Chapter 37 The Postpartum Family at Risk

Chapter 37   The Postpartum Family at Risk

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1) The charge nurse is assessing several postpartum clients. Which client has the greatest risk for postpartum hemorrhage?

1. The client who was overdue and delivered vaginally
2. The client who delivered by scheduled cesarean delivery
3. The client who had oxytocin augmentation of labor
4. The client who delivered vaginally at 36 weeks

Answer:  3

Explanation:  3. Uterine atony is a cause of postpartal hemorrhage. A contributing factor to uterine atony is oxytocin augmentation of labor.

Page Ref: 968

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Reduction of Risk Potential

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Identify the causes, contributing factors, signs and symptoms, clinical therapy, and nursing interventions for early and late hemorrhage during the postpartum period.

MNL LO:  5.3.2 Compare the various etiologies and management of postpartum hemorrhage.

2) The nurse is assisting a multiparous woman to the bathroom for the first time since her delivery 3 hours ago. When the client stands up, blood runs down her legs and pools on the floor. The client turns pale and feels weak. What would be the first action of the nurse?

1. Assist the client to empty her bladder
2. Help the client back to bed to check the fundus
3. Assess her blood pressure and pulse
4. Begin an IV of lactated Ringer’s solution

Answer:  2

Explanation:  2. Massaging the fundus is the top priority because of the excessive blood loss. If the fundus is not firm, gentle fundal massage is performed until the uterus contracts.

Page Ref: 969

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Current best practices. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Identify the causes, contributing factors, signs and symptoms, clinical therapy, and nursing interventions for early and late hemorrhage during the postpartum period.

MNL LO:  5.3.2 Compare the various etiologies and management of postpartum hemorrhage.

3) A client is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Methergine
2. Coumadin
3. Misoprostol
4. Serotonin reuptake inhibitors (SSRIs)
5. Nonsteroidal anti-inflammatory drugs

Answer:  1, 3

Explanation:  1. Methergine is commonly used orally for postpartum hemorrhage.

3. Misoprostol is commonly used rectally for postpartum hemorrhage.

Page Ref: 971, 972

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Reduction of Risk Potential

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Relationship-Centered Care: Current best practices. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Identify the causes, contributing factors, signs and symptoms, clinical therapy, and nursing interventions for early and late hemorrhage during the postpartum period.

MNL LO:  5.3.2 Compare the various etiologies and management of postpartum hemorrhage.

4) The client has experienced a postpartum hemorrhage at 6 hours postpartum. After controlling the hemorrhage, the client’s partner asks what would cause a hemorrhage. How should the nurse respond?

1. “Sometimes the uterus relaxes and excessive bleeding occurs.”
2. “The blood collected in the vagina and poured out when your partner stood up.”
3. “Bottle-feeding prevents the uterus from getting enough stimulation to contract.”
4. “The placenta had embedded in the uterine tissue abnormally.”

Answer:  1

Explanation:  1. Uterine atony (relaxation of the uterus) is the leading cause of early postpartum hemorrhage, accounting for over 50% of postpartum hemorrhage cases.

Page Ref: 968

Cognitive Level:  Understanding

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Identify the causes, contributing factors, signs and symptoms, clinical therapy, and nursing interventions for early and late hemorrhage during the postpartum period.

MNL LO:  5.3.2 Compare the various etiologies and management of postpartum hemorrhage.

5) The nurse is assessing a client who has been diagnosed with an early postpartum hemorrhage. Which findings would the nurse expect?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. A boggy fundus that does not respond to massage
2. Small clots and a moderate amount of lochia rubra on the pad
3. Decreased pulse and increased blood pressure
4. Hematoma formation or bulging/shiny skin in the perineal area
5. Rise in the level of the fundus of the uterus

Answer:  1, 4, 5

Explanation:  1. A boggy fundus indicates that the uterus is not contracted and will continue to bleed.

4. Shiny or bulging skin could indicate the presence of a hematoma.
5. The uterine cavity can distend with up to 1000 mL or more of blood causing the fundus to rise.

Page Ref: 969, 973, 976

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  1 Identify the causes, contributing factors, signs and symptoms, clinical therapy, and nursing interventions for early and late hemorrhage during the postpartum period.

MNL LO:  5.3.2 Compare the various etiologies and management of postpartum hemorrhage.