To help the postpartum woman avoid constipation, the nurse should teach her to:
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Question 2 of 105
The nurse notices the person with a PPH looks pale and their capillary refill is >3 seconds. What intervention can the nurse initiate?
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Question 3 of 105
A breastfeeding client, G10 P6408, delivered 10 minutes ago. Which of the following assessments is most important for the nurse to perform at this time?
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Question 4 of 105
The nurse is caring for a postpartum woman and her 2-hour-old baby. The new mother has been preoccupied with breastfeeding and visitors, but suddenly she complains of dizziness and is light-headed. Which response by the nurse is appropriate?
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Question 5 of 105
A postpartum patient informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the patient’s medical record and associates which risk factors related to a possible urinary tract infection (UTI)? Select all that apply.
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Question 6 of 105
A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed?
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Question 7 of 105
A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate?
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Question 8 of 105
The nurse assesses for signs of depression or postpartum blues. How can the nurse explain the difference?
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Question 9 of 105
A nurse is counseling a woman about postpartum blues. Which of the following should be included in the discussion?
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Question 10 of 105
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?
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Question 11 of 105
On admission to the labor and delivery unit, a client 's hemoglobin (Hgb) was assessed at 11.0 g/dL, and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery?
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Question 12 of 105
The nurse is developing a standard care plan for postpartum clients who have had midline episiotomies. Which of the following interventions should be included in the plan?
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Question 13 of 105
What assessment data increases the risk of postpartum infection?
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Question 14 of 105
A woman has an 8-lb, 9-oz baby after an 18-hour labor that required a vacuum extraction. Her membranes have been ruptured for 15 hours. Based on these facts, client teaching should emphasize:
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Question 15 of 105
The nurse is discussing the importance of doing Kegel exercises during the postpartum period. Which of the following should be included in the teaching plan?
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Question 16 of 105
The nurse and provider estimate the blood loss at delivery to be 400 mL in the measuring drape; now when doing the initial perineal care, the nurse finds a large amount of blood underneath the patient. What action reflects safe and accurate nursing care?
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Question 17 of 105
The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room?
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Question 18 of 105
The nurse on a postpartum unit observes a patient who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The patient states, “I think that my baby is deformed inside and we have to fix him.†Which risk factor is most strongly related to possible postpartum psychosis (PPP)?
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Question 19 of 105
What physiologic postpartum change occurs because the uterus shrinks in size, resulting in an increase in blood flow?
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Question 20 of 105
The nurse is developing a plan of care for the postpartum client during the 'taking in ' phase. Which of the following should the nurse include in the plan?
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Question 21 of 105
A new father tells a nurse friend that his wife is agitated and acting in a bizarre fashion. She says that she hears voices. Her baby is 2 weeks old. The father is concerned about the care the mother is giving the baby. The nurse should:
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Question 22 of 105
What is a risk factor for PPD?
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Question 23 of 105
What assessment finding would indicate a fluid volume deficit?
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Question 24 of 105
What nursing intervention does the nurse include in the plan of care for a person with mastitis?
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Question 25 of 105
The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient?
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Question 26 of 105
The nurse educates the person with a newborn in the NICU. What guidance does the nurse provide?
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Question 27 of 105
Which medications are used to manage PPH? (Select all that apply.)
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Question 28 of 105
What important assessment should the nurse perform on all postpartum persons?
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Question 29 of 105
The nurse is preparing to place a peripad on the perineum of a client who delivered her baby 10 minutes earlier. The client states 'I don 't use those. I always use tampons. ' Which of the following actions by the nurse is appropriate at this time?
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Question 30 of 105
A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with 'latch on ' and recommends that the mother do which of the following?
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Question 31 of 105
What nursing diagnosis would be appropriate for the person with a coagulation disorder?
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Question 32 of 105
A breastfeeding patient who is 5 weeks postpartum calls the clinic and reports that she is achy all over, has a temperature of 100.2°F, and has pain and tenderness in her right breast. What is the nurse’s best response?
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Question 33 of 105
The nurse is caring for a woman who is 6 hours postpartum after a vaginal delivery. She has a history of labial varicose veins and is reporting perineal pain of 8 on a 10-point scale. What interventions should the nurse include in the plan of care?
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Question 34 of 105
What symptom differentiates baby blues from PPD?
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Question 35 of 105
The nurse informs a postpartum woman that which of the following is the reason ibuprofen (Advil) is especially effective for afterbirth pains?
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Question 36 of 105
The postpartum nurse notices that the last dose of IV Cefazolin is not running well. The patient’s IV site appears red, inflamed, and swollen. The patient states that the IV is tender and sore. What are the nurse’s next actions?
