Chapter 33 Postpartum Family Adaptation and Nursing Assessment

Chapter 33   Postpartum Family Adaptation and Nursing Assessment

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1) The nurse determines the fundus of a postpartum client to be boggy. Initially, what should the nurse do?

1. Document the findings.
2. Catheterize the client.
3. Massage the uterine fundus until it is firm.
4. Call the physician immediately.

Answer:  3

Explanation:  3. The nurse would massage the uterine fundus until it is firm by keeping one hand in position and stabilizing the lower portion of the uterus. With one hand used to massage the fundus, the nurse would put steady pressure on the top of the now-firm fundus and to see if she was able to express any clots.

Page Ref: 874

Cognitive Level:  Applying

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

Standards:  QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | 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: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Delineate the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state.

MNL LO:  5.2.1 Determine nursing interventions that promote maternal comfort during the postpartum period.

2) The nurse is caring for a postpartum client who is experiencing afterpains following the birth of her third child. Which comfort measure should the nurse implement to decrease her pain?

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

Select all that apply.

1. Offer a warm water bottle for her abdomen.
2. Call the physician to report this finding.
3. Inform her that this is not normal, and she will need an oxytocic agent.
4. Administer a mild analgesic to help with breastfeeding.
5. Administer a mild analgesic at bedtime to ensure rest.

Answer:  1, 4, 5

Explanation:  1. A warm water bottle placed against the low abdomen may reduce the discomfort of afterpains.

4. The breastfeeding mother may find it helpful to take a mild analgesic agent approximately 1 hour before feeding her infant.
5. An analgesic agent such as ibuprofen is also helpful at bedtime if the afterpains interfere with the mother’s rest.

Page Ref: 867

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patient’s emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Delineate the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state.

MNL LO:  5.2.1 Determine nursing interventions that promote maternal comfort during the postpartum period.

3) The nurse would expect a physician to prescribe which medication to a postpartum client with heavy bleeding and a boggy uterus?

1. Methylergonovine maleate (Methergine)
2. Rh immune globulin (RhoGAM)
3. Terbutaline (Brethine)
4. Docusate (Colace)

Answer:  1

Explanation:  1. Methylergonovine maleate is the drug used for the prevention and control of postpartum hemorrhage.

Page Ref: 875

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Pharmacological and Parenteral Therapies

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | 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: Knowledge and Science: Value evidence-based approaches to yield best practices for nursing. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Delineate the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state.

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

4) A postpartum client has inflamed hemorrhoids. Which nursing intervention would be appropriate?

1. Encourage sitz baths.
2. Position the client in the supine position.
3. Avoid stool softeners.
4. Decrease fluid intake.

Answer:  1

Explanation:  1. Encouraging sitz baths is the correct approach because moist heat decreases inflammation and provides for comfort.

Page Ref: 882

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patient’s emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Delineate the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state.

MNL LO:  5.2.1 Determine nursing interventions that promote maternal comfort during the postpartum period.

5) The nurse assesses the postpartum client who has not had a bowel movement by the third postpartum day. Which nursing intervention would be appropriate?

1. Encourage the new mother, saying, “It will happen soon.”
2. Instruct the client to eat a low-fiber diet.
3. Decrease fluid intake.
4. Obtain an order for a stool softener.

Answer:  4

Explanation:  4. Obtaining an order for a stool softener is the correct intervention by the third day. In resisting or delaying the bowel movement, the woman may cause increased constipation and more pain when elimination finally occurs.

Page Ref: 879

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. 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: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  1 Delineate the basic physiologic changes that occur in the postpartum period as a woman’s body returns to its pre-pregnant state.

MNL LO:  5.2.1 Determine nursing interventions that promote maternal comfort during the postpartum period.