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MATERNAL AND CHILD NURSING

(POSTPARTUM CARE)

Prepared by: Dennis N. Muoz, PT, RN, RM, MANc

1) Which of the following SITUATIONs is more likely to predispose a patient to postpartum hemorrhage? a. b. c. d. Birth of a 3,175-g (7lb) infant Birth of twins Prolonged first stage of labor Pregnancy-induced hypertension

2) Postpartum hemorrhage can cause hypovolemic shock. The following findings are associated with hypovolemic shock. Which findings would the nurse see last in the cascade of events associated with hypovolemic shock? a. b. c. d. Decreased blood pressure A perineal pad soaked within 15 minutes Increased pulse rate Patient beginning to act anxious or exhibit air hunger

3) If a postpartum patient is experiencing hypovolemic shock resulting from uterine atony, the nurse recognizes that the most important diagnosis is:

a. Fluid volume deficit related to excessive blood loss b. Risk for infection related to decreased resistance compensatory mechanisms c. Fear related to uncertainty of outcome d. Anxiety related to lack of knowledge about complications and treatments

4) Suzanne Mays, a gravid 1 para 1001, has vaginally delivered a full-term infant without complications. After the first postpartum day, she tells the postpartum nurse that shes afraid that something is wrong because shes perspiring and urinating more than normal. Her temperature is 100.0F (37.8C). The nurse should appropriately reply: a. Youre probably responding to an infection in your body; Ill call the doctor and report your symptoms b. Your temperature is slightly elevated. You could have an infection. Ill call the doctor to report your temperature c. Its common to perspire and urinate a lot after childbirth; your body is getting rid of the excess fluid that was used in pregnancy d. Im surprised youre urinating a lot because you dont have other signs of diabetes

5) During a childbirth preparation class, the nurse explains that in the postpartum period, the process whereby the uterus shrinks to its prepregnancy state is called: a. Involution b. Puerperium c. Uterine atony d. Lochia rubra

6) To provide safe, effective care, the nurse must recognize that in a postpartum woman, subinvolution can be caused by: a. b. c. d. Pregnancy-induced hypertension Preterm vaginal delivery Uterine infection Mastitis

7) The nurse assessing the homeostatic status of a postpartum woman should recognize which of the following statements as correct? a. A slow trickle of blood from the vagina can cause as much harm as a greater outpouring b. Hematomas in the vulvar area are always resolved by the use of ice packs and arent a source of potential hemorrhage c. A uterine fundus that remains boggy isnt potential threat to the patients safety d. The patient who loses an estimated 300 ml of blood in a vaginal delivery is usually a candidate for a blood transfusion

8) The nurse is are that periodic relaxation and contraction of the uterine muscles cause pains and cramping after birth. Which of the following patients is more likely to experience severe pain after giving birth? a. A gravid 1 para 1001 patient whos bottle-feeding b. A gravid 2 para 2002 patient whos bottle-feeding c. A gravid 3 para 1103 patient whos bottle-feeding d. A gravid 2 para 1001 patient whos bottle-feeding

SITUATION: Barbara Shrader is a 22-year old gravid 1 who vaginally delivered her first infant. The vaginal delivery was uncomplicated.
Question: 9 to 11 SITUATION

9) One hour after delivery, which of the following findings would the nurse expect in a patient who didnt have complication? a. Boggy uterus; heavy amount of lochia rubra with small cloths b. Boggy uterus; moderate amount of lochia serosa c. Firm uterus; heavy amount of lochia rubra with small clots d. Firm uterus; scant amount og lochia serosa

10) Before assessing the position of Mrs. Shraders uterine fundus the nurse should:

a. Ask the patient to drink fluid to fill her bladder b. Position of Mrs. Shrader bed at 45 degrees c. Ask Mrs. Shrader to empty her bladder d. Ask Mrs. Shrader to refrain from drinking fluids for 30 minutes for the assessments

