ATI RN
Postpartum Care NCLEX Questions Questions
Question 1 of 5
A nurse is taking care of a G2P2 woman with a third-degree perineal tear during the fourth stage of labor. The nurse should include which intervention in the plan of care during her 12-hour shift?
Correct Answer: D
Rationale: The correct answer is D: Prepare ice pack for application to perineal area. This intervention is crucial for managing pain and reducing swelling in the perineal area post third-degree tear. Ice packs help vasoconstriction, decreasing blood flow and minimizing inflammation. It also provides comfort to the patient. A: Assess vital signs every 4 hours - This is important but not the priority in this situation. Monitoring vital signs is essential, but immediate comfort measures should be prioritized for the patient with a perineal tear. B: Keep patient NPO for first 12 hours - There is no indication to keep the patient NPO for 12 hours. Adequate hydration and nutrition are important for postpartum recovery. C: Catheterize patient prior to first ambulation - Catheterization may not be necessary unless there are specific indications. It is not a routine intervention for a perineal tear during the fourth stage of labor.
Question 2 of 5
Which nursing care goal is the highest priority for a woman who had a vaginal delivery 3 hours earlier?
Correct Answer: C
Rationale: The correct answer is C: The client will have a moderate lochia flow. This is the highest priority goal because monitoring lochia flow post-vaginal delivery helps assess for excessive bleeding, which is crucial for preventing postpartum hemorrhage. Choice A is not a priority in the immediate postpartum period. Choice B is important but not as critical as monitoring lochia flow. Choice D is also important for preventing complications but not as urgent as assessing for postpartum bleeding.
Question 3 of 5
The nurse is preparing a postpartum patient for discharge. Which patient teaching is most important for the nurse to provide?
Correct Answer: B
Rationale: The correct answer is B: The signs and symptoms of secondary hemorrhage. This is the most important teaching because postpartum hemorrhage can be life-threatening and requires immediate medical attention. The other choices, while important, are not as urgent as secondary hemorrhage. A: Uterine infection signs and symptoms can develop gradually and usually do not pose an immediate threat. C: Postpartum depression is a serious concern but does not require immediate medical intervention. D: A boggy uterus can be a sign of uterine atony but does not necessarily indicate an emergency situation like secondary hemorrhage.
Question 4 of 5
The nurse is performing a uterus assessment on a patient who is 20 hours postpartum. The nurse finds the fundus of the uterus to be soft and boggy. In addition, the uterus is displaced to the left and moderate bleeding is noted. If the uterus does respond to uterine massage, which actions does the nurse implement?
Correct Answer: D
Rationale: The correct answer is D: Place an emergency call to the HCP. In this scenario, the patient is displaying signs of uterine atony, a condition where the uterus fails to contract properly postpartum, leading to excessive bleeding. The soft and boggy fundus, displacement to the left, and moderate bleeding indicate a serious issue that requires immediate medical attention. By calling the healthcare provider, the nurse can ensure timely intervention and treatment to address the uterine atony and prevent further complications. The other options are not appropriate at this time: A may worsen the situation by increasing bleeding, B delays necessary action, and C may be needed but not as the first priority in this critical situation.
Question 5 of 5
The nurse is aware that some parenting skills are acquired through the process of intentional learning. Which activity does the nurse associate with intentional learning?
Correct Answer: B
Rationale: The correct answer is B because attending hospital classes on newborn and infant care involves intentional learning, where the couple actively seeks out knowledge and skills related to parenting. This choice allows them to receive structured education and guidance from professionals in a focused setting. Observing other individuals (choice A) may provide some insights but lacks the structured learning environment. Discussing their own upbringing (choice C) may be informative but does not necessarily involve intentional learning focused on acquiring new parenting skills. Watching media (choice D) may offer some information but lacks the interactive and hands-on learning experience provided by attending hospital classes.