Normal Antepartum and Normal Postpartum

A client tells the nurse that the first day of her last menstrual period was July 22. What is the estimated date of birth (EDB)? 1 May 7 2 April 29 3 April 22 4 March 6

2 April 29 Her EDB is April 29. The Nägele rule is an indirect, noninvasive method for estimating the date of birth: EDB = last menstrual period + 1 year - 3 months + 7 days. May 7 is beyond the expected date of birth. April 22 and March 6 are both before the EDB.

The nurse is teaching a client about self-management to prevent dry skin. Which statement made by the client indicates the need for further teaching? 1 "I should use nonalkaline soap for a bath." Correct2 "I should apply rubbing alcohol to the skin." 3 "I should avoid clothing that continuously rubs the skin." 4 "I should use a room humidifier during the winter months."

2 To prevent dry skin, rubbing alcohol is contraindicated because alcohol increases skin dryness. Use of nonalkaline soap for bathing prevents dry skin. Avoid clothing that continuously rubs the skin such as tight belts and nylon stockings. Use room humidifiers during winter months because skin is drier in winter.

One hour postpartum a nurse assesses the amount of vaginal bleeding and determines that a client's uterus has become relaxed and boggy. Which intervention is a priority for the nurse to take in this situation? 1 Massage the uterus until firm. 2 Check the client's blood pressure. 3 Obtain a prescription for oxytocin. 4 Notify the primary healthcare provider immediately.

1 Massage the uterus until firm. Immediate action to prevent excessive bleeding involves massaging the fundus until it is firm, which stimulates uterine muscle contraction. Obtaining the blood pressure is indicated if the bleeding persists. Obtaining a prescription for oxytocin may not be necessary if fundal massage is effective. Notifying the primary healthcare provider immediately is not necessary unless bleeding persists after uterine massage.

A pregnant client is asking the nurse when she will gain the greatest amount of weight during the pregnancy. At which time during prenatal development should the nurse tell the client to expect the greatest fetal and maternal weight gain? 1 Third trimester 2 Second trimester 3 First 8 weeks 4 Implantation period

1 Third trimester The third trimester is the period in which the fetus stores deposits of fat. There is growth, but fat deposition does not occur in the second trimester. The first 8 weeks is the period of organogenesis, when cells differentiate into major organ systems. The implantation period is the period of the blastocyst, when initial cell division takes place.

A nurse is caring for four mother-baby couplets on the postpartum unit. Which new mother is at the greatest risk for postpartum hemorrhage? 1 A primipara who has given birth to an 8-lb baby 2 A grand multipara who experienced a labor that lasted 1 hour 3 A multipara whose placental separation occurred 10 minutes after she gave birth 4 A primipara who received epidural anesthesia throughout the birthing experience

2 A grand multipara who experienced a labor that lasted 1 hour Increased parity contributes to an increased incidence of uterine atony because the uterine muscle may not contract effectively, leading to postpartum hemorrhage; it is not uncommon for a grand multipara to have a labor that lasts 1 hour. A primipara should maintain a well-contracted uterus; with only one pregnancy, the uterus usually maintains its tone. Expulsion of the placenta 10 minutes after the birth of the fetus is expected and will not affect the tone of the uterus. Uterine atony is not a major problem associated with epidural anesthesia.

The nurse is assessing a new mother at a healthcare facility. Which symptom does the nurse identify as a risk factor for postpartum blues? 1 Frantic energy 2 Mild irritability 3 Hallucinations 4 Unwillingness to sleep

2 Mild irritability Postpartum blues are transient symptoms that a client may experience after childbirth. About 85% of women experience postpartum blues with symptoms of mild irritability, tearfulness, rapid mood fluctuations, and anxiety. About 0.1% to 0.2% of postpartum women experience postpartum psychosis. Frantic energy, hallucinations, and unwillingness to sleep are clinical manifestations of postpartum psychosis.

Which component of postpartum care is most important for the nurse to provide when helping a new mother on the postpartum unit develop her role as a parent? 1 Teaching her how to care for the baby 2 Providing time for her and her baby to be together 3 Responding to any questions she has about her baby's behavior 4 Demonstrating baby care and evaluating her return demonstration

2 Providing time for her and her baby to be together Parenting can begin only when the baby and the mother have gotten to know each other. To promote development, the nurse should provide time for mother-infant interaction. Teaching the mother to care for the baby, responding to questions, and demonstrating baby care and then evaluating the client's return demonstration are not priorities.

