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What is one difference between recovery from a cesarean birth versus a vaginal birth?
- A. Breast-feeding is discouraged after cesarean birth due to pain medications taken.
- B. Lochia will be heavier after a cesarean birth.
- C. Pain with movement is more intense after a cesarean birth.
- D. Gas pain is more intense after a vaginal birth.
Correct Answer: C
Rationale: The correct answer is C because pain with movement is typically more intense after a cesarean birth compared to a vaginal birth. This is due to the surgery involving abdominal muscles and tissues. Breastfeeding is not discouraged after a cesarean birth; in fact, it is encouraged. Lochia, postpartum bleeding, is not necessarily heavier after a cesarean birth. Gas pain is more commonly associated with cesarean births due to reduced mobility and effects of anesthesia. Therefore, choice C is the most fitting difference between the two types of birth recoveries.
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A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, 'I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest. ' Which of the following actions should the nurse take at this time?
- A. Encourage the woman exclusively to breastfeed her baby.
- B. Have the woman massage her breasts hourly.
- C. Obtain an order to culture her expressed breast milk.
- D. Take the temperature and pulse rate of the woman.
Correct Answer: A
Rationale: Breastfeeding exclusively can help relieve engorgement, and frequent feedings prevent further complications.
The nurse is providing care for a patient who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this patient?
- A. Prescriptions for antidepressant/antipsychotic drugs
- B. Discharge to home with 24-hour observation in place
- C. Immediate hospitalization in a psychiatric unit
- D. Prescribed neonate visits during in-patient treatment
Correct Answer: C
Rationale: Step 1: Postpartum psychosis is a psychiatric emergency requiring immediate intervention.
Step 2: Immediate hospitalization in a psychiatric unit ensures safety and specialized care.
Step 3: Hospitalization allows for close monitoring, medication management, and therapy.
Step 4: Discharge to home or prescribed neonate visits are not appropriate due to the severity of symptoms in postpartum psychosis.
The nurse is admitting a 38-year-old patient to triage in early labor with ruptured membranes. Her history includes a previous vaginal delivery 4 years ago and the presence of a uterine fibroid. What interventions are appropriate based on the hemorrhage risk for this patient?
- A. The patient is a moderate hemorrhage risk, so a type and screen should be ordered.
- B. The patient is a high hemorrhage risk, so 4 units of packed red blood cells should be ordered.
- C. The patient is a low hemorrhage risk, so a hold tube should be drawn.
- D. The patient is a moderate hemorrhage risk, but blood is not drawn at this time.
Correct Answer: A
Rationale: Step 1: The patient is in early labor with ruptured membranes, which increases the risk of hemorrhage.
Step 2: The presence of a uterine fibroid also contributes to the hemorrhage risk.
Step 3: Previous vaginal delivery 4 years ago does not significantly alter the hemorrhage risk.
Step 4: Ordering a type and screen will allow for rapid access to blood products if needed in case of hemorrhage.
Step 5: This is a moderate hemorrhage risk situation, warranting the need for preparing for potential blood transfusion.
Summary:
- Choice B is incorrect as ordering 4 units of packed red blood cells is excessive for a moderate hemorrhage risk.
- Choice C is incorrect as a hold tube will not provide immediate access to blood products in case of hemorrhage.
- Choice D is incorrect as blood should be drawn to be prepared for potential hemorrhage in a moderate risk situation.
Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence the causes and incidence of obstetric lacerations of the lower genital tract? (Select all that apply.)
- A. Operative and precipitate births
- B. Adherent retained placenta
- C. Abnormal presentation of the fetus
- D. Congenital abnormalities of the maternal soft tissue
Correct Answer: A
Rationale: The correct answer is A because operative and precipitate births increase the risk of obstetric lacerations due to the rapid delivery or use of instruments. Operative births involve interventions like forceps or vacuum extraction, which can cause trauma. Precipitate births, characterized by rapid labor and delivery, may lead to tearing of the lower genital tract. Choices B, C, and D are incorrect as they do not directly influence the causes and incidence of obstetric lacerations. Adherent retained placenta, abnormal fetal presentation, and congenital abnormalities of maternal soft tissue are not primary factors contributing to lacerations during childbirth.
During the first 8 hours postpartum, the nurse will demonstrate how to perform a fundal massage and assist with breast-feeding techniques. What other assessment is important at this time?
- A. assessment of partner changing a diaper
- B. assessment of vaginal bleeding
- C. assessment of social support
- D. assessment of family dynamics
Correct Answer: B
Rationale: Monitoring vaginal bleeding in the first 8 hours postpartum helps detect any potential complications such as postpartum hemorrhage.