse is supervising a student nurse who is working with a 14-year-old client

who delivered her first child yesterday. Which statement indicates that the nursing

student understands the particular needs of an adolescent client?

"Because of her age, this client will probably need extra teaching about the

terminology for her anatomy."

The nurse is caring for a 15-year-old client who gave birth to her first child yesterday.

What action is the best indicator that the nurse understands the parenting

adolescent?

The nurse explains the characteristics and cues of the baby when assessing him.

The nurse is planning care for three newly delivered adolescents and their babies.

What should the nurse keep in mind when planning their care?

The baby's father should be encouraged to participate when the nurse is

providing instruction.

The nurse is preparing to receive a newly delivered client. The client is a young

single mother who is relinquishing custody of her newborn through an open

adoption. What action is most important?

Ask the client how much contact she would like with the baby, and whether she

wants to feed it.

The nurse is caring for a client who plans to relinquish her baby for adoption. The

nurse would implement which approach to care?Select all that apply

Encourage the client to express her emotions.

Respect any special requests for the birth.

Acknowledge the grieving process in the client.

Allow access to the infant, if the client requests it

The nurse is planning discharge teaching for a postpartum woman. What

recommendations should the woman receive before being discharged?Select all that apply

To avoid overexertion

To practice postpartum exercises

To obtain adequate rest

The nurse is preparing a teaching brochure for Spanish-speaking postpartum clients.

Which topics are critical for this population?

When and how to contact their healthcare provider

To actively involve the postpartal client during discharge teaching, the postpartum

nurse applies which learning principle?

Interactive nurse-patient relationships

The nurse is performing discharge teaching for a newly delivered first-time mother

and her infant on the 2nd postpartum day. Which statement by the mother indicates

that teaching has been successful?

"Taking baths will help my perineum feel less sore each day."

The nurse is assessing clients after delivery. For which client is early discharge at 24

hours after delivery appropriate?

Woman and baby who have had two successful breastfeedings

The nurse is preparing teaching material for a new mother. What should the nurse

include when instructing on areas to include when observing the infant?Select all that apply.

Touch

Vision

Hearing

General appearance

The nurse is monitoring a postpartum patient receiving methylergonovine maleate

(Methergine). Which assessment findings should the nurse identify as being

expected adverse effects of this medication?Select all that apply

Nausea

Headache

Hypertension

Uterine cramping

The nurse is preparing to administer a sitz bath to a postpartum patient. In which

order should the nurse perform the steps of this procedure?

Anchor the infusion bag to the sitz bath basin, with the tube facing upward

Fill the drainage bag with warm or cool water up to the top line as indicated on

the bag

Secure the drainage bag from a hook over the toilet or from the handle used to

flush the toilet

Open the clamp on the tubing

Close the clamp on the tubing, dry perineum with a clean towel, and apply new

peri-pad

A new mother is planning to bottle feed her infant and wants helps with suppressing

lactation. What should the nurse suggest to help this new mother?Select all that apply.

Wear a 24-hour support bra

Apply cabbage leaves to the breast tissue

Avoid all nipple stimulation for 7 to 10 days

A postpartum patient who received epidural morphine prior to a cesarean birth is

concerned about a severe headache that has persisted for several days. What

should the nurse suggest to this patient?Select all that apply.

Ingest fluids with caffeine

Increase the intake of all fluids

Lie in bed in a quiet dark room