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Question 1

Assessment findings associated with a postpartum complication

Answer 1

tenderness in the calf of a leg
increase in uterine or perineal pain
slight elevation in temperature
small increase in the amount of lochia flow

Question 2

example of expected outcomes

Answer 2

lochia is free from foul odor
fundus remains firm and midline with progressive descent
patient maintains a urinary output greater than 30 ml/hr
lochia discharge amount is 6 in or less on a perineal pad in 1 hour
patient maintains vital signs and oxygen saturation within defined normal limits
patient identifies signs and symptoms that should be reported
patient demonstrates attachment behaviors with infant despite separation or activity restrictions

Question 3

one of the primary causes of maternal mortality associated with childbearing

Answer 3

hemorrhage

Question 4

is defined as blood loss of ____ ml or more following a vaginal birth occurs in as many as __ to ___ % of postpartal women

Answer 4

postpartum hemorrhage
500 ml
5-15 %

Question 5

is present when there is a ___ ml of blood loss or a ___% decrease in hematocrit level

Answer 5

cesarean birth
hemorrhage
1000 ml
10%

Question 6

Two types of postpartum hemorrhages

Answer 6

early postpartal hemorrhage
late postpartal hemorrhage

Question 7

occur early within the first 24 hours following birth

Answer 7

eary postpartal hemorrhage

Question 8

occur from 24 hours to 6 weeks after birth the greatest danger is in the first 24 hours because of the grossly denuded and unprotected uterine area left after detachment of the placenta

Answer 8

late postpartal hemorrhage

Question 9

What are the three main reasons for postpartum hemorrhage

Answer 9

Uterine atony
trauma or lacerations
retained placental fragments

Question 10

therapeutic management of uterine atony

Answer 10

fundal massage
continue to assess carefully for the next 4 hours

Question 11

What are the drugs for uterine atony

Answer 11

oxytocin (pitocin)
carboprost tromethamine (hermabate)
methylergonovine maleate (methergine)
carboprost tromethamine (hermabate)

Question 12

given intramuscularly, may be repeated every ___ to ___ hours up to ___ doses

Answer 12

methylergonovine maleate
2-4 hours
5 doses

Question 13

a prostaglandin E1 analogue, may also be administered rectally to decrease postpartum hemorrhage

Answer 13

misoprostol

Question 14

Carboprost tromethamine may be repeated every ___ to ___ minutes up to ___ doses

Answer 14

15 to 90 minutes
8 doses

Question 15

a second dose of misoprostol should not be administered unless a minimum of ___ has elapsed

Answer 15

2 hours

Question 16

prostaglandins tend to cause ____ and ______

Answer 16

diarrhea and nausea
tx: antiemetic

Question 17

when should you check for the blood pressure

Answer 17

• before administration
• 15 minutes after admin.

Question 18

uterine atony:
1.
2.

Answer 18

1. elevate the woman’s lower extremities
2. offer bedpan at least every 4 hours

Question 19

offering bedpan

Answer 19

every 4 hours

Question 20

administer oxygen by face mask at a rate of about ___ to ___ L/min

Answer 20

10-12 L/min

Question 21

a ___ may be done to detect possible retained placental fragments, if fundal massage and uterotonics does not work

Answer 21

sonogram

Question 22

may be introduced into the vagina and inflated until it puts pressure against the bleeding site

Answer 22

balloon catheter

Question 23

are common and may be considered as a normal consequence of child bearing

Answer 23

common tears of birth canals

Question 24

large larcerations may occur in the following circumstances

Answer 24

1. with difficult or precipitate births
2. primigravidas
3. birth of a large infant (more than 9 lb.)
4. use of lithotomy position and instruments

Question 25

laceration of the cervix usually found on the sides of the cervix

Answer 25

cervical lacerations

Question 26

therapeutic management of cervical lacerations

Answer 26

must have adequate space to work adequate sponges and sutures supplies good light source

Question 27

therapeutic management of vaginal lacerations

Answer 27

vagina may be packed to maintain pressure on the suture line indwelling urinary catheter (foley catheter) must be placed at the same time because the packing causes pressure on the urethra and can interfere with voiding

