Chapter 17 review questions- Maternal Newborn & Women's Health Nursing 7th Edition

The nurse is teaching a postpartum client about breastfeeding. Which instruction should the nurse include? 1. The diet should include additional fluids 2. Prenatal vitamins should be discontinued 3. Soap should be used to cleanse the breasts 4. Birth control measures are unnecessary while BF

1

One day after discharge, the postpartum patient calls the clinic complaining of a reddened area on her lower leg, temperature elevation of 37 C (99.8 F), rust-colored lochia, and sore breasts. What does the nurse suspect from these symptoms? a. Phlebitis b. Puerperal infection c. Late postpartum hemorrhage d. Mastitis

ANS: A The complaints related to the leg are indicative of phlebitis. The other signs are normal in the postpartum patient.

The nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client required an episiotomy and has several hemorrhoids. What is the priority nursing consideration for this client? 1. Client pain level 2. Inadequate urinary output 3. Client perception of body changes 4. Potential for imbalanced body fluid volume

1

The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? 1. Changes in vitals 2. Signs of heavy bruising 3. Complaints of intense pain 4. Complaints of tearing sensation

1 Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma. Option 2 (heavy bruising) may be seen, but vital sign changes indicate hematoma caused by blood collection in the perineal tissues.

The nurse is providing postpartum instructions for a client who will be breast feeding her newborn. The nurse determines that the client understands the instructions if she makes which statement? Select all that apply. 1. "I should wear a bra that provides support" 2. "Drinking alcohol can affect my milk supply" 3. "The use of caffeine can decrease my milk supply" 4. "I will start my estrogen birth control pills again as soon as I get home" 5. "I know if my breasts get engorged, I will limit my BF and supplement the baby" 6. "I plan on having bottled water available in the refrigerator so I can get additional fluids easily"

1, 2, 3, 6

A postpartum client is diagnosed with cystitis. The nurse should plan for which priority action in the care of the client? 1. Providing sitz baths 2. Encouraging fluid intake 3. Placing ice on the perineum 4. Monitoring Hcg and Hct levels

2

After a precipitous delivery, the nurse notes that the new mother is passive and touches her newborn infant only briefly with her fingertips. What should the nurse do to help the woman process the delivery? 1. Encourage the mother to BF soon after birth 2. Support the mother in her reaction to the newborn infant 3. Tell the mother that it is important to hold the newborn infant 4. Document a complete account of the mother's reaction on the birth record

2

The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss? 1. A temperature of 100.4 F (38 C) 2. A increase in pulse rate from 88 to 102 bpm 3. A BP change from 130/88 to 124/80 mmHg 4. An increase in the respiratory rate from 18 to 22 BPM

2

The nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. After locating the fundus, the nurse notes that the uterus feels soft and boggy. Which nursing intervention is appropriate? 1. Elevate the client's legs 2. Massage the fundus until it is firm 3. Ask the client to turn on her left side 4. Push on the uterus to assist in expressing clots

2

The nurse is assessing a client in the fourth stage of labor and notes the fundus is firm, but the bleeding is excessive. Which should bee the initial nursing action? 1. Record the findings 2. Massage the fundus 3. Notify HCP 4. Place client in Trendelenburg

3

The nurse is assessing a client who is 6 hours postpartum after delivering a full term healthy newborn. The client complains to the nurse of feelings of faintness and dizziness. Which nursing action is most appropriate? 1. Raise the head of the client's bed 2. Obtain Hgb and Hct levels 3. Instruct the client to request help when getting out of bed 4. Inform nursery room nurse to avoid bringing the newborn to the client until the client's symptoms have subsided

3

The postpartum nurse is assessing a client who delivered a healthy infant by c-section for signs and symptoms of superficial venous thrombosis. Which sign should the nurse note if superficial venous thrombosis were present? 1. Paleness of the calf area 2. Coolness of the calf area 3. Enlarged, hardened veins 4. Palpable dorsalis pedis pulses

3

A client in postpartum unit complains of sudden sharp chest pain and dyspnea. The nurse notes that the client is tachycardia and the respiratory rate is elevated. The nurse suspects a pulmonary embolism. Which should be the initial nursing action? 1. Start an IV line 2. Assess the client's BP 3. Prepare to administer morphine sulfate 4. Administer oxygen 8-10 L/minute by face mask

4

The nurse is caring for four 1-day postpartum clients. Which client assessment requires the need for follow-up? 1. The client with mild afterpains 2. The client with a pulse rate of 60 bpm 3. The client with colostrum discharge form both breasts 4. The client with lochia that is red and has a foul smelling odor

4

The nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has saturated a perineal pad in 15 minutes. How should the nurse respond to this finding initially? 1. Document the finding 2. Encourage the client to ambulate 3. Encourage the client to increase fluid intae 4. Contact HCP and inform of the finding

