How often should VS be taken on a mom following a C/S delivery?

A. q 15 min X 4 then q 30 min X 2

B. q 5 min for 30 min then q 30 X 2

C. q 10 min X 6 then q 30 X 4

D. q 30 min X 4 then q hour X 2

What findings should the RN expect of the mom immediately following delivery?

A. increased BP & HR

B. decreased BP & HR

C. increased HR & decreased BP

D. decreased HR & increased BP

The student nurse checks VS on a mom 15 mins following delivery of her baby.  He reports that she is running a temp of 100.4^F.  What should be the nurse's response?

A. immediately notify the physician

B. take a CBC and assess for infection

C. prepare to admin antipyretics for fever

D. chart as a normal finding

D. chart as a normal finding;

Immediately following delivery it is normal for the mother to run a low grade fever up to 100.4^F due to exhaustition or dehydration

A couple return to the clinic 4 days following delivery of their baby.  The baby is doing well but the parents are concerned because the mother has had a fever sporatically for today and the day before.  What should be the RN's response?

A. this is normal due to the production of true breast milk

B. this is a sign of a possible infection

C. start an IV and begin running .45%NS

D. notify the MD as this could be an emergency

A. this is normal due to the production of true breast milk;

The thing to remember that it will be a LOW grade fever and is RANDOM, it is not a CONSTENT fever.

What are the appropriate nursing interventions for a mom presenting with "postpartum shakes"?

A. run LR @ 125mL/hr

B. stop Pitocin infusion until shakes stop

C. get the pt to relax and cover with a warm blanket

D. call the MD and prepare for an emergency D&C

C. get the pt to relax and cover with a warm blanket;

"PP shakes" are a normal reaction to the adjustment the woman's body is making to the volume change following delivery or caused by anesthesia

True;

"PP Diuresis" is a normal condition.  If the mother has a Foley inserted it may need to be kinked to prevent hypovolemic shock.  Keep an eye on the bag, it will fill up quickly.

Following delivery, what is the longest time that should pass before the mom is up and voiding?

A. 30-45 mins

B. 1-2 hrs

C. 3-4 hrs

D. 4-6 hrs

D. 4-6 hrs;

the mother should be up and voiding around this time

Immediately following delivery what is the location of the fundus?

A. midway between the symphisis pubis and umbilicus

B. level with the umbilicus

C. 3 cm superior to the umbilicus

D. 1 fingerbreath above the umbilicus

How long following delivery does it take the fundus to reach level with the umbilicus?

A. immediately

B. within 6 hrs

C. within 12 hrs

D. within 24 hrs

C. within 12 hrs;

Immediately following delivery the fundus is about midway between the symphisis pubis and the umbilicus.  Within 12 hrs it should be about level with the umbilicus and be one fingerbreath (cm) lower every 24 hrs.

Which are appropriate interventions to alleviate a "boggy" fundus?  Select all that apply

A. ambulate the pt q 30 mins

B. massage the fundus

C. IV Pitocin

D. IV Protonix

E. IM methergine

F. have mom breastfeed the baby

B,C,E,F

A. doesn't help

B. causes fundus to become firm

C. causes uterine ctx

D. is a PPI

E. causes smooth muscle ctx

F. stimulates release of natural oxytocin (which causes uterine ctx)

Term used to describe the changes the female reproductive organs (esp the uterus) undergo to return to their prepregnancy condition?

A. ballottement

B. regression

C. degradation

D. involution

Which are the 3 types of lochia?

A. lochia alba

B. lochia sangrious

C. placental lochia

D. lochia rubra

E. lochia serosa

A,D,E

lochia alba, rubra, serosa

Your pt delivered a baby 2 days ago and is experiencing dark red vaginal flow equivalent to a heavy menstrual flow with nickel sized clots.  What intervention is appropriate?

A. chart the findings, this is within expected limits

B. ensure 18g IV access and expect ordered blood product

C. expect order for Pitocin, she shouldn't be bleeding this much by now

D. admin Lovenox sub Q for clots

A. chart the findings, this is within expected limits

You won't be administering blood or Pitocin as lochia rubra is expected for 2-3 days and approximately the amount of a moderate or heavy menstrual flow. 

