Postpartum Complications and Care, Exams of Nursing

Download Postpartum Complications and Care and more Exams Nursing in PDF only on Docsity! Postpartum NCLEX 40 Correctly Answered Questions Rated 100%. Rubin identified a series of changes that a new mother makes during the postpartum period. The correct sequence of these changes is a) Taking-in, taking-hold, letting-go b) Taking, holding-on, letting-go c) Taking-in, holding-on, letting-go d) Taking-in, taking-on, letting-go - Correct answerTaking-in, taking-hold, letting-go Correct Explanation: The new mother makes progressive changes to know her infant, review the pregnancy and labor, validate her safe passage through these phases, learn the initial tasks of mothering, and let go of her former life to incorporate this new child. A postpartum client complains of stress incontinence. What information should the nurse suggest to the client to overcome stress incontinence? a) Perform aerobic exercises b) Frequently empty the bladder c) Reduce fluid intake d) Perform Kegel's exercises - Correct answerPerform Kegel's exercises Correct Explanation: The nurse should ask the client to perform the Kegel's exercises in which the client needs to alternately contract and relax the perineal muscles. Aerobic exercises will not help to strengthen perineal muscles. Reduced fluid intake and frequent emptying of the bladder will not help the client overcome stress incontinence. A nurse is monitoring the vital signs of a client 24 hours after childbirth. She notes that the client's blood pressure is 100/60 mm Hg. Which of the following postpartum complications should the nurse most suspect in this client, based on this finding? a) Postpartal gestational hypertension b) Bleeding c) Diabetes d) Infection - Correct answerBleeding Correct Explanation: Blood pressure should also be monitored carefully during the postpartal period, because a decrease in this can also indicate bleeding. In contrast, an elevation above 140 mm Hg systolic or 90 mm Hg diastolic may indicate the development of postpartal gestational hypertension, an unusual but serious complication of the puerperium. An infection would best be indicated by an elevated oral temperature. Diabetes would be indicated by an elevated blood glucose level. Bonding between a mother and her infant can be defined how? a) An ongoing process in the year after delivery b) The skin to skin contact that occurs in the delivery room c) A process of developing an attachment and becoming acquainted with each other d) Family growing closer together after the birth of a new baby - Correct answerA process of developing an attachment and becoming acquainted with each other Correct Explanation: Bonding in the maternal-newborn world is the attachment process that occurs between a mother and her newborn infant. This is how the mother and infant become engaged with each other and is the foundation for the relationship. Because bonding is a process and not a single event, option B is incorrect. The process of bonding is not a year-long process, so option C is incorrect. The family growing closer together after the birth of a new baby is not bonding, so option D is incorrect. The process by which the reproductive organs return to the nonpregnant size and function is termed what? a) Evolution b) Involution c) Decrement d) Progression - Correct answerInvolution Correct Explanation: Involution is the term used to describe the process of the return to nonpregnancy size and function of reproductive organs. Evolution is change in the genetic material of a population of organisms from one generation to the next. Decrement is the act or process of decreasing . Progression is defined as movement through stages such as the progression of labor. Options A, C, and D are distracters for this question. The nurse is caring for a client in the postpartum period. The client has difficulty in voiding and is catheterized. The nurse then would monitor the client for which of the following? a) Loss of pelvic muscle tone b) Stress incontinence c) Urinary tract infection d) Increased urine output - Correct answerUrinary tract infection Explanation: The nurse should suggest proper exercise to the client to heal the distended abdominal muscles. Application of warm compresses, application of moist heat, and massaging the muscles gently are not suggested for distended abdominal muscles. A woman who gave birth to a healthy newborn 2 months ago comes to the clinic and reports discomfort during sexual intercourse. Which suggestion by the nurse would be most appropriate? a) "You might try using a water-soluble lubricant to ease the discomfort." b) "This is entirely normal, and many women go through it. It just takes time." c) "It takes a while to get your body back to its normal function after having a baby." d) "Try doing Kegel exercises to get your pelvic muscles back in shape." - Correct answer"You might try using a water-soluble lubricant to ease the discomfort." Correct Explanation: Coital discomfort and localized dryness usually plague most postpartum women until menstruation returns. Water-soluble lubricants can reduce discomfort during intercourse. Although it may take some time for the woman's body to return to its prepregnant state, telling the woman this does not address her concern. Telling her that dyspareunia is normal and that it takes time to resolve also ignores her concern. Kegel exercises are helpful for improving pelvic floor tone but would have no effect on vaginal dryness. A woman is bottle-feeding her baby. When the nurse comes into the room the woman says that her breasts are painful and engorged. Which nursing intervention is appropriate? a) Ask if she wants