4

The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breastfeeding her newborn. Which statement would indicate the need for further instruction? 1. "I should breastfeed every 2-3 hours" 2. "I should change the breast pads frequently" 3. "I should wash my hands well before BF" 4. "I should wash my nipples daily with soap and water"

4

The postpartum nurse is taking the vitals of client who delivered a healthy newborn 4 hours ago. The nurse notes that the client's temperature is 100.2 F. What is the priority nursing action? 1. Document the findings 2. Retake the temperature in 15 mintues 3. Notify HCP 4. Increase hydration by encouraging oral fluids

4

27. Constipation is a common problem during the postpartum period. Select all the reasons for constipation during this period. (Select all that apply.) A. Diminished bowel tone B. Overhydration during labor C. Episiotomy that causes the fear of pain with elimination D. Iron supplementation E. Some pain medications

A C D E

30. Nursing measures to promote bonding and attachment include which of the following? (Select all that apply.) A. Assist the parents in unwrapping the baby to inspect. B. Point out that the infant grasping the mother's or father's finger is a natural reflex. C. Explain the physical changes in the newborn, such as molding, as being normal. D. Encourage the mother to let the infant stay in the nursery as much as possible so the mother can rest. E. Position the infant in a face to face position with the mother.

A E

A nurse performs an assessment on a client who is 4 hours PP. The nurse notes that the client has cool, clammy skin and is restless and excessively thirsty. The nurse prepares immediately to: A) Assess for hypovolemia and notify the health care provider B) Begin hourly pad counts and reassure the client C) Begin fundal massage and start oxygen by mask D) Elevate the head of the bed and assess vital signs

A) Assess for hypovolemia and notify the health care provider Rationale: Symptoms of hypovolemia include cool, clammy, pale skin, sensations of anxiety or impending doom, restlessness, and thirst. When these symptoms are present, the nurse should further assess for hypovolemia and notify the health care provider.

When performing a postpartum check, the nurse should: A) Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum B) Assist the woman into a supine position with her arms above her head and her legs extended for the examination of her abdomen C) Instruct the woman to avoid urinating just before the examination since a full bladder will facilitate fundal palpation D) Wash hands and put on sterile gloves before beginning the check

A) Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum Rationale: While the supine position is best for examining the abdomen, the woman should keep her arms at her sides and slightly flex her knees in order to relax abdominal muscles and facilitate palpation of the fundus. The bladder should be emptied before the check. A full bladder alters the position of the fundus and makes the findings inaccurate. Although hands are washed before starting the check, clean (not sterile) gloves are put on just before the perineum and pad are assessed

Select all of the physiological maternal changes that occur during the PP period. (Select all that apply) A) Cervical involution occurs B) Vaginal distention decreases slowly C) Fundus begins to descend into the pelvis after 24 hours D) Cardiac output decreases with resultant tachycardia in the first 24 hours E) Digestive processes slow immediately

A) Cervical involution occurs C) Fundus begins to descend into the pelvis after 24 hours Rationale: After 1 week the muscle begins to regenerate and the cervix feels firm and the external os is the width of a pencil. Although the vaginal mucosa heals and vaginal distention decreases, it takes the entire PP period for complete involution to occur and muscle tone is never restored to the pregravid state. The fundus begins to descent into the pelvic cavity after 24 hours, a process known as involution. Despite blood loss that occurs during delivery of the baby, a transient increase in cardiac output occurs. The increase in cardiac output, which persists about 48 hours after childbirth, is probably caused by an increase in stroke volume because Bradycardia is often noted during the PP period. Soon after childbirth, digestion begins to begin to be active and the new mother is usually hungry because of the energy expended during labor.

Which of the following findings would be expected when assessing the postpartum client? A) Fundus 1 cm above the umbilicus 1 hour postpartum B) Fundus 1 cm above the umbilicus on postpartum day 3 C) Fundus palpable in the abdomen at 2 weeks postpartum D) Fundus slightly to the right; 2 cm above umbilicus on postpartum day 2

A) Fundus 1 cm above the umbilicus 1 hour postpartum Rationale: Within the first 12 hours postpartum, the fundus usually is approximately 1 cm above the umbilicus. The fundus should be below the umbilicus by PP day 3. The fundus shouldn't be palpated in the abdomen after day 10.

Which of the following behaviors characterizes the PP mother in the taking in phase? A) Passive and dependant B) Striving for independence and autonomy C) Curious and interested in care of the baby D) Exhibiting maximum readiness for new learnin

A) Passive and dependant Rationale: During the taking in phase, which usually lasts 1-3 days, the mother is passive and dependent and expresses her own needs rather than the neonate's needs. The taking hold phase usually lasts from days 3-10 PP. During this stage, the mother strives for independence and autonomy; she also becomes curious and interested in the care of the baby and is most ready to learn.