Describe lochia serosa.  Select all that apply

A. clear, blood tinged (pink) discharge

B. usually noticed when wiping after voiding

C. contains nickel and dime sized clots

D. lasts until around 21 days postpartum

A,B

lochia rubra contains nickel and dime sized clots, lochia serosa lasts until around 10 days postpartum, not 21

Healing of the placental site and return of the uterus to its prepregnancy size takes approximately how long?

A. 6 wks

B. 12 wks

C. 1 year

D. it never returns to it prepregnancy size

The placental site heals by scaling off the dead tissue.  New endometrium is generated from glands and tissue that remain.  This process leaves the uterine lining free of scar tissue thereby protecting future pregnancies.  This process is called:

A. involution

B. regeneration

C. deciduagenesis

D. exfoliation

When determining lochia flow, "heavy" is considered a peripad that is saturated how quickly?

A. 15 mins

B. 30 mins

C. 45 mins

D. 1 hr

When determining lochia flow, "excessive" is considered when a peripad is saturated how quickly?

A. 5 mins

B. 15 mins

C. 30 mins

D. 45 mins

An episiotomy that extends through the anal sphincter into the rectal mucosa:

A. 1st

B. 2nd

C. 3rd

D. 4th

An episiotomy that involves the superficial vaginal mucosa or perineal skin:

A. 1st

B. 2nd

C. 3rd

D. 4th

An episiotomy that includes the vaginal mucosa, perineal skin, and deeper tissues, which may include muscles of the perineum:

A. 1st

B. 2nd

C. 3rd

D. 4th

An episiotomy that involves the vaginal mucosa, perineal skin, deeper tissue, and the anal sphincter:

A. 1st

B. 2nd

C. 3rd

D. 4th

Average blood loss of a vaginal delivery:

A. 500ml

B. 750ml

C. 1000ml

D. 1150ml

Average blood loss during a C/S delivery:

A. 250ml

B. 500ml

C. 650ml

D. 1000ml

Immediately following delivery the mother's cardiac output:

A. increases

B. decreases

A. increases;

this increase generally last 10-15 mins then falls back to the prelabor (still higher than prepregnancy) level about an hour after childbirth, but remains elevated for approximately 48 hrs.  Cardiac output decreases and returns to normal levels by 6 - 12 wks. 

This exerpt confuses me but is word for word out of Evolve: Maternal-Child Nursing Third Ed p 459 first paragraph

The mother's rise in cardiac output for the 10-15 mins immediately following delivery are caused by: Select all

A. electrolyte imbalances r/t dehydration

B. peripheral hypoxia

C. increase in flow back to the heart

D. decreased pressure on the vessels from the uterus

E. mobilization of excess extracellular fluid into the vascular compartment

C,D,E

with C. despite the blood loss the return of blood from the uteroplacental unit to central circulation is part of the rise in cardiac output

True;

A HR of 50-60 is expected

What are two ways the maternal body rids itself of excess plasma volume following delivery?

A. oliguria

B. diaphoresis

C. macrophages

D. diuresis

B. diaphoresis (profuse sweating)

&

D. diuresis (increased excretion of urine)

A 27 yr old female patient is 2 days postpartum on the unit.  Her UOP is 2500ml for the past 24 hrs, she is bleeding what she compares to a heavy menstrual flow, her Hct is 36%, and her WBC count is 21,000, and she has been shaking.  What would be the appropriate intervention?

A. try to get her to relax and offer her a blanket

B. ensure 18g IV access, she is anemic and will need blood

C. expect orders for cultures and broad spec antibiotics

D. restrict fluids and admin Lasix, she has fluid overload

A. try to get her to relax and offer her a blanket; to alleviate her "postpartum shakes"

pregnant moms are psuedoanemic due to excess volume and this doesn't return to normal until 4-6 wks postpartum.  WBC levels can reach as high as 30,000 in the postpartum period and UOP of up to 3,000ml/day is common especially on days 2-5.

A decrease of what hormone postpartum leads to decreased sodium retention and consequently increased excretion of urine?

A. hCG

B. progesterone

C. estrogen

D. aldosterone

D. aldosterone;

which increases during pregnancy to counteract the salt-wasting effect of progesterone

Plasma fibrinogen and other clotting factors increase during pregnancy.  Fibrinolysis is decreased during pregnancy and increases shortly after delivery, but clotting factors continue to be elevated for several days or longer after birth causing an increased risk of thrombus.  How long follwing delivery until the woman has a return to prepregnancy homeostasis?

