Puerperal Infection Practice Exam

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1. Gina a postpartum client is diagnosed with endometritis. Which position would you expect to place her based on this diagnosis?

  1. Supine
  2. Left side lying
  3. Trendelinburg
  4. Semi-fowlers

2. A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert?

  1. Endometritis
  2. Endometriosis
  3. Salpingitis
  4. Pelvic thrombophlebitis

3. A nurse is providing instructions to a mother who has been diagnosed with mastitis. Which of the following statements if made by the mother indicates a need for further teaching?

  1. “I need to take antibiotics, and I should begin to feel better in 24-48 hours.”
  2. “I can use analgesics to assist in alleviating some of the discomfort.”
  3. “I need to wear a supportive bra to relieve the discomfort.”
  4. “I need to stop breastfeeding until this condition resolves.”

4. A nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. Select all instructions that would be included on the list.

  1. Take the prescribed antibiotics until the soreness subsides.
  2. Wear supportive bra
  3. Avoid decompression of the breasts by breastfeeding or breast pump
  4. Rest during the acute phase
  5. Continue to breastfeed if the breasts are not too sore.
5. A postpartum client has a temperature of 101.4ºF, with a uterus that is tender when palpated, remains unusually large, and not descending as normally expected. Which of the following should the nurse assess next?
  1. Lochia
  2. Breasts
  3. Incision
  4. Urine

6. Which of the following is the primary predisposing factor related to mastitis?

  1. Epidemic infection from nosocomial sources localizing in the lactiferous glands and ducts
  2. Endemic infection occurring randomly and localizing in the periglandular connective tissue
  3. Temporary urinary retention due to decreased perception of the urge to avoid
  4. Breast injury caused by overdistention, stasis, and cracking of the nipples
Answers & Rationales
  1. D. Semi-fowlers
  2. A. Endometritis. Endometritis is an infection of the uterine lining and can occur after prolonged rupture of membranes. Endometriosis does not occur after a strong labor and prolonged rupture of membranes. Salpingitis is a tubal infection and could occur if endometritis is not treated. Pelvic thrombophlebitis involves a clot formation but it is not a complication of prolonged rupture of membranes.
  3. D. “I need to stop breastfeeding until this condition resolves.” In most cases, the mother can continue to breastfeed with both breasts. If the affected breast is too sore, the mother can pump the breast gently. Regular emptying of the breast is important to prevent abscess formation. Antibiotic therapy assists in resolving the mastitis within 24-48 hours. Additional supportive measures include ice packs, breast supports, and analgesics.
  4. B, D, and E. Mastitis are an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3 L a day, and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. Continued decompression of the breast by breastfeeding or pumping is important to empty the breast and prevent formation of an abscess.
  5. ALochia. The data suggests an infection of the endometrial lining of the uterus. The lochia may be decreased or copious, dark brown in appearance, and foul smelling, providing further evidence of a possible infection. All the client’s data indicate a uterine problem, not a breast problem. Typically, transient fever, usually 101ºF, may be present with breast engorgement. Symptoms of mastitis include influenza-like manifestations. Localized infection of an episiotomy or C-section incision rarely causes systemic symptoms, and uterine involution would not be affected. The client data do not include dysuria, frequency, or urgency, symptoms of urinary tract infections, which would necessitate assessing the client’s urine.
  6. D. Breast injury caused by overdistention, stasis, and cracking of the nipples. With mastitis, injury to the breast, such as overdistention, stasis, and cracking of the nipples, is the primary predisposing factor. Epidemic and endemic infections are probable sources of infection for mastitis. Temporary urinary retention due to decreased perception of the urge to void is a contributory factor to the development of urinary tract infection, not mastitis.