Nokea
A postpartum cesarean patient comes into the rural health clinic at 1 week postdelivery for an incision check by the nurse. The vital signs reveal a temperature of 100.5°F, and the patient reports moderate foul-smelling lochia. The nurse determines that the skin incision is healing normally, but when palpating the uterus, she discovers the patient to have uterine and pelvic tenderness. What are the most appropriate nursing actions?
- A. Explain to the patient that she may have an infection of her uterus, and blood will need to be drawn to determine if this is the cause of her pain and excess bleeding.
- B. Explain that the client should rest more to help the bleeding slow and that she should return to the clinic if she isn’t feeling better in a few days.
- C. Explain to the patient that she is experiencing normal postoperative pain and bleeding and to come back for her scheduled 6-week postpartum checkup.
- D. Explain to the patient that the incision appears to be healing nicely. Have her take Tylenol for the elevated temperature and continue with the ordered pain medication until her next visit.
Correct Answer: D
Rationale: The foul-smelling lochia, fever, and uterine tenderness point toward a uterine infection, requiring further investigation.
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A bottle-feeding woman, 11 1/2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated 2 pads in the past 1 hour. Which of the following responses by the nurse is appropriate?
- A. You must be doing too much. Lie down for a few hours and call back if the bleeding has not subsided.
- B. You are probably getting your period back. You will bleed like that for a day or two and then it will lighten up.
- C. It is not unusual to bleed heavily every once in a while after a baby is born. It should subside shortly.
- D. It is important for you to be examined by the doctor today. Let me check to see when you can come in.
Correct Answer: D
Rationale: Saturating 2 pads in 1 hour could indicate abnormal bleeding or a complication. Immediate evaluation by a healthcare provider is necessary.
A client, G1 P0101, postpartum 1 day, is assessed. The nurse notes that the client 's lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first?
- A. Notify the woman 's primary health care provider.
- B. Massage the woman 's fundus.
- C. Escort the woman to the bathroom to urinate.
- D. Check the quantity of lochia on the peripad.
Correct Answer: B
Rationale: A boggy fundus can indicate uterine atony, which can lead to postpartum hemorrhage. The first step is to massage the fundus to stimulate uterine contraction.
What symptom can partners of persons with PPD experience?
- A. depression
- B. psychosis
- C. bipolar disorder
- D. mania
Correct Answer: B
Rationale: The correct answer is B: psychosis. Partners of individuals with Paranoid Personality Disorder (PPD) may experience shared psychosis due to the intense distrust and suspicion exhibited by the person with PPD. This can lead partners to develop similar delusions or false beliefs. Depression (A), bipolar disorder (C), and mania (D) are not directly associated with PPD and are less likely to be experienced solely as a result of being in a relationship with someone with PPD.
The day after delivery, a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong: 'All I do is go to the bathroom. ' Which of the following is an appropriate nursing response?
- A. Catheterize the client per doctor 's orders.
- B. Measure the client 's next voiding.
- C. Inform the client that polyuria is normal.
- D. Check the specific gravity of the next voiding.
Correct Answer: C
Rationale: Polyuria, or frequent urination, is a normal phenomenon during the postpartum period as the body expels excess fluid.
A patient who has been on prolonged bedrest for bleeding associated with placenta previa was taken to the operating room for an emergency cesarean delivery. Sixteen hours postoperatively, the patient complains that her left leg is hurting. The nurse finds that the entire left leg is swollen and has pitting edema, while the right leg appears to be normal. Which order does the nurse anticipate when paging the health care provider to the room?
- A. White blood cell count (WBC)
- B. Ultrasound of the leg
- C. X-ray of the leg
- D. Serum creatinine
Correct Answer: B
Rationale: The swollen and painful leg may indicate a deep vein thrombosis (DVT), and an ultrasound is the appropriate diagnostic test.