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Post Part low and high risk (Exam 2)

Terms in this set (45)

Which description is accurate about hemodynamic changes in the postpartum period?
a) transient tachycardia
b) increase in cardiac output
c) rise in hematocrit
d) decrease in circulatory blood volume
c) rise in hematocrit
Hemoglobin and erythrocyte values vary during the early postpartum period, but they should approximate or exceed prelabor values within 2 to 6 weeks. As the woman excretes extracellular fluid, hemoconcentration occurs, with a concomitant rise in hematocrit. Puerperal bradycardia, with rates of 50 to 70 beats per minute, is common during the first 6 to 10 days postpartum. Blood volume decreases following placental separation, contraction of the uterus, and increased stroke volume. Cardiac output begins to increase early in pregnancy and peaks at 20 to 24 weeks' gestation at 30% to 50% above prepregnant levels. Cardiac output decreases during the postpartum period following placental separation, contraction of the uterus, and increased stroke volume.
What is the primary function of uterine contractions after birth of the infant and placenta?

a) returns the uterus to normal size
b) seals off the blood vessels at the site of the placenta
c) stops the flow of blood
d) closes the cervix
b) seals off the blood vessels at the site of the placenta
The contractions of the uterus help to constrict the vessels where the placenta was located. This does decrease the flow of blood but is secondary in occurrence to the constriction of the blood vessels. Uterine contraction also leads to uterine involution, which normally occurs at a predictable rate. Uterine involution assists in closing the cervix. Again, the other options are secondary to the constriction of blood vessels at the placental site.
When assessing a postpartum woman, which finding would be most significant in identifying possible postpartum hemorrhage?

a) increased hematocrit level
b) increased cardiac output
c) increased heart rate
d) increased blood pressure
c) increased heart rate
Tachycardia in the postpartum woman warrants further investigation. Typically the postpartum woman is bradycardic for the first 2 weeks. In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of a compensatory increase in heart rate. Red blood cell production ceases early in the puerperium, causing hemoglobin and hematocrit levels to decrease slightly in the first 24 hours and then rise slowly. Hematocrit would be unreliable as an indicator of hemorrhage.
A client who has given birth a week ago reports discomfort when defecating and ambulating. The birth involved an episiotomy. Which suggestions should the nurse provide to the client to provide local comfort? Select all that apply.
a) Use of anesthetic sprays.
b) Use good body mechanics.
c) Use of warm sitz baths.
d) Maintain correct posture.
e) Use of witch hazel pads.
a) Use of anesthetic sprays.
c) Use of warm sitz baths.
e) Use of witch hazel pads.
The nurse should tell the client to use warm sitz baths, witch hazel pads, and anesthetic sprays to provide local comfort. Using good body mechanics and maintaining a correct position are important to prevent lower back pain and injury to the joints.
A nurse is assessing a client's lochia every 15 minutes for the first hour during the fourth stage of labor. Which finding would the nurse expect to assess?
a) lochia alba saturating at least 3 pads
b) moderate lochia rubra with no clots
c) lochia rubra saturating two pads
d) lochia rubra with few clots
b) moderate lochia rubra with no clots
During the first hour following birth, the nurse should find moderate lochia rubra with no clots. Lochia rubra with few clots or saturation of two or more pads within this first hour are not abnormal findings that require further investigation. Lochia alba appears around the 10th day postpartum.
A client is exhibiting signs of early engorgement, but her milk is still flowing easily. Which suggestion would the nurse give to treat engorgement?

a) Restrict fluid intake.
b) Take a warm shower before a feeding.
c) Have the baby nurse on both breasts with every feeding.
d) Apply ice packs before a feeding.
b) Take a warm shower before a feeding.
Using warm compresses or a taking warm shower with water flowing over the breasts will soften the breast tissue before a feeding. Applying ice packs may be beneficial to reduce inflammation, but doing so is most appropriate after the feeding because cold application causes vasoconstriction. The woman should maintain adequate fluid intake. It is not necessary for the baby to nurse on both breasts during every feeding.
Which action would lead the nurse to assess that a postpartal woman is entering the taking-hold phase of the postpartal period?

a) She sits and rocks her infant for long intervals.
b) She did her perineal care independently.
c) She is eager to talk about her birth experience.
d) She has not asked for anything for pain all day.
b) She did her perineal care independently.
During the taking-in phase, women tend to be dependent; during the taking-hold phase, they begin independent actions.
A nurse is providing care to a postpartum client. Which client behavior would indicate to the nurse that she is in the letting-go phase?