A. 1-2 wks

B. 2-4 wks

C. 4-6 wks

D. 6-8 wks

When is the woman typically expected to have her first bowel movement following delivery?

A. 12-16 hrs

B. 18-32 hrs

C. 32-38 hrs

D. 48-72 hrs

D. 48-72 hrs;

the woman is expected to have her first bowel movement between 2 and 3 days postpartum

The RN is giving discharge instructions to a couple on the postpartum unit.  The mother asks when she can expect her bowel movements to become routine again.  What is the nurse's best response?

A. in about 8-14 days

B. approximately 21 days

C. within a few days

D. they should be normal before discharge

You have just come on shift on your postpartum unit and received report.  Which patient should you check on first?

A. a multipara with a WBC of 27,000 immediate postpartum

B. a 26 yr od mom in early postpartum with a HR 57

C. a 17yr old mom who hasn't voided 3 hrs postpartum

D. a 23 yr primipara, fundus located 2 cm superior umbilicus

D a 23 yr primipara, fundus located 2 cm superior umbilicus;

A,B,C are expected a fundal height 2 cm above the umbilicus is higher than expected which could be a sign of hemorrhage

During childbirth the urethra, bladder, and tissue around the urinary meatus may become edematous and traumatized causing a diminished sensitivity to fluid pressure.  What are can this lead to?  Select all that apply

A. UTI

B. bladder distention

C. diastasis recti

D. hemorrhage

A,B,D;

diminished sensitivity leads to urine retention with can cause both bladder distention and UTI.  The bladder distention can displace the uterus superiorly leaving it unable to contract causing hemorrhage.  Bladder distention won't cause diastasis recti

You are giving discharge instructions for a primipara from the postpartum unit.  She has had diminished urinary sensation and asks when her urinary system will be back to normal.  Your correct response is:

A. around 1-2 wks postpartum

B. around 3-5 wks postpartum

C. around 6-8 wks postpartum

D. around 8-10 wks postpartum

During the first few days, levels of the hormone ______ gradually subside and the ligaments and cartilage of the pelvis begin to return to normal.  These changes can cause hip or joint pain that interferes with ambulation.

A. relaxin

B. estrogen

C. hCG

D. prolactin

A 17 yr old primipara calls the unit 5 wks postpartum and says she noticed yellowish-white discharge when wiping after voiding.  What would the RN's response be?

A. it appears you have contracted an STD

B. this is normal progression of lochia

C. this is a sign of a UTI

D. this is caused by vaginal lacerations healing

B. this is normal progression of lochia;

Lochia alba- a clear, to yellowish-white discharge noted when wiping that lasts up to 6 wks postpartum.  Progressoin from lochia rubra to serosa to alba indicates uterine healing

Which of these are possible signs of hemorrhage?  Select all that apply

A. regression in lochia

B. return of clots

C. fever

D. headache

E. boggy fundus

F. fundus above the expected level

Instructions for the postpartum mom pertaining to voiding and bowel movements:

A. use warm water squirt bottle, pat dry

B. wipe vagina back to front, anus front to back

C. cleansing must be performed by the RN

D. cleansing may be performed but only in the shower

Your patient is 12 hrs postpartum and complains of discomfort at her perineum.  What interventions are appropriate?  Select all that apply

A. heat lamp, 3-4 times daily for 20 mins

B. sitz bath

C. ice placed in sterile glove

D. anesthetic spray

E. ibuprofen

B,C,D,E;

heat lamps are used AFTER 24 hrs.  Sitz baths and ice are comfort measures.  Anesthetic spray is used for episiotomy or hemorrhoid discomfort and ibuprofen is frequently used for its antiinflammatory property along with prescribed analgesics.

Your patient is post C/S delivery and complains of gas pain.  You know this is due to her body reabsorbing gas trapped in the abd spacing.  The appropriate intervention is:

A. PO Zofran

B. fundal massage

C. PO Pepcid

D. ambulation

D. ambulation;

is the only way to get rid of the gas

Colace is typically a standing order on the postpartum unit.  It is taken PO BID.  How does Colace work?