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Question 37 of 105
A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse 's response?
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Question 38 of 105
The nurse notices the uterus is boggy and the bladder is full. What intervention should the nurse perform next?
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Question 39 of 105
A postoperative cesarean section woman is to receive morphine 4 mg q 3 -4 h subcutaneously for pain. The morphine is available on the unit in premeasured syringes 10 mg/1 mL. Each time the nurse administers the medication, how many milliliters (mL) of morphine will be wasted? Calculate to the nearest tenth.
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Question 40 of 105
Choose the signs and symptoms that suggest postpartum hemorrhage causing a hematoma.
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Question 41 of 105
The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take?
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Question 42 of 105
What postpartum infection is caused by STIs and chorioamnionitis?
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Question 43 of 105
What is characteristic of an early (primary) PPH?
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Question 44 of 105
The labor and delivery unit nurses are adopting methods to reduce the number of women who develop postpartum depression. Research from Dennis and Dowswell (2013) provides evidence-based suggestions regarding beneficial interventions. Which suggestions do the nurses consider? Select all that apply.
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Question 45 of 105
A woman tells you she has been teary for most of the 2 weeks since the birth of her baby. Although the infant appears to be cared for appropriately, the mother states that she feels too tired to spend as much time with him as she should. She has lost her appetite and cannot sleep at night. She has been too ashamed to tell anyone before now. The nurse's best response is to:
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Question 46 of 105
What is a symptom of engorgement?
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Question 47 of 105
A woman who is 3 hours postpartum has had difficulty in urinating. She finally urinates 100 mL. The initial nursing action is to:
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Question 48 of 105
What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse?
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Question 49 of 105
The nurse screens for risk factors such as an infant in the neonatal intensive care unit (NICU), difficulty in role transition, birth complications, unmet social and physical needs, and lack of partner support for what complication?
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Question 50 of 105
What is a risk factor for uterine atony?
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Question 51 of 105
What nursing intervention does the nurse include in the plan of care for a person with a wound infection?
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Question 52 of 105
A nurse is assessing the fundus of a client during the immediate postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly?
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Question 53 of 105
What is characteristic of a late (secondary) PPH?
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Question 54 of 105
The nurse has provided teaching to a post-op cesarean client who is being discharged on Colace (docusate sodium) 100 mg po tid. Which of the following would indicate that the teaching was successful?
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Question 55 of 105
What drug should be readily available when a woman is receiving heparin therapy?
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Question 56 of 105
A medication order reads: Methergine (ergonovine) 0.2 mg po q 6 h Ã 4 doses. Which of the following assessments should be made before administering each dose of this medication?
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Question 57 of 105
What assessment finding suggests a possible infection?
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Question 58 of 105
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?
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Question 59 of 105
When referring to the 4 T’s of PPH, what does tissue refer to?
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Question 60 of 105
A woman is receiving patient-controlled analgesia (PCA) post -cesarean section. Which of the following must be included in the patient teaching?
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Question 61 of 105
Postpartum persons who lack attachment with their newborn exhibit what behavior?
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Question 62 of 105
A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following?
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Question 63 of 105
The nurse recognizes the postpartum person is in what stage of Rubin 's attachment model when the person is concerned with physical recovery and depends on the nurse or partner for help physically?
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Question 64 of 105
The nurse should warn a client who is about to receive Methergine (ergonovine) of which of the following side effects?
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Question 65 of 105
What is one of the initial signs and symptoms of puerperal infection in the postpartum client?
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Question 66 of 105
Which condition is considered a medical emergency that requires immediate treatment?
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Question 67 of 105
The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis?
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Question 68 of 105
What postpartum infection can be transferred between the breast-feeding person and newborn if both are not treated appropriately?
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Question 69 of 105
A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate?
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Question 70 of 105
The nurse is performing an assessment of the uterus 30 minutes after a normal delivery and finds the fundus to be soft and boggy. IV Pitocin is infusing at 150 mL/hr. What is the priority nursing intervention?
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Question 71 of 105
The nurse is assessing the laboratory report on a 2-day postpartum G1 P1001. The woman had a normal postpartum assessment this morning. Which of the following results should the nurse report to the primary health care provider?
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Question 72 of 105
What is the most common reason for cracked, sore nipples?
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Question 73 of 105
The home health nurse visits a client who is 6 days postdelivery. The client appears sad, weeps frequently, and states, 'I don 't know what is wrong with me. I feel terrible. I should be happy, but I 'm not. ' Which of the following nursing diagnoses is appropriate for this client?
