Nokea
What is characteristic of an early (primary) PPH?
- A. occurs after 12 weeks postpartum
- B. is not an emergency
- C. often occurs due to uterine atony
- D. is diagnosed after the person is discharged
Correct Answer: C
Rationale: Early (primary) postpartum hemorrhage is usually due to uterine atony and requires immediate medical intervention.
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The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance, the day before. The baby 's Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate?
- A. Sometimes babies just don 't deliver the way we expect them to.
- B. With all of your preparations, it must have been disappointing for you to have had a cesarean.
- C. I know you had to have surgery, but you are very lucky that your baby was born healthy.
- D. At least your husband was able to be with you when the baby was born.
Correct Answer: B
Rationale: The nurse should acknowledge the emotional impact of an unplanned cesarean section while validating the mother's feelings.
The nurse is assessing a patient who is 12 hours postpartum. The uterus is firm to palpation, at midline, and is 1 cm below the umbilicus with continuous heavy vaginal bleeding. What is the nurse’s first action?
- A. Massage the uterus and resume the IV Pitocin drip.
- B. Change the peri-pad and reassess the bleeding.
- C. Call the provider to check for a cervical laceration.
- D. Administer the ordered iron supplement and ibuprofen.
Correct Answer: A
Rationale: The nurse must address the uterine tone and bleeding immediately by massaging the uterus and resuming Pitocin to prevent hemorrhage.
What intervention by the nurse can help with PPD?
- A. encouraging the partner to let the postpartum person learn to take care of themself
- B. encouraging the family to have support available for the person and partner
- C. telling the person not to breast-feed if taking antidepressants
- D. keeping the newborn in the nursery most of the day and night
Correct Answer: B
Rationale: Support from family can be an effective intervention for those with PPD.
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: The correct answer is B. The birth of a fourth child being unexpected and unplanned can be a risk factor for paternal postnatal depression (PPND) due to increased stress and pressure. Choice A is incorrect because past depression during pregnancy doesn't directly correlate with PPND. Choice C is incorrect as feeling bored and underappreciated at work is not a direct risk factor for PPND. Choice D is incorrect as being recently estranged from family members doesn't directly relate to PPND.
The obstetrician has ordered that a post-op cesarean section client 's patient-controlled analgesia (PCA) be discontinued. Which of the following actions by the nurse is appropriate?
- A. Discard the remaining medication in the presence of another nurse.
- B. Recommend waiting until her pain level is zero to discontinue the medicine.
- C. Discontinue the medication only after the analgesia is completely absorbed.
- D. Return the unused portion of medication to the narcotics cabinet.
Correct Answer: A
Rationale: When discontinuing PCA, the unused medication must be discarded in the presence of another nurse to maintain security and prevent diversion.