A. brings water into the colon softening stools

B. slows peristalisis allowing more time for water absorbtion in stool

C. speeds up peristalisis to promote smaller, more frequent stools

D. neutralizes gastric acid allowing better absorbtion of nutrients which causes softer stools

False;

the postpartum woman's first BM is usually 2-3 days after delivery.  The first BM is normal but the second is usually uncomfortable

Define "bikini-line cut"

as pertains to C/S delivery

Define "classic cut"

as pertains to C/S delivery

False;

the pressure dressing should remain in place for 24 hours not 18.  Any drainage should be circled then dated and initailed

True;

this is usually given with an NSAID of some kind (ibuprofen) for aches and pains

Your patient will be going for a scheduled C/S delivery this morning.  What orders can you expect for this patient following the procedure? Select all that apply

A. ambulation @ 6 hours

B. PCA pump with morphine

C. Foley

D. turn, cough, and deep breathe q 2 hrs

E. sequential compression devices

B,C,D,E;

-women post C/S are on strict bedrest for 8-12 hrs

-PCA pumps may be used with morphine or dilaudid, telemetry HAS to be used for these and usually a pulse ox

-Foley placement is standard

-women are encouraged turn, cough, and deep breathe q 2 hrs while awake to prevent pooling of secretions; remember to splint the abd

-compression stockings to prevent DVT

oxygen sat is documented hourly when on pulse ox

Following a C/S delivery the Foley, PCA pump, telemetry are all disconnected and ambulation and PO meds are started at:

A. 12 hrs

B. 24 hrs

C. 36 hrs

D. 48 hrs

When the Foley is discontinued for your C/S delivery patient you know you will need to measure the first ____ void(s).

A. 1

B. 2

C. 3

D. 4

Discharge instructions for a mom from the postpartum unit include: Select all that apply

A. menstrual cycle will resume around 6-8 wks

B. increasing hormone levels may cause a rise in sexual arousal, but intercourse should be avoided 4-6 wks

C. first few menstrual flows will be heavier

D. use pads not tampons for the first 4-6 wks

E. lift nothing over 10 lbs for 2 wks

F. no driving for 6 wks

G. schedule a postpartum visit within 2-3 days

C,D,E;

-menstrual cycle will resume in 4-6 wks not 6-8

-hormone levels decreased can cause low libido and poor vaginal lubrication

-first menstrual flows will be heavier and tampons shouldn't be used for 4-6 wks (same as intercourse)

-no lifting over 10 lbs for the first 2 wks

-no driving for 2 wks not 6 (slowed reflexes)

-schedule postpartum visit for 4 wks, schedule a pediatric visit for 2-3 days

Homan's sign is an indicator of what?

A. DVT

B. appendicitis

C. increased intracranial pressure

D. decreased level of consciousness

A. DVT; Homan's sign is discomfort felt when the foot is dorsoflexed.

Other signs of DVT are redness, tenderness, or warmth of the leg

The normal stay at the hospital for a mom with a vaginal delivery is?

A. 24 hrs

B. 48 hrs

C. 72 hrs

D. 96 hrs

The normal stay in the hospital of a mom with a C/S delivery is?

A. 24 hrs

B. 48 hrs

C. 72 hrs

D. 96 hrs

D. 96 hrs

What is the time frame for administering RhoGAM postpartum to the mother who is Rh^-?

A. 6 hrs

B. 24 hrs

C. 72 hrs

D. at the 4 week visit

C. 72 hrs;

RhoGAM should be aministered to the RH^- mom within this time frame in order to protect future pregnancies

A Rubella screen is done on each pregnant woman to determine is she is immune.  If she is not it is recommended she have the vaccine before leaving for what reason?

A. she could catch Rubella from the infant

B. she could acquire Rubella and give it to the infant

C. her risk of hemorrhage is greater if not immune

D. prevent acquiring Rubella during future pregnancies

D. prevent acquiring Rubella during future pregnancies;

acquiring Rubella during a pregnancy can cause serious fetal anomalies

What recommendation comes with administration of the Rubella vaccine to a postpartum mom?

