intrapartum

The nurse assess a swollen ecchymoses area to the right of the episiotomy on a primiparous client 6 hours after a vaginal birth. What should be the nurse do next? 1. apply an icepack to the perineal area. 2. assess the client's temperature. 3. have the client take a warm sitz bath. 4. contact the health care provider (HCP) for prescriptions for an antibiotic.

1

While caring for a multiparous client 4 hours after vaginal birth of a term neonate, the nurse notes that the mother's temperature is 99.8F (37.2 C), the pulse is 66 beats/min, and the respirations are 18 breaths/min. Her fundus is firm, midline, and at the level of the umbilicus. What should the nurse do? 1. Continue to monitor the client's vital signs. 2. Assess the client's lochia for large clots. 3. Notify the client's health care provider (HCP) about the findings. 4. Offer the mother an ice pack for her forehead.

1

A 25 year old primiparous client who gave birth 2 hours ago has decided to breastfeed her neonate. which instructions should the nurse add as the highest priority in the teaching plan about preventing nipple soreness? 1. keeping plastic liners in the brassiere to keep the nipple drier 2. placing as much of the areola as possible in the baby's mouth 3. smoothly pulling the nipple out of the mouth after 10 minutes 4. removing any remaining milk left on the nipple with a soft washcloth

2

After instructing a primiparous client about episiotomy care, which client statement indicates successful teaching? 1. "I will use hot, sudsy water to clean the episiotomy area." 2. "I wipe the area from front to back using a blotting motion." 3. "Before bedtime, I will use cold water sitz bath." 4. "I can use ice packs for 3 to 4 days after birth."

2

The nurse working on the postpartum unit is in charge of a team that includes an unlicensed assistive personnel (UAP). Which task would the nurse question if completed by the UAP caring for a 1 day postpartum client? 1. changing the perineal pad and reporting the drainage 2. teaching the mother to latch the infant onto the breast 3. reinforcing good hygiene while assisting the client with washing the perineum 4. assisting the client with ambulation shortly after birth

2

A client is in the first hour of her recovery after vaginal birth. during assessment, the loch is moderate, is bright red, and is trickling from the vagina. the nurse locates the funds at the umbilicus; it is firm and midline with no palpable bladder. the clients vital signs remain at their baseline. based on this information, the nurse would implement which action? 1. increase the IV rate 2. recheck the admission hematocrit and hemoglobin levels. 3. report findings to the health care provider (HCP) 4. document the findings as normal.

3

Twelve hours after vaginal birth with epidural anesthesia, the nurse palpates the fundus of the primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. What should the nurse do next? 1. Document this as normal finding in the client's record. 2. Contact the health care provider (HCP) for a prescription for oxytocin. 3. Encourage the client to ambulate to the bathroom and void. 4. Gently massage the fundus to expel the clots

3

during a home visit on the fourth postpartum day, a primiparous client tells the nurse that she has been experiencing breast engorgement. to relieve engorgement , the nurse teaches the client to use which intervention before nursing her baby? 1. apply an ice cube to the nipples 2. rub the nipples gently with lanolin cream 3. express a small amount of breast milk 4. offer the neonate a small amount of formula

3

A multiparous client, 28 hours after cesarean birth, who is breastfeeding has severe cramps or afterpains. The nurse explains that these are caused by which factor? 1. flatulence accumulation after cesarean birth 2. healing of the abdominal incision after cesarean birth 3. adverse effects of the medications administered after birth 4. release of oxytocin during the breastfeeding session

4

In preparation for discharge, the nurse discusses sexual issues with a multiparous client who had a routine vaginal birth with a midline episiotomy. The client asks, "I've heard recommendations about when to resume intercourse have changed since my last baby. What are they saying now?" When should the nurse instruct the client that she can resume sexual intercourse? 1. in 6 weeks when the episiotomy is completely healed 2. after a postpartum check by the health care provider (HCP) 3. whenever the client is feeling amorous and desirable 4. when lochia flow and episiotomy pain have stopped

4

The nurse is caring for a multiparous client after vaginal birth of a set of twins 2 hours ago. what should the nurse encourage the mother and partner to do? 1. Bottle-feed the twins to prevent exhaustion and fatigue. 2. Plan for each parent to spend equal amounts of time with each twin. 3. Avoid assistance from other family members until attachment occurs. 4. Relate to each twin individually to enhance the attachment process.