Methergine or pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client's medical history? A) Peripheral vascular disease B) Hypothyroidism C) Hypotension D) Type 1 diabetes

A) Peripheral vascular disease Rationale: These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.

2. When reading the postpartum chart the nurse notices that the patient's fundus is recorded as "u+1." The nurse understands that this means the fundus is A. 1cm above the umbilicus B. 1cm below the umbilicus C. 1in. above the umbilicus D. 1in. below the umbilicus

A. 1cm above the umbilicus

14. As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be A. Soft, nontender; colostrum is present. B. Leakage of milk at let-down. C. Swollen, warm, and tender on palpation. D. A few blisters and a bruise on each areola.

A. Soft, nontender; colostrum is present.

4. The nurse is assessing the patient's vaginal discharge. It is red and has about a 2-inch stain on the peripad. The nurse will record this finding as a A. light amount of lochia rubra B. scant amount of lochia alba. C. moderate amount of lochia rubra. D. heavy amount of lochia alba.

A. light amount of lochia rubra Lochia rubra is red in color and occurs the first 3 or 4 days after birth. A light amount of discharge is classified as a 1- to 4-inch stain on the peripad.

16. The new mother comments that the newborn "has his father's eyes." The nurse recognizes this as A. part of the bonding process termed claiming. B. the mother trying to find signs of the baby's paternity. C. the mother trying to include the father in the bonding process. D. part of the letting-go phase of maternal adaptation.

A. part of the bonding process termed claiming Claiming or binding-in begins when the mother begins to identify specific features of the newborn. She then begins to relate features to family members.

13. During the early post-cesarean section phase, it is important for the woman to turn, cough, and deep breathe. The rationale for this is to prevent A. pooling of secretions in the airway. B. thrombus formation in the lower legs. C. gas formation in the intestinal tract. D. urinary retention.

A. pooling of secretions in the airway.

11. The first time a woman ambulates after the birth of the newborn, she has a nursing diagnosis of Risk for injury because of the A. risk for developing orthostatic hypotension. B. development of bradycardia. C. increase in cardiac output. D. increase in circulatory volume

A. risk for developing orthostatic hypotension.

Although the nurse has massaged the uterus every 15 minutes, it remains flaccid, and the patient continues to pass large clots. What does the nurse recognize these signs indicate? a. Uterine atony b. Uterine dystocia c. Uterine hypoplasia d. Uterine dysfunction

ANS: A Atony describes a lack of normal muscle tone. If the uterus is atonic, then muscle fibers are flaccid and will not compress bleeding vessels

The nurse assesses a boggy uterus with the fundus above the umbilicus and deviated to the side. What should the nurses next assessment be? a. Fullness of the bladder b. Amount of lochia c. Blood pressure d. Level of pain

ANS: A Bladder distention can cause uterine atony. The uterus is massaged to firmness and then the bladder is emptied.

A woman had a vaginal delivery two days ago and is preparing for discharge. What will the nurse plan to teach the woman to report to help prevent postpartum complications? a. Fever b. Change in lochia from red to white c. Contractions d. Fatigue and irritability

ANS: A Increased temperature is a sign of infection. The other choices are normal in the postpartum period.

While caring for a postpartum patient who had a vaginal delivery yesterday, the nurse assesses a firm uterine fundus and a trickle of bright blood. How does the nurse most likely feel and react to this finding? a. Concerned and reports a probable cervical laceration b. Attentive and massages the uterus to expel retained clots c. Distressed and reports a possible clotting disorder d. Satisfied with the normal early postpartum finding

ANS: A The bright trickle of blood with a firm uterus suggests a cervical laceration.

The nurse instructs the postpartum patient that her nutritional intake should include which food(s) particularly supportive to healing? (Select all that apply.) a. Legumes b. Potatoes and pasta c. Citrus fruits d. Rice e. Canatloupe

ANS: A, C, E Legumes and foods containing vitamin C are conducive to healing. Starches are not.

After a prolonged labor, a woman vaginally delivered a 10 pound, 3 ounce infant boy. What complication should the nurse be alert for in the immediate postpartum period? a. Cervical laceration b. Hematoma c. Endometritis d. Retained placental fragments

ANS: B Delivering a large infant and a prolonged labor are risk factors for hematoma formation.

At her 6-week postpartum checkup, a woman mentions to the nurse that she cannot sleep and is not eating. She feels guilty because sometimes she believes her infant is dead. What does the nurse recognize as the cause of this womans symptoms? a. Bipolar disorder b. Major depression c. Postpartum blues d. Postpartum depression

ANS: B Major depression is a disorder characterized by deep feelings of worthlessness, guilt, serious sleep and appetite disturbances, and sometimes delusions about the infant being dead.