A. not to become pregnant within 28 days

B. limit environmental exposure due to weakened immune system for 3 days

C. avoid excessive sun exposure for 7 days

D. avoid extreme hot or cold for 14 days

A. not to become pregnant within 28 days;

the vaccine is a live virus and has some risk of fetal defects occuring if the mom becomes pregnant to soon after receiving the vaccine

-starting doses range from 0.5-6 mU/min

-increasing dosage by 1-2 mU/min q 15-45 mins

(high dose protocol may increase by up to 6 mU/min)

-the actual dose is based on uterine response and absence of adverse effects

-augentation of labor usually follow low dose protocol

-once an adequate ctx pattern is established and the cervix is dialated 5-6 cm, the dosage is reduced by similar amounts

-IV dilute 10-40 units in 1000 mL solution

-begin rate at 20-40 mU/min increasing or decreasing the rate based on uterine response

-IM 10 units given after delivery of the placenta

Oxytocin is absorbed ________ when administered IV and __________ when administered IM.

A. 3-5 mins, 15-30 mins

B. immediately, 3-5 mins

C. immediately, 10-15 mins

D. 3-5 mins, 5-10 mins

You are an evening shift RN on the postpartum unit and one of your patients, who delivered vaginally this morning, is having voids measuring around 100 mL per void.  What should your initial intervention be?

A. chart the amount of UOP and continue to monitor

B. notify the physician immediately

C. assess the bladder with a Doppler

D. assess the fundus

D. assess the fundus;

postpartum UOP less than 150 mL per void suggests urinary retention which can cause a distended bladder.  This can be seen with a Doppler but the uterus is displaced by a distended bladder causing it to be non-midline or above the umbilicus and it will not be firm.  You should assess the fundus first.

The postpartum mom is encouraged to drink _______ mL of fluid daily.

A. 500

B. 750

C. 1000

D. 2500

A single dose of opioid (morphine or fentanyl) injected into the epidural or subarachnoid space immediately following a C/S delivery provides _______ hrs of analgesia.

A. 6-8

B. 4-6

C. 10-12

D. 18-24

Which assessment is an indication that a postpartum C/S delivery patient is ready to advance from a clear diet to a soft diet?

A. passing of flatus

B. pt states no nausea

C. 18 hrs, when anesthesia has worn off

D. immediately following 1st breastfeeding session

Which are measures to prevent abdominal distention in a postpartum C/S delivery patient?  Select all that apply

A. early, frequent ambulation

B. avoiding carbonated beverages and straws

C. tightening and relaxing abd muscles

D. Simethicone, as ordered

E. rectal suppositories, as ordered

F. pelvic lifts

ALL;

-ambulation is the best method to prevent abd distention

-Simethicone helps disperse upper gastrointestinal flatulence

-rectal suppositories stimulate peristalisis and the passage of flatus

True;

using soap to wash the nipples will remove the natural lubrication provided by the Montgomery's glands

While giving discharge instructions to a postpartum mom she states that she will be formula feeding the baby.  What should you teach this mother to do to avoid breast distention and suppress milk production?

A. massage the breast 4-5 times daily for 15 mins

B. apply a heating pad to the breast 3-4 times daily for 30 mins

C. pump the breast BID until production ceases

D. wear a well-fitting support bra 24 hrs daily until breasts become soft

D. wear a well-fitting support bra 24 hrs daily until breasts become soft;

-discomfort can be relieved by applying ice or with analgesics

-all other choices should be avoided

The process of maternal role adaption according to Rubin has three phases.  What are they?  Select three

A. taking up

B. taking in

C. taking hold

D. letting go

According to Rubin, during the taking in phase of postpartum adaption, the mom spends the first 1-2 days focused on what?

A. her own needs

B. learning her baby

C. her new family structure

D. her new role as a mother

A. her own needs; for fluid, food, and sleep

-while Rubin believed this lasted approximately 2 days it is more likely this lasts 24 hrs or less today.

-the mother will take in every detail of the infant but seems content to allow others to make decisions

You are an RN on the postpartum unit and one of your patients has become more assertive in taking care of herself and the behaviors of her baby.  She has begun to ask a lot of questions about the care of her newborn.  What phase of the maternal role adaption has she entered?

A. taking in

B. taking hold

C. letting go

B. taking hold;

this is when the mother becomes more independant, relying less on healthcare providers and begins to manage her own body functions and assumes reponsibility for her own care.  She also is more interested in hearing information of her baby's behaviors

Which phase of Rubin's maternal role adaption is characterized by the parents accepting a lifestyle that is less carefree and accepting perceived short comings in the size, sex, or characteristics of their baby?