a breast pump to empty her breasts b) Assist the woman in placing ice packs on her breasts c) Assist the woman into the shower and have her run cold water over her breasts d) Explain to the woman that she should breastfeed because she is producing so much milk - Correct answerAssist the woman in placing ice packs on her breasts Correct Explanation: If the breasts are engorged and the woman is bottle-feeding her newborn, instruct her to keep a support bra on 24 hours per day. Cool compresses or an ice pack wrapped in a towel will usually be soothing and help to suppress milk production. A client gave birth to a healthy boy 2 days ago. Both mother and baby have had a smooth recovery. The nurse enters the room and tells the client that she and her baby will be discharged home today. The client states, "I do not want to go home." Which of the following is the nurse's most appropriate response? a) Tell the client that she must go home as per hospital policy. b) Ask the client if she has any support in the home. c) Inform the physician that the client does not want to go home. d) Ask the client why she does not want to go home. - Correct answerAsk the client why she does not want to go home. Correct Explanation: It is important for the nurse to identify the client's concerns and reasons for wanting to stay in the hospital. Open-ended questioning facilitates both effective and therapeutic communication and allows the nurse to address concerns appropriately. Asking about supports at home implies that the nurse has made assumptions about why the client may not want to go home. Informing the physician or telling the client that discharge is hospital policy is not appropriate at this time, because the nurse has not addressed the underlying reason for the client's comment. The client may have safety-related concerns, undisclosed fears, or a need for increased support before discharge. It is imperative that the nurse not make assumptions but further explore concerns. For several hours after delivery, Norah, a multigravida who experienced a much more difficult labor this time than any time previously, wants to talk about why the birthing process was so hard for her this time. In fact, she's focusing on this aspect to the point that she seems relatively indifferent to her newborn. How should you handle this situation? a) Redirect her attention to the baby by reminding her of the details of newborn care b) Encourage her to discuss her experience of the birth and answer any questions or concerns she may have c) Point out positive features of her baby and encourage her to hold and cuddle the baby d) Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings - Correct answerEncourage her to discuss her experience of the birth and answer any questions or concerns she may have Explanation: The patient needs to explore her birth experience and clarify her questions. The nurse should allow her to ask questions, be supportive and encourage her to express her feelings. Redirecting her attention to the baby, asking her to describe how she plans to integrate the new baby into the family, or pointing out positive features of the new baby do not meet the needs of the patient at this time, and are therefore incorrect answers. A new mother, who is an adolescent, was cautious at first when holding and touching her newborn. She seemed almost afraid to make contact with baby and only touched it lightly and briefly. However, 48 hours after the birth, the nurse now notices that the new mother is pressing the newborn's cheek against her own and kissing her on the forehead. The nurse recognizes these actions as which of the following? a) Engorgement b) Engrossment c) Involution d) Attachment - Correct answerAttachment Correct Explanation: When a woman has successfully linked with her newborn it is termed attachment or bonding. Although a woman carried the child inside her for 9 months, she often approaches her newborn not as someone she loves but more as she would approach a stranger. The first time she holds the infant, she may touch only the blanket. Gradually, as a woman holds her child more, she begins to express more warmth, touching the child with the palm of her hand rather than with her fingertips. She smoothes the baby's hair, brushes a cheek, plays with toes, and lets the baby's fingers clasp hers. Soon, she feels comfortable enough to press her cheek against the baby's or kiss the infant's nose; she has successfully bonded or become a mother tending to her child. Engrossment describes the action of new fathers when they stare at their newborn for long intervals. Involution is the process whereby the reproductive organs return to their nonpregnant state. Engorgement is the tension in the breasts as they begin to fill with milk. What is the primary function of uterine contractions after delivery of the infant and placenta? a) Return the uterus to normal size b) Seal off the blood vessels at the site of the placenta c) Stop the flow of blood d) Close the cervix - Correct answerSeal off the blood vessels at the site of the placenta Correct Explanation: 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, options A, C, and D are secondary to the constriction of blood vessels at the placental site. After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, which statement indicates the need for additional teaching? a) "This line on my belly will go away over time." b) "I can't wait for these stretch marks to disappear after delivery." c) "My nipples won't be so dark after I give birth." d) "I might lose some hair, but it will grow back." - Correct answer"I can't wait for these stretch marks to disappear after delivery." Correct Explanation: c) Estrogen d) Progesterone - Correct answerOxytocin Correct Explanation: Secretion of oxytocin stimulates uterine contraction and causes the woman to experience afterpains. Decrease in progesterone and estrogen after placental delivery stimulates the anterior pituitary to secrete prolactin which causes lactation A nurse is caring for a non-breastfeeding client in the postpartum period. The client complains of engorgement. What suggestion should the nurse provide to alleviate breast discomfort? a) Express milk frequently b) Apply hydrogel dressing c) Wear a well-fitting bra d) Apply warm compress - Correct answerWear a well-fitting bra Correct Explanation: The nurse should suggest the client wear a well-fitting bra to provide support and help alleviate breast discomfort. Application of warm compress and expressing milk frequently is suggested to alleviate breast engorgement in breastfeeding clients. Hydrogel dressings are used prophylactically in treating nipple pain. A woman has just delivered a baby. Her prelabor vital signs were T - 98.8 B/P-P-R 120/70, 80, 20. Which combination of findings during the early postpartum period are the most concerning? a) Shaking chills with a fever of 100.3 b) B/P-P-R 90/50, 120, 24 c) Bradycardia and excessive, soaking diaphoresis d) Blood loss of 250 mL and WBC 25,000 cells/mL - Correct answerB/P-P-R 90/50, 120, 24 Correct Explanation: The decrease in BP with an increase in HR and RR indicate a potential significant complication, and are out of the range of normals, from delivery and need to be reported ASAP. Shaking chills with a temperature of 100.3ºF can occur due to stress on the body and is considered a normal finding. A fever of 100.4ºF should be reported. Options C and D are considered to be within normal limits after delivering a baby. A woman who delivered a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which of the following factors/conditions does the nurse believe is causing this experience? a) Postpartum depression. b) Postpartum reaction. c) Postpartum anxiety. d) Postpartum baby blues. - Correct answerPostpartum baby blues. Explanation: Postpartum baby blues is common in women after giving birth. It is a mild depression; however, functioning usually is not impaired. Postpartum blues usually peaks at day 4 or 5 after birth. Postpartum anxiety and postpartum depression do not usually start until at least 3 to 4 weeks and up to 1 year following the birth of a baby. Postpartum reaction is a term to include postpartum depression, anxiety, and psychosis. The nurse is monitoring a postpartum client who says she's concerned because she feels mildly depressed. The nurse recognizes that she's most likely experiencing "postpartum blues," and reassures the client that this symptom is experienced by approximately what percentage of women? a) 25% b) 100% c) 75% d) 40% - Correct answer75% Explanation: Postpartum blues, or mild depression during the first 10 days after giving birth, affects 75% to 80% of women who give birth. More intense depression during this period is referred to as postpartum depression, which affects approximately 10% to 15% of postpartum clients. Postpartum depression can be severe with negative implications for maternal and neonatal well-being. A nurse is caring for a client on the second day postpartum. The client informs the nurse that she is voiding a large volume of urine frequently. Which of the following should the nurse identify as a potential cause for urinary frequency? a) Urinary overflow b) Postpartum diuresis c) Trauma to pelvic muscles d) Urinary tract infection - Correct answerPostpartum diuresis Correct Explanation: The nurse should identify postpartum diuresis as the potential cause for urinary frequency. Urinary overflow occurs if the bladder is not completely emptied. Urinary tract infection may be accompanied by fever and a burning sensation. Trauma to pelvic muscles does not affect urinary frequency. For the first hour after birth, the height of the fundus is at the umbilicus or even slightly above it. a) True b) False - Correct answerTrue When assessing a postpartum woman, which finding would be most significant in identifying possible postpartum hemorrhage? a) Increased cardiac output b) Increase heart rate c) Increased hematocrit level d) Increased blood pressure - Correct answerIncrease heart rate Correct Explanation: 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. The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? a) Edematous vagina b) Lochia serosa c) Diaphoresis d) Uterus 1 cm below umbilicus - Correct answerUterus 1 cm below umbilicus Correct Explanation: By the fourth postpartum day, the uterus should be approximately 4 cm below the umbilicus. Being only at 1 cm indicates that the uterus is not contracting as it should. Lochia serosa is normal from days 3 to 10 postpartum. After birth the vagina is edematous and thin with few rugae. It eventually thickens and rugae return in approximately 3 weeks. Diaphoresis is common during the early postpartum period, especially in the first week. It is a mechanism to reduce fluids retained during pregnancy and restore prepregnant body fluid levels. Which maternal reaction is the most concerning? a) She is tearful for several days and has difficulty eating and sleeping b) She hesitates to take her newborn when offered and expresses disappointment with the way the baby looks c) She expresses doubt about her ability to care for the baby as well as the nurse can d) She neglects to engage with or provide care for the baby and shows little interest in it - Correct answerShe neglects to engage with or provide care for the baby and shows little interest in it Correct Explanation: