D
(Rationale: A woman that develops postpartum psychosis usually does so within four weeks of delivery. Only 1% of women develop this disorder. Suicide
... [Show More] and infanticide are common and the disorder is considered a medical emergency. Delusions and hallucinations accompany the disorder and the woman usually has a past history of a psychiatric disorder and treatment.)
The clinic nurse is caring for a woman who is suspected of developing postpartum psychosis. Which of the following statements characterizes this disorder:
A. Symptoms start within several days of delivery
B. The disorder is common in postpartum women
C. Suicide and infanticide are uncommon in this disorder
D. Delusions and hallucinations accompany this disorder
C
(A parent that is grieving over a recent loss (in the process of detachment) will have the most difficulty bonding with the new baby. Knowledge of parent-infant attachment or being an only child are not related to successful bonding. A job loss does not have the impact that death of a family member does.)
During the early postpartum period, the nurse is evaluating a client's attachment to her neonate. Which type of parent has the most difficulty attaching to her newborn?
A. One who has little knowledge of parent-infant attachment
B. One who recently lost a job
C. One whose father recently died
D. One who is an only child
A
(A full bladder displaces the uterus and prevents contraction of the uterus and uterine atony is the primary cause of postpartum hemorrhage. Shock, infection and DIC are not related to bladder distention)
In the fourth stage of labor, a full bladder increases the risk for
A. Hemorrhage
B. Dissesminated intravascular coagulation
C. Infection
D. Shock
B
(Rho(D) immune globulin (RhoGam) is given to the Rho(D)-negative mother, within 72 hours after delivery of an Rho(D)-positive baby (if the Coombs is negative). RhoGam is never given to the baby.)
The client has just given birth to a healthy, full-term infant. The client is Rho(D) negative and her baby is Rho(D) positive. Which intervention will take place to reduce the possibility of isoimmunization?
A. Administering Rho(D) immune globulin to the baby, IM, within 72 hours
B. Administering Rho(D) immune globulin to the mother, IM, within 72 hours
C. Administering Rho(D) immune globulin to the mother, IM, at her 6-week visit
D. Administering Rho(D) immune globulin to the mother, IM, within 3 months
B
(Rationale: Cardiac output increases immediately after delivery as blood that had been diverted to the uterus reenters the central circulation. A client who cannot tolerate these changes may experience cardiac decompensation and cardiac failure. After delivery, renal function increases. There is usually not an increase in pain after delivery except for small increments attributable to uterine cramps, perineal discomfort and breast tenderness. Although hepatic blood flow decreases to normal levels after delivery, this does not affect cardiac function.)
A client with cardiac disease delivers a baby. Afterwards, the nurse assesses the client for signs of cardiac decompensation. During the postpartum period, which condition can cause cardiac decompensation?
A. Increased pain
B. Increased cardiac output
C. Decreased renal function
D. Decreased hepatic blood flow
A
(During the early postpartum period, lochia rubra should be moderate to significant. Scant lochia may indicate that large clots are blocking the flow. Thirst, fatigue and a temperature up to 100.4oF (38oC) are normal within the first 24 hours. Immediately after delivery, vasomotor changes may cause a shaking chill.)
The nurse assesses a client who delivered 24 hours ago. Which of the following suggests the need for further assessment?
A. Scant lochia rubra
B. Chills
C. Thirst and fatigue
D. A temperature of 100.2oF (37.9oC)
C
(Rationale: Since the client is already hemorrhaging, it is inappropriate to initiate a pad count. Fundal massage and administration of oxytocics would be indicated if the hemorrhage is due to uterine atony. If a full bladder is displacing the uterus and preventing it from contracting, insertion of an indwelling catheter would be an appropriate response.)
A woman is experiencing an early postpartum hemorrhage. Which of the following actions would be inappropriate?
A. Insertion of an indwelling urinary catheter
B. Fundal massage
C. Pad count
D. Administration of oxytocics
A
(Rationale: Sudden dyspnea, diaphoresis and confusion are the classic signs of the dislodgment of a thrombus (stationary blood clot) from a varicose vein and its travel to and its becoming enlodged in the pulmonary circulation. Chills and fever would indicate infection. A person with a pulmonary embolism would be hypotensive and not hypertensive.)
A woman with a past history of varicose veins has just delivered and the nurse suspects she has developed a pulmonary embolism. Which of the data below would lead to this nursing judgment?
A. Sudden dyspnea and confusion
B. Hypertension
C. Chills and fever
D. Leg pain
B
(Rationale: When caring for a client who has suffered perinatal loss, the nurse should provide opportunity for her to bond with the dead infant and for the infant to become part of the family unit. Parents not given that opportunity may have fantasies about the infant that are worse than reality. If the child has gross deformities, the nurse should prepare the client for these. If the client doesn't ask about her child, the nurse should encourage her to do so and provide any information she seems ready to hear. The client needs a full explanation of all factors related to the experience so she can grieve appropriately. Allowing the father to determine which information the client is given is inappropriate.)
A client gives birth to a stillborn infant at 36 weeks. When caring for this client, which strategy by the nurse would be most helpful?
A. Be selective in providing the information that the client seeks
B. Encourage the client to see, touch and hold the dead infant
C. Provide information about the possible causes of the stillbirth only if the client requests it
D. Let the child's father decide what information the mother receives.
B
(Rationale: Based on the signs and symptoms presented by the client (especially the elevated temperature), the physician should be notified because the client probably has mastitis, an infection in the breast. An antibiotic that is tolerated by the infant as well as the mother may be prescribed. The mother should continue to nurse on both breasts but should start the infant on the unaffected breast while the affected breast lets down.)
A ten-day postpartum breastfeeding client telephones the postpartum unit complaining of a reddened, painful breast and elevated temperature. Based on assessment of the client's complaints, the nurse tells the client to:
A. "Stop breastfeeding because you probably have an infection."
B. "Notify your physician because you may need medication."
C. "Continue breastfeeding because this is a normal response in breastfeeding mothers."
D. "Breastfeed only with the unaffected breast."
D
(Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning.)
Which statement by a postpartal woman indicates that further teaching is not needed regarding thrombus formation?
a. "I'll stay in bed for the first 3 days after my baby is born."
b. "I'll keep my legs elevated with pillows."
c. "I'll sit in my rocking chair most of the time."
d. "I'll put my support stockings on every morning before rising."
B
(If a portion of the placenta is missing, the clinician can explore the uterus, locate the missing fragments, and remove the potential cause of late postpartum hemorrhage.)
The nurse knows that a measure for preventing late postpartum hemorrhage is to:
a. administer broad-spectrum antibiotics.
b. inspect the placenta after delivery.
c. manually remove the placenta.
d. pull on the umbilical cord to hasten the delivery of the placenta.
D
(Postpartum blues affects 50% to 70% of new mothers. It is believed to be related to hormonal fluctuations after childbirth.)
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
B
(Treatment of excessive bleeding requires the collaboration of the physician and the nurses. Do not leave the client alone.)
A multiparous woman 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 woman void and massages her fundus, but her fundus remains difficult to find, and the rubra lochia remains heavy. The nurse should:
a. continue to massage the fundus.
b. notify the physician.
c. recheck vital signs.
d. insert a Foley catheter. [Show Less]