A. taking in

B. taking hold

C. letting go

There are two types of postpartum hemorrhage, early which occurs within _______ hrs, and late which occurs between _________.

A. 6, 24-36 hrs

B. 24, 24-96 hrs

B. 36, 2-10 days

D. 24, 24 hrs and 2 wks

The most common cause of early postpartum hemorrhage is:

A. eclampsia

B. dehydration

C. atony

D. retained placental fragments

The most common cause of late postpartum hemorrhage is:

A. uterine atony

B. UTI

C. trauma

D. retained placental fragments

RhoGAM is given at ____ wks gestation for RH^- moms to prevent possible blood incompatibility.

A. 6

B. 18

C. 28

D. 36

Why does a uterine atony cause hemorrhage?

A. pooled blood is allowed to flow out to quickly

B. muscle fibers fail to contract around blood vessles

C. uterine inversion is occuring

D. disseminated intravascular clotting

Which are predisposing factors for postpartum hemorrhage?  Select all that apply

A. overdistention of the uterus

B. prolonged labor

C. precipitate labor

D. labor induced with oxytocin

E. obesity

F. preeclampsia

A,B,C,D

-overdistention of the uterus can be caused by multiple gestation, large infant, hydramnios, etc

-precipitate labor caused by excessively vigorous ctx

Which are early signs of postpartum hemorrhage?  Select all that apply

A. preeclampsia

B. gestational diabetes

C. low birth weight

D. severe, unrelieved perineal or rectal pain

E. tachycardia

D,E;

-also an uncontracted uterus

-large gush or slow trickle of blood from the vagina

-saturation of more than one peripad per 15 mins

False;

it is actually critical that the uterus be contracted or the nurse may cause the uterus to invert which would cause massive hemorrhage

Put these interventions in order they should be performed to stop postpartum hemorrhage.

A. bimanual compression

B. IV oxytocin

C. hysterectomy

D. fundal massage

E. ligation of uterine arteries

D, B, A, E, C;

-bimanual compression is performed by the MD or nurse-midwife, one hand is inserted into the vagina and the other compresses the uterus through the abdominal wall

False;

These drugs will be the initial intervention for retained placental framents

The pregnant mom can tolerate blood loss that approaches the volume added during pregnancy which is approximately:

A. 500 mL

B. 1000 mL

C. 1500 mL

D. 2000 mL

C. 1500 mL;

after this amount hypovolemic shock can ensue

You are an RN on a postpartum unit.  You are reviewing the most recent lab results on your patient and you notice her Hct now is 6% lower than her prelabor level.  Just looking at this you can estimate she lost how much blood?

A. 1000 mL

B. 750 mL

C. 600 mL

D. 2500 mL

D. 2500 mL;

-When looking at a Hct postpartum, if the level is lower after delivery the woman has lost the volume added during pregnancy (1500 mL) and 500 mL for every 3% drop

Signs and symptoms of hypovolemic shock are: Select all

A. bradycardia

B. decrease in blood pressure

C. increase in pulse pressure

D. decreased respirations

E. flushed skin

F. anxiousness

B, F;

-tachycardia is one of the earlist signs

-pulse pressure (the difference between systolic and dystolic pressures) decreases

-respirations increase as the woman becomes more anxious

-vasoconstriction causes pale, cool skin

Which are interventions for hypovolemic shock? Select all

A. establish a second IV access, 18g

B. restrict fluids

C. vasopressors

D. locate and stop bleed

E. Foley

F. O₂ 8-10L

A,C,D,E,F;

-18g IV access to admin blood products

-fluids are infused to maintain a UOP of at least 30 mL/hr

-vasopressors may be needed for low BP

-locating and stopping the bleed may consist of uterine packing, ligation of uterine ovarian or hypogastric arteries, or a hysterectomy

-Foley inserted to measure hourly UOP

-O₂ administered to increase the saturation of decreased RBCs

By ______, the uterus is no longer palpable above the symphysis pubis.