11) Its now 24 hours since Mrs. Shraders delivery, in accordance with the normal involution process, the nurse should locate Mrs. Shraders fundus in which of the following position? a. Midline, 1 cm above the umbilicus b. Midline, 1 cm below the umbilicus c. Deviated to the right, 2 cm above the umbilicus d. Midline, 3 cm below the umbilicus

SITUATION: Darleen Stepanski is a gravid 2 par 1001 that experience a prolonged second stage of labor but finally delivered to the postpartum unit? Questions 12 to 14 refer to this SITUATION

12) Thirty minutes after birth, the nurse assesses Mrs. Stepankis fundus and lochia flow and notes an increased amount of lochia rubra and a few large clots. The uterine fundus reains midline and firm. What should the nurse suspect as a possible cause of this bleeding? a. Inadequate amount of oxytocin in the I.V fluids b. Prolonged second stage of labor c. Primiparous status d. Retained placental fragments

13) Uterine atony, a condition in which the uterus is unable to maintain a state of firness, is a common cause of hemorrhage in the postpartum period. In providing patient care for Mrs. Stepanski, the nurse is aware that uterine atony can result from: a. Hypertension b. Cervical and vaginal tears c. Urinary retention d. Endometritis

14) It has been since Mrs. Stepanskis initial voiding and the nurse assess her fundus to be 3 cm above the umbilicus and deviated to the right side. The nurse has an order to catheterize this patient if shes unable to void. Mrs. Stepanski walks to the bathroom and is able to urinate. The nurse should expect to catheterize the patient if she measures: a. 100ml of urine b. 350ml of urine c. 400ml of urine d. 500ml of urine

SITUATION: Marjorie Sloan is a 28-year-old primigrabida who vaginally delivered a fullterm infant with a forceps-assisted delivery and midline episiotomy. An ice pack is applied to the perineum to decrease swelling and pain. Question 15 to 17 refers to this SITUATION.

15) Six hours after being on the postpartum unit, Mrs. Sloan complains of excruciating perineal and rectal pain and a feeling of fullness in the vaginal area. The nurse may suspect the cause of the pain to be related to:
a. Vaginal hematoma b. Hemorrhoid c. Episiotomy d. Full bladder

16) In performing a nursing assessment of Mrs. Sloans episiotomy, the nurse would especially assess for:

a. b. c. d.

Discomfort and redness Discharge and odor Edema and approximation Swelling and color

17) In performing a routine fundal assessment, the nurse finds Mrs. Sloans fundus to be boggy. The nurse should first:
a. b. c. d. Call the doctor Massage the fundus Assess lochia flow Start methylergonovine as ordered

SITUATION: Carole Soccer,a 28-year-old multipara, vaginally delivered a term infant. Her amniotic membranes were ruptured for 12 hours before her admission. She experienced a prolonged first stage of labor and received lumbar epidural anesthetic and a midline episiotomy.
Questions 18 to 21 refer to this SITUATION

18) The nurse prepares the nursing plan of care and recognizes that Mrs. Soccer is at high risk for infection related to: a. b. c. d. Leukocytosis 20,000/l 99.6F (37.5C) temperature Pulse rate 76 beat/minute Midline episiotomy

19) During the nursing assessment, which of the following findings in Mrs. Soccer would be indicative of dehydration related to prolonged labor? a. b. c. d. Temperature 100.1F (37.8C) Pulse rate 80beats/minute Leukocytosis 20,000/l Blood pressure 140/90

20) When preparing a plan of care for Mrs. Soccer, the nurse recognizes that the least appropriate diagnosis is related to: a. Impaired skin integrity related to episiotomy b. Pain related to uterine contraction and episiotomy c. Anxiety related to parenting responsibilities and family adaptation d. Impaired gas exchange related to pulse rate of 80 beats/minute

21) Mrs. Soccer has been diagnosed with a puerperal (postpartum) infection. Which of the following events most likely contributes to development of a puerperal infection?

a. Prolonged first stage of labor (more 12 hours) b. Prolonged rupture of membranes (more than 24 hours) c. Midline episiotomy d. Multiparity status

than

SITUATION: Collette Holmes is a 35-year-old multigravida who delivered a full-term infant via cesarean section because of a breech presentation. Questions 22 to 27 refer to this SITUATION

22) The nurse recognizes that which of the following events would be the most important contribution to the prevention of thromboembolism?

a. Increasing oral fluid intake b. Providing oxygen therapy c. Administering pain medications as needed d. Encouraging frequent ambulation

23) Mrs. Holes is in a hypercoagulable state immediately after birth. To determine Mrs. Holmes risk of developing thrombophlebitis in the postpartum period, the nurse should assess: a. b. c. d. The condition of the I.V. site For Homans sign The lungs for adventitious sounds Deep tendon reflexes

24) The nurse should be aware that in the usual treatment of thrombophlebitis, its most important to: a. Administer pain medications as needed b. Encourage frequent ambulation c. Encourage increased oral intake d. Avoid rubbing or massaging the affected leg

25) Pulmonary embolism is a rare event postpartum but carries a high mortality rate. Its usually caused by a thrombus fragment thats carried by venous circulation to the right side of the heart. The pulmonary artery is obstructed; therefore, blood isnt carried to the lungs. The nurse should be aware that a key symptom of pulmonary embolism is: a. Hypertension b. Chest pain c. Diuresis d. Bradycardia

26) The risk of postpartum thromboembolism occurs because of a physiologic increase in: a. Coagulation factors b. Heart rate c. Diuresis d. Blood pressure

27) Mrs. Holmes has been kept nothing by mouth for the surgery and remains nothing by mouth on the postpartum floor. At the end of the first postpartum day, Mrs. Holmes states she would like some water and custard to eat. The nurse tells the patient that shell be allowed food and drink when:

a. b. c. d.

Her vital signs are stable Her I.V. fluids are discontinued 24 hours have passed since the operation The nurse is able to assess bowel sounds

SITUATION: Brenda Gillano is a 32-year-old primigravida who vaginally delivered a fullterm infant without complications. She states that she would like to take a nap but allows the nurse to take vital signs and performs an assessment. Questions 28 to 29 refer to this SITUATION

28) According to Reva Rubin, the nurse recognizes that Mrs. Gillano is experiencing what phase? a. Postpartum phase b. Taking-in phase c. Taking-hold phase d. Letting-go phase

29) According to Reva Rubin, the best time to teach a postpartum patient about maternal and infant care is during which of the following pahse?

a. Postpartum phase b. Taking-in phase c. Taking-hold phase d. Letting-go phase

SITUATION: Ling Poh, a 24-year-old gravid 1 para 1001, vaginally delivered a full-term infant without complications except for a midline episiotomy.

Questions 30 to 35 refer to this SITUATION

30) To prevent swelling and discomfort of the perineal site immediately after delivery, the nurse caring for Mrs. Poh should:

a. Set up the portable sitz bath for the patients use b. Apply an ice bag to the perineal area for 30 minutes c. Assist the patient on the bedpan and squirt warm water over the perineal area d. Apply dry heat therapy to the perineal area

31) The nurse instructs Mrs. Poh on perineal care. Mrs. Poh asks the nurse why she must squirt warm water over her perineal area after every urination and defecation. The nurse states that the most important reason to perform perineal care is to: a. b. c. d. Prevent infection Promote comfort Encourage clean hygienic practices Promote bladder functioning

32) In preparing a sitz bath for Mrs. Poh, the nurse should remember that normal water temperature should be maintained at: a. 98F(34.7C) b. 99F (37.2C) c. 101F (38.3C) d. 106F (41.1C)

33) Mrs. Poh states that she has difficulty sitting down in a chair because of the discomfort of her episiotomy sutures. The nurse should advise her to:
a. Bear weight on one side of the buttocks when sitting in a chair b. Bring her buttocks together before sitting; then let her full weight down on the chair c. Slowly sit down in the chair; bear weight on one side of her buttocks d. Maintain a rigid posture when sitting in the chair

34) Mrs. Poh requests pain medication for episiotomy discomfort. She has used her anesthetic spray and has had a sitz bath. The baby is scheduled to be bottle-fed in 30minutes. When should the nurse administer pain medication? a. 1 hour after feeding the infant b. 1 hour before feeding the infant c. Immediately and allow the nursery to feed infant d. Immediately and allow the mother to the infant

staff feed

35) Mrs. Poh plans to bottle-feed her baby. To prevent lactation from occurring, the nurse instruct the patient to:
a. Increase her oral fluid intake b. Wear a tight-fitting brassiere c. Allow hot shower water to flow on her chest d. Place cabbage leaves inside her brassiere

SITUATION: Rafaela Mendez, a primigravida, vaginally delivered a 4,309-g (9 lb, 8 oz) infant. She had a midline episiotomy and experienced a third-degree laceration. Questions 36 to 45 refer to this SITUATION

36) The nurse understands that this type of laceration: a. Extends into the anterior wall of the rectum b. Extends to the perineal skin and other superficial structures c. Extends into the anal sphincter muscle d. Extends into the perineal muscles

37) The nurse should be aware that Mrs. Mendezs third-degree laceration may increase her likelihood of developing: a. Constipation b. Hypertension c. Hemorrhage d. Subinvolution

38) Mrs. Mendez plans to breast-feed her baby and asks the nurse how to clean her breast before breast-feeding the baby. The nurse states that to clean her breast before breastfeeding she should use only: a. Rubbing alcohol b. Water c. Soap d. Lotion

39) The nurse has reviewed the principles and practice of breast-feeding with Mrs. Mendez. The nurse assesses that the patient understands how to breast-feed by which of the following statements from Mrs. Mendez? a. As long as the baby breast-feeds every 2 to 3 hours, my milk supply will be adequate b. My baby should breast-feed only for 5 minutes on each side c. Its OK if my baby feeds only 5 minutes on each side because shes getting the milk with the highest fat content d. If my nipples become sore, I think Ill quit breast-feeding

40) Mrs. Mendez has continued to breast-feed her infant every 3 to 4 hours except at night. About 48 hours after delivery, she complains that her breasts have become larger, firmer, and tender. The nurse recognizes that Mrs. Mendez is probably experiencing: a. Mastitis b. Engorgement c. Let-down reflex d. Involution

41) Mrs. Mendez complains that she experiences cramping while shes breast-feeding. The nurse states that this is normal because of a certain hormone thats released during breast-feeding. That hormone is: a. Prolactin b. Estrogen c. Progesterone d. Oxytocin

42) When Mrs. Mendez is receiving discharge instructions from the nurse, she asks the nurse when she can resume sexual intercourse. The nurse states that sexual intercourse can be resumed:

a. b. c. d.

6 weeks after giving birth With doctor approval When the lochia has stopped At the mans discretion

43) Mrs. Mendez asks the nurse about the reliability of breast-feeding as a form of contraception. The nurse recognizes that breast-feeding as a form of contraception is least affected by:

a. The age and sex of a full-term newborn b. The amount of time the newborn is on the breast c. The use of supplementary formula d. Partial weaning

44) The nurse is reviewing discharge instructions with Mrs. Mendez. Which of the following symptoms is least important in characterizing postpartum blues?

a. b. c. d.

Crying easily and feeling despondent Loss of appetite and anxiety Altered body image Difficulty sleeping; poor concentration

45) In reviewing discharge instructions with Mrs. Mendez, the nurse is aware that a higher incidence of postpartum blues can result from: a. b. c. d. Fatigue Subinvolution Neonatal jaundice Pregnancy-induced hypertension

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