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Chapter 20: Postpartum Adaptations
Terms in this set (31)
A postpartum 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
a. "You have pitting edema in your ankles."
b. "You have deep tendon reflexes rated 2+."
c. "You have calf pain when I flexed your foot."
d. "You have a 'fleshy' odor to your vaginal drainage."
Discomfort in the calf with sharp dorsiflexion of the foot may indicate a deep vein thrombosis. It does not indicate edema, rate deep tendon reflexes, or describe the odor of lochia.
Which woman is most likely to have severe afterbirth pains and request a narcotic analgesic?
a. Gravida 5, para 5
b. Woman who is bottle-feeding her first child
c. Primipara who delivered a 7-lb boy
d. Woman who has started to breastfeed
The discomfort of after pains is more acute for multiparas because repeated stretching of muscle fibers leads to loss of uterine muscle tone. After pains are particularly severe during breastfeeding, not bottle-feeding. The uterus of a primipara tends to remain contracted. The breastfeeding woman may have increased pain due to engorgement, but the multipara probably will have the most severe afterbirth pains.
Which maternal event is abnormal in the early postpartum period?
a. Diuresis and diaphoresis
b. Flatulence and constipation
c. Extreme hunger and thirst
d. Lochial color changes from rubra to alba
For the first 3 days after childbirth, lochia is mostly red and is termed rubra. Lochia serosa follows, and then at about 11 days, the discharge becomes clear, colorless, or white. The body rids itself of increased plasma volume after birth. Urine output of 3000 mL/day is common for the first few days after delivery and is facilitated by hormonal changes in the mother. Bowel tone remains sluggish for days after birth, leading to flatulence and constipation. The new mother is hungry and thirsty because of energy used in labor and thirsty because of fluid restrictions during labor.
Which finding 12 hours after birth requires further assessment?
a. The fundus is palpable two fingerbreadths above the umbilicus.
b. The fundus is palpable at the level of the umbilicus.
c. The fundus is palpable one fingerbreadth below the umbilicus.
d. The fundus is palpable two fingerbreadths below the umbilicus.
The fundus rises to the umbilicus after delivery and remains there for about 24 hours. A fundus that is above the umbilicus may indicate uterine atony or urinary retention. The nurse needs to make further assessments. The other findings are within normal limits for the time period.
Postpartal overdistention of the bladder and urinary retention can lead to which complication?
a. Postpartum hemorrhage and eclampsia
b. Fever and increased blood pressure
c. Postpartum hemorrhage and urinary tract infection
d. Urinary tract infection and uterine rupture
Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle. There is no correlation between bladder distention and eclampsia, blood pressure, or fever. The risk of uterine rupture decreases after the birth.
A postpartum patient asks, "Will these stretch marks go away?" The nurse's best response is
a. "They will fade and be gone by your 6-week checkup."
b. "No, unfortunately they will never fade away."
c. "Yes, eventually they will totally disappear."
d. "They will fade to silvery lines but won't disappear completely."
The stretch marks will fade to silvery lines but will not disappear completely.
A pregnant patient asks when the dark line on her abdomen (linea nigra) will go away. The nurse knows the pigmentation will decrease after delivery because of
a. increased estrogen.
b. increased progesterone.
c. decreased melanocyte-stimulating hormone.
d. decreased human placental lactogen.
Melanocyte-stimulating hormone increases during pregnancy and is responsible for changes in skin pigmentation; the amount decreases after delivery. The linea nigra will eventually fade away for most women. Estrogen and progesterone levels decrease after delivery. Human placental lactogen production continues to aid in lactation. However, it does not affect pigmentation.
If the fundus is palpated on the right side of the abdomen above the expected level, the nurse should suspect that the patient has
a. been lying on her right side too long.
b. a distended bladder.
c. stretched ligaments that are unable to support the uterus.
d. a normal involution.
The presence of a full bladder will displace the uterus. This finding does not signify a problem with positioning or ligaments, nor is it an expected finding.
A woman gave birth vaginally to a 9-pound, 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?
a. The woman is a gravida 2, para 2.
b. The woman had a vacuum-assisted birth.
c. The woman received epidural anesthesia.
d. The woman has an episiotomy.
These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids. A multiparous classification is not an indication for these orders. A vacuum-assisted birth may be used in conjunction with an episiotomy, which indicates these interventions, but that is not the only situation in which an episiotomy would be used, so this is not the best answer. Use of epidural anesthesia has no correlation with these orders.
Rho immune globulin will be ordered postpartum if which situation occurs?
a. Mother Rh-, baby Rh+
b. Mother Rh-, baby Rh-
c. Mother Rh+, baby Rh+
d. Mother Rh+, baby Rh-
An Rh- mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. The other blood type combinations would not necessitate the use of Rhogam.
If rubella vaccine is indicated for a postpartum patient, instructions to the patient should include
a. drinking plenty of fluids to prevent fever.
b. no specific instructions.
c. recommending that she stop breastfeeding for 24 hours after injection.
d. explaining the risks of becoming pregnant within 1 month after injection.
Potential risks to the fetus can occur if pregnancy results within 28 days after rubella vaccine administration. Drinking fluids will not prevent a fever. Small amounts of the vaccine do cross the breast milk, but it is believed that there is no need to discontinue breastfeeding.
Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?
a. Notify the provider of an impending hemorrhage.
b. Assess the blood pressure and pulse.
c. Evaluate the lochia.
d. Assist the patient in emptying her bladder.
Urinary retention can cause overdistention of the urinary bladder, which lifts and displaces the uterus. Nursing actions need to be implemented before notifying the provider. Blood pressure, pulse, and lochia are important to assess, but first the nurse assesses the bladder so corrective action can be taken if needed.
When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is
a. rectal suppositories.
b. early and frequent ambulation.
c. tightening and relaxing abdominal muscles.
d. providing carbonated beverages.
Activity can aid the movement of accumulated gas in the gastrointestinal tract so early, and frequent ambulation is the best option. Rectal suppositories can be helpful after distention occurs but do not prevent it. Tightening and relaxing the abdominal muscles is not related. Carbonated beverages may increase distention.
What documentation on a woman's chart on postpartum day 14 indicates a normal involution process?
a. Moderate bright red lochial flow
b. Breasts firm and tender
c. Fundus below the symphysis and not palpable
d. Episiotomy slightly red and puffy
The fundus descends 1 cm/day, so by postpartum day 14 it is no longer palpable. The lochia should be changed by this day to serosa. Breasts are not part of the involution process. The episiotomy should not be red or puffy at this stage.
To assess fundal contraction 6 hours after cesarean delivery, the nurse should
a. palpate forcefully through the abdominal dressing.
b. gently palpate, applying the same technique used for vaginal deliveries.
c. place hands on both sides of the abdomen and press downward.
d. rely on assessment of lochial flow rather than palpating the fundus.
Assessment of the fundus is the same for both vaginal and cesarean deliveries; however, palpation should be gentle due to increased discomfort caused by the uterine incision. Forceful palpation should never be used. The top of the fundus, not the sides, should be palpated and massaged. The fundus should be palpated and massaged to prevent bleeding.
A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As the nurse prepares her for discharge, she begins to cry. What action should the nurse take first?
a. Assess her for pain.
b. Point out how lucky she is to have a healthy baby.
c. Explain that she is experiencing postpartum blues.
d. Allow her time to express her feelings.
Many women experience transient postpartum blues and need assistance in expressing their feelings. This condition affects 70% to 80% of new mothers. The nurse should allow time for the new mother to express herself. The nurse should not assume she is in pain at this point. Pointing out how lucky she is belittles her feelings. Patient teaching can be done later.
A man calls the nurse's station stating that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, "She was never like this before the baby was born." What response by the nurse is best?
a. Tell him to ignore the mood swings, as they will go away.
b. Reassure him that this behavior is normal.
c. Advise him to get immediate psychological help for her.
d. Instruct him in the signs, symptoms, and duration of postpartum blues.
Before providing further instructions, inform family members of the fact that postpartum blues are a normal process to allay anxieties and increase receptiveness to learning. Telling him the mood swings will go away is belittling his concerns. Postpartum blues are a normal process that is short lived; no medical intervention is needed. Client teaching is important; however, his anxieties need to be allayed before he will be receptive to teaching.
To promote bonding and attachment immediately after delivery, what action by the nurse is most important?
a. Allow the mother quiet time with her infant.
b. Assist the mother in assuming an en face position with her newborn.
c. Teach the mother about the concepts of bonding and attachment.
d. Assist the mother in feeding her baby.
Assisting the mother in assuming an en face position with her newborn will support the bonding process. Quiet time with the infant is helpful but not as important as en face positioning. The mother has just delivered and is more focused on the infant; she will not be receptive to teaching at this time. This is a good time to initiate breastfeeding, but this is not as specific to bonding and attachment as the en face position.
In providing support to a new mother who must return to full-time employment 6 weeks after a vaginal delivery, which action by the nurse is best?
a. Allow her to express her positive and negative feelings freely.
b. Reassure her that she'll get used to leaving her baby.
c. Discuss child care arrangements with her.
d. Allow her to solve the problem on her own.
Allowing the patient to express feelings will provide positive support in her process of maternal adjustment. Simply reassuring the mother blocks further communication and belittles her feelings. Discussing child care arrangements should wait until she has expressed herself. She should be instrumental in solving the problem; however, allowing her time to express her feelings and talk the problem over will assist her in making this decision.
A new father states, "I know nothing about babies," but he seems to be interested in learning. What action by the nurse is best?
a. Continue to observe his interaction with the newborn.
b. Tell him when he does something wrong.
c. Show no concern, as he will learn on his own.
d. Include him in teaching sessions.
