OB-ex2: PrepU Chapter 15: Postpartum Adaptations
A client who recently gave birth to her third child expresses a desire to have her older two children come to the hospital for a visit. What should the nurse say in response to this request? "As long as they are well, absolutely. Why don't we give you a dose of pain medication beforehand so that you will enjoy the visit?" "I recommend that you introduce the new baby to her siblings once you are back at home. Right now you need to rest and recover." "Your baby is so vulnerable to infections right now that it would be better to wait until you are at home to introduce her to her siblings." "That's a great idea! They can also take the baby out into the hall and walk with it for a while to give you a break."
"As long as they are well, absolutely. Why don't we give you a dose of pain medication beforehand so that you will enjoy the visit?"
After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, the nurse understands there is a need for additional teaching when one of the women makes which statement? "I can't wait for these stretch marks to disappear after I give birth." "I might lose some hair, but it will grow back." "This line on my belly will go away over time." "My nipples won't be so dark after I give birth."
"I can't wait for these stretch marks to disappear after I give birth."
A mother just gave birth 3 hours ago. The nurse enters the room to continue hourly assessments and finds the client on the phone telling the listener about her fear while driving to the hospital and not making it in time. The mother finishes the call, and the nurse begins her assessment with which phrase? "I need to assess your fundus now." "It sounded like you had quite a time getting here. Would you like to continue your story?" "You have a beautiful baby, why worry about that now?" "If you plan to breastfeed, you need to calm down."
"It sounded like you had quite a time getting here. Would you like to continue your story?"
A nurse is making an initial call on a new mother who gave birth to her third baby 5 days ago. The woman says, "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother? "Every baby is different with their own temperament. Maybe this one just isn't ready to sleep when you want him to." "It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the birth. They will most likely go away in a day or two." "It sounds like you need to make an appointment with a counselor. You may have postpartum depression." "Tell me, are you seeing things that aren't there, or hearing voices?"
"It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the birth. They will most likely go away in a day or two."
A new mother is concerned because it is 24 hours after birth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? "It takes about 3 days after birth for milk to begin forming." "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs." "You may have developed mastitis. I'll ask the primary care provider to examine you." "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in."
"It takes about 3 days after birth for milk to begin forming."
A 2-day old newborn is crying after being circumcised and the mother is attempting to comfort the infant but he continues to be fussy. Which statement by the nurse would best support the mother's actions? "You would probably be more successful if you wrapped him in on a warm blanket." "Many mothers find that offering a nipple dipped in sugar water helps soothe a baby after a painful procedure." "Let me show you how to calm him down. I've been doing this for many years." "Maybe you your husband will have better luck calming him down. Why don't you let him hold him?"
"Many mothers find that offering a nipple dipped in sugar water helps soothe a baby after a painful procedure." Explanation:
The postpartum client and her husband are excited about their new baby. However, they are also concerned about getting pregnant again too soon and ask about using birth control. Which instruction should the nurse include in their discharge education to address this issue? "You may have intercourse until next month with no fear of pregnancy." "Ovulation may return as soon as 3 weeks after birth." "You will not ovulate until your menstrual cycle returns." "Ovulation does not return for 6 months after birth."
"Ovulation may return as soon as 3 weeks after birth."
A client who had a vaginal birth 2 days ago asks the nurse when she will be able to breathe normally again. Which response by the nurse is accurate? "You should notice a change in your respiratory status within the next 24 hours." "Everyone is different, so it is difficult to say when your respirations will be back to normal." "It usually takes about 3 months before all of your abdominal organs return to normal, allowing you to breathe normally." "Within 1 to 3 weeks, your diaphragm should return to normal, and your breathing will feel like it did before your pregnancy."
"Within 1 to 3 weeks, your diaphragm should return to normal, and your breathing will feel like it did before your pregnancy."
A woman comes to the clinic. She gave birth about 2 months ago to a healthy term male newborn. During the visit, the woman tells the nurse, "I've noticed that I'm a bit uncomfortable now when we have sexual intercourse. Is there anything that I can do?" The woman's menstrual period has not yet resumed. Which suggestion by the nurse would be most appropriate? "You might try using a water-soluble lubricant to ease the discomfort." "It takes a while to get your body back to its normal function after having a baby." "This is entirely normal, and many women go through it. It just takes time." "Try doing Kegel exercises to get your pelvic muscles back in shape."
"You might try using a water-soluble lubricant to ease the discomfort."
A client who gave birth to a baby 36 hours ago informs the nurse that she has been passing unusually large volumes of urine very often. How should the nurse explain this to the client? "Bruising and swelling of the perineum often causes excessive urination." "Larger than normal amounts of urine frequently occur due to swelling of tissues surrounding the urinary meatus." "Your body usually retains extra fluids during pregnancy, so this is one way it rids itself of the excess fluid." "Anesthesia causes decreased bladder tone, which causes you to urinate more frequently."
"Your body usually retains extra fluids during pregnancy, so this is one way it rids itself of the excess fluid."
Parents tell the nurse that their 3-year-old son has begun to have "accidents" at home following the arrival of his baby sister and wants to sit in his mother's lap all the time now. What advice would the nurse offer these parents? Select all that apply. Tell the older sibling that he is a big boy and has to share his mommy with the little sister. Set aside time every day for the parents to focus on the big brother exclusively. Buy the older sibling a doll for him to care for, as the mother is caring for the new baby. Scold him whenever he wets his pants and place him back in diapers. Be aware of potential aggressive behaviors from the older sibling.
- Set aside time every day for the parents to focus on the big brother exclusively. - Buy the older sibling a doll for him to care for, as the mother is caring for the new baby. - Be aware of potential aggressive behaviors from the older sibling.
The nurse is preparing to assess a client who is 1 day postpartum. The nurse predicts the client's fundus will be at which location on assessment? At level of umbilicus 1 cm above the umbilicus 1 cm below the umbilicus At the symphysis pubis
1 cm below the umbilicus Explanation: The fundus of the uterus should be at the umbilicus after birth. Every day after birth it should decrease 1 cm until it is descended below the pubic bone.
nurse is assessing a postpartum client and notes an elevated temperature. Which temperature protocol should the nurse prioritize? 99.1ºF (37.3ºC) at 12 hours postbirth and decreases after 18 hours 100.1ºF (37.8ºC) at 24 hours postbirth and decreases the second postpartum day 100.3ºF (37.9ºC) at 24 hours postbirth and remains the same for the second postpartum day 100.5ºF (38.1ºC) at 48 hours postbirth and remains the same the third day postpartum
100.5ºF (38.1ºC) at 48 hours postbirth and remains the same the third day postpartum Explanation: A temperature that is greater than 100.4ºF (38ºC) on two postpartum days after the first 24 hours puts the client at risk for a postpartum infection. A fever in the first 24 hours of birth is considered normal and could be caused by dehydration and analgesia.
Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? applying ice restricting fluids applying warm compresses administering bromocriptine
applying ice
During a home visit, the client mentions she is still having significant of joint pain. The nurse explains that the changes that softened the pelvic joints to allow for the birth were due to the hormone relaxin. The nurse informs the client that it takes approximately how long for the joints to return to prepregnancy status? 6 to 8 weeks after pregnancy 4 to 6 weeks after pregnancy 8 to 10 weeks after pregnancy 2 to 4 weeks after pregnancy
6 to 8 weeks after pregnancy
The nursing instructor is conducting a class exploring the various changes that occur in the early postpartum period. The instructor determines the session is successful when the students correctly point out which definition of bonding? A process of developing an attachment and becoming acquainted with each other The skin-to-skin contact that occurs in the birth room An ongoing process in the year after birth Family growing closer together after the birth of a new baby
A process of developing an attachment and becoming acquainted with each other Explanation: Bonding in the maternal-newborn world is the attachment process that occurs between a mother and her newborn infant. This is how the mother and infant become engaged with each other and is the foundation for the relationship. Bonding is a process and not a single event. The process of bonding is not a yearlong process, and the family growing closer together after the birth of a new baby is not bonding.