A 19-year-old primigravida in the first trimester of pregnancy is diagnosed with gonorrhea. What dosage of ceftriaxone is recommended to prevent the transmission of gonorrhea? 1 250 mg given after delivery 2 125 mg given after delivery 3 250 mg started immediately 4 125 mg started immediately

3 250 mg started immediately 250 mg of ceftriaxone is used to treat gonorrhea. This dosage should be taken during pregnancy as soon as the disease is diagnosed to prevent the transmission of infection to the fetus.

What action should the nurse take to assist parents with bonding immediately after birth? 1 Assess for typical parenting techniques 2 Demonstrate desired behaviors to the parents 3 Delay applying the antibiotic to the newborn's eyes 4 Postpone footprinting the newborn until later in the day

3 Delay applying the antibiotic to the newborn's eyes The parents need an opportunity for close eye-to-eye contact during the first hour after birth. Prophylactic eye medications may irritate the newborn's eyes, preventing them from opening. Assessment is appropriate but will not facilitate parent-newborn bonding; favorable conditions for bonding should be provided before assessment. The nurse should assess, not demonstrate, behavior at this time. Footprinting should be done immediately to ensure proper identification of the newborn.

The nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day? 1 Dark red 2 Deep brown 3 Pinkish brown 4 Yellowish white

3 Pinkish brown Lochia serosa is the expected vaginal discharge between the third and tenth postpartum days; it is pinkish to brownish and consists of serous exudate, shreds of degenerating decidua, erythrocytes, leukocytes, cervical mucus, and numerous microorganisms. Lochia rubra is the expected vaginal discharge on the first 2 or 3 postpartum days; it is dark red and consists of epithelial cells, erythrocytes, leukocytes, shreds of decidua, and occasionally fetal meconium, lanugo, and vernix caseosa. Lochia is never dark brown. Lochia alba is the expected vaginal discharge about 10 days postpartum; it persists for 1 to 2 weeks. A creamy or yellowish color, it consists of leukocytes, decidual cells, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria.

Iron supplementation is prescribed for a postpartum client. The nurse tells her which liquid she should drink with her iron supplement. What drink does the client select that indicates that the instruction is understood? 1 Milk 2 Water 3 Cream soda 4 Cranberry juice

4 Cranberry juice Iron is absorbed best when given in an acidic medium. One cup of cranberry juice contains 90 mg of vitamin C (ascorbic acid). Milk, water, and cream soda will all decrease the acidity of the stomach.

A client who has missed two menstrual periods tells a nurse at the prenatal clinic that the home pregnancy test was positive. Her last menstrual period began on June 18. According to Nägele's rule, what is the estimated date of birth (EDB)? 1 March 8 2 March 11 3 March 1 4 March 25

4 March 25 March 25 is the EDB. Using Nägele's rule, take the first day of the last menstrual period (June 18), subtract 3 months, and then add 7 days. March 8, March 11, and March 1 are incorrect calculations according to Nägele's rule.

The postpartum nurse has just received report on four clients. Which client should the nurse evaluate first? 1 Client who vaginally delivered a 7-lb (3175 g) baby 1 hour ago 2 Client who vaginally delivered a 9-lb (4082 g) baby 1 hour ago 3 Client who vaginally delivered a preterm baby 4 hours ago 4 Client who had a planned cesarean delivery of an 8-lb (3629 g) baby 2 hours ago

Client who vaginally delivered a 9-lb (4082 g) baby 1 hour ago The nurse should assess the client at risk for postpartum hemorrhage first. Uterine atony after a vaginal delivery is the main cause of postpartum hemorrhage. An overdistended uterus caused by a large fetus (9-lb; 4082 g) can result in uterine atony. Delivering a 7-lb baby (3175 g) or a preterm baby is not a risk factor. Uterine atony is minimized in a planned cesarean delivery.

A nurse is planning a childbirth education class regarding maternal psychologic and physiologic changes as pregnancy nears term. Which problems and concerns should the nurse include in the presentation? Select all that apply. 1 Food cravings increase. 2 Nesting needs increase. 3 Dependency needs decrease. 4 Anxiety about childbirth increases. 5 Gastrointestinal motility decreases.

Correct2 Nesting needs increase. Anxiety about childbirth increases. Correct5 Gastrointestinal motility decreases. Nesting needs increase as pregnancy reaches term; it is a psychologic preparation for motherhood. As pregnancy nears term, maternal thoughts turn to the problems that may occur during labor and birth. Because the enlarged uterus is pressing on the organs of the gastrointestinal tract, digestive and elimination problems increase. Food cravings start early in the pregnancy and do not commonly intensify as the pregnancy nears term. Maternal dependency needs increase as the pregnancy nears term; there is a need for being nurtured in preparation for providing it to the newborn.

A primipara about to be discharged with her newborn asks the nurse many questions regarding infant care. What phase of maternal adjustment does this behavior illustrate? 1 Let-down 2 Taking-in 3 Taking-hold 4 Early parenting

Correct3 Taking-hold The taking-hold phase, which begins around the second or third postpartum day, involves concern about being a "good" mother; the new mother is most receptive to teaching at this time. The behavior described refers to the taking-hold phase of bonding. Let-down is not related to bonding. The let-down reflex refers to the flow of milk in response to suckling and is caused by the release of oxytocin from the posterior pituitary. The taking-in phase is the first period of adjustment to parenthood. It includes the first 2 postpartum days; the mother is passive and dependent and preoccupied with her own needs. Early parenting involves many behaviors, of which taking-hold is only one.

Which topics should the nurse include in the teaching session for a pregnant client regarding maternal discomforts caused by fetal growth and hormonal changes? Select all that apply. 1 Emesis 2 Nausea 3 Diarrhea 4 Backache 5 Dyspepsia

Emesis 2 Nausea Backache 5 Dyspepsia Maternal discomforts during pregnancy that are associated with fetal growth and hormonal changes include emesis (vomiting), nausea, backache, and dyspepsia (heartburn). Constipation, not diarrhea, is an expected maternal discomfort caused by fetal growth and hormonal changes.

The nurse plans to assess a postpartum client's uterine fundus. What should the nurse ask the client to do before this assessment? 1 Drink fluids 2 Empty her bladder 3 Perform the Valsalva maneuver 4 Assume the semi-Fowler position

Empty her bladder Having the client empty her bladder will help ensure accurate assessment of fundal height. A full bladder may promote a boggy uterus and may elevate the uterus upward and toward the client's right side. There is no need to drink fluids before this assessment; however, the client should drink at least 2 L of fluid a day during the postpartum period. The Valsalva maneuver has no effect on the assessment of fundal height. Assessing the fundus while the client is in the semi-Fowler position will result in an inaccurate assessment. The bed should be flat, and the client should assume the supine position.

The nurse should be concerned about a client's mother-infant bonding if the client is reluctant to do what on the first postpartum day? 1 Undress the newborn 2 Breast-feed her newborn 3 Look at her newborn's face 4 Attend classes for newborn care

Look at her newborn's face Looking at the face or seeking eye-to-eye contact with the infant is an early sign of the initiation of bonding with the infant. The mother may feel inept or worry about upsetting the nurse by undressing her infant; new mothers need encouragement to undress their infants. Refusing to breast-feed her newborn may indicate that the mother is worried that she does not have enough milk, a common concern. The client may have attended prenatal classes, may be otherwise occupied, may not be feeling well enough to attend the class, or may feel that she has enough experience to care for her infant without attending a class for newborn care.

The charge nurse is delegating tasks for the nursing assistants regarding the postpartum care of a client. Which task is appropriate to be delegated to an unlicensed assistive personnel (UAP) to provide effective client care? Select all that apply. 1 Feeding the client 2 Providing basic hygiene 3 Teaching care of the infant 4 Encouraging breastfeeding 5 Administering intravenous fluids

Feeding the client 2 Providing basic hygiene 4 Encouraging breastfeeding The UAP can feed the client in postpartum care, provide basic hygiene by assisting in changing sanitary napkins, and provide encouragement for breastfeeding. Teaching care of the infant is not provided by the UAP. The UAP is not eligible and does not have the knowledge to administer intravenous fluids.

When palpating a client's fundus on the second postpartum day, the nurse determines that it is above the umbilicus and displaced to the right. What does the nurse conclude? 1 There is a slow rate of involution. 2 There are retained placental fragments. 3 The bladder has become overdistended. 4 The uterine ligaments are overstretched

3 The bladder has become overdistended A distended bladder will displace the fundus upward and laterally to the right. A slow rate of involution is manifested by slow contractions and uterine descent into the pelvis. If retained placental fragments were present, the uterus would be boggy in addition to being displaced, and vaginal bleeding would be heavy. From this assessment the nurse cannot make a judgment regarding overstretched uterine ligaments.

A nurse is caring for a postpartum client. Where does the nurse expect the fundus to be located if involution is progressing as expected 12 hours after birth? 1 2 cm below the umbilicus 2 3 cm above the umbilicus 3 1 cm above the umbilicus 4 3 cm below the umbilicus

Correct3 1 cm above the umbilicus Twelve hours after birth, the uterus is 1 cm above the umbilicus, and each succeeding day it descends one fingerbreadth. Therefore the uterus should be 2 cm below the umbilicus on the second postpartum day. A uterus 3 cm above the umbilicus indicates that the bladder is full. The uterus is 3 cm below the umbilicus on the fourth postpartum day because the uterus descends one fingerbreadth per day.

A nursing student is learning about expected postpartum anatomic and physiologic changes. Which statement made by the nursing student indicates a need for further learning? 1 "The capacity of the bladder increases postpartum." 2 "The uterus involutes to approximately 350 g by two weeks after birth." 3 "The cervical dilation decreases to 2 to 3 cm by the second or third postpartum day." 4 "After birth, the vagina gradually decreases in size and returns to its pre-pregnancy state."

4 "After birth, the vagina gradually decreases in size and returns to its pre-pregnancy state." During the postpartum period, normal anatomic and physiological changes occur. After a birth, the vagina gradually decreases in size; however, does not return to its pre-pregnancy state. The capacity of the bladder increases postpartum, which may lead to a decreased urge to void. The uterus returns to a nonpregnant state after birth in a process known as involution. The uterus involutes to approximately 350 g by two weeks after birth. During labor, the cervix dilates to approximately 10 cm; the dilation decreases to 2 to 3 cm by the second or third postpartum day.

A client who has been breastfeeding tells the nurse on the third postpartum day that her breasts are painful and that she is afraid that the baby will hurt her while grasping the nipple and suckling. How should the nurse respond at this time? 1 Offering the client an analgesic before breastfeeding 2 Recommending that the client limit fluids for several days 3 Suggesting that the client formula feed the baby for 2 days 4 Helping the client express some milk manually before feeding

4 Helping the client express some milk manually before feeding The pressure and tenderness resulting from accumulated milk can be relieved by manually expressing some of the fluid before feeding. Pain medication may be offered if other measures are unsuccessful; however, medication can be transferred to the infant through breast milk. Also, giving medication is a dependent function of the nurse that requires a prescription. The mother should not limit fluids, especially if she is breastfeeding. Breastfeeding, not formula feeding, should continue as a means of limiting engorgement and aiding milk production.

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How does the nurse, using the GTPAL format, document the client's obstetric history? 1 G4 T3 P2 A1 L4 2 G5 T2 P2 A1 L4 3 G5 T2 P1 A1 L4 4 G4 T3 P1 A1 L4

Correct3 G5 T2 P1 A1 L4 The acronym GTPAL represents gravidity, term births, preterm births, abortions, and living children; G5 T2 P1 A1 L4 indicates that the client has had five pregnancies (twins count as one pregnancy and the current pregnancy counts as one); two term births; one preterm birth (the twins); one abortion; and four living children. G4 T3 P2 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one, not two, preterm birth; one abortion; and four living children. G5 T2 P2 A1 L4 indicates that there were five pregnancies; two term births; twins counted as one, not two, preterm births; one abortion; and four living children. G4 T3 P1 A1 L4 indicates that there were four, not five, pregnancies; three, not two, term births; twins counted as one preterm birth; one abortion; and four living children.

A nurse is giving discharge instructions to a new mother. What is the most important instruction to address the prevention of postpartum infection? 1 "Don't take tub baths for at least 6 weeks." 2 "Wash your hands before and after changing your sanitary napkins." 3 "Douche with a dilute antiseptic solution twice a day and continue for a week." 4 "Tampons are better than sanitary napkins for inhibiting bacteria in the postpartum period."

