Nokea
What is a risk factor for PPH found in the prenatal record?
- A. primipara
- B. rubella nonimmune
- C. von Willebrand disorder
- D. history of appendectomy
Correct Answer: C
Rationale: Von Willebrand disorder is a bleeding disorder that increases the risk of postpartum hemorrhage due to impaired clotting.
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The nurse is collecting information during a follow-up OB appointment with a patient who delivered 3 months ago. The patient reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply.
- A. The father exhibited depression during the pregnancy
- B. The birth of this fourth child was unexpected and unplanned
- C. The father expresses feeling bored and underappreciated in his job
- D. The father is recently estranged from his parents and siblings
Correct Answer: B
Rationale: Exhibiting paternal depression during the pregnancy can be a risk factor for the development of PPND. An unexpected or unplanned pregnancy can be a risk factor for the development of PPND. The father’s estrangement from his parents and siblings can be a stressful life event and/or indicate a lack of social support.
The nurse reviews postpartum discharge instructions regarding sexual health. What information is important to review?
- A. Place nothing in the vagina for 4 -6 weeks.
- B. Pregnancy cannot occur until 3 months after birth.
- C. Sexual intercourse can resume after discharge from the facility.
- D. Postpartum persons do not have a need for sexual intimacy.
Correct Answer: A
Rationale: It is important to wait 4 -6 weeks before placing anything in the vagina to allow for physical recovery and reduce infection risk.
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.
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: Step 1: The nurse's assessment reveals signs of infection (fever, foul-smelling lochia, uterine, and pelvic tenderness).
Step 2: The nurse should address the immediate concerns - fever and pain. Tylenol helps reduce fever and pain.
Step 3: The incision healing well indicates no immediate surgical intervention required.
Step 4: Continuing pain medication ensures comfort until next visit.
Step 5: Blood tests for infection are not urgent; they can be done at the next visit if symptoms persist.
Summary:
A: Immediate blood draw is not necessary without a clear indication of sepsis.
B: Resting more won't address the infection; waiting a few days can worsen the condition.
C: Normal postoperative pain doesn't include fever and foul-smelling lochia; waiting for the 6-week checkup is risky.
A woman who is 4 hours postpartum ambulates to the bathroom and suddenly has a large gush of lochia rubra. The nurse 's first action should be to:
- A. Determine whether the bleeding slows to normal or remains as a large volume.
- B. Observe vital signs for signs of hypovolemic shock.
- C. Check to see what her previous lochia flow has been.
- D. Identify the type of pain relief that was given when she was in labor.
Correct Answer: A
Rationale: The nurse should first determine whether the bleeding slows or continues to be excessive, as it may be a normal occurrence post-ambulation or indicative of a complication.