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7 Cards in this Set

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Perineal care is an important infection control measure. When evaluation a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman:
a) Uses soap and warm water to wash the vulva and perineum
b) Washes from symphysis pubis back to the episiotomy
c) Changes her perineal pad every 2 to 3 hours
d) Uses the peribottle to rinse upward into her vagina
Uses the peribottle to rinse upward into her vagina
On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to:
a) Begin an IV infusion of Ringer's lactate solution
b) Assess the woman's vital signs
c) Call the woman's primary health care provider
d) Message the woman's fundus
Massage the woman's fundus
Excessive blood loss after childbirth can have several causes; however, the most common is:
a) Vaginal or vulvar hematomas
b) Unrepaired lacerations of the vagina or cervix
c) Failure of the uterine muscle to contract firmly
d) Retained placental fragments
Failure of the uterine muscle to contract firmly
Baby-friendly hospitals mandate their infants be put to breast within the first _______ after birth.
a) 1 hour
b) 30 minutes
c) 2 hours
d) 4 hours
1 hour
Which finding would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum?
a) Postural hypotension
b) Temperature of 38 C
c) Bradycardia- pulse rate of 55 beats/min
d) Pain in left calf with dorsiflexion of left foot
Pain in left calf with dorsiflexion of left foot
The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action is to:
a) Place her on a bedpan to empty her bladder
b) Massage her fundus
c) Call the physician
d) Administer methylergonovine (Methergine), 0.2mg IM, which has been ordered prn
Massage her fundus
Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse suspects:
a) Bladder distention
b) Uterine atony
c) Constipation
d) Hematoma formation
Hematoma formation