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: Correct Answer: D Rationale: 1. Ice pack application helps reduce swelling and pain in the perineal area post-tear. 2. Ice packs can promote vasoconstriction, reducing bleeding risk. 3. Ice packs are non-invasive and can offer immediate relief. Summary: A: Assessing vital signs every 4 hours is important but not directly related to perineal tear care. B: Keeping the patient NPO for 12 hours is unnecessary and may lead to dehydration. C: Catheterization is not typically required for perineal tear care unless there are specific indications.
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 because excessive or scant lochia flow can indicate postpartum hemorrhage or retained placental fragments, which are serious postpartum complications. Ensuring a moderate lochia flow is essential for assessing the woman's postpartum recovery and preventing potential complications. Choice A (The client will wear a well-supported bra) is not a priority in the immediate postpartum period and does not directly impact the woman's physical health. Choice B (The client will eat 100% of her meals) is important for the woman's nutrition and recovery but is not as critical as monitoring the lochia flow to prevent complications like hemorrhage. Choice D (The client will ambulate to the bathroom) is important for preventing complications like blood clots and promoting circulation, but monitoring the lochia flow takes precedence in the immediate postpartum period to assess for any signs of hemorrhage or infection.
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 for the nurse to provide because it is a potentially life-threatening complication that requires immediate medical attention. Secondary hemorrhage can occur after the initial postpartum period and can lead to severe bleeding. Understanding the signs and symptoms of secondary hemorrhage can help the patient seek prompt medical care if needed. Choice A: The signs and symptoms of uterine infection are important to know, but they are usually treated with antibiotics and are not as immediately life-threatening as secondary hemorrhage. Choice C: Postpartum depression is a serious concern but does not require immediate medical attention like secondary hemorrhage. Choice D: A boggy uterus is a sign of uterine atony, which can lead to hemorrhage, but teaching about secondary hemorrhage takes precedence because it directly addresses a more severe form of bleeding that requires urgent intervention.
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 showing signs of uterine atony, which is a common cause of postpartum hemorrhage. A soft, boggy fundus with displacement and moderate bleeding indicates inadequate uterine contractions. If uterine massage does not improve the condition, it is crucial to involve the healthcare provider immediately for further interventions such as administering uterotonic medications or considering manual removal of retained placental fragments. Options A and B are not the priority in this critical situation, and option C, administering oxytocin, can be done but the immediate action should be to seek guidance from the healthcare provider due to the severity of the condition.
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 by actively seeking out information and skills related to parenting. The couple is proactively engaging in a structured learning environment to acquire knowledge and techniques essential for parenting. A: Observing other individuals who are parents may provide some insight, but it is more passive and not as structured as intentional learning. C: Discussing how they were parented is reflective, but it does not necessarily involve seeking out new information or skills actively. D: Watching media containing parenting roles can provide some information passively, but it may not be as reliable or comprehensive as attending formal classes.