4

Three hours postpartum, a primiparous client's fundus is firm and midline. On perineal inspection, the nurse observes a small, constant trickle of blood. Which condition should the nurse assess further? 1. retained placental tissue 2. uterine inversion 3.bladder distention 4. perineal lacerations

4

While assisting a primiparous client with first breastfeeding session, the nurse should instruct the mother to perform which action in order to stimulate the neonate to open the mouth and grasp the nipple? 1. Pull down gently on the neonate's chin and insert the nipple. 2. Squeeze both of the neonate's cheeks simultaneously 3. Place the nipple into the neonates mouth on top of the tongue 4. Brush the neonates lips lightly with the nipple

4

A primiparous client is on a regular diet 24 hours postpartum. The client's mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds based on the understanding about which principle? 1. Foods from home are generally discouraged on the postpartum unit. 2. The mother can bring the daughter any foods that she desires. 3. This is permissible as long as the foods are nutritious and high in iron. 4. The client's health care provider (HCP) needs to give permission for the foods.

2

The nurse is reviewing discharge instructions with a postpartum breastfeeding client who is going home. She has chosen depot mediroxy-progesterone acetate (DMPA) injections as birth control. Which statement by the client identifies that she needs further instruction concerning birth control? 1. "I will wait for my 6-week checkup to get my first birth control injection." 2. "Depot injections last for 90 days." 3. "My milk supply should be well established before receiving a birth control injection." 4. "You will give me my first depot injection before I leave today"

4

After the nurse counsels a primiparous, breastfeeding client about diet and nutritional needs during the lactation period, which client statement indicates a need for additional teaching? 1. "I need to increase my intake of vitamin D." 2. "I should drink at least five glasses of fluid daily." 3. "I need to get an extra 500 cal/day." 4. "I need to make sure I have enough calcium in my diet."

2

An adolescent primiparous client 24 hours postpartum asks the nurse how often she can hold her baby without "spoiling" him. Which response would be most appropriate? 1. "Hold him when he is fussy or crying." 2. "Hold him as much as you want to hold him." 3. "Try to hold him infrequently to avoid overstimulation." 4. "You can hold him periodically throughout the day."

2

The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains? 1. G4, P1 client who is breastfeeding her infant 2. G3, P3 client who is breastfeeding her infant 3. G2, P2 cesarean client who is bottle-feeding her infant 4. G3, P3 client who is bottle-feeding her infant

2

a primigravida client gave birth vaginally 2 hours ago with no complications. as the nurse plans care for this postpartum client, which postpartum goal would have the highest priority? 1. by discharge, the family will bong with the neonate. 2. the nurse will demonstrate self-care and infant care by the end of the shift/ 3. the nurse will state instructions for discharge during the first postpartum day. 4. by the end of the shift, the nurse will describe a safe home environment.

2

Which principle forms the basis for the teaching plan about avoiding nonprescription medication for a primiparous client who is breastfeeding? 1. Breast milk quality and richness are decreased. 2. The mother's motivation to breastfeed is diminished. 3. Medications may be excepted in breast milk to the nursing neonate. 4. Medications interfere with the mother's letdown reflex.

3

A 1-day-old breastfed infant has a bilirubin level that is at an intermediate risk for jaundice. Which statement by the infants's mother indicates an understanding of the teaching regarding jaundice? 1. "I should breastfeed my baby as often as possible." 2. "I should supplement with formula after every feeding." 3. "I should discontinue breastfeeding and change to formula feeding." 4. "I should place my baby in direct sunlight several times a day."

1

A breastfeeding primiparous client asks the nurse how breast milk differs from cow's milk. The nurse responds by saying that breast milk is higher in which nutrient? 1. fat 2. iron 3.sodium 4. calcium

1

the nurse is providing follow-up care to a client 10 days after the birth. the nurse would anticipate what outcomes from the new mother? select all that apply 1. the client feels tired but is bale to care for herself and her new infant 2. the family has adequate support from one another and others 3. loch is changing from red to pink and is smaller in amount 4. the client feeds the baby every 6 to 8 hours without difficulty 5. the client has positive comments about her new infant

1,2,3,5

A newly postpartum primiparous client asks the nurse, "Can my baby see?" Which statement about neonatal vision should the nurse include in the explanation? 1. Neonates primarily focus on moving objects. 2. They can see objects up to 12 inches (30.5 cm) away. 3. Usually the see clearly by about 2 days after birth. 4. Neonates primarily distinguish light from dark.

