Obstetric Nurse Test Obstetric Nurse Postpartum Complications 4 — Questions and Answers
Question 1: A postpartum patient on day 10 calls the clinic reporting a foul-smelling, greenish vaginal discharge with fever and pelvic pain. The nurse should advise the patient to:
- Use a douche to cleanse the vagina and monitor symptoms
- Come in immediately or go to the nearest ER for evaluation of endometritis (Correct answer)
- Take an OTC yeast infection treatment and follow up in 2 weeks
- Increase oral fluids and apply a heating pad until symptoms resolve
Correct answer: Come in immediately or go to the nearest ER for evaluation of endometritis
Foul-smelling discharge, fever, and pelvic pain at day 10 are classic signs of endometritis requiring urgent evaluation and IV antibiotics.
Question 2: A nurse is assessing a postpartum patient who had a cesarean delivery and notes the incision has red, warm edges with seropurulent drainage and the patient has a fever. This MOST likely indicates:
- Normal inflammatory healing response
- Wound infection requiring provider notification and possible opening/debridement (Correct answer)
- Allergic reaction to suture material
- Keloid formation in the early stages
Correct answer: Wound infection requiring provider notification and possible opening/debridement
Erythema, warmth, purulent drainage, and fever at a surgical site are classic signs of wound infection requiring medical management.
Question 3: Which uterotonic agent is CONTRAINDICATED in a postpartum patient with hypertension who is experiencing uterine atony?
- Oxytocin (Pitocin)
- Methylergonovine (Methergine) (Correct answer)
- Misoprostol (Cytotec)
- Carboprost (Hemabate) in a patient without asthma
Correct answer: Methylergonovine (Methergine)
Methylergonovine is contraindicated in hypertensive patients because it causes vasoconstriction and can dangerously elevate blood pressure.
Question 4: During a postpartum home visit, the nurse notes the patient has erythema and induration in her right calf that is warm to touch. The patient's D-dimer is elevated. Which diagnostic test will CONFIRM the suspected diagnosis?
- Chest X-ray
- Compression ultrasonography of the lower extremity (Correct answer)
- Coagulation panel (PT/PTT)
- Ventilation-perfusion scan
Correct answer: Compression ultrasonography of the lower extremity
Compression duplex ultrasonography is the gold-standard first-line imaging test to confirm or rule out deep vein thrombosis in the lower extremities.
Question 5: A postpartum patient with retained placental fragments would MOST likely present with which combination of findings?
- Firm uterus, scant lochia, and normal temperature
- Subinvoluted boggy uterus, persistent heavy bleeding, and low-grade fever (Correct answer)
- Firm uterus with foul-smelling lochia and severe pelvic pain
- Involuted uterus with lochia alba on day 5
Correct answer: Subinvoluted boggy uterus, persistent heavy bleeding, and low-grade fever
Retained placental fragments prevent uterine involution, causing a boggy subinvoluted uterus, ongoing hemorrhage, and potential secondary infection.
Question 6: A patient 72 hours postpartum reports visual disturbances (blurred vision, scotoma) and epigastric pain. Her BP is 162/110 mmHg. The nurse's PRIORITY action is:
- Administer a PRN analgesic for epigastric pain and recheck BP in 1 hour
- Activate the rapid response team and prepare to administer antihypertensive medication per protocol (Correct answer)
- Encourage the patient to lie in a dark, quiet room and recheck in 30 minutes
- Draw labs and wait for results before escalating
Correct answer: Activate the rapid response team and prepare to administer antihypertensive medication per protocol
Visual disturbances, epigastric pain, and BP ≥160/110 indicate severe postpartum preeclampsia or impending eclampsia — this is an emergency requiring immediate intervention.
Question 7: Which intervention is MOST effective in preventing postpartum venous thromboembolism in a high-risk cesarean delivery patient?
- Strict bed rest for the first 48 hours to reduce strain
- Early ambulation combined with sequential compression devices and prophylactic low-molecular-weight heparin (Correct answer)
- High-dose aspirin initiated immediately after surgery
- Compression stockings alone without pharmacologic prophylaxis
Correct answer: Early ambulation combined with sequential compression devices and prophylactic low-molecular-weight heparin
Multimodal VTE prophylaxis using early ambulation, mechanical compression, and LMWH is the evidence-based standard for high-risk postoperative obstetric patients.
Obstetric Nurse Test Obstetric Nurse Postpartum Complications 4
A postpartum patient on day 10 calls the clinic reporting a foul-smelling, greenish vaginal discharge with fever and pelvic pain.
The nurse should advise the patient to: