ATI RN
Postpartum Body Changes Questions
Question 1 of 5
A mother, G4 P4004, is 15 minutes postpartum. Her baby weighed 4,595 grams at birth. For which of the following complications should the nurse monitor this client?
Correct Answer: B
Rationale: In the postpartum period, the nurse should monitor a mother closely for complications. In this case, the correct answer is B) Hemorrhage. After delivery, the uterus should contract to control bleeding. However, in a mother who gave birth to a large baby (4,595 grams) and is only 15 minutes postpartum, there is a risk of uterine atony leading to postpartum hemorrhage. Option A) Seizures are not typically associated with immediate postpartum body changes unless there are underlying conditions like eclampsia. Option C) Infection is a concern in the postpartum period but is less likely to present within the first 15 minutes postpartum. It usually takes some time for signs of infection to develop. Option D) Thrombosis is a risk postpartum due to changes in blood clotting factors, but it is not a common immediate concern at 15 minutes postpartum. Educationally, understanding the risks and complications in the postpartum period is crucial for nurses to provide appropriate care and interventions promptly. Monitoring for signs of hemorrhage, infection, and other complications allows for early detection and intervention, promoting the well-being of both the mother and the baby.
Question 2 of 5
The nurse assesses a 2-day postpartum, breastfeeding client. The nurse notes blood on the mother's breast pad and a crack on the mother's nipple. Which of the following actions should the nurse perform at this time?
Correct Answer: B
Rationale: In this scenario, the correct action for the nurse to take is to provide the woman with a tube of topical lanolin (Option B). This is because the presence of blood on the breast pad and a crack on the nipple indicate a common issue known as nipple trauma, often associated with breastfeeding. Topical lanolin can help soothe and protect the cracked nipple, promoting healing and providing relief to the mother. Option A is incorrect because washing with soap can further irritate the already sensitive area and potentially worsen the condition. Option C is incorrect as it can cause unnecessary worry and stress to the mother; ingesting a small amount of blood is generally not harmful to the baby. Option D is not the best course of action as a topical anesthetic may not address the underlying issue of nipple trauma and could potentially be harmful to the newborn if transferred during breastfeeding. Educationally, it is crucial for nurses to be knowledgeable about postpartum body changes and common breastfeeding issues to provide effective care and support to new mothers. Understanding the appropriate interventions for nipple trauma can help prevent complications and promote successful breastfeeding experiences for both the mother and baby.
Question 3 of 5
The nurse administers RhoGAM to a postpartum client. Which of the following is the goal of the medication?
Correct Answer: A
Rationale: RhoGAM is administered to a postpartum client who is Rh-negative to prevent the mother's immune system from producing antibodies against Rh-positive fetal blood cells, a condition known as Rh incompatibility. Option A, "Inhibit the mother's active immune response," is the correct answer because RhoGAM works by suppressing the mother's immune response to Rh-positive blood cells she may have been exposed to during pregnancy or delivery. Option B, "Aggressively destroy the Rh antibodies produced by the mother," is incorrect because RhoGAM does not destroy existing Rh antibodies but rather prevents their formation. Option C, "Prevent fetal cells from migrating throughout the mother's circulation," is incorrect as RhoGAM does not act on fetal cells but on the mother's immune system. Option D, "Change the maternal blood type to Rh-positive," is inaccurate as RhoGAM does not alter the mother's blood type. In an educational context, understanding the rationale behind administering RhoGAM is crucial for nurses caring for postpartum clients. By grasping the purpose of this medication, nurses can provide safe and effective care to prevent complications related to Rh incompatibility in future pregnancies. It also highlights the importance of maternal-fetal blood type compatibility and the role of immunoprophylaxis in preventing hemolytic disease of the newborn.
Question 4 of 5
A client is 1 day post-cesarean section with spinal anesthesia. Even though the nurse advised against it, the client has had the head of her bed in high Fowler's position since delivery. Which of the following complications would the nurse expect to see in relation to the client's action?
Correct Answer: B
Rationale: In this scenario, the correct answer is B) Severe postural headache. When a client undergoes a cesarean section with spinal anesthesia, maintaining the head of the bed elevated can lead to a postural headache due to leakage of cerebrospinal fluid from the dural puncture site, exacerbated by the high Fowler's position. This positional headache is a common complication post-spinal anesthesia and can be severe. Option A) Postpartum hemorrhage is incorrect as it is not directly related to the client's position in bed. Postpartum hemorrhage usually occurs due to issues like uterine atony or retained placental fragments. Option C) Pruritic skin rash is also unrelated to the client's bed position and is more commonly associated with allergic reactions or dermatological conditions. Option D) Paralytic ileus is not typically caused by the client's bed position but rather by factors like decreased peristalsis following abdominal surgery. Educationally, this scenario highlights the importance of understanding the potential complications of specific postpartum interventions, like maintaining proper positioning post-cesarean section with spinal anesthesia to prevent avoidable issues such as postural headaches. It also emphasizes the need for clear patient education and compliance with healthcare provider instructions to ensure optimal recovery and outcomes.
Question 5 of 5
A client, who had no prenatal care, delivers a 10-lb 10-oz baby boy whose serum glucose result 1 hour after delivery was 20 mg/dL. Based on these data, which of the following tests should the mother have at her 6-week postpartum checkup?
Correct Answer: A
Rationale: The correct answer is A) Glucose tolerance test. In this scenario, the mother's baby had a high birth weight and low serum glucose level, indicating a risk for gestational diabetes. Without prenatal care, there was no monitoring of the mother's blood glucose levels during pregnancy. Therefore, a glucose tolerance test at the 6-week postpartum checkup is crucial to assess the mother's glucose metabolism and screen for diabetes. Option B) Indirect Coombs' test is used to detect antibodies in the mother's blood that could attack the baby's red blood cells, which is unrelated to the presented scenario of glucose monitoring. Option C) Blood urea nitrogen (BUN) measures kidney function and is not directly related to the mother's risk of developing gestational diabetes. Option D) Complete blood count (CBC) assesses levels of different blood components and is not specific to monitoring glucose levels postpartum. Educationally, understanding the importance of postpartum monitoring for women who had high-risk pregnancies, like in this case with a large baby and low serum glucose levels, highlights the necessity of comprehensive care for both the mother and baby. Regular follow-up and appropriate tests are essential for early detection and management of potential health issues postpartum.