Chapter 23 Postpartum Complications

Chapter 23  Postpartum Complications

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is:
a.
Uterine atony.
b.
Uterine inversion.
c.
Vaginal hematoma.
d.
Vaginal laceration.

ANS: A

Feedback
A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage.
B
Uterine inversion may lead to hemorrhage, but it is not the most likely source of this patient’s bleeding. Furthermore, if the woman were experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus.
C
A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding.
D
A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.

DIF: Cognitive Level: Comprehension REF: 725
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

2. To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features:
a.
Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist.
b.
Is more common among older, Caucasian women because they have higher expectations.
c.
Is distinguished by irritability, severe anxiety, and panic attacks.
d.
Will disappear on its own without outside help.

ANS: C

Feedback
A
PPD even without psychotic features is more serious and persistent than postpartum baby blues.
B
PPD is more common among younger mothers and African-American mothers.
C
PPD is also characterized by spontaneous crying long after the usual duration of the baby blues.
D
Most women need professional help to get through PPD, including pharmacologic intervention.

DIF: Cognitive Level: Comprehension REF: 741
OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

3. The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by:
a.
Subinvolution of the placental site.
b.
Defective vascularity of the decidua.
c.
Cervical lacerations.
d.
Coagulation disorders.

ANS: A

Feedback
A
Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments.
B
Although defective vascularity of the decidua may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.
C
Although cervical lacerations may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.
D
Although coagulation disorders may cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.

DIF: Cognitive Level: Comprehension REF: 726
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

4. The nurse should be aware that a pessary would be most effective in the treatment of what disorder?
a.
Cystocele
b.
Uterine prolapse
c.
Rectocele
d.
Stress urinary incontinence

ANS: B

Feedback
A
A pessary is not used for the treatment of cystoceles.
B
A fitted pessary may be inserted into the vagina to support the uterus and hold it in the correct position.
C
A pessary is not used for the treatment of rectoceles.
D
A pessary is not used to treat stress urinary incontinence.

DIF: Cognitive Level: Knowledge REF: 740
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

5. One of the first symptoms of puerperal infection to assess for in the postpartum woman is:
a.
Fatigue continuing for longer than 1 week.
b.
Pain with voiding.
c.
Profuse vaginal bleeding with ambulation.
d.
Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.

ANS: D

Feedback
A
Fatigue would be a late finding associated with infection.
B
Pain with voiding may indicate a urinary tract infection, but it is not typically one of the earlier symptoms of infection.
C
Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.
D
Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth.

DIF: Cognitive Level: Comprehension REF: 735
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment