Obstetric Nurse Test Obstetric Nurse Postpartum Complications 5 — Questions and Answers
Question 1: A postpartum patient is diagnosed with HELLP syndrome on day 2. Which lab trend would the nurse MOST expect to see?
- Elevated hemoglobin, elevated platelets, normal LFTs
- Hemolysis on peripheral smear, elevated liver enzymes, low platelets (Correct answer)
- Low hemoglobin, low liver enzymes, elevated platelets
- Normal CBC with isolated elevation of AST
Correct answer: Hemolysis on peripheral smear, elevated liver enzymes, low platelets
HELLP is defined by hemolysis (elevated LDH, schistocytes), elevated liver enzymes (AST/ALT), and low platelets (<100,000/µL).
Question 2: A breastfeeding patient on day 4 postpartum develops a firm, painful, erythematous area on one breast but is afebrile and otherwise well. This presentation MOST suggests:
- Breast abscess requiring incision and drainage
- Plugged milk duct, managed with warm compresses and frequent feeding (Correct answer)
- Bilateral engorgement treated by stopping breastfeeding
- Inflammatory breast cancer requiring biopsy
Correct answer: Plugged milk duct, managed with warm compresses and frequent feeding
A localized, tender lump without systemic symptoms in a breastfeeding patient on day 4 is most consistent with a plugged duct, which resolves with heat, massage, and frequent emptying.
Question 3: Which assessment technique should the nurse use to evaluate uterine involution and document fundal findings accurately?
- Palpate the fundus only when the patient complains of bleeding
- With the patient supine and bladder emptied, support the lower uterine segment and palpate the fundus to assess firmness, position, and height in finger-breadths below the umbilicus (Correct answer)
- Ask the patient to stand while the nurse assesses the fundal height
- Assess fundal height only if lochia is heavy without palpating firmness
Correct answer: With the patient supine and bladder emptied, support the lower uterine segment and palpate the fundus to assess firmness, position, and height in finger-breadths below the umbilicus
Accurate fundal assessment requires a supine position with an emptied bladder; the lower segment is supported to prevent uterine inversion while firmness and location are assessed.
Question 4: A postpartum patient develops Sheehan syndrome after massive hemorrhage. Which long-term consequence is she at risk for if the condition goes unrecognized?
- Postpartum thyroiditis only
- Panhypopituitarism leading to failure of lactation, hypothyroidism, and adrenal insufficiency (Correct answer)
- Isolated growth hormone deficiency with no other endocrine effects
- Transient prolactin excess causing hyperlactation
Correct answer: Panhypopituitarism leading to failure of lactation, hypothyroidism, and adrenal insufficiency
Sheehan syndrome results from pituitary necrosis due to hypovolemic shock, causing deficiency of multiple pituitary hormones including prolactin, TSH, ACTH, FSH, and LH.
Question 5: A patient's lochia has a strong, fishy odor on postpartum day 4. The MOST appropriate nursing action is:
- Reassure her that all lochia normally has a fishy odor
- Document the finding and notify the provider, as malodorous lochia may indicate uterine infection (Correct answer)
- Instruct her to use a vaginal deodorant spray to mask the odor
- Advise increased fluid intake and recheck in 24 hours without provider notification
Correct answer: Document the finding and notify the provider, as malodorous lochia may indicate uterine infection
Normal lochia has a fleshy, menstrual-like odor; a fishy or foul odor is abnormal and may signal endometritis or other infection requiring evaluation.
Question 6: A postpartum patient who is 3 weeks post-cesarean delivery presents to the clinic with a 2 cm opening in her incision with serous drainage but no signs of systemic infection. The expected management is:
- Immediate surgical re-closure under general anesthesia
- Wound care with wet-to-dry dressings or negative pressure wound therapy and close follow-up (Correct answer)
- Application of a topical antibiotic ointment and waterproof bandage only
- Reassurance that all cesarean incisions open partially by week 3
Correct answer: Wound care with wet-to-dry dressings or negative pressure wound therapy and close follow-up
Small, superficial wound dehiscence without infection is managed conservatively with wound care, possibly negative pressure therapy, allowing healing by secondary intention.
Question 7: When teaching a postpartum patient about warning signs that require immediate medical attention, the nurse should include all of the following EXCEPT:
- Soaking more than one pad per hour for two consecutive hours
- Mild breast tenderness on day 3 to 4 as milk comes in (Correct answer)
- Calf redness, swelling, or warmth
- Fever greater than 38°C (100.4°F) persisting after the first 24 hours
Correct answer: Mild breast tenderness on day 3 to 4 as milk comes in
Breast engorgement and mild tenderness as milk comes in on days 3–4 is a normal physiologic process, not a warning sign requiring emergency evaluation.
Obstetric Nurse Test Obstetric Nurse Postpartum Complications 5
A postpartum patient is diagnosed with HELLP syndrome on day 2.
Which lab trend would the nurse MOST expect to see?