a) shows increased confidence when caring for the newborn
b) talks about her labor experience to others around her
c) shows independence with self-care
d) points out specific features in the newborn
a) shows increased confidence when caring for the newborn
During the letting-go phase, the woman assumes responsibility and care for the newborn with increased confidence. Recounting her labor experience is usually part of the taking-in phase. Identifying specific features of the newborn is typical of the taking-in phase. Independence with self-care is an important aspect of the taking-hold phase.
A nurse is assessing a postpartum woman. Which finding would lead the nurse to suspect that a postpartum woman is having a problem?

a) slightly increased hematocrit
b) increased levels of clotting factors
c)pulse rate of 110 beats/minute
d) elevated white blood cell count
c)pulse rate of 110 beats/minute
Tachycardia (heart rate above 100 bpm) in the postpartum woman warrants further investigation. It may indicate hypovolemia, dehydration, or hemorrhage. Despite a decrease in blood volume after birth, hematocrit levels remain relatively stable and may even increase. An acute decrease is not an expected finding. The WBC count remains elevated for the first 4 to 6 days and clotting factors remain elevated for 2 to 3 weeks.
The nurse assesses a postpartum woman for thromboembolism based on the understanding that her risk is increased because of which factor?

a) increased white blood cell count
b) decrease in coagulation factors
c) vessel damage during birth
d) episiotomy
c) vessel damage during birth
A woman's risk for thromboembolism increases due to her hypercoagulable state, vessel damage during birth, and immobility. The increase in white blood cell count is unrelated to her risk for thromboembolism. Coagulation factors remain elevated for 2 to 3 weeks postpartum. An episiotomy is not a risk factor for thromboembolism.
While visiting a client at home on the 10th day postpartum, the nurse assesses the client's lochia. Which color would the nurse expect the lochia to be?
a) yellowish pink
b) pink
c) yellowish white
d) red
c) yellowish white
The normal color of lochia on the tenth day of postpartum is yellowish white. The color of lochia changes from red to pink by approximately four or five days postpartum. The color of lochia is never yellowish pink.
A client gave birth vaginally 2 days prior and wishes to prevent getting pregnant again. She asks the nurse when she will need to begin birth control measures. How should the nurse respond?
a) "You may have intercourse until next month with no fear of pregnancy."
b) "Ovulation may return as soon as 3 weeks after birth."
c) "Ovulation does not return for 6 months after birth."
d) "You will not ovulate until your menstrual cycle returns."
b) "Ovulation may return as soon as 3 weeks after birth."
Ovulation may start at soon as 3 weeks after birth. The client needs to be aware and use a form of birth control. She needs to be cleared by her provider prior to intercourse if she has a vaginal birth, but in the event that she has intercourse, needs to be prepared for the possibility of pregnancy. Ovulation can occur without the return of the menstrual cycle, and ovulation does return sooner than six months after birth.
A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply.

a) prolonged labor
b) breastfeeding
c) early ambulation
d) uterine infection
e) hydramnios
f) empty bladder
a) prolonged labor
d) uterine infection
e) hydramnios
Factors that inhibit involution include prolonged labor and difficult birth, uterine infection, overdistention of the uterine muscles such as from hydramnios, a full bladder, close childbirth spacing, and incomplete expulsion of amniotic membranes and placenta. Breastfeeding, early ambulation, and an empty bladder would facilitate uterine involution.
A patient who delivered her infant 3 days ago and was discharged home calls her provider's office with a complaint of sweating all night. What is the cause of the increased perspiration?

a) The body is trying to get rid of the extra blood made during pregnancy
b) Body secreting the excess fluids from pregnancy
c) Change in pregnancy hormone
d) The patient may be drinking too much fluid
b) Body secreting the excess fluids from pregnancy
Copious diaphoresis occurs in the first few days after childbirth as the body rids itself of excess water and waste via the skin. The excessive diaphoresis is not caused by changes in hormones, nor because of the patient drinking too much fluid, nor because of the body trying to rid itself of the excess blood made during pregnancy.
A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus. Which finding would the nurse identify as expected?

a) two fingerbreadths above the umbilicus
b) at the level of the umbilicus
c) four fingerbreadths below the umbilicus
d) two fingerbreadths below the umbilicus
b) at the level of the umbilicus
During the first few days after birth, the uterus typically descends downward from the level of the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by 3 days, the fundus lies 2 to 3 fingerbreadths below the umbilicus.
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