. What statement by the patient leads the nurse to determine a woman with mastitis understands treatment instructions? a. I will apply cold compresses to the painful areas. b. I will take a warm shower before nursing the baby. c. I will nurse first on the affected side. d. I will empty the affected breast every 8 hours.

ANS: B Moist heat promotes blood flow to the area, comfort, and complete emptying of the breast.

The 1-day postpartum patient shows a temperature elevation, cough, and slight shortness of breath on exertion. What action should the nurse implement based on these symptoms? a. Notify the charge nurse of a possible upper respiratory infection. b. Notify the physician of a possible pulmonary embolism. c. Document expected postpartum mucous membrane congestion. d. Medicate with antipyretic remedy for elevated temp

ANS: B Symptoms of early pulmonary embolism may not be dynamic. The cough with shortness of breath and temperature elevation is a clue to this possible complication

What is the first sign of hypovolemic shock from postpartum hemorrhage? a. Cold, clammy skin b. Tachycardia c. Hypotension d. Decreased urinary output

ANS: B Tachycardia is usually the first sign of inadequate blood volume.

. A nurse is discussing risk factors for postpartum shock with a childbirth preparation class. What will the nurse include in this education session? (Select all that apply.) a. Hypertension b. Blood clotting disorders c. Anemia d. Infection e. Postpartum hemorrhage

ANS: B, C, D, E Hypertension is not a cause for postpartum shock; all the other options can cause shock.

28. What will the nurse teach a nursing mother to do to reduce the risk of mastitis? (Select all that apply.) a. Limit fluid intake to 1 liter per day. b. Empty both breasts with each feeding. c. Take warm showers. d. Wear a supportive bra. e. Pump breasts to ensure emptying.

ANS: B, C, D, E Nursing mothers should take in about 3 liters of fluid a day. All the other options are interventions to reduce the risk of mastitis and milk accumulation in the breast.

. The nurse assesses the perineal pad placed on a 3-hour postdelivery patient and finds that there is no lochia on it. What would the nurse expect to find on further assessment? (Select all that apply.) a. A firm fundus the size of a grapefruit b. A full bladder c. Retained placental fragments d. Vital signs indicative of shock e. A soft, boggy fundus

ANS: B, E Large clots that form in a flaccid uterus can obstruct the flow of lochia. A full bladder is a major cause of a uterus that is boggy

What should the nurses first action be when postpartum hemorrhage from uterine atony is suspected? a. Teach the patient how to massage the abdomen and then get help. b. Start IV fluids to prevent hypovolemia and then notify the registered nurse. c. Begin massaging the fundus while another person notifies the physician. d. Ask the patient to void and reassess fundal tone and location.

ANS: C When the uterus is boggy, the nurse should immediately massage it until it becomes firm.

. Five days after a spontaneous vaginal delivery, a woman comes to the emergency room because she has a fever and persistent cramping. What does the nurse recognize as the possible cause of these signs and symptoms? a. Dehydration b. Hypovolemic shock c. Endometritis d. Cystitis

ANS: C Fever after 24 hours following delivery is suggestive of an infection. Severe cramping and fever are manifestations of endometritis.

What is the best response to a postpartum woman who tells the nurse she feels tired and sick all of the time since I had the baby 3 months ago? a. This is a normal response for the body after pregnancy. Try to get more rest. b. Ill bet you will snap out of this funk real soon. c. Why dont you arrange for a babysitter so you and your husband can have a night out? d. Lets talk about this further. I am concerned about how you are feeling.

ANS: D If a postpartum woman seems depressed, it is important to explore her feelings to determine if they are persistent and pervasive

The nurse assesses a positive Homans sign when the patients leg is flexed and foot sharply dorsiflexed. Where does the patient report that the pain is felt? a. Groin b. Achilles tendon c. Top of the foot d. Calf of the leg

ANS: D A pain in the calf of the leg when the leg is flexed and the foot is dorsiflexed is a positive Homans sign. Homans sign is suggestive of a deep vein thrombosis.

Mom is correct when she says, "I am getting RhoGAM now..." A. "...because I can become sick if my baby was Rh positive." B. "...because I could make antibodies that could harm my next baby." C. "...to ensure my miscarriage is complete." D. "...because my baby was for sure Rh positive."

B

A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse instructs the mother that she should expect normal bowel elimination to return: A) One the day of the delivery B) 3 days PP C) 7 days PP D) within 2 weeks PP

B) 3 days PP Rationale: After birth, the nurse should auscultate the woman's abdomen in all four quadrants to determine the return of bowel sounds. Normal bowel elimination usually returns 2 to 3 days PP. Surgery, anesthesia, and the use of narcotics and pain control agents also contribute to the longer period of altered bowel function

Methergine or pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the: A) Amount of lochia B) Blood pressure C) Deep tendon reflexes D) Uterine tone

B) Blood pressure Rationale: Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.

