Maternity Practice Questions
A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, "I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest." Which of the following actions should the nurse take at this time? 1. Encourage the woman exclusively to breastfeed her baby. 2. Have the woman massage her breasts hourly. 3. Obtain an order to culture her expressed breast milk. 4. Take the temperature and pulse rate of the woman.
*1. Encourage the woman exclusively to breastfeed her baby.* Clients should be strongly encouraged exclusively to breastfeed their babies to prevent engorgement. The lactating breast produces milk in response to being stimulated. When a feeding is skipped, milk is still produced for the baby. When the baby is not fed, breast congestion or engorgement results. Engorgement is not only uncomfortable, but it also gives the body the message to stop producing milk, resulting in an insufficient milk supply.
The nurse in the obstetric clinic received a telephone call from a bottlefeeding mother of a 3-day-old. The client states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform? 1. Intermittently apply ice packs to her axillae and breasts. 2. Apply lanolin to her breasts and nipples every 3 hours. 3. Express milk from the breasts every 3 hours. 4. Ask the primary health care provider to order a milk suppressant.
*1. Intermittently apply ice packs to her axillae and breasts.* Breast milk is produced in the glandular tissue of the breast. An adequate blood supply to the area is required for the milk production. When cold is applied to the breast, the blood vessels constrict, decreasing the blood supply to the area. This is a relatively easy, nonhazardous action that helps to suppress breast milk production
Which of the following statements is true about breastfeeding mothers as compared to bottlefeeding mothers? 1. Breastfeeding mothers usually involute completely by 3 weeks postpartum. 2. Breastfeeding mothers have decreased incidence of diabetes mellitus later in life. 3. Breastfeeding mothers show higher levels of bone density after menopause. 4. Breastfeeding mothers are prone to fewer bouts of infection immediately postpartum.
*2. Breastfeeding mothers have decreased incidence of diabetes mellitus later in life.* There is evidence to show that women who breastfeed their babies are less likely to develop type 2 diabetes later in life Breastfeeding has many beneficial properties for both mothers and babies. It is a nursing responsibility to provide couples with the knowledge so that they can make fact-based decisions about how they will feed their babies.
A breastfeeding woman, 11⁄2 months postdelivery, calls the nurse in the obstetri- cian's office and states, "I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me?" The nurse should base the response to the client on which of the following? 1. The woman is exhibiting signs of pathological galactorrhea. 2. The same hormone stimulates orgasms and the milk ejection reflex. 3. The woman should have a serum galactosemia assessment done. 4. The baby is stimulating the woman to produce too much milk.
*2. The same hormone stimulates orgasms and the milk ejection reflex* Oxytocin stimulates sexual orgasms and is also the hormone that stimulates the milk ejection reflex. It is important for the nurse in the obstetrician's office to warn breastfeeding clients of this situation. Because clients are strongly encouraged to refrain from having intercourse until they are 6 weeks postpartum, the postpartum nurse may not include this information in the client's discharge instructions. When the client is seen for her postpartum check, however, the information should be included
A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following? 1. Use a nipple shield at each breastfeeding. 2. Cleanse the nipples with soap 3 times a day. 3. Rotate infant positions at each feed. 4. Bottle feed for 2 days then resume breastfeeding.
*3. Rotate infant positions at each feed.* If a mother rotates positions at each breastfeeding, the baby is likely to put pressure on varying points on the nipple. A good, deep latch, however, is the most important way to prevent nipple soreness and cracking. The mother could also apply lanolin to her breasts after each feeding.
A 2-day-postpartum breastfeeding woman states, "I am sick of being fat. When can I go on a diet?" Which of the following responses is appropriate? 1. "It is fine for you to start dieting right now as long as you drink plenty of milk." 2. "Your breast milk will be low in vitamins if you start to diet while breastfeeding." 3. "You must eat at least 3000 calories per day in order to produce enough milk for your baby." 4. "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."
*4. "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."* Many mothers who consume approximately the same number of calories while breastfeeding as they did when they were pregnant do lose weight while breastfeeding. Mothers should be advised to eat a well-balanced diet and drink sufficient quantities of fluids while breastfeeding. There is no absolute number of calories that the mother should consume, but if she does go on a restrictive diet, it is likely that her milk supply may dwindle. Babies do take in about 600 calories a day at the breast so mothers can be advised that breastfeeding alone is a form of dieting
The nurse is caring for a breastfeeding mother who asks advice on foods that will provide both vitamin A and iron. Which of the following should the nurse recommend? 1. 1⁄2 cup raw celery dipped in 1 ounce cream cheese. 2. 8 ounce yogurt mixed with 1 medium banana. 3. 12 ounce strawberry milk shake. 4. 1 1⁄2 cup raw broccoli.
*4. 1 1⁄2 cup raw broccoli.* Broccoli is very high in vitamin A and also contains iron. Breastfeeding clients should be advised to consume a well balanced diet high in vitamins and minerals. As a result, nurses must be prepared to suggest foods that meet those needs.
A client informs the nurse that she intends to bottlefeed her baby. Which of the following actions should the nurse encourage the client to perform? 1. Increase her fluid intake for a few days. 2. Massage her breasts every 4 hours. 3. Apply heat packs to her axillae. 4. Wear a supportive bra 24 hours a day.
*4. Wear a supportive bra 24 hours a day.* The postpartum body naturally prepares to breastfeed a baby. In order to suppress the milk production, the mother should refrain from stimulating her breasts. Both massage and heat stimulate the breasts to produce milk. Mothers, therefore, should be encouraged to refrain from touching their breasts and, when showering, to direct the warm water toward their backs rather than toward their breasts. A supportive bra will help to minimize any engorgement the client may experience.