Exam 3 (Mod 7&8)
Which of the following are reasons for late PPH? 1. Subinvolution of the uterus 2. Pelvic infection 3. Coagulation disorders 4. Retained placental fragments 5. Cervical lacerations
1, 2, 4 The others are also causes of PPH, but not causes of LATE PPH
Which ratio would be used to restore effective circulating volume in a postpartum patient who is experiencing hypovolemic shock?
3:1 A 3:1 ratio, of 3 ml fluid infused for every 1 ml of estimated blood loss, is recommended to restore circulating volume
Traditionally, a ______ ml blood loss after a vaginal birth and a _____ ml blood loss after a cesarean birth constitute PPH. However, medical personnel tend to underestimate blood loss by as much as 50%.
500 and 1,000
A nurse is monitoring a healthy newborn's blood glucose level 90 minutes after birth. Which result should the nurse anticipate in terms of mg/dL? 80 to 100 60 to 70 Less than 40 55 to 60
55 to 60
A mother expresses fear about changing her infant's diaper after he is circumcised. What should the nurse teach the mother about providing caring for the infant upon discharge? A. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change B. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs C. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours D. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection
A
A nurse is preparing to weight a newborn. Which action should the nurse include as part of the procedure? A. Weigh the newborn at the same time each day for accuracy B. Place a sterile scale paper on the scale for infection control C. Keep a hand on the newborn's abdomen for safety D. Leave its diaper on for comfort
A
A nurse must administer erythromycin ophthalmic ointment to a newborn after birth. Which action should the nurse include when administering the medication? A. Cleanse eyes from inner to outer canthus before administration if necessary B. Flush eyes 10 minutes after instillation to reduce irritation C. Apply directly over the cornea D. Instill within 15 minutes of birth for maximum effectiveness
A
Following birth, the nurse assigns an Apgar score of 10 at 1 minute to a newborn. How would the nurse explain this score? A. An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth B. An infant having no difficulty adjusting to extrauterine life and needing no further testing C. A prediction of a future free of neurologic problems D. An infant in severe distress that needs resuscitation
A
The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Which statement should the maternity identify as correct? A. A common practice among Mexican women is known as las dos cosas B. Muslim cultures do not encourage breastfeeding because of modesty concerns C. Latino women born in the United States are more likely to breastfeed D. East Indian and Arab women believe that cold foods are best for a new mother
A
The nurse is providing discharge instructions related to the baby's respiratory system. Which statement should the nurse not include as part of discharge teaching? A. Don't let the infant sleep on his or her back B. Avoid loose bedding, waterbeds, and beanbag chairs C. Prevent exposure to people with upper respiratory tract infections D. Keep the infant away from secondhand smoke
A
Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? A. Heroin B. Alcohol C. Phencyclidine palmitate (PCP) D. Cocaine
A
While caring for the newborn, the nurse must be alert for any signs of cold stress. Which finding should the nurse anticpate? A. Increased respiratory rate B. Decreased activity level C. Hyperglycemia D. Shivering
A
A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. Three thromboembolic conditions are of concern during the postpartum period; which of the following is not? A. Amniotic fluid embolism (AFE) B. Superficial venous thrombosis C. Deep vein thrombosis D. Pulmonary embolism
A An AFE occurs during the intrapartum period, when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis, the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis, occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs.
Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps-Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. Which of the following is not included in the 4 Ps-Plus screening tool? A. Present B. Partner C. Past D. Pregnancy
A Parents: The woman should be asked, "Did either of your parents have a problem with alcohol or drugs?" Partner: "Does your partner have a problem with alcohol or drugs?" Past: "Have you ever had any beer, wine, or liquor?" Pregnancy: "In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?"