After the birth of the newborn, the mother is ready to be discharged home. The client's mother is present and will remain with her for 1 month. The client's mother tells the nurse that her daughter will not be allowed to leave the house for the first month after the birth, based on the family's cultural customs. How should the nurse respond to this statement? - Remind the client's mother that the woman needs to get out and get fresh air over the next month. - Ask the client's mother why she is putting such restrictions on her daughter. - Accept the mother's statement and perform discharge teaching accordingly. - Explain to the client's mother that her daughter may have to go places in caring for the newborn.
Accept the mother's statement and perform discharge teaching accordingly.
The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? Uterine atony Full bowel Bladder distention Poor bladder tone
Bladder distention
A client who is 3 days' postpartum calls the office and reports excessive night sweats. Which explanation should the nurse provide for the client? Change in pregnancy hormone Body secreting the excess fluids from pregnancy The patient may be drinking too much fluid. The body is trying to get rid of the extra blood made during pregnancy.
Body secreting the excess fluids from pregnancy
A new mother is in the second developmental stage of becoming a mother and is becoming independent in her actions. Which action by the nurse would best foster this stage? Changing the infant's diapers for the mother Demonstrating how to do cord care on the newborn Correcting the mother when she holds the newborn incorrectly. Telling the mother to feed the baby when it cries.
Demonstrating how to do cord care on the newborn Explanation: When a mother enters the independent period of the second stage of becoming a mother, the nurse can assist her best by supporting her and praising her when she cares for the newborn. By demonstrating cord care to her, it empowers her to do the cord care the next time it is needed. The nurse's job is to not take over but to assist the mother in caring for her newborn.
A multigravida client is still focusing on her difficult labor and discusses it with the nurse at each opportunity, several hours after the birth. Which action should the nurse prioritize after noting the client's partner is spending more time with the infant than the client? Redirect her attention to the baby by reminding her of the details of newborn care. Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings. Encourage her to discuss her experience of the birth and answer any questions or concerns she may have. Point out positive features of her baby, and encourage her to hold and cuddle the baby.
Encourage her to discuss her experience of the birth and answer any questions or concerns she may have.
A client is exhibiting signs of engorgement, but her milk is still flowing easily. Which suggestion should the nurse prioritize? Restrict fluid intake to 2 L each day. Ensure the baby empties the breasts at each feeding Apply ice packs before a feeding. Wear a tight fitting bra at all times.
Ensure the baby empties the breasts at each feeding
A nurse is caring for a breastfeeding client who reports engorgement. The nurse identifies that the client's condition is due to not fully emptying her breasts at each feeding. Which suggestion should the nurse make to help her prevent engorgement? Feed the baby at least every two or three hours. Apply cold compresses to the breasts. Provide the infant oral nystatin. Dry the nipples following feedings.
Feed the baby at least every two or three hours.
A nurse is performing an assessment on a female client who gave birth 24 hours ago. On assessment, the nurse finds that the fundus is 2 cm above the umbilicus and boggy. Which intervention is a priority? Notify the primary care provider, and document the findings. Have the client void, and then massage the fundus until it is firm. Assess a full set of vital signs. Check and inspect the lochia, and document all findings.
Have the client void, and then massage the fundus until it is firm.
A concerned client tells the nurse that her husband, who was very excited about the baby before its birth, is apparently happy but seems to be afraid of caring for the baby. What suggestion should the nurse give to the client's husband to resolve the issue? Hold the baby frequently. Speak to his friends who have children. Read up on parental care. Have the client speak to the primary care provider on her husband's behalf
Hold the baby frequently.