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Question 74 of 105
The surgeon has removed the surgical cesarean section dressing from a post-op day 1 client. Which of the following actions by the nurse is appropriate?
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Question 75 of 105
A breastfeeding woman, 1 1/2 months postdelivery, calls the nurse in the obstetrician 's office and states, 'I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me? ' The nurse should base the response to the client on which of the following?
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Question 76 of 105
A client has just been transferred to the postpartum unit from labor and delivery. Which of the following tasks should the registered nurse delegate to the nursing care assistant?
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Question 77 of 105
The lactation nurse takes a phone call from a mother who is breastfeeding her 2-month-old infant. The mother reports an area of redness and warmth on the breast and a painful burning sensation when breastfeeding. Which statement by the nurse is correct if mastitis is suspected?
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Question 78 of 105
The person with a cesarean birth has additional nursing concerns beyond those of a person with a vaginal birth. What concern should the nurse anticipate for the cesarean birth?
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Question 79 of 105
A client is receiving an epidural infusion of a narcotic for pain relief after a cesarean section. The nurse would report to the anesthesiologist if which of the following were assessed?
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Question 80 of 105
The nurse educates the non -breast-feeding person on breast discomfort caused by engorgement. What instructions would they give?
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Question 81 of 105
What nursing intervention does the nurse include in the plan of care for a person with postpartum endometritis?
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Question 82 of 105
The nurse is caring for a birth mother who is relinquishing her newborn. What intervention is appropriate for the nurse?
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Question 83 of 105
The nurse is caring for a Seventh Day Adventist woman who delivered a baby boy by cesarean section. Which of the following questions should be asked regarding this woman 's care?
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Question 84 of 105
What is a risk factor for PPH found in the prenatal record?
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Question 85 of 105
The nurse is assessing the midline episiotomy on a postpartum client. Which of the following findings should the nurse expect to see?
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Question 86 of 105
What is the most common reason for late postpartum hemorrhage (PPH)?
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Question 87 of 105
A breastfeeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective?
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Question 88 of 105
To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks?
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Question 89 of 105
The nurse assesses the fundus and finds it to be boggy, elevated >2 fingerbreadths above the umbilicus, and deviated to one side. What is the common cause of this finding?
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Question 90 of 105
A post -cesarean section, breastfeeding client, whose subjective pain level is 2/5, requests her as needed (prn) narcotic analgesics every 3 hours. She states, 'I have decided to make sure that I feel as little pain from this experience as possible. ' Which of the following should the nurse conclude in relation to this woman 's behavior?
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Question 91 of 105
Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate?
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Question 92 of 105
The nurse is caring for a postpartum client who experienced a second-degree perineal laceration at delivery 2 hours ago. Which of the following interventions should the nurse perform at this time?
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Question 93 of 105
A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her baby. Which of the following responses by the nurse is appropriate?
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Question 94 of 105
The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply.
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Question 95 of 105
Research has shown what intervention increases involvement of the adolescent partner postpartum?
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Question 96 of 105
A breastfeeding client, 7 weeks postpartum, complains to an obstetrician 's triage nurse that when she and her husband had intercourse for the first time after the delivery, 'I couldn 't stand it. It was so painful. The doctor must have done something terrible to my vagina. ' Which of the following responses by the nurse is appropriate?
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Question 97 of 105
The nurse educates the person recovering from a cesarean birth on how to care for the incision. What education is discussed?
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Question 98 of 105
A young mother is excited about her first baby. Choose the best teaching to help her obtain adequate rest after discharge.
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Question 99 of 105
During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see?
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Question 100 of 105
What information about pain medication should postpartum discharge instructions include?
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HESI LPN · HESI Complication Postpartum
Question 101 of 105
The nurse palpates a distended bladder on a woman who delivered vaginally 2 hours earlier. The woman refuses to go to the bathroom, 'I really don 't need to go. ' Which of the following responses by the nurse is appropriate?
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HESI LPN · HESI Complication Postpartum
Question 102 of 105
The nurse places one hand above the symphysis pubis during uterine massage to:
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HESI LPN · HESI Complication Postpartum
Question 103 of 105
Hemabate has been ordered for a postpartum patient who has uncontrolled bleeding and uterine atony. Which is the appropriate nursing action?
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HESI LPN · HESI Complication Postpartum
Question 104 of 105
What nursing intervention does the nurse include in the plan of care for a person with a perineal laceration infection?
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HESI LPN · HESI Complication Postpartum
Question 105 of 105
The nurse takes a newborn to a primipara for a feeding. The mother holds the baby en face, strokes his cheek, and states that this is the first newborn she has ever held. Which of the following nursing assessments is most appropriate?
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