Question 28

usually occur when a woman is placed on lithotomy position for birth because this position increases tension on the ____

Answer 28

perineal lacerations perineum

Question 29

therapeutic management of perineal laceration

Answer 29

sutured and treated as an episiotomy repair - degree of the laceration is documented

Question 30

a placenta with an accessory lobe

Answer 30

succenturiate placenta

Question 31

a placenta with an accessory lobe

Answer 31

succenturiate placenta

Question 32

a placenta that fuses with the myometrium because of an abnormal decidua basalis layer

Answer 32

placenta accreta

Question 33

therapeutic management of retained placental fragments

Answer 33

- removal of the placental fragment is necessary to stop the bleeding - D & C (dilatation and curettage)

Question 34

is another leading cause of maternal mortality

Answer 34

puerperal infection

Question 35

the risk of infection is even greater if ____ and ____ are present

Answer 35

tissue edema and trauma

Question 36

the prognosis for complete recovery depends on many factors including the following:

Answer 36

virulence of the invading MOs woman’s general health portal of entry degree of uterine involution presence of lacerations in the reproductive tract

Question 37

internal fetal heart monitoring, why does it incnrease the woman’s risk for post partal infections?

Answer 37

may be introduced with placement of the scalp electrode

Question 38

what are the postpartal puerperal infections

Answer 38

endometritis wound infection UTI

Question 39

is an infection of the endometrium, the lining of the uterus.

Answer 39

endometritis

Question 40

this may occur with any birth but it is associated with ____ and ____

Answer 40

endometritis ass. with : chorioamnionitis cesarean birth

Question 41

assessment for endometritis

Answer 41

- benigh temperature elavation in the first postpartal day - fever on the 3rd and 4th postpartal day - WBC increase

Question 42

therapeutic management for endometritis

Answer 42

- wear gloves when changing her perineal pads - handwashing techniques

Question 43

infection of the puerperium s/s

Answer 43

pain heat feeling of pressure - purulent drainage - localized infection

Question 44

usually occurs as an extension of endometritis. It is one of the gravest complications of childbearing and is a major cause of death from puerperal infection.

Answer 44

peritonitis

Question 45

peritonitis.- an abcess may form in the _____ because this is the lowest point of the peritoneal cavity and gravity causes infected material to localize there

Answer 45

cul-de-sac of Douglas

Question 46

s/s peritonitis

Answer 46

rigid abdomen abdominal pain high fever rapid pulse vomiting

Question 47

peritonitis is often accompanied by a _____

Answer 47

paralytic ileus (a blockage of inflamed intestines)

Question 48

is inflammation of the lining of a blood vessel

Answer 48

phlebitis

Question 49

is inflammation with the formation of blood clots.

Answer 49

thrombophlebitis

Question 50

thrombophlebitis is classified as either 1. 2.

Answer 50

1. superficial vein disease 2. deep vein thrombosis

Question 51

thrombophlebitis occurs because:

Answer 51

- fibrinogen level is elevated —> increased blood clotting - dilatation of lower extremitiy veins is still present

Question 52

with femoral thrombophlebitis the: 1. 2. 3. are involved

Answer 52

femoral saphenous popliteal

Question 53

Although the inflammation site in thrombophlebitis is a vein, an accompanying

Answer 53

arterial spasm

Question 54

femoral thrombophlebitis is also called

Answer 54

milk leg or phlegmasia alba dolens

Question 55

when a woman has femoral thrombophlebitis what medication should be avoided

Answer 55

acetylsalicylic acid

Question 56

what sign is positive in femoral thrombophlebitis

Answer 56

Homans sign

Question 57

pelvic thrombophlebitis involves: 1. 2. 3.

Answer 57

ovarian uterine hypogastric vein

Question 58

is obstruction of the pulmonary artery by a blood clot; it usually occurs as a complication of thrombophlebitis when a blood clot moves from a leg vein to the pulmonary artery

Answer 58

pulmonary embolus

Question 59

is obstruction of the pulmonary artery by a blood clot; it usually occurs as a complication of thrombophlebitis when a blood clot moves from a leg vein to the pulmonary artery

Answer 59

pulmonary embolus

Question 60

signs of pulmonary embolus are

Answer 60

1. sudden, sharp chest pain 2. tachypnea 3. tachycardia 4. orthopnea 5. cyanosis

Question 61

infection of the breast may occur as early as the seventh postpartal day or not until the baby is weeks or months old

Answer 61

mastitis

Question 62

occurs when the bladder is unable to empty completely

Answer 62

urinary retention

Question 63

occurs when the bladder is unable to empty completely

Answer 63

urinary retention

Question 64

s/s of urinary retention

Answer 64

prolonged labor perineal lacerations use of epidural anesthesia

Question 65

If the amount of urine left in the bladder after voiding (termed residual) is greater than _____, the woman is retaining more than the usual amount of urine.

Answer 65

100 ml

Question 66

what drugs are prescribed for a urinary tract infection

Answer 66

sulfa drugs c/i breastfeeding women = neonatal jaundice

Question 67

The reason the condition occurs is usually retention of some placental material.

Answer 67

postpartal preeclampsia

Question 68

If the ligaments of the uterus are weakened because of pregnancy, they may no longer be able to maintain the uterus in its usual position or level after pregnancy, thus creating concerns such as

Answer 68

1. retroflexion 2. anteflexion 3. retroversion 4. anteversion or prolapse of the uterus.

Question 69

outpouching of the bladder into the vaginal wall

Answer 69

cystocele

Question 70

outpouching of the rectum into the vaginal wall

Answer 70

rectocele

Question 71

During pregnancy, many women feel some discomfort at the _____ because of relaxation of the joint preparatory for birth.

Answer 71

symphysis pubis

Question 72

Almost every woman notices some immediate (1 to 10 days postpartum) feelings of sadness (postpartal “blues”) after childbirth

Answer 72

postpartal depression

Question 73

This probably occurs as a response to the anticlimactic feeling after birth and also probably is related to hormonal shifts as the levels of estrogen, progesterone, and gonadotropin-releasing hormone in her body decline.

Answer 73

postpartal depression

Question 74

what are the risk factors for postpartal depression:

Answer 74

history of depression troubled childhood low self esteem stress in the home or at work lack of effective support different expectations between partners disappointment in the child

Question 75

post partal blues

Answer 75

1-10 days after birth

Question 76

postpartal depression

Answer 76

1-12 months after birth

Question 77

postpartal psychosis

Answer 77

within first year after birth

Question 78

Possible activation of previous mental illness, hormonal changes, family history of bipolar disorder

Answer 78

postpartal psychosis

Question 79

depression scales to help detect postpartum depression

Answer 79

Patient Health Questionnaire-9 (PHQ-9) Edinburg Postnatal Depression Scale (EPDS)

Question 80

When the illness coincides with the postpartal period or occurs during the following year, it is termed

Answer 80

postpartal psychosis

Question 81

exists when a person has lost contact with reality

Answer 81

psychosis

Question 82

what phrase should not be said to a patient

Answer 82

one door closes, another one opens God must have another purpose for you

Question 83

s/s of mastitis

Answer 83

pain swelling redness

Question 84

are a normal accompaniment to birth.

Answer 84

postpartal blues

Question 85

therapy for 1. postpartal blues 2. postpartal depression 3. postpartal psychosis

Answer 85

1. postpartal blues - support - empathy 2. postpartal depression - counseling, possibly drug therapy 3. postpartal psychosis - psychotherapy - drug therapy

Question 86

mastitis can be spread to one person to another this is termed as

Answer 86

epidemic mastitis or epidemic breast abscess

Question 87

treatment of mastitis

Answer 87

dicloxacillin or cephalosporin

Question 88

s/s of urinary tract infections

Answer 88

burning on urination hematuria feeling of frequency

Question 89

DIC

Answer 89

Disseminated intravascular coagulation

Question 90

Puerpereal infection

Answer 90

1. ROM 2. Placental fragments 3. Post partal hemorrhage 4. Preexisting anemia 5. Prolonged and dificult labor 6. Internal fetal heart monitoring 7. Local vaginal infection 8. Uterus

Question 91

Antibiotic for endometritis

Answer 91

Clindamycin

Question 92

The position of the patient in endometritis

Answer 92

Fowler's position