Obstetric Nurse Postpartum Complications Questions and Answers — Questions and Answers
Question 1: A client, 4 hours postpartum from a forceps-assisted vaginal delivery, reports intense, persistent perineal pain and a strong sensation of rectal pressure. Her fundus is firm at the umbilicus, and lochia rubra is moderate. What is the most likely cause of her symptoms?
- Uterine atony
- Puerperal hematoma (Correct answer)
- Bladder distention
- Perineal laceration infection
Correct answer: Puerperal hematoma
Intense perineal pain, a feeling of fullness, and rectal pressure that are disproportionate to visible trauma are classic signs of a developing puerperal hematoma, especially with a firm, contracted uterus. Forceps-assisted delivery is a significant risk factor for this complication.
Question 2: A client at her 2-week postpartum check-up is concerned because her vaginal bleeding, which had decreased to lochia serosa, has now become heavier and red again. She also reports ongoing pelvic discomfort. The nurse should suspect which late postpartum complication?
- Postpartum endometritis
- Subinvolution of the uterus (Correct answer)
- Deep vein thrombosis
- Normal lochia progression
Correct answer: Subinvolution of the uterus
Subinvolution is the failure of the uterus to return to its non-pregnant state in the expected timeframe. It is characterized by prolonged lochial discharge, irregular or excessive bleeding, and a uterus that is larger than expected for the postpartum period. Endometritis would typically also present with fever and foul-smelling lochia.
Question 3: A nurse is providing education to a new mother on preventing mastitis. Which statement by the mother indicates a correct understanding of the teaching?
- "I should stop breastfeeding from the sore breast to let it heal."
- "A tight-fitting bra will help reduce milk flow and prevent engorgement."
- "I need to ensure my baby latches on correctly and empties the breast with each feeding." (Correct answer)
- "If my breast gets sore, applying cold packs before feeding will be most helpful."
Correct answer: "I need to ensure my baby latches on correctly and empties the breast with each feeding."
The most effective strategies for preventing and managing mastitis involve ensuring proper latch and frequent, complete emptying of the breasts to prevent milk stasis. Stopping breastfeeding on the affected side can worsen the condition, and tight bras can obstruct milk flow. Warm compresses are typically recommended before feeding to facilitate milk flow.
Question 4: A client who is 3 days postpartum suddenly becomes extremely agitated and confused. She tells the nurse that she hears voices saying her baby is an evil entity. Her partner states she has not slept and is talking nonsensically. These findings are most characteristic of which complication?
- Postpartum anxiety disorder
- Severe postpartum 'baby blues'
- Postpartum depression
- Postpartum psychosis (Correct answer)
Correct answer: Postpartum psychosis
Postpartum psychosis is a medical emergency characterized by a rapid onset of symptoms including hallucinations, delusions, paranoia, and disorganized thoughts or behavior. These symptoms represent a break from reality and are distinct from the mood swings of 'baby blues' or the persistent sadness of postpartum depression.
Question 5: A nurse is assessing a client 30 minutes after the delivery of a 4,200-gram infant. The client has a continuous, steady stream of bright red vaginal bleeding. Upon palpation, the uterine fundus is firm and located at the umbilicus. These findings are most suggestive of which complication?
- Uterine atony
- Bladder distention
- Cervical laceration (Correct answer)
- Retained placental fragments
Correct answer: Cervical laceration
A steady trickle of bright red blood in the presence of a firm, well-contracted uterus is the classic sign of a genital tract laceration (e.g., cervical or vaginal). Uterine atony, the most common cause of PPH, would present with a soft, boggy uterus.
Question 6: A postpartum client experiencing a massive hemorrhage develops disseminated intravascular coagulation (DIC). Which of the following laboratory findings would the nurse anticipate?
- Increased platelet count and increased fibrinogen
- Prolonged prothrombin time (PT) and decreased D-dimer
- Decreased platelet count and increased fibrin degradation products (FDPs) (Correct answer)
- Increased hematocrit and normal activated partial thromboplastin time (aPTT)
Correct answer: Decreased platelet count and increased fibrin degradation products (FDPs)
In DIC, a widespread activation of the clotting cascade leads to the consumption of platelets and clotting factors, resulting in thrombocytopenia (decreased platelets) and low fibrinogen. The subsequent breakdown of clots leads to elevated levels of fibrin degradation products (FDPs) and D-dimer. Coagulation times like PT and aPTT become prolonged.
