The postpartum nurse has just received report on four clients. Which client should the nurse care for first? Client who vaginally delivered a 7-lb baby 1 hour ago

Client who vaginally delivered a 9-lb baby 1 hour ago

Client who vaginally delivered a preterm baby 4 hours ago

Client who had a planned cesarean delivery of an 8-lb baby 2 hours ago

The nurse should assess the client at risk for postpartum hemorrhage first. Uterine atony after a vaginal delivery is the main cause of postpartum hemorrhage. An overdistended uterus caused by a large fetus (9-lb baby) can cause uterine atony. Delivering a 7-lb baby or a preterm baby is not a risk factor. Uterine atony is minimized in a planned cesarean delivery.

The nurse is planning care for a client with postpartum psychosis. Which priority intervention should the nurse plan to implement? Teaching the client about normal newborn care

Ensuring adequate bonding time with the infant

Giving the client time and space to express her feelings

Referring the client to a psychiatric health care provider as prescribed

Assessment and management of postpartum psychosis are beyond the scope of a maternity nurse, and a mother who experiences this condition must be referred to a specialist for comprehensive therapy. Women with signs of postpartum psychosis need immediate medical attention to prevent suicide or infanticide. In light of this psychiatric emergency condition it would not be appropriate to plan bonding time for the client and infant, teach her about normal newborn care, or allow expression of her feelings.

A nurse is caring for a postpartum client who had abruptio placentae. Which assessment indicates that disseminated intravascular coagulation (DIC) is occurring?

Boggy uterus Hypovolemic shock Multiple vaginal clots

Bleeding at the venipuncture site

Bleeding at the venipuncture site indicates afibrinogenemia; massive clotting in the area of the separation has resulted in a decrease in the circulating fibrinogen level. A boggy uterus indicates uterine atony. Although hypovolemic shock may occur with DIC, there are other causes of hypovolemic shock, not just DIC. Blood clots indicate an adequate fibrinogen level; however, vaginal clots may indicate a failure of the uterus to contract and should be explored further.

A nurse determines that a postpartum client is gravida 1, para 1. Her blood type is B negative, and her baby's blood type is O positive. What should the nurse include in the plan of care?

Obtaining an order for RhoGAM Determining the father's blood type Checking for signs of ABO incompatibility Obtaining blood for type and crossmatching

RhoGAM will prevent sensitization from Rh incompatibility that may arise between an Rh-negative mother and an Rh-positive infant. Because the newborn has type O blood with no ABO incompatibility, neither mother nor infant will require a transfusion; this is the mother's first pregnancy, so the risk for RH incompatibility is minimal. Only the mother's and the newborn's Rh factors are relevant at this time. ABO incompatibility does not exist; it may if the mother has O-positive and the newborn has type B blood.

A nurse is concerned about a client's mother-infant bonding when on the first postpartum day she is reluctant to: Undress the newborn.

Breastfeed her newborn.

Look at her newborn's face. Attend classes for newborn care.

Looking at the face or seeking eye-to-eye contact with the infant is an early sign of the start of bonding with the infant. The mother may feel inept or worry about upsetting the nurse by undressing her infant; new mothers need encouragement to undress their infants. Refusing to breastfeed her newborn may indicate that the mother is worried that she does not have enough milk, a common concern. The client may have attended prenatal classes, may be otherwise occupied, may not be feeling well enough to attend the class, or may feel that she has enough experience to care for her infant without attending a class for newborn care.

A nurse is assessing several postpartum clients. Which conditions increase the risk for postpartum hemorrhage? Select all that apply. Twin birth

Overdistended bladder

Hypertonic uterine dystocia