Obstetric Nurse Test Obstetric Nurse Postpartum Complications 3 — Questions and Answers
Question 1: A postpartum patient who delivered 48 hours ago has a temperature of 38.1°C taken once. What is the nurse's BEST initial action?
- Document as normal and continue routine monitoring
- Encourage fluids, reassess in 4 hours, and notify provider if fever persists or rises (Correct answer)
- Start broad-spectrum antibiotics immediately
- Obtain blood cultures and transfer to ICU
Correct answer: Encourage fluids, reassess in 4 hours, and notify provider if fever persists or rises
A single low-grade fever within the first 24 hours after delivery is common; persistent or higher fever warrants investigation for infection.
Question 2: On postpartum day 6, a patient reports soaking more than one pad per hour for the past 2 hours with passage of large clots. This presentation is MOST consistent with:
- Normal lochia serosa progression
- Secondary postpartum hemorrhage (Correct answer)
- Lochia rubra returning due to overexertion
- Physiologic diuresis
Correct answer: Secondary postpartum hemorrhage
Excessive bleeding with clots after 24 hours and up to 12 weeks postpartum is classified as secondary (late) postpartum hemorrhage, often caused by subinvolution or retained products.
Question 3: A postpartum patient with preeclampsia is receiving IV magnesium sulfate. Which assessment finding requires the nurse to HOLD the infusion and call the provider?
- Urine output of 35 mL/hr
- Respiratory rate of 10 breaths/min (Correct answer)
- Deep tendon reflexes 2+
- Mild flushing and warmth
Correct answer: Respiratory rate of 10 breaths/min
Respiratory depression (RR <12) indicates magnesium toxicity and requires holding the infusion; calcium gluconate should be at bedside.
Question 4: Which postpartum patient is at HIGHEST risk for a pulmonary embolism?
- A 24-year-old G1P1 who had a normal vaginal delivery
- A 38-year-old with obesity, cesarean delivery, and a history of DVT (Correct answer)
- A 30-year-old who ambulated 4 hours after vaginal delivery
- A 27-year-old with gestational hypertension treated with labetalol
Correct answer: A 38-year-old with obesity, cesarean delivery, and a history of DVT
Advanced maternal age, obesity, cesarean delivery, and prior DVT are cumulative risk factors for postpartum pulmonary embolism.
Question 5: A postpartum patient with a third-degree perineal laceration reports inability to control gas or stool. The nurse should document this as:
- Normal expected outcome of third-degree laceration
- Fecal incontinence warranting provider notification and referral (Correct answer)
- Temporary constipation related to opioid analgesia
- Hemorrhoidal pressure causing incomplete sphincter control
Correct answer: Fecal incontinence warranting provider notification and referral
Third-degree lacerations involve the anal sphincter, and fecal or flatus incontinence indicates sphincter dysfunction requiring evaluation and possible referral to a colorectal specialist.
Question 6: A postpartum patient is concerned because her lochia changed from pink (serosa) back to red (rubra) after she returned home. She states she has been caring for a toddler and a newborn with minimal rest. What should the nurse advise?
- Go to the ER immediately for possible hemorrhage
- Increase activity to promote uterine contractions
- Rest more, reduce activity, and monitor; return if soaking >1 pad/hour or passing clots (Correct answer)
- This change is permanent and she needs a uterine evaluation
Correct answer: Rest more, reduce activity, and monitor; return if soaking >1 pad/hour or passing clots
Return of lochia to rubra with overexertion is a sign that the patient needs more rest; if bleeding remains light without clots, it usually resolves with decreased activity.
Question 7: Which lab value would the nurse expect to find in a patient with postpartum disseminated intravascular coagulation (DIC)?
- Elevated fibrinogen and elevated platelets
- Prolonged PT/PTT, low fibrinogen, and thrombocytopenia (Correct answer)
- Normal PT/PTT with elevated D-dimer only
- Elevated hemoglobin and hematocrit
Correct answer: Prolonged PT/PTT, low fibrinogen, and thrombocytopenia
DIC is characterized by consumption of clotting factors and platelets, resulting in prolonged coagulation times, low fibrinogen, thrombocytopenia, and elevated D-dimer/FDP.
Obstetric Nurse Test Obstetric Nurse Postpartum Complications 3
A postpartum patient who delivered 48 hours ago has a temperature of 38.1°C taken once.
What is the nurse's BEST initial action?