The nurse must be sensitive to the father's needs and include him whenever possible. As fathers take on care new role, the nurse should praise every attempt even if his early care is awkward. It is important to note the bonding process of the mother and the father, but that does not satisfy the expressed needs of the father. He should be encouraged by pointing out the correct procedures he does. Criticizing him will discourage him. The nurse should be sure to include him in all teaching sessions.
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
a. "Didn't you like your lunch?"
b. "Does your doctor know that you are planning to eat that?"
c. "What is that anyway?"
d. "I'll warm the soup in the microwave for you."
This statement shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response. Cultural dietary preferences must be respected. Women may request that family members bring favorite or culturally appropriate foods to the hospital. Asking if the provider knows she is eating this soup is insensitive.
A postpartum woman is unable to empty her bladder. What intervention would the nurse try last?
a. Pouring water from a squeeze bottle over the woman's perineum
b. Providing hot tea
c. Asking the physician to prescribe analgesics
d. Inserting a sterile catheter
Invasive procedures usually are the last to be tried, especially with so many other simple methods available. Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried early on. Hot tea or other fluids ad lib is an easy, noninvasive strategy that should be tried early on. If the woman is anticipating pain from voiding, pain medications may be helpful. Other nonmedical means could be tried first, but medications still come before insertion of a catheter.
The nurse caring for the postpartum woman understands that breast engorgement is caused by
a. overproduction of colostrum.
b. accumulation of milk in the lactiferous ducts and glands.
c. hyperplasia of mammary tissue.
d. congestion of veins and lymphatics.
Breast engorgement is caused by the temporary congestion of veins and lymphatics, not overproduction of colostrum, accumulation of milk, or hyperplasia.
Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
d. Human placental lactogen
Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. Human placental lactogen levels dramatically decrease after expulsion of the placenta.
The nurse explains to the nursing student that one mechanism for the diaphoresis and diuresis experienced during the early postpartum period is which of the following?
a. Elevated temperature caused by postpartum infection
b. Increased basal metabolic rate after giving birth
c. Loss of increased blood volume associated with pregnancy
d. Increased venous pressure in the lower extremities
Within 12 hours of birth, women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. An elevated temperature causes chills and may cause dehydration, not diaphoresis and diuresis. Diaphoresis and diuresis are not caused by an increase in the basal metabolic rate. Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities
Which condition seen in the postpartum period is likely to require careful medical assessment?
a. Varicosities of the legs
b. Carpal tunnel syndrome
c. Periodic numbness and tingling of the fingers
Headaches in the postpartum period can have a number of causes, some of which deserve medical attention. Varicosities are common. Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition.
A nurse has taught a woman how to do Kegel exercises. What statement by the patient shows good understanding?
a. "I contract my thighs, buttocks, and abdomen."
b. "I do 10 of these exercises every day."
c. "I stand while practicing this new exercise routine."
d. "I pretend that I am trying to stop the flow of urine midstream."
The woman can pretend that she is attempting to stop the passing of gas, or the flow of urine midstream. This will replicate the sensation of the muscles drawing upward and inward. Each contraction should be as intense as possible without contracting the abdomen, buttocks, or thighs. Guidelines suggest that these exercises should be done 24 to 100 times per day. Positive results are shown with a minimum of 24 to 45 repetitions per day. The best position to learn Kegel exercises is to lie supine with knees bent. A secondary position is on the hands and knees.
Nurses must be aware of the conditions that increase the risk of hemorrhage, one of the most common complications of the puerperium. What are these conditions? (Select all that apply.)
b. Rapid or prolonged labor
c. Overdistention of the uterus
d. Uterine fibroids
ANS: B, C, D, E
Rapid or prolonged labor, overdistention of the uterus, uterine fibroids, and preeclampsia are all risk factors for postpartum hemorrhage. Being a primipara is not a risk factor.
Many women given up smoking during pregnancy to protect the health of the fetus. The majority of women resumed smoking within the first 6 months postpartum. Factors that increase the likelihood of relapse include (Select all that apply.)
a. living with a smoker.
b. returning to work.
c. weight concerns.
d. successful breastfeeding.
e. failure to breastfeed.
ANS: A, C, E
Living with a smoker, weight concerns, and failure to breastfeed are all associated with a higher relapse rate after smoking cessation during pregnancy.
The nurse assesses a woman's episiotomy or perineal laceration using the acronym REEDA. What factors does this include? (Select all that apply.)
ANS: A, B, C, E
The acronym REEDA indicates redness, edema, ecchymosis or bruising, discharge, and approximation. Depth is not a consideration with this acronym.
A woman's chart indicates she has a second-degree laceration. When assessing this patient, the nurse plans to observe which of the following structures? (Select all that apply.)
a. Vaginal mucosa
b. Perineal skin
c. Peritoneal muscle
ANS: A, B, C
A second-degree perineal laceration includes vaginal mucosa, perineal skin, and peritoneal muscle. A third-degree laceration involves the anus, while a fourth-degree laceration includes the rectum.
This set is often in folders with...
Chapter 13: Adaptations to Pregnancy
Chapter 14: Nutrition for Childbearing
Chapter 16: Giving Birth
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