A. 5 days

B. 10 days

C. 14 days

D. 21 days

C. 14 days;

by approximately 2 weeks the uterus is no longer palpable above the symphysis pubis

Which of these are the two most common causes of subinvolution of the uterus?  Pick 2

A. retained placental fragments

B. pelvic infection

C. trauma

D. distended bladder

E. macrosomia

A,B;

usually treatment for retained placental fragments initially is PO methergine, pelvic infection is treated with antimicrobial therapy

The RN is giving discharge instructions for the postpartum woman.  Signs of subinvolution are included in the teaching.  These include: Select all that apply

A. progression of lochia

B. fundus that does not shrink

C. odorous lochia

D. backache

E. pelvic pressure

B,C,D,E;

-progression of lochia is a sign of involution (uterine healing)

-the fundus should drop 1 cm daily

-odorous lochia may be a sign of infection (which causes subinvolution)

-the more signs that are present the more likely subinvolution is to blame

The three major causes of thrombus in pregnant women are: Select three

A. preeclampsia

B. hypercoagulation

C. venous stasis

D. endothelial injury

B,C,D;

-hypercoagulation is caused by the increase in fibrin and fibrinogen during pregnancy and the suppression of the fibrinolytic system (clot dissolving)

-venous stasis is the abnormal slowing of blood flow which is caused by compression of large pelvic and leg  vessels by the uterus, standing for long periods leads to dialation and pooling of blood in these areas which can lead to thrombus formation

-endothelial is the inner most layer of the vessel and can be damaged during a C/S delivery with can trigger a thrombus to form

Risk factors of thrombosis in the pregnant woman are: Select all that apply

A. inactivity

B. obesity

C. C/S delivery

D. varicose veins

E. diabetes mellitus

F. age >30 yrs

ALL;

others include sepsis, history of thrombosis, trauma, prolonged labor, prolonged time in stirrups, smoking

Superficial Venous Thrombosis (SVT) is usually associated with varicose veins and typically limited to the calf area.  What are appropriate interventions for the postpartum mom with SVT?

A. bed rest, Lovenox sub q, compression stockings

B. ice packs, passive ROM exercises, analgesics

C. elevated legs, ice packs, Lovenox sub q

D. elevated legs, heat, support hose

D. elevated legs, heat, compression stockings

-elevated legs promotes venous return and prevents venous stasis

-anticoagulants are not needed, antiinflammatorys may be used

-ambulation is gradually began as signs disappear and support hose should be worn to prevent venous stasis

-pulmonary embolism is not a major concern with SVT

Heparin or Lovenox can be used during pregnancy prophylactically to prevent DVT.  (Heparin does not cross the placenta)  It is discontinued for labor and delivery but can be resumed ________ hrs after vaginal delivery and ________ after C/S delivery.

A. 3-6, 6-8

B. 2-4, 4-6

C. 4-7, 9-12

D. 12-16, 18-24

A. 3-6 hrs post vaginal, 6-8 hrs post C/S;

-women receiving Lovenox are switched to standard heparin at 36 wks because of its shorter half life and because epidual anesthesia is CONTRAINDICATED within 18-24 hrs of the last dose of Lovenox

-ambulation should be started as soon as the postpartum mom can tolerate, passive ROM excercises can be used until then

-she should avoid placing pillows under her knees in bed or having the knees sharply flexed

Interventions for the postpartum mom with DVT are: Select all that apply

A. Lovenox

B. scheduled ambulation

C. massage of site

D. elevated leg

E. moist heat

A,D,E;

-Lovenox can be switched to Coumadin for continued use of the postpartum mom, if she is pregnant Coumadin is CONTRAINDICATED due to teratogenic effects on the fetus it is safe to use while breastfeeding though

-massaging the site and ambulation could cause embolism

-elevation decreases interstitial swelling and promotes venous return

-moist heat provides pain relief and inproves circulation

Which foods should the postpartum mom on Coumadin avoid?

A. red meats

B. cereals

C. dairy

D. leafy vegetables

E. fruits

D. leafy vegetables;

-leafy vegetables such as broccoli, cabbage, lettuce, spinch contain high amounts of Vitamin K which may interfere with anticoagulation

Which are signs of pulmonary embolism? Select all

A. dyspnea

B. sycope

C. hemoptysis

D. bradycardia

E. abdominal pain

F. wheezing

A,B,C,E;

-dyspnea (difficultly breathing) and tachypnea are common

-sycope (fainting) may result from inadequate O₂

-hemoptysis (bloody sputum) is common

-tachycardia not bradycardia is a sign

-pulmonary rales not wheezing is a sign

-also cough, decreased O₂ sat, decreased partial pressure of oxygen on ABGs, chest radiography while show areas of atelectasis and pleural effusion

