solved)
While reviewing laboratory values, the nurse sees a postpartum patient's white blood cell count is
26,699 mg/dL, and her neutrophil count is also elevated. Which is the nurse's priority action?
A. Assessing the episiotomy for signs of infection
B. Notifying the RN and/or provider
C. Continuing to monitor laboratory findings
D. Obtaining STAT vital signs correct answers C. Continuing to monitor laboratory findings
These are expected changes after childbirth, so the nurse should continue to monitor laboratory
findings.
The nurse is assessing a postpartum patient 1 hour after delivery. Where should the nurse expect
to palpate the fundus?
A. Between the umbilicus and the symphysis pubis
B. Even with the umbilicus
C. Even with the symphysis pubis
D. 1 cm above the symphysis pubis correct answers B. Even with the umbilicus
One hour after delivery, the fundus of the uterus should be palpable at the umbilicus.
Which events after delivery of the placenta cause the uterus to contract and begin shrinking to
nonpregnant size?
A. Reduced estrogen and progesterone levels
B. Reduced estrogen and oxytocin levels
C. Reduced progesterone and oxytocin levels
D. Estrogen, progesterone, and oxytocin levels decline. correct answers A. Reduced estrogen and
progesterone levels
After delivery, estrogen and progesterone levels drop quickly, which cause the uterus to contract
and begin the process of shrinking to pre-pregnancy size.
The nurse is assessing a student's knowledge of postpartum care. Which of the following
statements regarding nursing care during the first hour after delivery is incorrect?
A. "I should observe the patient's peripads for the amount of lochia, color, odor, and the presence
of clots."
B. "I should check vital signs, including pulse and blood pressure, every hour."
C. "I should palpate the fundus of the uterus for firmness and location every 15 minutes."
D. "The first hour after delivery is the most dangerous hour in childbearing because of the risk of
hemorrhage after delivery." correct answers B. "I should check vital signs, including pulse and
blood pressure, every hour."
This is incorrect and would require the nurse to correct the student. During the first hour after
delivery, the nurse should check vital signs, including pulse and blood pressure, every 15
minutes.
The nurse is assessing a postpartum patient within the first hour after delivery and notes that her
peripad is saturated. Which is the nurse's priority action?
, A. Call the provider immediately.
B. Obtain consent for blood transfusion.
C. Change the peripad and document findings.
D. Put the patient in the Trendelenberg position. correct answers C. Change the peripad and
document findings.
During the first hour after delivery, one saturated pad would be an expected finding. The nurse
should change the peripad, document findings, and continue to monitor the lochia.
A woman reports that she has not urinated since delivering 8 hours ago and says she has no urge
to void despite drinking adequate fluids postpartum. The nurse attributes this to what?
A. The woman was dehydrated and has not fully hydrated yet to produce urine.
B. The woman's bladder tone is reduced, and she does not feel the urge to urinate.
C. The bladder has more room to expand and can hold more urine because of a smaller uterus.
D. The woman is experiencing a release of epinephrine, causing absence of bladder sensation.
correct answers B. The woman's bladder tone is reduced, and she does not feel the urge to
urinate.
In the first days after delivery, the woman's bladder tone is reduced, resulting in the lack of an
urge to void. She is not aware of the full bladder but should be encouraged to try to void.
The nurse is caring for a woman who delivered her third child 2 days ago and who says, "I am
having pain; it feels like labor pain. I never experienced this with my other children, and it is
worse when I breastfeed." Which is the nurse's priority response?
A. Further assess the pain's location, intensity, and frequency.
B. Explain the purpose of afterpains and reassure the patient.
C. Immediately obtain vital signs and monitor vital signs every 15 minutes.
D. Administer a narcotic analgesic to control pain. correct answers B. Explain the purpose of
afterpains and reassure the patient.
The nurse should explain that these are afterpains resulting from the involution of the uterus and
that they are stronger in women who are multiparous.
The nurse is explaining afterpains to a postpartum patient. Which of the following statements is
correct?
A. Afterpains are more painful for women who have not given birth previously.
B. Oxytocin may be administered to resolve afterpains.
C. Afterpains usually last for 3 weeks.
D. Afterpains can be noticed while breastfeeding as a result of nipple stimulation. correct
answers D. Afterpains can be noticed while breastfeeding as a result of nipple stimulation.
Afterpains can be noticed while breastfeeding as a result of nipple stimulation, which causes the
release of oxytocin.
A patient who is 6 weeks postpartum asks the nurse when she will start her menstrual cycle. How
should the nurse respond?
A. "You should start your cycle in 2 weeks."
B. "How much sleep are you getting?"
C. "Are you breastfeeding?"