Which of the following is the most common kind of placental adherence seen in pregnant women? A. Accreta B. Placenta Previa C. Percreta D. Increta
A Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient's risk for painless vaginal bleeding during the pregnancy and/or delivery process. Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Placenta increta leads to deep penetration of the myometrium
The nurse is assessing the respiratory system of a newborn. Which statement should the nurse be aware of with regard to the respiratory development of the newborn? A. Crying increases the distribution of air in the lungs B. Seesaw respirations are no cause for concern in the first hour after birth C. Newborns must expel the fluid at uterine life from the respiratory system within a few minutes of birth D. Newborns are instinctive mouth breathers
A Respirations in the newborn can be stimulated by mechanical factors such as changes in intrathoracic pressure resulting from the compression of the chest during vaginal birth. With birth, the pressure on the chest is released, helping draw air into the lungs. The positive pressure created by crying helps keep the alveoli open and increases distribution of air throughout the lungs. Newborns continue to expel fluid for the first hour of life. They are natural nose breathers and may not have the mouth-breathing response to nasal blockage for 3 weeks. Seesaw respirations instead of normal abdominal respirations are not normal and should be reported.
Which medications are used to manage postpartum hemorrhage (PPH)? (Select all that apply.) a. Oxytocin b. Methergine c. Terbutaline d. Hemabate e. Magnesium sulfate
A, B, D Terbutaline and magnesium sulfate are tocolytic medications that are used to relax the uterus, which would cause or worsen PPH. *****Methergine is contraindicated in moms with high BP*****
Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps Plusis a screening tool specifically designed to identify the need for a more in-depth assessment. Which are the correct components of the 4 Ps Plus? (Select all that apply) a. Parents b. Partner c. Present d. Past e. Pregnancy
A, B, D, E
A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. What information should the nurse provide to the parents regarding the presence of petechiae? A. Should always be further investigated B. Are benign if they disappear within 48 hours of birth C. Usually occur with forceps delivery D. Result from increased blood volume.
B
A nurse administers Vitamin K to the newborn post delivery. The nurse understands that the reason for this medication to be given is? A. Reduce bilirubin levels B. Enhance the ability of blood to clot C. Stimulate the formation of surfactant D. Increase the production of red blood cells
B
A nurse examining a newborn infant notes that the infant is jaundiced. Which observation would lead the nurse to continue to monitor but not to intervene and contact the physician? A. Infant is being bottle fed and within the first 24 hours of life. B. Jaundice appeared on the third day of life. C. Jaundice appeared within the first 24 hours of life. D. Preterm infant who is 12 hours old
B
A nurse has provided client teaching to a breastfeeding mother. Which action if observed by the nurse would indicate the need for further instruction? A. Puts her finger into newborn's mouth before removing breast B. Leans forward to bring breast toward the baby C. Holds breast with four fingers along bottom and thumb at top D. Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth
B
A nurse is assisting a breastfeeding mother with positioning of the baby. Which finding should the nurse be aware of? A. While supporting the head, the mother should push gently on the occiput B. Whatever the position used, the infant is held in direct skin with the mother C. Women with perineal pain and swelling prefer the modified cradle position D. The cradle position is usually preferred by mothers who had a cesarean birth
B
A nurse is reviewing the concept of weaning with regard to infant care. Which statement should the nurse identify as correct? A. Abrupt weaning is easier than gradual weaning B. Weaning can be mother or infant initiated C. Weaning should proceed from breast to bottle to cup D. The feeding of most interest should be eliminated first
B
A nursing student is reviewing concepts related to infant feeding. Which statement should the nurse identify as being correct concerning tandem feeding? A. Supplementing breastfeeding with bottle feeding to maintain adequate weight gain. B. Breastfeeding an infant and an older sibling during the same period. C. Using both breasts to nurse the baby. D. Adequate nutritional stores for the mother and infant
B
During rounds, a nurse suspects that a patient who has recently delivered via vaginal route is having excessive postpartum bleeding. Which intervention would be the priority action taken by the nurse at this time? A. Call the physician B. Massage the uterine fundus C. Increase rate of IV fluids D. Monitor pad count and perform catheterization
B
The 5 As screening intervention tool is used to implement smoking cessation strategies on the basis of patient response. What do the 5 As stand for? A. Ask, advise, administer, approve, and admit B. Ask, assess, advise, assist, and arrange follow-up C. Assess, assist, advise, apply, and arrange D. Assess, apply, advise, ask, and arrange follow-up
B
The birth weight of a breastfed newborn was 8 lb, 4 oz. On the third day the newborn's weight is 7 lb, 12 oz. Which action should the nurse take based on this finding? A. Notify the physician because the newborn is being poorly nourished B. Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs C. Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients D. Refer the mother to a lactation consultant to improve her breastfeeding technique
B
A nurse is providing umbilical cord care to a newly delivered infant. What information should the nurse be aware of? A. The cord clamp is removed at cord separation B. The stump can easily become infected C. The average cord separation time is 5 to 7 days D. A nurse noting bleeding from the vessels of the cord should immediately call for assistance
B The cord stump is an excellent medium for bacterial growth. If bleeding occurs, the nurse should first check the clamp (or tie) and apply a second one; if the bleeding does not stop, then the nurse calls for assistance. The cord clamp is removed after 24 hours when it is dry. The average cord separation time is 10 to 14 days.
In which situations would the use of Methergine or prostaglandin be contraindicated even if the patient was experiencing a postpartum significant bleed? A. Patient has delivered twin pregnancies B. Patient's blood pressure postpartum is 180/90 C. Patient has a history of asthma D. Patient has a mitral valve prolapse E. Patient is a grand multip
B, C, D
A nurse is reviewing possible etiologies for hyperbilirubinemia in the newborn. Which findings would the nurse expect to lead to increased bilirubin levels in the newborn? (Select all that apply) A. Cord clamped immediately following delivery of newborn B. Initiation of newborn feedings delayed following birth C. Twin-to-twin transfusion syndrome D. Hyperglycemia E. Meconium passed after 24 hours
B, C, E
Following a vaginal delivery, the client tells the nurse that she intends to breastfeed her infant but she is very concerned about returning to her prepregnancy weight. On the basis of this interaction, the nurse would advise the client that: (Select all that apply.) A. She should join Weight Watchers as soon as possible to ensure adequate weight loss. B. Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period. C. If breastfeeding, she should regulate her fluid consumption in response to her thirst level. D. If she decreases her calorie intake by 100-200 calories a day she will lose weight more quickly. E. Weight loss diets are not recommended for women who breastfeed.
B, C, E
Which of the following statements about the prevalence of perinatal mental health problems is true? SATA A. The World Health Organization (WHO) recognizes postpartum depression as the leading cause of disability in women. B. Up to a ¼ of pregnant women will experience some aspect of depression during their pregnancies. C. Income status plays a significant role in the presentation of perinatal mental health problems. D. A higher incidence of postpartum depression (PPD) is found in about 50% of the population. E. Between 30 and 50 billion dollars accounts for productivity and direct medical costs related to depression in women
B, C, E
A nurse is advising a pregnant patient who has a substance abuse problem about a contingency management program. Which statement identifies an aspect of this type of program? A. Pregnant woman are confined to an inpatient treatment method during their pregnancy B. Pregnant woman are given biofeedback modalities as stimulus responses to control their addiction C. Pregnant woman are given motivational incentives as a primary approach to stop their drug abuse problem D. Pregnant woman must follow a strict medication nutritional program during the course of pregnancy
C
A nurse is discussing with an obese client potential long-term consequences of infant feeding practices. Which method should the nurse identify to the client as having a decreased risk for the development of childhood obesity for the infant? A. Lower-calorie infant formula B. An on-demand feeding schedule C. Breastfeeding D. Smaller, more frequent feedings
C
A nurse is examining a newborn male, who is estimated to be 39 weeks of gestation. Which physical finding should the nurse anticipate to be present? A. Abundant lanugo over his entire body B. Ability to move his elbow past his sternum C. Testes descended into the scrotum D. Extended posture when at rest
C
A nurse is placing a newborn under a radiant heat warmer for temperature stabilization. Which action should the nurse include during this procedure? A. Cover the probe with a non-reflective material B. Recheck temperature by periodically taking a rectal temperature C. Perform all examinations and activities under the warmer D. Place the thermistor probe on the left side of the chest
C
A nurse is reviewing the concept of breastfeeding. Which statement should the nurse identify as being inaccurate as it relates to the effect of breastfeeding on the family or society at large? A. Breastfeeding benefits the environment B. Breastfeeding requires fewer supplies and less cumbersome equipment C. Breastfeeding costs employers in terms of time lost from work D. Breastfeeding saves families money
C
During pregnancy, alcohol withdrawal may be treated using: A. Disulfiram (Antabuse) B. Corticosteroids C. Benzodiazepines D. Aminophylline
C
Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance? A. Methamphetamine is a depressant B. All methamphetamines are vasodilators C. Methamphetamine users are extremely psychologically addicted D. Rehabilitation is usually successful
C
The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: A. Call the woman's primary health care provider B. Administer the standing order for an oxytocin C. Palpate the uterus and massage it if it is boggy D. Assess maternal blood pressure and pulse for signs of hypovolemic shock
C
