Obstetric Nurse Postpartum Maternal Care Questions and Answers — Questions and Answers
Question 1: A nurse is assessing a client who is two hours postpartum. The client's fundus is palpated as boggy, 2 cm above the umbilicus, and deviated to the right. The client's lochia rubra flow is heavy. What is the nurse's priority action?
- Administer a PRN analgesic for afterpains.
- Assist the client to the bathroom to void. (Correct answer)
- Increase the rate of the intravenous oxytocin infusion.
- Document the findings and reassess in 30 minutes.
Correct answer: Assist the client to the bathroom to void.
The assessment findings of a boggy fundus, located above the umbilicus and deviated from the midline, are classic indicators of a distended urinary bladder. A full bladder impedes the uterus's ability to contract effectively, leading to uterine atony, which is a primary cause of postpartum hemorrhage. Assisting the client to empty her bladder is the priority nursing action to allow the uterus to contract properly and control bleeding.
Question 2: A nurse is providing discharge instructions to a new mother regarding normal postpartum lochia changes. Which statement by the client indicates a need for further teaching?
- "The reddish discharge, lochia rubra, should last for the first 3 to 4 days after birth."
- "I should call my doctor if I soak a perineal pad in an hour or less."
- "It is normal for my bleeding to turn bright red again after it has become a yellowish-white color." (Correct answer)
- "The discharge will become pinkish-brown, called lochia serosa, for about a week after the red flow stops."
Correct answer: "It is normal for my bleeding to turn bright red again after it has become a yellowish-white color."
The normal progression of lochia is from rubra (red) to serosa (pinkish-brown) to alba (yellowish-white). A return to bright red bleeding after the lochia has progressed to serosa or alba is an abnormal finding and may indicate late postpartum hemorrhage, which requires immediate medical evaluation. The other statements reflect an accurate understanding of normal lochia progression and warning signs.
Question 3: On postpartum day 4, a client who experienced a prolonged rupture of membranes reports uterine tenderness and chills. The nurse assesses a temperature of 101.5°F (38.6°C) and notes profuse, foul-smelling lochia. These findings are most indicative of which postpartum complication?
- Mastitis
- Endometritis (Correct answer)
- Urinary Tract Infection
- Thrombophlebitis
Correct answer: Endometritis
The classic signs and symptoms of endometritis, an infection of the uterine lining, include fever (typically >38°C), uterine tenderness, and foul-smelling lochia. A prolonged rupture of membranes is a significant risk factor for developing this infection. Mastitis would present with breast symptoms, a UTI with urinary symptoms, and thrombophlebitis with leg pain and swelling.
Question 4: A nurse is preparing to administer Rh(D) immune globulin to a postpartum client. Which of the following conditions must be met for this intervention to be appropriate?
- The mother is Rh-positive, and the newborn is Rh-negative.
- The mother is Rh-negative, and her direct Coombs test is positive.
- Both the mother and the newborn are Rh-negative.
- The mother is Rh-negative, and the newborn is Rh-positive. (Correct answer)
Correct answer: The mother is Rh-negative, and the newborn is Rh-positive.
Rh(D) immune globulin is administered to an Rh-negative mother who has delivered an Rh-positive newborn. This is done to prevent the mother from developing antibodies against the Rh factor, which could cause hemolytic disease in future Rh-positive pregnancies. It is not indicated if the mother is Rh-positive or if the baby is Rh-negative.
Question 5: A client on postpartum day 6 complains of persistent pain, tenderness, and warmth in her right calf. The nurse's assessment reveals unilateral swelling and redness of the lower leg. What is the most appropriate initial nursing action?
- Gently massage the affected leg to improve circulation.
- Encourage the client to ambulate to prevent venous stasis.
- Instruct the client to maintain bed rest with the affected leg elevated. (Correct answer)
- Apply a heating pad to the affected area for comfort.
Correct answer: Instruct the client to maintain bed rest with the affected leg elevated.
The client's symptoms are highly suggestive of a deep vein thrombosis (DVT). The immediate priority is to prevent the thrombus from dislodging and traveling to the lungs, causing a pulmonary embolism. Therefore, the nurse should instruct the client to maintain bed rest and elevate the affected extremity to reduce swelling and promote venous return without disturbing the clot. Massaging the leg is strictly contraindicated as it can dislodge the clot.
Question 6: When educating a postpartum support group, how should the nurse best distinguish between postpartum 'baby blues' and postpartum depression (PPD)?
- "Postpartum blues are a normal, transient condition of mood swings and tearfulness that resolves within two weeks, whereas PPD involves more severe, persistent symptoms that impair daily functioning." (Correct answer)
- "Postpartum depression typically begins within 2-3 days of delivery, while the 'baby blues' can start any time in the first year."
- "The 'baby blues' often include thoughts of harming the infant, which are not present in postpartum depression."
- "Only postpartum depression requires professional treatment; the 'baby blues' can be managed with herbal remedies alone."
Correct answer: "Postpartum blues are a normal, transient condition of mood swings and tearfulness that resolves within two weeks, whereas PPD involves more severe, persistent symptoms that impair daily functioning."
The key differences between postpartum blues and PPD are the severity and duration of symptoms. Postpartum blues are common, characterized by mild mood swings and crying spells, and typically resolve spontaneously within two weeks of delivery. Postpartum depression is a more severe mood disorder with symptoms lasting longer than two weeks, significantly interfering with the mother's ability to function and care for her baby, and requires professional intervention.
Obstetric Nurse Postpartum Maternal Care Questions and Answers
A nurse is assessing a client who is two hours postpartum.
The client's fundus is palpated as boggy, 2 cm above the umbilicus, and deviated to the right.
The client's lochia rubra flow is heavy.
What is the nurse's priority action?