Chapter 28 Postpartum Adaptation and Nursing Assessment

Chapter 28   Postpartum Adaptation and Nursing Assessment

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse has received an end of shift report on the postpartum unit. Which client should she see first?

1. Multipara, second day post-cesarean, moderate lochia serosa
2. Primipara, day of delivery, fundus firm 2 cm above umbilicus
3. Multipara, first postpartum day, 4 cm diastasis recti abdominis
4. Primipara, first postpartum day, hypoactive bowel sounds all quadrants

Answer:  2

Explanation:  1. This client is not experiencing any unexpected findings.

2. This client is the top priority. The fundus should not be positioned above the umbilicus after delivery. This high location could indicate an over distended bladder or uterine atony and excessive bleeding.
3. This finding is normal, especially in a multiparous patient.
4. Bowel sounds are often decreased after delivery.

Page Ref: 619, 620

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 28.1-Describe the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state, and the related nursing care.

MNL LO:  Examine the components of a postpartum assessment.

 

 

2) The nurse expects an initial weight loss for the average postpartum client to be:

1. 5 to 8 pounds.
2. 10 to 12 pounds.
3. 12 to 15 pounds.
4. 15 to 20 pounds.

Answer:  2

Explanation:  1. 5 to 8 pounds might be the loss after a preterm birth.

2. 10 to 12 pounds is the usual initial weight loss. This weight is lost with the birth of the infant and the expulsion of the placenta and the amniotic fluid.
3. 12 to 15 pounds is close, but it does not match the usual weight of placenta, amniotic fluid, and full-term infant weight.
4. 15 to 20 pounds might be the loss from a multiple birth.

Page Ref: 624

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 28.1-Describe the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state, and the related nursing care.

MNL LO:  Examine the normal physiologic changes expected in the postpartum client.

3) To assess healing of the uterus at the placental site, the nurse assesses:

1. Lab values.
2. Blood pressure.
3. Uterine size.
4. Type, amount, and consistency of lochia.

Answer:  4

Explanation:  1. Lab values is incomplete as an answer because it does not indicate which lab values are in question.

2. Blood pressure varies slightly in the normal postpartum woman and would not affect the placental site.
3. Uterine size alone is not enough to assess the placenta site.
4. Type, amount, and consistency of lochia determine the stage of healing of the placenta site, which occurs by a process of exfoliation.

Page Ref: 620-621

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 28.1-Describe the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state, and the related nursing care.

MNL LO:  Examine the normal physiologic changes expected in the postpartum client.

 

4) A Jewish client delivers a healthy baby boy on Thursday afternoon, and she is set to be discharged on Saturday morning. Why might this present a problem for the client?

1. Jewish custom is to have the infant circumcised 2 days after birth.
2. The woman will expect to be in the hospital at least 7 days after delivery.
3. Saturday is considered the Sabbath and she will not be able to leave the hospital that day.
4. The husband cannot touch his wife while she is experiencing vaginal discharge, so he will not be able to assist his wife to and from the vehicle.

Answer:  3

Explanation:  1. Jewish custom is to have the infant circumcised 8 days after birth, not 2 days after birth. Jewish couples will need to return to the hospital for circumcision of the infant after discharge.

2. The woman will expect to be cared for by her family for the first 7 days after delivery. This does not need to take place in the hospital and should not interfere with discharge from the hospital.
3. The Sabbath is sacred for Jews, and Jewish custom prohibits travel, writing, and the use of electricity on the Sabbath. Therefore, the woman will not travel home or sign any discharge forms until after the Sabbath.
4. If the patient had a normal delivery and healthy baby, she will be able to walk on her own. Therefore, this would not interfere with the woman’s discharge from the hospital.

Page Ref: 628

Cognitive Level:  Understanding

Client Need&Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 28.3-Explain the impact of cultural influence on providing nursing care during the postpartum period.

MNL LO:  Apply strategies to promote maternal well-being after birth including nutrition, rest, and activity.