2

A primiparous client who gave birth 12 hours ago under epidural anesthesia with a midline episiotomy tells the nurse that she is experiencing a great deal of discomfort when she sits in a chair with the baby. Which instructions would be most appropriate? 1. "Ask for one pain medication before you sit down." 2. "Squeeze your buttock muscles together before sitting down." 3. "Keep a relaxed posture before sitting down with your full weight." 4. "Ask the health care provider for some analgesic cream or spray."

2

A primiparous client who gave birth vaginally 8 hours ago desires to take a shower. The nurse anticipates remaining near the client to assess for which problem? 1. fatigue 2. fainting 3. diuresis 4. hygiene needs

2

a client gave birth vaginally 2 hours ago and has third-degree laceration. there is ice in place on her perineum. however, her perineum is slightly edematous, and the client is having pain rated 6 on a scale of 1-10. which nursing intervention would be the most appropriate at this time? 1. begin sitz baths. 2. administer pain medication per subscription. 3. replace ice packs to the perineum. 4. initiate prescription anesthetic sprays to the perineum.

2

A breastfeeding primiparous client with a midline episiotomy id prescribed ibuprofen orally. When does the nurse instruct the client to take the medication? 1. before going to bed 2. midway between feedings 3. immediately after a feeding 4. when providing supplemental formula

3

A primiparous client, 20 hours after birth asks the nurse about starting postpartum exercise. Which instruction would be most appropriate to include in the plan of care? 1. Start in a sitting position, and then lie back, and return to a sitting position, repeating this. 2. Assume a prone position, and then do push ups by using the arms to lift the upper body. 3. Flex the knees while supine, and then inhale deeply and exhale while contracting the abdominal muscles. 4. Flex the knees while supine, and then bring chin to chest while exhaling and reach for knees by lifting the head and shoulder and inhaling.

3

At a postpartum checkup 11 days after birth the nurse ask the client about the color of her lochia. Which color is expected? 1. dark red 2. pink 3. brown 4. white

4

During a home visit, a breastfeeding client asks the nurse what contraceptive method she and her partner should use until she has her 6-week postpartum examination. Which method would be most appropriate for the nurse to suggest? 1. condom with spermicide 2. oral contaceptive 3. rhythm method 4. abstinence

1

A nurse is discussing discharge instructions with a client. Which statement indicates that the client understands the resources and information available if needed after discharge? Select all that apply. 1. "My fertility can return as early as 21 days after my baby's birth." 2. "I have the hospital phone number if I have any questions." 3. "If I have any breathing problems, chest pain, or pounding fast heart rate, I will seek medical assistance." 4. "My mother is coming to help for a month, so I will be fine." 5. "I know if I get fever or chills or change in lochia to call the health care provider." 6. "I will continue my prenatal vitamins until my postpartum checkup or longer."

1,2,3,5,6

A breastfeeding client is seen at home by the visiting nurse 10 days after vaginal birth. The client has warm, red, painful breast, a temperature of 100F (37.7C), and flu-like symptoms. What should the nurse do? 1. Encourage the client to breastfeed her infant using the unaffected breast. 2. Refer the women to her health care provider (HCP). 3. Inform the client that she needs to discontinue breastfeeding. 4. Instruct the women to apply warm compresses to the affected breast.

2

A primiparous client who is bottle-feeding her neonate at 12 hour after birth asks the nurse, "when will y menstrual cycle return?" Which response by the nurse would be most appropriate? 1. "Your menstrual cycle will return in 3 to 4 weeks." 2. "It will probably be 6 to 10 weeks before it starts again." 3. "You can expect your menses to start in 12 to 14 weeks." 4. "Your menses will return in 16 to 18 weeks."

2

A postpartum primiparous client is having difficulty breastfeeding her infant. The infant latches on to the great, but the mother's nipples are extremely sore during and after each feeding. The client needs further instruction about breastfeeding when she makes which statement? 1.. "The baby needs to have as much of the nipple and areola in the mouth as possible to prevent sore and cracked nipples." 2. "I can put breast milk on my nipples to heal the sore areas." 3. "As long as some of my nipple is in the baby's mouth, the baby will receive enough milk." 4. "Feeding the baby for a half-hour on each side will not make my breasts sore."

3

While assessing the episiotomy site of a primiparous client on the first postpartum day, the nurse observes a fairly large hemorrhoid at the client's rectum. After instructing the client about measures to relieve hemorrhoid discomfort, which client statement indicates the need for additional teaching? 1. "I should ask my health care provider about using a stool softener." 2. "Analgesic sprays and witch hazel pads can relieve the pain." 3. "I should lie on my back as much as possible to relieve the pain." 4. "I should drink lots of water and eat foods that have a lot of roughage."

3

At which location would the nurse expect to palpate the fungus of a primiparous client immediately after birth of a neonate? 1. halfway between the umbilicus and the symphysis pubis. 2. at the level of the umbilicus 3. just below the level of the umbilicus 4. above the level of the umbilicus

1

While the nurse is caring for a primiparous client on the first postpartum day, the client asks, "How is that women doing who lost her baby from prematurity? We were in labor together." Which response by the nurse would be most appropriate? 1. Ignore the client's question and continue with morning care. 2. Tell the client, "I'm not sure how the other women is doing today." 3. Tell the client, "I need to ask the woman's permission before discussing her well-being." 4. Explain to the client that "nurses are not allowed to discuss other clients on the unit."

4

a breastfeeding primiparous client who gave birth 8 hours ago asks the nurser, "how will I know that my baby is getting enough to eat?" which guideline should the nurse include in the teaching plan as evidence of adequate intake? 1. six to eight wet diapers by the 5th day 2. three to four transitional stools on the 4th day 3. ability to fall asleep easily after feeding on the first day 4. regain of lost birth weight by the 3rd day

1

after the nurse teaches a primiparous client planning to return to work in 6 weeks about storing breast milk, which client statement indicates the need got further teaching? 1. "I can safely stor freshly expressed breast milk at room temperature for 8 hours." 2. "I will be sure to label the breast milk with the date, time and amount." 3. "I must discard any bread milk stored for more than 3 days in the refrigerator." 4. "I can keep the breast milk in a deep freeze in clean glass bottle for up to 1 year."

3

Two hours after a vaginal birth under epidural anesthesia, a client with a midline episiotomy ambulates to the bathroom to void. After voiding, the nurse assesses the client's bladder, finding it distended. The nurse interprets this finding based on the understanding that the client's bladder distention is most likely caused by which factor? 1. prolonged first stage labor 2. urinary tract infection 3. pressure of the uterus on the bladder 4. edema in the lower urinary tract area

4

While the nurse id preparing to assist the primiparous client to the bathroom to void 6 hours after a vaginal birth under epidural anesthesia, the client says the she feels dizzy when sitting up on the side of the bed. The nurse explains that this is most likely caused by which factor? 1. effects of the anesthetic during labor 2. hemorrhage during the birth process 3. effects of analgesics used during labor 4. decreased blood volume in the vascular system

4

which client statement indicates effective teaching about burping a breastfed neonate? 1. "breastfed babies who are burped frequently will take more on each breast." 2. "if I supplement the baby with formula, I rarely have to burp the baby." 3. "I will breastfeed my baby every 3 hours and will not have to burp the baby." 4. "when I switch to the other breast, I will burp the baby."

4

While assessing the Fundus of a multiparous client 36 hours after birth a term neonate, the nurse notes a separation of the abdominal muscles. What should the nurse tell the client? 1. that she will have a surgical repair at 6 weeks postpartum 2. to remain on bed rest until resolution occurs 3. that the separation will resolve on its own with the right posture and diet 4. to perform exercises involving head and shoulder raising in a lying position

4

In response to the nurses question about how she is feeling, a postpartum client states that she is fine. she then begins talking to the baby, checking the diaper, and asking infant care care questions. The nurse determines the client is in which postpartum phase of psychological adaption 1. taking in 2. taking on 3. taking hold 4. letting go

3

During a home visit on the fourth postpartum day. a primiparous client tells the nurse she is aware of a "letdown sensation" in her breasts and asks what causes it. the nurse explains that the letdown sensation is stimulated by which hormone? 1. progesterone 2. estrogen 3. prolactin 4. oxytocin

