A nurse is assessing a postpartum client for signs of postpartum depression. Which of the following symptoms is most indicative of postpartum depression rather than normal postpartum adjustment?

Feeling anxious about the baby's health and well-being, but still able to care for the baby effectively

Experiencing occasional mood swings and irritability while adjusting to the new role of motherhood

Feeling overwhelmed and having difficulty sleeping due to the demands of a newborn

Persistent feelings of sadness, severe fatigue, and loss of interest in activities, including caring for the baby

Answer and Explanation

The Correct Answer is D

A. Feeling anxious about the baby's health and well-being, but still able to care for the baby effectively
Mild anxiety about the baby’s health is a common experience for new mothers and does not necessarily indicate PPD. It becomes concerning if anxiety becomes overwhelming or interferes with daily functioning.

B. Experiencing occasional mood swings and irritability while adjusting to the new role of motherhood
Mood swings and irritability are normal postpartum adjustments, often due to hormonal changes, sleep deprivation, and new responsibilities. These symptoms typically resolve within a few weeks.

C. Feeling overwhelmed and having difficulty sleeping due to the demands of a newborn
Feeling overwhelmed and sleep disturbances are common in the postpartum period due to frequent infant care needs. However, severe or persistent sleep disturbances, especially with loss of interest in daily activities, may indicate PPD.

D. Persistent feelings of sadness, severe fatigue, and loss of interest in activities, including caring for the baby
Postpartum depression is characterized by prolonged sadness, extreme fatigue, withdrawal, and difficulty bonding with the baby. These symptoms extend beyond normal postpartum blues (which typically resolve within two weeks) and require medical intervention, including therapy and possibly medication.

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Correct Answer is []

Explanation

Condition: Postpartum Hemorrhage (PPH)

Postpartum hemorrhage is defined as blood loss ≥ 500 mL after vaginal delivery or ≥ 1000 mL after cesarean delivery. In this case, the client has heavy bleeding, large clots, and lightheadedness, which are key indicators of excessive postpartum blood loss.

Risk Factors

1. Fetal Macrosomia: The baby weighs 9 lbs 4 oz (4196 grams), which is considered macrosomia (birth weight > 4000 g). Large fetal size increases the risk of uterine overdistension, which can impair uterine contractions and lead to uterine atony, the most common cause of postpartum hemorrhage.

2. Uterine Atony: The nurse initially noted a boggy uterus that required massage to become firm. Uterine atony occurs when the uterus fails to contract effectively after delivery, leading to excessive bleeding. This is the leading cause of PPH.

3. Prolonged Labor: A prolonged labor can cause uterine fatigue, reducing the uterus's ability to contract properly after delivery, thereby increasing the risk of uterine atony and PPH.

Assessment Findings

1. Heavy vaginal bleeding: The client has heavy bleeding with three quarter-sized clots, which is abnormal postpartum and indicates excessive blood loss.

2. Blood pressure: The client’s BP is 150/86 mmHg, which may indicate compensatory vasoconstriction due to ongoing blood loss. If hemorrhage continues, hypotension may develop.

3. Urine output: The client did not feel the urge to void, and catheterization drained 450 mL of urine. A full bladder can prevent proper uterine contraction, worsening uterine atony and bleeding.

A. Negative for protein on a urine dipstick: B. Blood pressure of 150/96 mmHg C. Elevated ALT/AST D. Blood pressure of 162/112 mmHg E. Seizures

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Preeclampsia:

Blood pressure of 150/96 mmHg: A BP of ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive client is diagnostic of preeclampsia.

Preeclampsia with Severe Features:

Blood pressure of 162/112 mmHg: Severe hypertension is ≥160/110 mmHg on two occasions at least 4 hours apart. This is a criterion for severe preeclampsia, requiring immediate intervention to prevent complications like eclampsia or stroke.

Elevated liver enzymes (ALT/AST > 2x the upper limit of normal) are indicative of severe preeclampsia due to hepatic involvement. This can progress to HELLP syndrome, increasing the risk of liver rupture and disseminated intravascular coagulation (DIC).

Neither:

Negative for protein on a urine dipstick: Preeclampsia is typically diagnosed with proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3). A negative urine dipstick means proteinuria is absent, making preeclampsia unlikely. However, preeclampsia can also be diagnosed without proteinuria if other systemic features (e.g., thrombocytopenia, renal dysfunction) are present.

Seizures in a client with preeclampsia indicate eclampsia, which is a medical emergency requiring magnesium sulfate to prevent further seizures. If the client had no preeclampsia, the seizures could be due to another cause (e.g., epilepsy, metabolic disturbance).

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A nurse is assessing a postpartum client for signs of postpartum depression. Which of the following symptoms is most indicative of postpartum depression rather than normal postpartum adjustment?

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Naxlex Comprehensive Predictor Exams

35-year-old postpartum client. Select the condition, risk factors and assessment findings that the client may be experiencing.

Correct Answer is []

Explanation

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) As the nurse, you can identify whether the following findings are indicative of preeclampsia, preeclampsia with severe features, or neither. Select at least one answer in each row.

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

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