On which of the postpartum days can the client expect lochia serosa? A) Days 3 and 4 PP B) Days 3 to 10 PP C) Days 10-14 PP D) Days 14 to 42 PP

B) Days 3 to 10 PP Rationale: On the third and fourth PP days, the lochia becomes a pale pink or brown and contains old blood, serum, leukocytes, and tissue debris. This type of lochia usually lasts until PP day 10. Lochia rubra usually last for the first 3 to 4 days PP. Lochia alba, which contain leukocytes, decidua, epithelial cells, mucus, and bacteria, may continue for 2 to 6 weeks PP.

A postpartum nurse is preparing to care for a woman who has just delivered a healthy newborn infant. In the immediate postpartum period the nurse plans to take the woman's vital signs: A) Every 30 minutes during the first hour and then every hour for the next two hours. B) Every 15 minutes during the first hour and then every 30 minutes for the next two hours. C) Every hour for the first 2 hours and then every 4 hours D) Every 5 minutes for the first 30 minutes and then every hour for the next 4 hours.

B) Every 15 minutes during the first hour and then every 30 minutes for the next two hours. Rationale: Every 15 minutes during the first hour and then every 30 minutes for the next two hours.

The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is: A) Normal B) Indicates the presence of infection C) Indicates the need for increasing oral fluids D) Indicates the need for increasing ambulation

B) Indicates the presence of infection Rationale: Lochia, the discharge present after birth, is red for the first 1 to 3 days and gradually decreases in amount. Normal lochia has a fleshy odor. Foul smelling or purulent lochia usually indicates infection, and these findings are not normal. Encouraging the woman to drink fluids or increase ambulation is not an accurate nursing intervention

When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which of the following nursing actions is most appropriate? A) Document the findings B) Notify the physician C) Reassess the client in 2 hours D) Encourage increased intake of fluids

B) Notify the physician Rationale: Normally, one may find a few small clots in the first 1 to 2 days after birth from pooling of blood in the vagina. Clots larger than 1 cm are considered abnormal. The cause of these clots, such as uterine atony or retained placental fragments, needs to be determined and treated to prevent further blood loss. Although the findings would be documented, the most appropriate action is to notify the physician.

Which of the following physiological responses is considered normal in the early postpartum period? A) Urinary urgency and dysuria B) Rapid diuresis C) Decrease in blood pressure D) Increase motility of the GI system

B) Rapid diuresis Rationale: In the early PP period, there's an increase in the glomerular filtration rate and a drop in the progesterone levels, which result in rapid diuresis. There should be no urinary urgency, though a woman may feel anxious about voiding. There's a minimal change in blood pressure following childbirth, and a residual decrease in GI motility.

21. The new parents express concern that their 4-year-old son is jealous of the new baby. They are planning on going home tomorrow and are not sure how the preschooler will react when they bring the baby home. Which one of the following suggestions by the nurse will be most helpful? A. Be aware that the child may regress to an earlier stage. B. Have the mother spend time with the child while the father cares for the baby. C. Have the child stay with a grandparent until the parents adjust to the new baby. D. Tell the child that he is a "big boy" now and doesn't need his crib so the new baby will be using it for a while.

B. Have the mother spend time with the child while the father cares for the baby.

5. The new mother is complaining of pain at the episiotomy site; however, because she is breastfeeding, she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain? A. Ambulation B. Topical Anesthetics C. hot fluids to drink D. stool softeners

B. Topical Anesthetics

A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following? A) Ask the client to turn on her side B) Ask the client to lie flat on her back with the knees and legs flat and straight C) Ask the mother to urinate and empty her bladder D) Massage the fundus gently before determining the level of the fundus.

C) Ask the mother to urinate and empty her bladder Rationale: Before starting the fundal assessment, the nurse should ask the mother to empty her bladder so that an accurate assessment can be done. When the nurse is performing fundal assessment, the nurse asks the woman to lie flat on her back with the knees flexed. Massaging the fundus is not appropriate unless the fundus is boggy and soft, and then it should be massaged gently until firm.

Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? A) Retained placental fragments B) Urinary tract infection C) Cervical laceration D) Uterine atony

C) Cervical laceration Rationale: Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting. Retained placental fragments and uterine atony may cause subinvolution of the uterus, making it soft, boggy, and larger than expected. UTI won't cause vaginal bleeding, although hematuria may be present.