What are appropriate interventions for postpartum mom with pulmonary embolism? Select all that apply

A. scheduled ambulation

B. Trendelburg position

C. administer oxygen

D. narcotic analgesics

E. anticoagulant therapy

C,D,E;

-pt should be on bed rest with the head of the bed elevated

-oxygen is given to decrease hypoxia

-narcotics reduce pain and anxiety

-Heparin is given and can be switched to Coumadin for postpartum moms

-pt may need intensive care treatment or ventilation depending on respiratory status

You are an RN on a postpartum unit and one of your patients has a diagnosis of DVT.  Which of these findings would warrant immediate call to the physican?

A. warmth and tenderness of the calf

B. expiratory wheezing heard bilaterally

C. fever of 100.4^F

D. dyspnea and tachycardia

D. dyspnea and tachycardia; are sign of PE

-A. are expected with a DVT

-rales not wheezing are a sign of PE so this is unrelated

C. postpartum moms are expected to have a low grade fever

Which is the correct protocal for administering oxygen to the pt with pulmonary embolism?

A. 2-3 L via nasal canula, elevated HOB

B. 4-6 L via mask, elevated HOB

C. 8-10 L via mask, supine position

D. 8-10 L via mask, elevated HOB

The defining characteristic of puerperal infection is a fever of >100.4 occuring when?

A. at least 2 of the first 10 postpartum days

B. a single instant in the first 2 postpartum days

C. at least 3 consecutive days in the first postpartum week

D. at least 4 of the first 14 postpartum days

The entire female reproductive tract is connected and well supplied with blood vessels during pregnancy and after childbirth which can result in what life-threatening condition if an infection is present?

A. mastitis

B. septicemia

C. pulmonary embolism

Which changes at delivery increase the mother's risk for infection? Select all that apply

A. increased vaginal ph

B. trauma

C. C/S delivery

D. prolonged ROM

E. Foley placement

B,C,D,E;

the vaginal ph is decreased during childbirth due to alkalitic amniotic fluid, blood, and lochia

-postpartum women and expected to run a low grade fever up to 100.4^F and are expected to have a WBC of up to 30,000.  The signs of infection can also be masked by the signs of dehydration immediately postpartum.

-a temp >100.4^F is the most important sign of infection

If a pregnant woman is considered high risk for infection a prophylactic antibiotic may be given.  When would this be administered?

A. upon admission for delivery

B. when she reaches active labor

C. the third stage of labor

D. the fourth stage of labor

False;

-most UTIs in postpartum moms can be treated with antibiotics on an outpatient basis

-pyelonephritis during pregnancy may require IV hydration and IV antibiotics

The postpartum mom with a UTI is incouraged to drink how much fluid daily?

A. 1000-1500 mL

B. 2000-2500 mL

C. 2.5-3 L

D. 3-4 L

The postpartum mom with a UTI should be encouraged to drink what?

A. prune juice

B. grapefruit juice

C. Sprite

D. milk

A. prune juice;

-along with apricot and cranberry juice raise the acidity of urine reducing the ability of bacteria to grow

-carbonated drink and grapefruit juice increase the alkalinity of urine making it easier for bacteria to grow

When giving discharge instructions to the postpartum mom, the RN includes instructions on watching for signs of mastitis.  These include what?  Select all that apply

A. temp >or= 101.1^F

B. abd pain

C. altered LOC

D. headache

E. malaise

A,D,E

-also chills and a localized wedge-shaped area on the breast that is red, edematous, hot and painful

Which two interventions constitute initial treatment of mastitis?  Pick two

A. antibiotic treatment

B. continued expression of milk

C. antipyretics

D. I&D

A,B

-an incision and drainage may be performed later if an abscess develops

A postpartum patient on outpatient antibiotics for mastitis calls the clinic and asks what else can be done for her discomfort.  The RN correctly replies with which interventions?  Select all that apply

A. heat application only

B. allow the breast freedom from supportive bras

C. expression of milk via feeding or pump

D. analgesics

C,D

-heat and ice packs can be used

-the breasts need to be in a support bra at all times except feedings

-expression of milk will prevent abscess formation