2 "Wash your hands before and after changing your sanitary napkins." Infection is most commonly transmitted through contaminated hands. Tub baths are permitted. Douching is contraindicated. Tampons are contraindicated in the postpartum period until the cervix has closed completely; they may promote infection when used too early.

On the third postpartum day, the nurse enters the room of a client who had an unexpected cesarean birth and finds her crying. The client says, "I know my baby is fine, but I can't help crying. I wanted natural childbirth so much. Why did this have to happen to me?" What should the nurse consider when responding? 1 The client's feelings will pass after she has bonded with her infant. 2 The client is probably suffering from postpartum depression and needs special care. 3 A cesarean birth may be a traumatic experience, but most women know that it is a possible outcome. 4 A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this.

A woman's self-concept may be negatively affected by a cesarean birth, and the client's statement may reflect this. The client's response is appropriate to the situation, reflecting disappointment in not achieving her goal; in addition, this is the time when "postpartum blues" occurs. The client's feelings may or may not pass after she has bonded with her infant; there is no indication that the feeling will pass or that bonding is involved. The client's statement is not indicative of depression. With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment a client may feel over not reaching her goal.

Sitz baths are prescribed for a client with an episiotomy during the postpartum period. How do the sitz baths aid the healing process? 1 Promoting vasodilation 2 Cleansing perineal tissue 3 Softening the incision site 4 Tightening the rectal sphincter

Correct1 Promoting vasodilation Heat causes vasodilation and increased blood supply to the area. Cleansing is performed with a perineal bottle and cleansing solution immediately after voiding and defecation. Sitz baths do not soften the incision site. Neither relaxation nor tightening of the rectal sphincter will speed healing of an episiotomy.

A nurse is teaching a client about self-management techniques for smoking cessation. Which statement made by the client indicates the need for further teaching? 1 "I should list the reasons why I should stop smoking." 2 "I should visit all the places where I started smoking." 3 "I should remove all ashtrays and lighters." 4 "I should try replacing tobacco with sugarless mints and gum."

Correct2 "I should visit all the places where I started smoking." Clients may be tempted to smoke if they visit the places where they started smoking. Listing the reasons to stop smoking may help the client to prevent smoking. Removing ashtrays and lighters from the environment may help the client to prevent smoking. When the client is tempted to smoke, sugarless mints and gums may act as good substitutes for tobacco smoking.

The nurse is reviewing a client's history. Which two predisposing causes of puerperal (postpartum) infection should prompt the nurse to monitor this client closely? 1 Malnutrition and anemia 2 Hemorrhage and trauma during labor 3 Preeclampsia and retention of placental fragments 4 Organisms in the birth canal and trauma during labor

Hemorrhage and trauma during labor Blood loss depletes the cellular response to infection; trauma provides an excellent avenue for bacteria to enter. These issues may create problems if hemorrhage occurs, because the hemoglobin and hematocrit are already low. Preeclampsia is not a predisposing factor in postpartum infection; retained placental fragments cause hemorrhage and, if not removed immediately, will result in hypovolemic shock, not infection. Endogenous infections are rare; infection is usually caused by outside contamination. Trauma and the denuded placental site may contribute to the development of infection.

A 37-year-old client with hypertension, type 1 diabetes and good glycemic control is pregnant for the third time. Her first child is 4 years old, and her second pregnancy resulted in a stillbirth. She is seen in the antepartum testing unit for a nonstress test (NST) at 33 weeks' gestation. What are the primary risk factors in the client's history that indicate the need for a nonstress test? Select all that apply. 1 Age older than 35 years 2 The risk for placenta previa 3 The risk for placental insufficiency 4 A history of stillbirth from her last pregnancy 5 Maternal history of hypertension

The risk for placental insufficiency Correct4 A history of stillbirth from her last pregnancy Correct5 Maternal history of hypertension Pregnant women with diabetes are prone to placental insufficiency, which can threaten fetal well-being. In addition, history of stillbirth is also an indication for NST. In addition, maternal conditions that can affect placental perfusion such as hypertension are an indication for an NST. Advanced maternal age alone is not an indicator for an NST; although advanced maternal age increases the risk of placenta previa, it is not the primary reason for having an NST.