When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse’s primary concern in planning the client’s care?
Harm to herself or her infant.
Displaying outbursts of anger.
Neglecting her hygiene.
Losing trust in her husband.
The Correct Answer is A
Choice A rationale
Postpartum depression with psychotic features may lead to suicidal ideation or infanticidal tendencies due to delusions or hallucinations. Ensuring safety is critical to prevent harm to both mother and infant.
Choice B rationale
Anger outbursts, though concerning, do not pose immediate threats like harm to self or infant. Addressing this behavior is secondary to prioritizing safety in severe postpartum psychosis cases.
Choice C rationale
Neglecting hygiene reflects depressive symptoms but does not indicate psychosis severity or imminent danger. Primary focus remains on managing safety risks to the mother and infant.
Choice D rationale
Losing trust in her husband is relevant to interpersonal stress but does not constitute a primary care concern. The immediate threat of harm takes precedence over marital dynamics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Choice A rationale
Postpartum hemorrhage may occur weeks after delivery due to subinvolution of the uterus or retained placental fragments. Educating about late risks ensures patients monitor symptoms and seek timely care.
Choice B rationale
Breastfeeding is encouraged even after postpartum hemorrhage as it helps stimulate uterine contractions, reducing bleeding risk. Recommending avoidance could delay recovery and is scientifically unsupported unless contraindicated.
Choice C rationale
Oxytocin may be prescribed for ongoing uterine atony or to prevent late postpartum hemorrhage. It is essential to educate patients about its purpose and correct administration for safety and effectiveness.
Choice D rationale
Saturating a peri-pad within 1 hour may indicate active bleeding. Reporting this promptly ensures swift intervention to prevent further complications, aligning with standard postpartum care protocols.
Choice E rationale
Postpartum hemorrhage is not limited to 24–48 hours after birth; late-onset hemorrhage, occurring up to weeks later, is a known complication. Misleading patients with this incorrect timeframe can delay critical interventions.
Correct Answer is D
Explanation
Choice A rationale
Uterine prolapse involves the descent of the uterus into the vaginal canal and is not a direct fatal complication of postpartum hemorrhage. It primarily stems from weakened pelvic floor muscles or ligament damage.
Choice B rationale
Von Willebrand’s disease is a hereditary bleeding disorder related to factor VIII and von Willebrand factor deficiencies, predisposing individuals to bleeding. It is not a direct result of prolonged postpartum hemorrhage.
Choice C rationale
Preeclampsia is a hypertensive disorder associated with proteinuria and organ dysfunction during pregnancy, not a postpartum hemorrhage complication. It can lead to significant morbidity but is unrelated to hemorrhagic complications.
Choice D rationale
Disseminated Intravascular Coagulation (DIC) is a life-threatening condition involving widespread coagulation and fibrinolysis, leading to uncontrolled bleeding, often triggered by severe postpartum hemorrhage. Laboratory findings may include low platelets, prolonged PT/INR, and elevated D-dimer.
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