The nurse is assessing a newborn and discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver. What should be the priority action taken by the nurse? A. Informs the parents and physician that molding has not taken place B. Tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking C. Alerts the physician that the infant has a dislocated hip D. Suggests that if the condition does not change, surgery to correct vision problems might be needed
C
Where do most deliveries for pregnant women who have mental health issues take place? A. Mental health hospital setting B. Midwife assisted births C. Community hospital settings D. Psychiatric hospitals on locked units
C
Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? A. Endometritis B. Wound infections C. Mastitis D. UTIs
C Mastitis is infection in a breast, usually confined to a milk duct. Most women who get it are first-timers who are breastfeeding. Endometritis is the most common postpartum infection. Its incidence is higher after a cesarean birth, not in first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal exams, and epidural anesthesia.
Which indicator would lead the nurse to suspect that a postpartum patient experiencing hemorrhagic shock is getting worse? A. Restoration of blood pressure levels to normal range B. Capillary refill brisk C. Patient complaint of headache and increased reaction time to questioning D. Patient statement that she sees "stars"
C Patient complaint of a headache accompanied by an increased reaction (response) time indicates that cerebral hypoxia is getting worse. Return of blood pressure to normal range would indicate resolving symptoms. Brisk capillary refill is a normal finding. The patient may see "stars" early on in decreased blood flow states.
A group of nursing students are reviewing the process of bathing for a newborn. Which statement should the nursing students identify as being incorrect? A. Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed B. Only plain warm water should be used to preserve the skin's acid mantle C. Powders are not recommended because the infant can inhale powder D. Newborns should be bathed every day, for the bonding as well as the cleaning
D
The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black. She asks the nurse whether something is wrong. Which of the following would be the best response offered by the nurse? A. Telling the mother not to worry because all breastfed babies have this type of stool. B. Asking the mother what she ate for her last meal. C. Suggesting to the mother that she ask her pediatrician to explain normal newborn stooling patterns to her. D. Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns
D
The nurse taught new parents the guidelines to follow regarding the bottle feeding of their newborn who will be using formula from a can of concentrate. Which action if observed by the nurse would indicate that the parents correctly understand the nurse's instruction? A. Warm formula in a microwave oven for a couple of minutes prior to feeding B. Add some honey to sweeten the formula and make it more appealing to a fussy newborn C. Adjust the amount of water added according to weight gain pattern of the newborn D. Wash the top of can and can opener with soap and water before opening the can
D
To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features: A. Is more likely to occur in women with more than two children. B. Is rarely delusional and is usually about someone trying to harm her (the mother). C. Although serious, is not likely to need psychiatric hospitalization. D. Is typified by auditory or visual hallucinations
D
Which of these medications would be classified as a Category X substance that is not to be used during pregnancy? A. Lorazepam (Ativan) B. Alprazolam (Xanax) C. Chlordiazepoxide (Librium) D. Temazepam (Restoril)
D
While evaluating the reflexes of a male newborn, the nurse notes that with a loud noise, the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. The nurse documents this finding as a positive: A. Glabellar (Myerson) reflex response B. Babinski reflex response C. Tonic neck reflex response D. Moro reflex response
D
Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels rise naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII fall. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: A. Cryoprecipitate B. Factor VIII and vWf C. Hemabate D. Desmopressin
D Desmopressin is the primary treatment of choice. This hormone, which can be administered orally, nasally, and intravenously, promotes the release of factor VIII and vWf from storage. Treatment with cryoprecipitate or with plasma products such as factor VIII and vWf is acceptable, but because of the associated risk of possible viruses from donor blood products, other modalities are considered safer. Although the administration of the synthetic prostaglandin in Hemabate is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.
What are the two classifications of PPH?
Early/Primary/Acute and Late/Secondary Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH. Unfortunately, PPH can occur with little warning and is often recognized only after the mother has profound symptoms.
A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this brown, sticky stuff in her diaper?" What is the nurse's bestresponse? a ."That's meconium, which is your baby's first stool. It's normal." b. "That's transitional stool." c. "That means your baby is bleeding internally." d. "Oh, don't worry about that. It's okay."
a
A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the client is experiencing profuse bleeding. What is the most likely cause for this bleeding? a. Uterine atony b. Uterine inversion c. Vaginal hematoma d. Vaginal laceration
a
According to research, which risk factor for postpartum depression (PPD) is likely to have the greatest effect on the client postpartum? a. Prenatal depression b. Single-mother status c. Low socioeconomic status d. Unplanned or unwanted pregnancy
a
Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)? a. Respiratory conditions b. Intellectual impairment c. Neural development disorder d. Alcohol-related birth defects (ARBDs)
a
The nurse caring for a newborn checks the record to note clinical findings that occurred last shift. Which finding related to the renal system would be of increased significance and require further action? a. The newborn has not voided in 24 hours b. The breastfed infant voided more often than a formula feed infant c. Brick dustwas noted on several diapers d. Weight loss from fluid loss and other normal factors has yet to be regained
a
What is the correct term for the cheeselike, white substance that fuses with the epidermis and serves as a protective coating? a. Vernix caseosa b. Surfactant c. Caput succedaneum d. Acrocyanosis
a
Which condition is considered a medical emergency that requires immediate treatment? a. Inversion of the uterus b. Hypotonic uterus c. Idiopathic thrombocytopenic purpura (ITP) d. Uterine atony
a
With one exception, the safest pregnancy is one during which the woman is drug and alcohol free. What is the optimaltreatment for women addicted to opioids? a. Methadone b. Detoxification c. Smoking cessation d. 4 Ps Plus
a
A new mother states that her infant must be cold because the baby's hands and feet are blue. This common and temporary condition is called what? a. Acrocyanosis b. Erythema toxicum neonatorum c. Harlequin sign d. Vernix caseosa
a Acrocyanosis,or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and intermittently appears over the first 7 to 10 days after childbirth. Erythema toxicum neonatorum (also called erythema neonatorum) is a transient newborn rash that resembles flea bites. The harlequin sign is a benign, transient color change in newborns. One half of the body is pale, and the other one half is ruddy or bluish-red with a line of demarcation. Vernix caseosa is a cheeselike, whitish substance that serves as a protective covering for the newborn.
A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped ina blanket. The mother asks why. How would the nurse respond? a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and should prevent cool air from blowing on him." b. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and should prevent cool air from blowing on him." c. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and should prevent cool air from blowing on him." d. "Your baby will easily get cold stressed and needs to be bundled up at all times."
a Convection is the flow of heat from the body surface to cooler ambient air. Because of heat loss by convection, all newborns in open bassinets should be wrapped to protect them from the cold.
Part of the health assessment of a newborn is observing the infant's breathing pattern. What is the predominate pattern of newborn's breathing? a. Abdominal with synchronous chest movements b. Chest breathing with nasal flaring c. Diaphragmatic with chest retraction d. Deep with a regular rhythm
a In a normal infant respiration, the chest and abdomen synchronously rise and infant breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is also a sign of respiratory distress.
What is the most common reason for late postpartum hemorrhage (PPH)? a. Subinvolution of the uterus b. Defective vascularity of the decidua c. Cervical lacerations d. Coagulation disorders
a Although defective vascularity, cervical lacerations, and coagulation disorders of the decidua may also cause PPH, late PPH typically results from subinvolution of the uterus, pelvic infection, or retained placental fragments.
A primiparous woman is watching her newborn sleep. She wants him to wake up and respond to her. The mother asks the nurse how much he will sleep every day. What is an appropriate response by the nurse? a. "He will only wake up to be fed, and you should notbother him between feedings." b. "The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing." c. "He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon." d. "He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night."
b
The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What information provided by the nurse would be most useful to these new parents? a. "Infants can see very little until approximately 3 months of age." b. "Clearest visual distance is 8 to 12 inches and they can distinguish patterns; preferring complex ones." c. "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes." d. "It's important to shield the newborn's eyes. Overheadlights help them see better."
b
The use of methamphetamine (meth) has been described as a significant drug problem in the United States. The nurse who provides care to this client population should be cognizant of what regarding methamphetamine use? a. Methamphetamines are similar to opiates b. Methamphetamines are stimulants with vasoconstrictive characteristics c. Methamphetamines should not be discontinued during pregnancy d. Methamphetamines are associated with a low rate of relapse
b
What is the primarynursing responsibility when caring for a client who is experiencing an obstetric hemorrhage associated with uterine atony? a. Establishing venous access b. Performing fundal massage c. Preparing the woman for surgical intervention d. Catheterizing the bladder
b
What would a steady trickle of bright red blood from the vagina in the presence of a firm fundus suggest to the nurse? a. Uterine atony b. Lacerations of the genital tract c. Perineal hematoma d. Infection of the uterus
b
Which statement best describes the transition period between intrauterine and extrauterine existence for the newborn? a. Consists of four phases, two reactive and two of decreased responses b. Lasts from birth to day 28 of life c. Applies to full-term births only d. Varies by socioeconomic status and the mother's age
b Changes begin immediately after birth; the cutoff time when the transition is considered over (although the baby keeps changing) is 28 days. This transition period has three phases: first reactivity, decreased response, and second reactivity. All newborns experience this transition period, regardless of age or type of birth.
The nurse is circulating during a cesarean birth of a preterm infant. The obstetrician requests that cord clamping be delayed. What is the rationale for this directive? a. To reducethe risk for jaundice b. To reduce the risk of intraventricular hemorrhage c. To decrease total blood volume d. To improve the ability to fight infection
b Delayed cord clamping provides the greatest benefits to the preterm infant. These benefits include a significant reduction in intraventricular hemorrhage, a reduced need for a blood transfusion, and improved blood cell volume. The risk of jaundice can increase, requiring phototherapy. Although no difference in the newborn's infection fighting ability occurs, iron status is improved, which can provide benefits for 6 months.
Which client is at greatest risk for early postpartum hemorrhage (PPH)? a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primigravida in spontaneous labor with preterm twins
b Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony.
Which information about variations in the infant's blood counts is important for the nurse to explain to the new parents? a. A somewhat lower-than-expected red blood cell count could be the result of a delay in clamping the umbilical cord b. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease c. Platelet counts are higher in the newborn than in adults for the first few months d. Even a modest vitamin K deficiency means a problem with the blood's ability to properly clot
b The WBC count is normally high on the first day of birth and then rapidly declines. Delayed cord clamping results in an increase in hemoglobin and the red blood cell count. The platelet count is essentially the same for newborns and adults. Clotting is sufficient to prevent hemorrhage unless the deficiency of vitamin K is significant.