A PP client is being treated for DVT. The nurse understands that the client's response to treatment will be evaluated by regularly assessing the client for: A) Dysuria, ecchymosis, and vertigo B) Epistaxis, hematuria, and dysuria C) Hematuria, ecchymosis, and epistaxis D) Hematuria, ecchymosis, and vertigo

C) Hematuria, ecchymosis, and epistaxis Rationale: The treatment for DVT is anticoagulant therapy. The nurse assesses for bleeding, which is an adverse effect of anticoagulants. This includes hematuria, ecchymosis, and epistaxis. Dysuria and vertigo are not associated specifically with bleeding.

Which measure would be least effective in preventing postpartum hemorrhage? A) Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered B) Encourage the woman to void every 2 hours C) Massage the fundus every hour for the first 24 hours following birth D) Teach the woman the importance of rest and nutrition to enhance healing

C) Massage the fundus every hour for the first 24 hours following birth Rationale: The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Responses 1, 2, and 4 are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.

Which of the following interventions would be helpful to a breastfeeding mother who is experiencing engorged breasts? A) Applying ice B) Applying a breast binder C) Teaching how to express her breasts in a warm shower D) Administering bromocriptine (Parlodel)

C) Teaching how to express her breasts in a warm shower Rationale: Teaching the client how to express her breasts in a warm shower aids with let-down and will give temporary relief. Ice can promote comfort by vasoconstriction, numbing, and discouraging further letdown of milk.

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: A) Return to pre pregnant weight is usually achieved by the end of the postpartum period B) Fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3 pound weight loss C) The expected weight loss immediately after birth averages about 11 to 13 pounds D) Lactation will inhibit weight loss since caloric intake must increase to support milk production

C) The expected weight loss immediately after birth averages about 11 to 13 pounds Rationale: Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 pounds. Weight loss continues during breast

Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage? A) Hypertension B) Cervical and vaginal tears C) Urine retention D) Endometritis

C) Urine retention Rationale: Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period

20. The home care nurse is visiting a new mother who delivered 1 week ago. The mother complains about not being able to sleep and that she is tired and cries easily. The best response by the nurse would be: A. "Having a baby is difficult; it will be a long time before you get a good night's sleep." B. "Maybe your mother can come in and help you out." C. "It is normal for this to happen and should go away in 2 weeks. It must be very difficult for you to feel this way with a new baby." D. "The hospital nurses must not have taught you enough information about the changes you will experience during these first 6 weeks."

C. "It is normal for this to happen and should go away in 2 weeks. It must be very difficult for you to feel this way with a new baby."

6. A mother who is 3 days postpartum calls the clinic and complains of "night sweats." She is afraid that she is going into early menopause. The nurse should base her answer on the fact that A. Birth may put some women into early menopause; an appointment is needed to have this checked out. B. night sweats may be an indication of many other problems; an appointment is needed to assess the problem. C. diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. D. diaphoresis is normal only if the mother is breastfeeding.

C. diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother.

8. One nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is A. forcing fluids. B. perineal care. C. encouraging voiding every 2 to 3 hours. D. encouraging the use of stool softeners.

C. encouraging voiding every 2 to 3 hours.

17. A new father of 1 day expresses concern to the nurse that his wife, who is normally very independent, is asking him to make all the decisions. The nurse can best explain this as a(n) A. normal occurrence because the mother is in pain. B. abnormal occurrence that needs to be assessed further. C. normal occurrence because the mother is in the taking-in phase. D. normal occurrence because the mother is frustrated with the care of the newborn.

C. normal occurrence because the mother is in the taking-in phase.

10. A woman was admitted to the ED with her newborn baby. The baby was born 4 days ago at home. The woman had no prenatal care. The nurse is assessing the lab work and sees that the mother has an O-negative blood type, the baby is O-positive, and the Coombs test shows that the mother is not sensitized to the positive blood. The nurse's next action should be A. order Rho(D) immune globulin to be given to the mother. B. order Rho(D) immune globulin to be given to the baby. C. record the findings of the lab work and not plan on any further action at this time.

C. record the findings of the lab work and not plan on any further action at this time.

The new mother who had a vaginal delivery yesterday has a white blood cell count of 30,000 cells/dL. What action should the nurse implement? a. Notify the charge nurse of a possible infection. b. Prepare to put the patient in isolation. c. Have the infant removed from the room and returned to the nursery. d. Assess the patient further

D The patient should be assessed further for other signs of infection because a white blood cell (WBC) count of 20,000 to 30,000 cells/dL is normal in the early postpartum period.

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? A) "I need to take antibiotics, and I should begin to feel better in 24-48 hours." B) "I can use analgesics to assist in alleviating some of the discomfort." C) "I need to wear a supportive bra to relieve the discomfort." D) "I need to stop breastfeeding until this condition resolves."

D) "I need to stop breastfeeding until this condition resolves." Rationale: 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.

