ATI RN
Postpartum Body Changes Questions
Question 1 of 5
A client received general anesthesia during her cesarean section 4 hours ago. Which of the following postpartum nursing interventions is important for the nurse to make?
Correct Answer: C
Rationale: In this scenario, the correct answer is C) Auscultate lung fields. The reason this is important is that a client who received general anesthesia during a cesarean section is at risk for respiratory complications due to the effects of anesthesia on respiratory drive and function. Auscultating the lung fields allows the nurse to assess for any signs of respiratory distress, such as decreased breath sounds, crackles, or wheezing, which could indicate a potential problem that needs immediate intervention. Option A) Place the client flat in bed is incorrect because after receiving general anesthesia, the client should not be placed flat as this position can increase the risk of aspiration and compromise respiratory function. Option B) Assess for dependent edema is not the priority in this situation as it does not directly address the potential respiratory complications associated with general anesthesia. Option D) Check patellar reflexes is unrelated to the client's current condition following general anesthesia and cesarean section, and it does not help in assessing or managing any immediate postpartum issues. Educationally, understanding the impact of anesthesia on postpartum clients and the importance of monitoring respiratory status postoperatively is crucial for nurses caring for women in the postpartum period. By prioritizing interventions based on the client's condition and potential risks, nurses can provide safe and effective care to promote positive outcomes for both the mother and the newborn.
Question 2 of 5
A rubella nonimmune, breastfeeding client has just received the rubella vaccine. Which of the following side effects should the nurse warn the client about?
Correct Answer: D
Rationale: The correct answer is D) The mother's joints may become painful and stiff. This side effect is associated with rubella vaccination and is known as arthralgia or joint pain. It is important for the nurse to warn the client about this potential side effect to ensure the client is informed and prepared. Option A) The baby may develop a rash a week after the shot is incorrect because rubella vaccination does not typically cause a rash in babies. Option B) The baby may temporarily reject the breast milk is incorrect as rubella vaccination in the mother does not directly impact the baby's acceptance of breast milk. Option C) The mother's milk supply may decrease precipitously is incorrect because rubella vaccination is not known to affect milk supply. Educational Context: It is crucial for nurses to educate postpartum clients about common side effects of vaccinations, especially when they are breastfeeding. By providing accurate information, nurses empower clients to make informed decisions about their health and the health of their baby. Understanding the potential side effects of vaccinations can alleviate anxiety and promote trust in the healthcare provider's guidance.
Question 3 of 5
Which symptom would the nurse expect to observe in a postpartum client with a vaginal hematoma?
Correct Answer: A
Rationale: Rationale: The correct answer is A) Pain. Vaginal hematoma is a serious postpartum complication characterized by the accumulation of blood in the vaginal tissues. Pain is a common and significant symptom associated with a vaginal hematoma. The presence of a hematoma can cause severe localized pain due to the pressure exerted on surrounding tissues and nerves. Option B) Bleeding is not typically associated with vaginal hematoma. While bleeding may occur if the hematoma ruptures, it is not a primary symptom of a vaginal hematoma. Option C) Warmth is not a specific symptom of a vaginal hematoma. Warmth may be a sign of infection, but it is not a typical finding in a vaginal hematoma. Option D) Redness is also not a typical symptom of a vaginal hematoma. Redness may indicate inflammation or infection but is not a characteristic feature of a hematoma. Educational Context: Understanding the symptoms of postpartum complications like vaginal hematoma is crucial for nurses caring for postpartum clients. Recognizing these symptoms promptly can lead to early intervention and prevention of serious complications. Pain in the presence of a vaginal hematoma should never be ignored and requires immediate assessment and management to ensure the well-being of the mother. Nurses should be vigilant in monitoring postpartum clients for any signs of complications to provide timely and appropriate care.
Question 4 of 5
A woman who wishes to breastfeed advises the nurse that she had a breast reduction one year earlier. Which of the following responses by the nurse is appropriate?
Correct Answer: C
Rationale: The correct answer to the question is option C: "Monitor the baby's daily weights for excessive weight loss." This response is appropriate because it focuses on proactive monitoring of the baby's weight to ensure adequate nutrition intake, which is a crucial aspect of breastfeeding support, especially in cases where there may be challenges such as a history of breast reduction surgery. Option A is incorrect because it provides a definitive and discouraging statement without exploring potential solutions or supportive measures. It is essential in nursing practice to offer guidance and support rather than shutting down options for the patient. Option B is incorrect as examining the incision site does not directly address the immediate concern of breastfeeding success. While understanding the anatomy may be helpful, it is not the most pressing issue at hand. Option D is incorrect as it downplays the potential impact of breast reduction surgery on milk transfer. While it is true that surgery may not always prevent breastfeeding, it is important to acknowledge the potential challenges and take proactive measures to support successful breastfeeding. In an educational context, it is crucial for nurses to approach breastfeeding support holistically, considering individual circumstances and potential barriers. By emphasizing monitoring the baby's weight, the nurse can ensure early detection of any issues and provide timely interventions to support successful breastfeeding despite the woman's history of breast reduction surgery.
Question 5 of 5
A nurse who is called to a client's room notes that the client's cesarean incision has separated. Which of the following actions is the highest priority for the nurse to perform?
Correct Answer: B
Rationale: In this scenario, the highest priority action for the nurse is option B) Notify the surgeon. This is the correct answer because a separated cesarean incision is a serious complication that requires immediate attention by a healthcare provider, typically the surgeon who performed the cesarean section. Option A) Cover the wound with sterile wet dressings is incorrect because simply covering the wound will not address the underlying issue of the separation and delay in seeking appropriate medical intervention. Option C) Elevate the head of the client's bed slightly and option D) Flex the client's knees are also incorrect as they are not relevant or necessary in addressing a separated incision. Educationally, it is crucial for nurses and healthcare providers to recognize the significance of postpartum complications such as a separated incision and understand the appropriate steps to take in such situations to ensure the safety and well-being of the client. Prompt communication with the surgeon or healthcare provider is essential in managing postpartum complications effectively.