The nurse is aware that theinitiation of breastfeeding is most effective during the first 30 minutes after birth. What is the correct term for this phase of alertness? a. Transition period b. First period of reactivity c. Organizational stage d. Second period of reactivity
b The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase. The transition period is the phase between intrauterine and extrauterine existence. An organizational stage is not a valid stage. The second period of reactivity occurs approximately between 4 and 8 hours after birth, after a period of sleep.
A woman who has recently given birth reports pain and tenderness in her leg. On physical examination, the nurse notices warmth and redness over an enlarged, hardened area. Which condition should the nurse suspect, and how will it be confirmed? a. Disseminated intravascular coagulation (DIC); asking for laboratory tests b. von Willebrand disease (vWD); noting whether bleeding times have been extended c. Thrombophlebitis; using real-time and color Doppler ultrasound d. Idiopathic or immune thrombocytopenic purpura (ITP); drawing blood for laboratory analysis
c
The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse range (in beats per minute)? a. 80 to 100 b. 100 to 120 c. 110 to 160 d. 150 to 180
c
When a woman is diagnosed with postpartum depression (PPD) withpsychotic features, what is the nurse's primary concern in planning the client's care? a. Displaying outbursts of anger b. Neglecting her hygiene c. Harming her infant d. Losing interest in her husband
c
Which is the initial treatment for the client diagnosed with von Willebrand disease (vWD) who experiences a postpartum hemorrhage (PPH)? a. Cryoprecipitate b. Factor VIII and von Willebrand factor (vWf) c. Desmopressin d. Hemabate
c
Which is the most accurate description of postpartum depression (PPD) without psychotic features? a. Postpartum baby blues requiring the woman to visit with a counselor or psychologist b. Condition that is more common among older Caucasian women because they have higher expectations c. Distinguishable by pervasive sadness along with mood swings d. Condition that disappears without outside help
c
Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications? a. Alcohol b. Caffeine c. Tobacco d. Chocolate
c
While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a clunk when performing the Ortolani maneuver. These findings are likely indicative of what? a. Polydactyly b. Clubfoot c. Hip dysplasia d. Webbing
c
While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion? a. Phobias b. Panic disorder c. Post traumatic stress disorder (PTSD) d. Obsessive-compulsive disorder (OCD)
c
While assessing the integument of a 24-hour-old newborn, the nurse notes a pink papular rash with vesicles superimposed on the thorax, back, and abdomen. What action is the highest priority for the nurse to take immediately? a. Immediately notify the health care professional. b. Move the newborn to an isolation nursery. c. Document the finding as erythema toxicum neonatorum. d. Take the newborn's temperature and obtain a culture of one of the vesicles.
c Erythema toxicum neonatorum (or erythema neonatorum) is a newborn rash that resembles flea bites. Documentation of the condition is the priority. Notification of the health care provider, isolation of the newborn, or additional interventions are not necessary when erythema toxicum neonatorum is present.
What marks on a baby's skin may indicate an underlying problem that requires notification of a physician? a. Mongolian spots on the back b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infant's body d. Erythema toxicum neonatorum anywhere on the body
c Petechiae (bruises) scattered over the infant's body should be reported to the pediatrician because they may indicate underlying problems such as infection or low platelet count. Mongolian spots are bluish-black spots that resemble bruises but gradually fade over months and have no clinical significance. Telangiectatic nevi (stork bites, angel kisses) fade by the second year and have no clinical significance. Erythema toxicum neonatorum is an appalling-looking rash; however, it has no clinical significance and requires no treatment.
The most effective and least expensive treatment of puerperal infection is prevention. What is the most important strategy for the nurse to adopt? a. Large doses of Vitamin C during pregnancy b. Prophylactic antibiotics c. Strict aseptic technique by all health care personnel d. Limited protein and fat intake
c Strict adherence by all health care personnel to aseptic techniques during childbirth and the postpartum period is extremely important and the least expensive measure to prevent infection.