A nurse in a PP unit is instructing a mother regarding lochia and the amount of expected lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but should never exceed the need for: A) One peripad per day B) Two peripads per day C) Three peripads per day D) Eight peripads per day

D) Eight peripads per day Rationale: The normal amount of lochia may vary with the individual but should never exceed 4 to 8 peripads per day. The average number of peripads is 6 per day.

Which of the following findings would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum? A) Postural hypotension B) Temperature of 100.4°F C) Bradycardia — pulse rate of 55 BPM D) Pain in left calf with dorsiflexion of left foot

D) Pain in left calf with dorsiflexion of left foot Rationale: Responses 1 and 3 are expected related to circulatory changes after birth. A temperature of 100.4°F in the first 24 hours is most likely indicative of dehydration which is easily corrected by increasing oral fluid intake. The findings in response 4 indicate a positive Homan sign and are suggestive of thrombophlebitis and should be investigated further.

On the first PP night, a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases? A) Depression phase B) Letting-go phase C) Taking-hold phase D) Taking-in phase

D) Taking-in phase Rationale: The taking-in phase occurs in the first 24 hours after birth. The mother is concerned with her own needs and requires support from staff and relatives. The taking-hold phase occurs when the mother is ready to take responsibility for her care as well as the infants care. The letting-go phase begins several weeks later, when the mother incorporates the new infant into the family unit.

Before giving a PP client the rubella vaccine, which of the following facts should the nurse include in client teaching? A) The vaccine is safe in clients with egg allergies B) Breast-feeding isn't compatible with the vaccine C) Transient arthralgia and rash are common adverse effects D) The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects

D) The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects Rationale: The client must understand that she must not become pregnant for 3 months after the vaccination because of its potential teratogenic effects. The rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies. The virus is not transmitted into the breast milk, so clients may continue to breastfeed after the vaccination. Transient arthralgia and rash are common adverse effects of the vaccin

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: A) Uses soap and warm water to wash the vulva and perineum B) Washes from symphysis pubis back to episiotomy C) Changes her perineal pad every 2 - 3 hours D) Uses the peribottle to rinse upward into her vagina

D) Uses the peribottle to rinse upward into her vagina Rationale: Responses 1, 2, and 3 are all appropriate measures. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still-open cervix.

Which of the following complications is most likely responsible for a delayed postpartum hemorrhage? A) Cervical laceration B) Clotting deficiency C) Perineal laceration D) Uterine subinvolution

D) Uterine subinvolution Rationale: Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution. Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn't corrected at the time of delivery.

3. During the second postpartum day, a woman asks the nurse, "Why are my afterpains so much worse this time than after the birth of my other child?" The best answer by the nurse would be: A. "Most women forget how strong the afterpains can be." B."They should not be strong with you because you are breastfeeding." C."You should not be feeling the pains now; I will notify the physician for you." D. "Afterpains are more severe for women who have already given birth."

D. "Afterpains are more severe for women who have already given birth."

1. Immediately after birth, the nurse can anticipate the fundus to be located A. at the umbilicus B. 2cm above the umbilicus C. 1cm below the umbilicus D. midway between the symphysis pubis and umbilicus

D. midway between the symphysis pubis and umbilicus

7. On the first postpartum day a patient's white blood cell count is 25,000/mm3. The nurse's next action should be to A. notify the physician for an antibiotic order. B. assess the patient's temperature and blood pressure. C. request the count be repeated. D. note the results in the chart.

D. note the results in the chart.

24. Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should A. tell the woman she can rest after she feeds her baby. B. recognize this as a behavior of the taking-hold stage. C. record the behavior as ineffective maternal-newborn attachment. D. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

D. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

The nurse has provided discharge instructions to a client who delivered a healthy newborn by c-section. Which statement by the client indicates a need for further instruction? 1. "I will begin abdominal exercises immediately" 2. "I will notify the HCP if I develop a fever" 3. "I will turn on my side and push with my arms to get out of bed" 4. "I will lift nothing heavier than my newborn baby for at least 2 weeks"

1

Which statement indicates to the nurse on a postpartum home visit that the patient understands the signs of late postpartum hemorrhage? a. My discharge would change to red after it has been pink or white. b. If I have a postpartum hemorrhage, I will have severe abdominal pain. c. I should be alert for an increase in bright red blood. d. I would pass a large clot that was retained from the placenta

ANS: A When the nurse teaches the postpartum woman about normal changes in lochia, it is important to explain that a return to red bleeding after it has changed to pink or white may indicate a late postpartum hemorrhage.

