Nokea
The nurse in a labor and delivery department carefully assesses postpartum patients for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign evaluation?
- A. Blood pressure may be elevated from prenatal conditions.
- B. Respirations are increased due to activity of labor.
- C. Changes in blood pressure may not be an immediate sign.
- D. Heart rate may increase with intensity of labor.
Correct Answer: C
Rationale: Changes in blood pressure may not be an immediate sign of hemorrhage in a postpartum patient. OB patients may not show the same signs and symptoms observed in nonpregnant patients during hemorrhage until approximately one-third of the woman’s entire blood volume is lost.
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What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?
- A. Uterine atony
- B. Lacerations of the genital tract
- C. Perineal hematoma
- D. Infection of the uterus
Correct Answer: A
Rationale: The steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests uterine atony. Uterine atony is a condition where the uterus fails to contract effectively after childbirth, resulting in postpartum hemorrhage. The firm fundus indicates that the uterus is not properly contracting to control bleeding, leading to the continuous flow of blood from the vagina. Prompt intervention is crucial to manage uterine atony and prevent further complications such as excessive blood loss.
What symptom differentiates baby blues from PPD?
- A. Baby blues last longer than 14 days.
- B. Baby blues cause hallucinations.
- C. Baby blues occur in the first few days of the postpartum period.
- D. Baby blues are treated with inpatient therapy.
Correct Answer: A
Rationale: The correct answer is A: Baby blues last longer than 14 days. Baby blues typically resolve within 1-2 weeks postpartum. If symptoms persist for more than 14 days, it may indicate postpartum depression (PPD). Choice B is incorrect as hallucinations are not a common symptom of baby blues. Choice C is incorrect because baby blues can occur within the first few weeks postpartum, not just the first few days. Choice D is incorrect because baby blues are usually managed with support, counseling, and self-care, not inpatient therapy.
The nurse is caring for a birth mother who is relinquishing her newborn. What intervention is appropriate for the nurse?
- A. Use words like 'giving away your child' or 'giving up for adoption.'
- B. Tell the person not to hold the baby.
- C. Ask the person why she is giving up her baby.
- D. Ask about the patient 's expectations for having newborn photos or video.
Correct Answer: D
Rationale: The nurse should support the person's emotional needs including helping with decision-making and documenting memories.
What important assessment should the nurse perform on all postpartum persons?
- A. Screen for PPD with the EPDS.
- B. Screen for drug use with a urine drug screen.
- C. Screen for breast-feeding failure.
- D. Screen for contraception contraindications.
Correct Answer: A
Rationale: Using the Edinburgh Postnatal Depression Scale (EPDS) helps identify postpartum depression and provides early intervention.
A G2 P2002, who is postpartum 6 hours from a spontaneous vaginal delivery, is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia rubra, and perineal sutures are intact. Which of the following actions should the nurse take at this time?
- A. Do nothing. This is a normal finding.
- B. Massage the woman 's fundus.
- C. Take the woman to the bathroom to void.
- D. Notify the woman 's primary health care provider.
Correct Answer: A
Rationale: A firm fundus at the umbilicus and heavy lochia rubra is normal during the first few hours after delivery.