Which information related to the newborn's developing cardiovascular system should the nurse fully comprehend? a. The heart rate of a crying infant may rise to 120 beats per minute b. Heart murmurs heard after the first few hours are a cause for concern c. The point of maximal impulse (PMI) is often visible on the chest wall d. Persistent bradycardia may indicate respiratory distress syndrome (RDS)
c The newborn's thin chest wall often allows the PMI to be observed. The normal heart rate for infants who are not sleeping is 110 to 160 beats per minute. However, a crying infant could temporarily have a heart rate of 180 beats per minute. Heart murmurs during the first few days of life have no pathologic significance; however, an irregular heart rate beyond the first few hours should be further evaluated. Persistent tachycardia may indicate RDS; bradycardia may be a sign of congenital heart blockage
Neonatal signs of maternal SSRI use include: _____________________________________________. The onset of signs and symptoms ranges from several hours to several days after birth, but the signs generally resolve within 2 weeks.
continuous crying, irritability, jitteriness, shivering, fever, hypertonia, respiratory distress, feeding difficulty, hypoglycemia, and seizures
As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth? a. Heroin b. Alcohol c. Phencyclidine (1-phenylcyclohexylpiperidine; PCP) d. Cocaine
d
If nonsurgical treatment for late postpartum hemorrhage (PPH) is ineffective, which surgical procedure would be appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. Dilation and curettage (D&C)
d
What is the most critical physiologic change required of the newborn after birth? a. Closure of fetal shunts in the circulatory system b. Full function of the immune defense system c. Maintenance of a stable temperature d. Initiation and maintenance of respirations
d
What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant? a. Genetic changes and anomalies b. Extensive CNS damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction
d
An African-American woman noticed some bruises on her newborn daughter's buttocks. The client asks the nurse what causes these. How would the nurse best explain this integumentary finding to the client? a. Lanugo b. Vascular nevus c. Nevus flammeus d. Mongolian spot
d A Mongolian spot is a bluish-black area of pigmentation that may appear over anypart of the exterior surface of the infant's body and is more commonly noted on the back and buttocks and most frequently observed on infants whose ethnic origins are Mediterranean, Latin American, Asian, or African. Lanugo is the fine, downy hair observed on a term newborn. A vascular nevus, commonly called a strawberry mark, is a type of capillary hemangioma. A nevus flammeus, commonly called a port wine stain, is most frequently found on the face.
What is one of the initial signs and symptoms of puerperal infection in the postpartum client? a. Fatigue continuing for longer than 1 week b. Pain with voiding c. Profuse vaginal lochia with ambulation d. Temperature of 38° C (100.4° F) or higher on 2 successive days
d Fatigue is a late finding associated with infection. Pain with voiding may indicate a urinary tract infection (UTI), but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.
Which classification of placental separation is notrecognized as an abnormal adherence pattern? a. Placenta accreta b. Placenta increta c. Placenta percreta d. Placenta abruptio
d Placenta abruptiois premature separation of the placentaas opposed to partial or complete adherence
Which infant response to cool environmental conditions is either not effective or not available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position
d The newborn's flexed position guards against heat loss, because it reduces the amount of body surface exposed to the environment. The newborn's body is able to constrict the peripheral blood vessels to reduce heat loss. Burning brown fat generates heat. The respiratory rate may rise to stimulate muscular activity, which generates heat.
The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which observation indicates or would confirm this diagnosis? a. Absence of cyanosis in the buccal mucosa b. Cool, dry skin c. Calm mental status d. Urinary output of at least 30 ml/hr
d The presence of adequate urinary output indicates adequate tissue perfusion (answer d). The assessment of the buccal mucosa for cyanosis can be subjective (option a). The presence of cool, pale, clammy skin is associated with hemorrhagic shock (option b). Hemorrhagic shock is associated with lethargy, not restlessness.
Placenta accreta/increta/percreta
endometrium, myometrium, entire
A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is: Hearing Taste Smell Vision
vision
