Postpartum - Nclex
The nurse provides home care instructions to a postpartum client following a vaginal birth with an
episiotomy. Which statement by the client indicates the need for further teaching? - verified answer
"I can resume sexual activity at any time"
A client has just experienced a precipitate delivery. The nurse observes that the mother is lying
quietly in bed & touches the infant only briefly & occasionally. How should the nurse be most
therapeutic in this situation? - verified answer Provide support to the mother
The nurse is assisting in administering beractant (Survanta) to a premature infant who has
respiratory distress syndrome. The nurse understands that the medication should be administered
by which route? - verified answer Intratracheal
The client received an epidural anesthesia during labor & delivery & had a forceps delivery after
pushing for 2 hours. At 6 hours postpartum, the clients systolic BP dropped 20 points, the diastolic
BP dropped 10 points, & her pulse is 120 bpm. The client's very anxious & restless. The nurse is told
that the client has a vulvar hematoma. On the basis of this diagnosis the nurse should plan which
action? - verified answer Prep the client for surgery
The nurse is assigned to care for the client after a C-section. To prevent thrombophlebitis, the nurse
should encourage the woman to take which priority action? - verified answer Ambulate frequently
The nurse in the postpartum unit is instructing a mother regarding lochia & the amount of expected
lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but
should never exceed which amount? - verified answer 8 pads a day
The nurse is checking lochia discharge on a client in the immediate postpartum period & notes that
the lochia is bright red & contains some small clots. Which interpretation should the nurse make
about this finding? - verified answer It's normal
The nurse is preparing a list of self-care instructions for a postpartum client who has been diagnosed
with mastitis. Which instructions should be included on the list? Select all that apply - verified
answer - Rest during the acute phase
- Wear a supportive, non-underwire bra
- Maintain a fluid intake of at least 3000mL
, - Continue to breastfeed if the breasts aren't too sore
The nurse is reviewing the procedure for vitamin K injection in a NB. Which info is included in the
procedure? - verified answer Injection into the skin that has been cleansed & allowed to have
alcohol dry on the puncture site for 1 min
The nurse in the NB nursery is collecting data on a neonate who was born of a mother addicted to
cocaine. Which s/s would the nurse expect to note in the neonate? Select all that apply. - verified
answer - Tremors
- Irritability
- HTN
- Exaggerated startle reflex
A postpartum client with mastitis in the right breast complains that the breast is too sore for her to
breastfeed her infant. What should the nurse tell the client? - verified answer "Breastfeed from the
left breast & gently pump the right breast"
A client has a cesarean delivery with a low transverse uterine incision. What is the benefit of this
type of incision? - verified answer It allows a vaginal birth after cesarean (VBAC) to be possible in a
subsequent pregancy
The nurse is assigned to care for a client 1 hour after delivery. The nurse palpates a firm, uterine
fundus 2 cm above the umbilicus & displaced to the right. The nurse recognizes that this finding
indicates which? - verified answer Bladder distention
A postpartum client with gestational diabetes is scheduled for discharge. During the discharge, the
client asks the nurse, "Do I have to worry about this diabetes anymore?" The nurse should make
which response to the client? - verified answer "You will be at risk for developing gestational
diabetes with your next pregnancy & developing diabetes mellitus"
The nurse provides home care instructions to a postpartum client following a vaginal birth with an
episiotomy. Which statement by the client indicates the need for further teaching? - verified answer
"I can resume sexual activity at any time"
A client has just experienced a precipitate delivery. The nurse observes that the mother is lying
quietly in bed & touches the infant only briefly & occasionally. How should the nurse be most
therapeutic in this situation? - verified answer Provide support to the mother
The nurse is assisting in administering beractant (Survanta) to a premature infant who has
respiratory distress syndrome. The nurse understands that the medication should be administered
by which route? - verified answer Intratracheal
The client received an epidural anesthesia during labor & delivery & had a forceps delivery after
pushing for 2 hours. At 6 hours postpartum, the clients systolic BP dropped 20 points, the diastolic
BP dropped 10 points, & her pulse is 120 bpm. The client's very anxious & restless. The nurse is told
that the client has a vulvar hematoma. On the basis of this diagnosis the nurse should plan which
action? - verified answer Prep the client for surgery
The nurse is assigned to care for the client after a C-section. To prevent thrombophlebitis, the nurse
should encourage the woman to take which priority action? - verified answer Ambulate frequently
The nurse in the postpartum unit is instructing a mother regarding lochia & the amount of expected
lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but
should never exceed which amount? - verified answer 8 pads a day
The nurse is checking lochia discharge on a client in the immediate postpartum period & notes that
the lochia is bright red & contains some small clots. Which interpretation should the nurse make
about this finding? - verified answer It's normal
The nurse is preparing a list of self-care instructions for a postpartum client who has been diagnosed
with mastitis. Which instructions should be included on the list? Select all that apply - verified
answer - Rest during the acute phase
- Wear a supportive, non-underwire bra
- Maintain a fluid intake of at least 3000mL
, - Continue to breastfeed if the breasts aren't too sore
The nurse is reviewing the procedure for vitamin K injection in a NB. Which info is included in the
procedure? - verified answer Injection into the skin that has been cleansed & allowed to have
alcohol dry on the puncture site for 1 min
The nurse in the NB nursery is collecting data on a neonate who was born of a mother addicted to
cocaine. Which s/s would the nurse expect to note in the neonate? Select all that apply. - verified
answer - Tremors
- Irritability
- HTN
- Exaggerated startle reflex
A postpartum client with mastitis in the right breast complains that the breast is too sore for her to
breastfeed her infant. What should the nurse tell the client? - verified answer "Breastfeed from the
left breast & gently pump the right breast"
A client has a cesarean delivery with a low transverse uterine incision. What is the benefit of this
type of incision? - verified answer It allows a vaginal birth after cesarean (VBAC) to be possible in a
subsequent pregancy
The nurse is assigned to care for a client 1 hour after delivery. The nurse palpates a firm, uterine
fundus 2 cm above the umbilicus & displaced to the right. The nurse recognizes that this finding
indicates which? - verified answer Bladder distention
A postpartum client with gestational diabetes is scheduled for discharge. During the discharge, the
client asks the nurse, "Do I have to worry about this diabetes anymore?" The nurse should make
which response to the client? - verified answer "You will be at risk for developing gestational
diabetes with your next pregnancy & developing diabetes mellitus"