What two elements play the biggest role in becoming a mother after delivery of her newborn? Confidence and happiness with the pregnancy Love and attachment to the child and engagement with the child Planned and desired pregnancy and previous experience with infants Interactions with the child and support systems
Love and attachment to the child and engagement with the child
The nurse is caring for several postpartum clients on the unit. Which client's reaction should the nurse prioritize for possible intervention? Hesitates to hold newborn, expressing disappointment with baby's appearance. Neglects to engage or provide care or show interest in infant. Tearful for several days, difficulty eating and sleeping. Express doubt in ability to care for newborn.
Neglects to engage or provide care or show interest in infant.
The nurse is conducting a postpartum examination on a client who reports pain and is unable to sit comfortably. The perineal exam reveals an episiotomy without signs of a hematoma. Which action should the nurse prioritize? Notify a health care provider. Apply a warm washcloth. Place an ice pack. Put on a witch hazel pad.
Place an ice pack.
A nurse is assessing a postpartum woman. Which behavior would the nurse interpret as an indication that the woman is entering the taking-hold phase of the postpartum period? She sits and rocks her infant for long intervals. She is eager to talk about her birth experience. She has not asked for anything for pain all day. She did her perineal care independently.
She did her perineal care independently.
A nurse is caring for a client who gave birth a week ago. The client informs the nurse that she experiences painful uterine contractions when breastfeeding the baby. What should the nurse do next? Tell the client to take an NSAID orally. Have the client stop breastfeeding. Instruct the client to take a warm shower. Ask how often the client is breastfeeding.
Tell the client to take an NSAID orally.
Which body system is most vulnerable to infection during the postpartum period? Gastrointestinal Urinary Breasts Respiratory
Urinary
A nurse is caring for a non-breastfeeding client in the postpartum period. The client reports engorgement. What suggestion should the nurse provide to alleviate breast discomfort? Apply warm compresses. Wear a well-fitting bra. Express milk frequently. Apply hydrogel dressing.
Wear a well-fitting bra.
A new mother asks the nurse what she is allowed to do when she goes home from the hospital. Which statement by the nurse would be correct? You should be able to resume normal activities after 2 weeks. You should not lift anything heavier than your infant in its carrier. Only clean half of the house per day to allow yourself more rest. You need to hire a maid for the first month after delivery to help out around the house.
You should not lift anything heavier than your infant in its carrier.
The postpartum nurse is assessing clients, and all have given birth within the past 24 hours. Which client assessment leads the nurse to suspect the woman is experiencing postpartum blues? an 18-year-old mother who is currently holding her baby and looking face-to-face at the baby without saying a word a 29-year-old mother who has lots of family visiting, offering to help her with meals and cleaning for the next few months a 30-year-old woman who is teary-eyed when asked how she and the baby are doing with breastfeeding a 38-year-old G1P1 who is constantly holding the baby and touching the baby's hands and fingers
a 30-year-old woman who is teary-eyed when asked how she and the baby are doing with breastfeeding
A client has come to the office for her first postpartum visit. On evaluating her blood work, the nurse would be concerned if the hematocrit is noted to have: acutely decreased. acutely increased. slightly decreased. slightly increased.
acutely decreased. Despite the decrease in blood volume, the hematocrit remains relatively stable and may even increase, reflecting the predominant loss of plasma. An acute decrease in hematocrit is not an expected finding and may indicate hemorrhage.
While caring for a client following a lengthy labor and birth, the nurse notes that the client repeatedly reviews her labor and birth and is very dependent on her family for care. The nurse is correct in identifying the client to be in which phase of maternal role adjustment? letting-go taking-hold taking-in acquaintance/attachment
aking-in Explanation: The taking-in phase occurs during the first 24 to 48 hours following the birth of the newborn and is characterized by the mother taking on a very passive role in caring for herself, as well as recounting her labor experience. The second maternal adjustment phase is the taking-hold phase and usually lasts several weeks after the birth. This phase is characterized by both dependent and independent behavior, with increasing autonomy. During the letting-go phase the mother reestablishes relationships with others and accepts her new role as a parent. Acquaintance/attachment phase is a newer term that refers to the first 2 to 6 weeks following birth when the mother is learning to care for her baby and is physically recuperating from the pregnancy and birth.