Massage and putting the infant to the breast of a postpartum patient have been ineffective in controlling a boggy uterus. What will the nurse anticipate might be ordered by the physician? a. Ritodrine b. Magnesium sulfate c. Oxytocin d. Bromocriptine

ANS: C Oxytocin (Pitocin) is the most common drug ordered to control uterine atony

The nurse is caring for a woman who had a cesarean birth yesterday. Varicose veins are visible on both legs. What nursing action is the most appropriate to prevent thrombus formation? a. Have the woman sit in a chair for meals. b. Monitor vital signs every 4 hours and report any changes. c. Tell the woman to remain in bed with her legs elevated. d. Assist the woman with ambulation for short periods of time

ANS: D Early ambulation and range-of-motion exercises are valuable aids to prevent thrombus formation in the postpartum

A 4-week postpartum patient with mastitis asks the nurse if she can continue to breastfeed. What is the nurses most helpful response? a. Stop breastfeeding until the infection clears. b. Pump the breasts to continue milk production, but do not give breast milk to the infant. c. Begin all feedings with the affected breast until the mastitis is resolved. d. Breastfeeding can continue unless there is abscess formation

ANS: D The woman with mastitis can continue to breastfeed unless an abscess forms.

25. A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing women's needs during this stage, should A. foster an active role in the baby's care B. provide time for the mother to reflect on the events of the childbirth. C. recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. D. promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

B. provide time for the mother to reflect on the events of the childbirth.

19. A nurse is asked to do a home visit on a woman who delivered 2 weeks ago. When assessing the woman, the nurse was not able to locate the fundus. The next action would be A. massage the fundus until firm. B. monitor for bleeding. C. arrange transportation for the woman to the nearest hospital. D. document this normal finding.

D. document this normal finding. The uterus descends at the rate of about 1 cm/day. By 10 to 14 days, it is no longer palpable above the symphysis pubis. This is a normal finding.

Which type of lochia should the nurse expect to find in a client 2 days PP? A) Foul-smelling B) Lochia serosa C) Lochia alba D) Lochia rubra

D) Lochia rubra

The postpartum nurse is providing instructions to a client after birth of a healthy newborn. Which time frame should the nurse relay to the client regarding the return of bowel function? 1. 3 days postpartum 2. 7 days postpartum 3. On the day of birth 4. Within 2 weeks postpartum

1

28. When assessing the perineum, episiotomy site, or surgical site, the nurse should assess for specific signs. Select all the signs that are appropriate when assessing a surgical site. (Select all that apply.) A. Redness B. Edema C. Ecchymosis D. Discharge E. Asymetry

A B C D

A nurse notices a patient has heavy lochia on her pad. The uterus is firm and midline. What should the nurse do next? A. Gently massage the fundus. B. Notify the charge nurse immediately. C. Document this expected finding. D. Ask the patient when she last changed her pad

D

The nurse is preparing a list of self care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. 1. Wear a supportive bra 2. Rest during the active phase 3. Maintain a fluid intake of at least 3000 mL/day 4. Continue to breastfeed if the breasts are not sore 5. Take the prescribed antibiotics until the soreness subsides 6. Avoid decompression of the breasts by breastfeeding or breast pump

1, 2, 3, 4

On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should be taking which initial action? 1. Document the findings 2. Elevate the client's legs 3. Massage the fundus until it is firm 4. Push on the uterus to assist in expressing clots

3

A patient had an uncomplicated vaginal delivery 8 days ago. She calls with complaints of fever, fatigue, and generally feeling terrible. She also states she has a hard, round, red mass on her left breast. What is the best response by the nurse: A. Encourage the patient to continue breastfeeding and to come to the clinic for evaluation. B. Encourage the patient to rest and stay hydrated; the flu is going around the community. C. Tell the patient she should quit breastfeeding immediately and come to the clinic for evaluation. D. Tell the patient to quit breastfeeding on the side with the mass and take ibuprofen for the pain.

A

26. After a cesarean birth, the woman needs to be assessed routinely. Select all the assessments necessary for this woman. (Select all that apply.) A. Vital Signs B. Return of motion and sensation C. Abdominal dressing D. Pupil dilation E. Uterine firmness and position F. Urine output G. Deep tendon reflexes H. IV infusion

A B C E F H

29. To promote bonding during the first hour after birth, the nurse can do which of the following? (Select all that apply.) A. Delay procedures if appropriate. B. Allow the father to hold the newborn. C. demonstrate proper bottle feeding techniques. D. Allow as much contact with the newborn as possible. E. Use the time to do parent teaching on newborn characteristics.

A B D

9. While doing patient teaching, the woman tells the nurse, "I don't have to worry about contraception because I am breastfeeding." The nurse should base her answer on the fact that A. breastfeeding can be considered a reliable system of birth control. B. breastfeeding can be used as a contraceptive method if strict guidelines are followed through C.breastfeeding is not a reliable contraceptive method.

C.breastfeeding is not a reliable contraceptive method.