Obstetric Nurse Test Obstetric Nurse Postpartum Maternal Care 5 — Questions and Answers
Question 1: A nurse is providing discharge teaching about postpartum warning signs. Which symptom should prompt the patient to call her provider immediately?
- Mild cramping with breastfeeding
- Headache unrelieved by acetaminophen with visual changes (Correct answer)
- Breast tenderness on day 3
- Fatigue and need for extra sleep
Correct answer: Headache unrelieved by acetaminophen with visual changes
A headache unresponsive to analgesics combined with visual changes may indicate postpartum preeclampsia or hypertensive crisis requiring emergency evaluation.
Question 2: Which postpartum patient is at highest risk for developing postpartum hemorrhage?
- Primigravida who delivered a 3.2 kg infant after a 6-hour labor
- Multigravida who delivered twins with a prolonged third stage of labor (Correct answer)
- Patient who received epidural analgesia during labor
- Patient who breastfed within 1 hour of delivery
Correct answer: Multigravida who delivered twins with a prolonged third stage of labor
Multiple gestation and prolonged third stage of labor are major risk factors for uterine atony, the leading cause of postpartum hemorrhage.
Question 3: A postpartum patient is being assessed using the 'BUBBLE-HE' framework. What does the second 'B' represent?
- Blood pressure
- Bladder
- Bowel (Correct answer)
- Bleeding
Correct answer: Bowel
In the BUBBLE-HE mnemonic (Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy/laceration, Homan's sign/Homans, Emotions), the second B stands for Bowel.
Question 4: A postpartum patient reports difficulty starting a urine stream and dribbling. She voided only 50 mL since delivery 8 hours ago. What should the nurse do next?
- Reassure her that this is normal and encourage oral fluids
- Palpate and percuss the suprapubic area to assess for bladder distention (Correct answer)
- Immediately insert an indwelling urinary catheter
- Administer a diuretic as ordered
Correct answer: Palpate and percuss the suprapubic area to assess for bladder distention
Assessing for bladder distention by palpation and percussion is the next step to determine whether the patient has urinary retention before proceeding to catheterization.
Question 5: Which instruction should the nurse provide to a postpartum patient about performing Kegel exercises?
- Avoid Kegel exercises until the 6-week visit to allow healing
- Begin Kegel exercises as soon as tolerated postpartum to strengthen pelvic floor muscles (Correct answer)
- Kegel exercises are only recommended for patients with episiotomies
- Perform Kegel exercises only while lying flat for the first 2 weeks
Correct answer: Begin Kegel exercises as soon as tolerated postpartum to strengthen pelvic floor muscles
Kegel exercises can be started as soon as comfortable after delivery to improve pelvic floor tone, reduce incontinence, and promote perineal healing.
Question 6: A postpartum nurse notes that a patient's fundus is displaced to the right of midline and is boggy. What is the most likely cause?
- Normal uterine involution
- Bladder distention (Correct answer)
- Retained placental fragments
- Postpartum endometritis
Correct answer: Bladder distention
A full bladder displaces the uterus to the right and inhibits uterine contraction, causing a boggy fundus; bladder emptying is the priority intervention.
Question 7: A breastfeeding patient at day 4 postpartum asks the nurse about contraception. Which method is recommended as the safest option for breastfeeding women?
- Combined oral contraceptives starting immediately
- Progestin-only pills (mini-pill) (Correct answer)
- Combined estrogen-progestin patch
- Monthly combined injectable contraceptives
Correct answer: Progestin-only pills (mini-pill)
Progestin-only contraceptives are preferred for breastfeeding women because estrogen can suppress milk supply and is not recommended in early postpartum lactation.
Obstetric Nurse Test Obstetric Nurse Postpartum Maternal Care 5
A nurse is providing discharge teaching about postpartum warning signs.
Which symptom should prompt the patient to call her provider immediately?