# The home-care nurse reviews a visit note eight days after birth. Which findings require immediate follow-up? Highlight the findings associated with possible postpartum psychosis. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=495006&lang=en > language: en > subject: Mental Health Concepts > category: PSI ## Question The home-care nurse reviews a visit note eight days after birth. Which findings require immediate follow-up? Highlight the findings associated with possible postpartum psychosis. Nurses' Notes 1105: The nurse visits the client and infant eight days after birth. The client whispers that the infant was secretly replaced by another family's baby. The partner reports that the client cried when left alone yesterday but accepted comfort. The client asks for help with positioning the infant during the next feeding. The client says that worry about feeding feels excessive and counseling may help. The infant is sleeping safely in a bassinet beside the partner. The client suddenly states, a voice ordered the client to hide the baby from demons. After reassurance, the client sits calmly and drinks a cup of water. The client identifies the current date and complete home address correctly. The client then allows the partner to hold the infant during the discussion. The partner reports three sleepless nights with pacing and claims of unlimited power. The client says that the postpartum appointment is written on the calendar. The kitchen contains food and clean water. The client denies incisional drainage. The nurse remains with the family while arranging emergency evaluation. The infant has no visible injury. The partner agrees not to leave the client alone with the infant. ## Explanation A fixed bizarre belief about the infant, a command hallucination involving the infant, and sleepless grandiose behavior require immediate follow-up. Postpartum psychosis is a psychiatric emergency. ## In-depth explanation Quick answer Highlight the fixed belief that the infant was replaced, the voice ordering the client to hide the infant, and several sleepless nights with grandiose pacing. These findings suggest loss of reality testing and possible postpartum psychosis. Why this is correct Postpartum psychosis can begin rapidly with delusions, hallucinations, mania, confusion, or severe insomnia. A belief held despite evidence and a command voice involving the infant create an immediate safety concern. The nurse should maintain supervision and arrange emergency psychiatric evaluation rather than leaving the client alone with the infant.[2][3] Easy analogy or mental picture Think of reality as a compass. Ordinary worry may shake the needle, but a delusion or hallucination points the compass away from shared reality. The picture helps separate urgency; it does not diagnose the cause of psychosis. Memory hook Postpartum loss of reality means protect two people and get emergency help. NCLEX decision rule When a recently postpartum client has delusions, hallucinations, severe manic sleeplessness, or thoughts involving harm, treat the situation as an emergency and secure immediate evaluation. Do not label loss of reality as routine baby blues. Why the other choices are wrong Tearfulness with intact reality, asking for feeding help, recognizing excessive worry, improving with support, and accurately stating time and place can still need support but do not match the displayed psychotic emergency cues.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]ACOG: Summary of Perinatal Mental Health ConditionsAmerican College of Obstetricians and Gynecologists - [3]ACOG Clinical Practice Guideline 4: Perinatal Mental Health Screening and DiagnosisAmerican College of Obstetricians and Gynecologists ## Related questions - [A client hospitalized for depression says, "My family would be better off without me." Whi…](https://mymerci.kr/pages/nclex_q.php?qn_id=393687&lang=en) - [A client with schizophrenia says, "The voices are telling me to do something bad." Which r…](https://mymerci.kr/pages/nclex_q.php?qn_id=394025&lang=en) - [A client arrives with bruises at different stages of healing. 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