4

On the first postpartum day, the primiparous client reports perineal pain of a 5 on a scale of 1-10 that was unrelieved by ibuprofen 800mg given 2 hours ago. The nurse should further assess the client for which complication? 1. puerperal infection 2. vaginal lacerations 3. history of drug abuse 4. perineal hematoma

4

The nurse from the nursery is bringing a new-born to a mothers room. the nurse took care of the mother yesterday and knows the mother and baby well. the nurse should implement which action next to ensure the safest transition of the infant to the mother? 1. assess whether the mother is able to ambulate to care for the infant. 2. ask the mother if there is anything else she needs for the care of her baby. 3. check the crib to determine if there are enough diapers and formula. 4. complete the hospital identification procedure with mother and infant

4

A primiparous client, 48 hours after vaginal birth, is to be discharged with a prescription for vitamins with iron because she is anemic. To maximize absorption of the iron, the nurse instructs the client to take the medication with which liquid? 1. orange juice 2. herbal tea 3. milk 4. grape juice

1

The nurse is caring for a primipara who gave birth yesterday and has chosen to breastfeed her neonate. Which assessment finding is considered unusual for the client at this point postpartum? 1. milk production 2. diaphoresis 3. constipation 4. diuresis

1

Which information would the nurse include in the primiparous client's discharge teaching pain about measures to provide visual stimulation for the neonate? 1. Maintain eye contact while talking to the baby. 2. Paint the baby's room in bright colors accented with teddy bears. 3. Use brightly colored animals and cartoon figures on the wall. 4. Move a brightly colored rattle in front of the baby's eyes.

1

A multiparous client whose funds is firm and midline at the umbilicus 8 hours after vaginal birth tells the nurse that when she ambulated to the bathroom after sleeping for 4 hours, her dark red loch seemed heavier. Which information would the nurse include when explaining to the client about the increased loch on ambulation? 1. The increased loch needs to be reported to the health care provider (HCP) immediately. 2. The increased loch occurs from loch pooling in the vaginal vault. 3. The increase in lochia may be and early sign of postpartum hemorrhage. 4. This increase in lochia usually indicates retained placental fragments.

2

While the nurse is assessing the fundus of a multiparous client who gave birth 24 hours ago, the client asks, "What can I do to get rid of these stretch marks?" Which response would be most appropriate? 1. "As long as you do not get pregnant again, the marks will disappear completely." 2. "They usually fade to a slivery-white color over a period of time." 3. "You will need to use a specially prescribed cream to help the, disappear." 4. If you lose the weight you gained during pregnancy, the marks will fade to a pale pink."

2

A postpartum client gave birth 6 hours ago without anesthesia and just voided 100 mL. The nurse palpates the fundus 2 fingerbreadths above the umbilicus and off to the right side. What should the nurse do first? 1. Administer ibuprofen. 2. Reassess in 1 hour. 3. Catheterize the client. 4. Obtain a prescription for a fluid bolus.

3

A diabetic postpartum client plans to breastfeed. The nurse determines that the client's understanding of breastfeeding instructions is sufficient when the client makes which statement? 1. "Insulin will be transferred to the baby through breast milk." 2. "Breast-feeding is not recommenced for diabetic mothers." 3. "Breast milk from diabetic mothers contains few antibodies." 4. "Breastfeeding will assist in lowering maternal blood glucose."

4

A primiparous client who is beginning to breastfeed her neonate asks the nurse, "Is it important for my baby to get colostrum?" When instructing the client, the nurse would explain that colostrum provides the neonate with which factor? 1. more fat than breast milk 2. vitamin K, which the neonate lacks 3. delayed meconium passage 4. passive immunity from maternal antibodies

4

the nurse is caring for multigravida women who is 1 day postpartum following vaginal birth. which finding indicates a need for further assessment? 1. hemoglobin 12.1 g/dL (121 g/L) 2. WBC count of 15,000 mcL (15 x 10^9/L) 3. pulse of 60 beats/min 4. temperature of 100.8F (38.2C)

4

A primiparous client who gave vaginal birth to a viable term neonate 48 hours ago has a midline episiotomy and repair of a third-degree laceration. When preparing the client for discharge, which assessment would be most important? 1. constipation 2. diarrhea 3. excessive bleeding 4. rectal fistulas

1