A nurse works at a facility that provides care to clients holding various cultural beliefs. The nurse integrates understanding of the areas recognized by other cultures that are not necessarily acknowledged by the Western culture. Which area would the nurse need to incorporate into the plans of care? balance of hot and cold introducing the infant to the rest of the family allowing family members at the birth expectations of what the new mother should be doing
balance of hot and cold
A nurse is monitoring the vital signs of a client 24 hours after birth. She notes that the client's blood pressure is 100/60 mm Hg. Which postpartum complication should the nurse most suspect in this client, based on this finding? bleeding postpartum gestational hypertension infection diabetes
bleeding
A nurse is reviewing the history of a postpartum woman. The nurse determines that the woman is at low risk for uterine subinvolution based on which findings? Select all that apply. uterine infection prolonged labor hydramnios breastfeeding early ambulation
breastfeeding early ambulation
The nurse, assessing the lochia of a client, attempts to separate a clot and identifies the presence of tissue. Which observation would indicate the presence of tissue? yellowish-white lochia foul-smelling lochia easy to separate clots difficult to separate clots
difficult to separate clots Explanation: If tissue is identified in the lochia, it is difficult to separate clots. Yellowish-white lochia indicates increased leukocytes and decreased fluid content. Easily separable lochia indicates the presence of clots only. Foul-smelling lochia indicates endometritis.
While making a follow-up home visit to a client in her first week postpartum, the nurse notes that she has lost 5 pounds. Which reason for this loss would be the most likely? diuresis lactation blood loss nausea
diuresis
A client in her sixth week postpartum reports general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which condition? hyperglycemia hypertension hypovolemia hypothyroidism
hypovolemia
he nurse is assessing a postpartum woman and is concerned the client may be hemorrhaging. Which assessment finding is the nurse finding most concerning? increased blood pressure increased cardiac output increased hematocrit level increased heart rate
increased heart rate Explanation: Tachycardia in the postpartum woman warrants further investigation as it can indicate postpartum hemorrhage. Typically the postpartum woman is bradycardic for the first 2 weeks. In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of a compensatory increase in heart rate. Hypotension would be another concerning assessment, especially orthostatic hypotension, as it can also indicate hemorrhage. Red blood cell production ceases early in the postpartum period, causing hemoglobin and hematocrit levels to decrease slightly in the first 24 hours and then rise slowly. Hematocrit would be unreliable as an indicator of hemorrhage.
A nurse is providing discharge instructions to a postpartum client about possible complications after returning home. For which finding will the client contact the health care provider? increasing amount and darkening of the color of lochia passing clots smaller than 1 inch (2.5 cm) decreasing amount and lightening of the color of lochia palpating a firm fundus
increasing amount and darkening of the color of lochia
During the early postpartum period, a new parent is displaying dependent behaviors typical of the taking-in phase. What behavior(s) will the nurse recognize as normal for this period? Select all that apply. needing assistance with changing the peripad desiring to hold the newborn telling the nurse about the birth experience asking the nurse to take the newborn away so the client can rest changing the newborn's diaper with guidance from the nurse
needing assistance with changing the peripad telling the nurse about the birth experience asking the nurse to take the newborn away so the client can rest
A nurse is caring for a client who is nursing her baby boy. The client reports afterpains. Secretion of which substance would the nurse identify as the cause of afterpains? prolactin progesterone oxytocin estrogen
oxytocin Explanation: Secretion of oxytocin stimulates uterine contraction and causes the woman to experience afterpains. Decrease in progesterone and estrogen after placental delivery stimulates the anterior pituitary to secrete prolactin, which causes lactation.
The nurse is used to working on the postpartum floor taking care of women who have had normal vaginal births. Today, however, the nurse has been assigned to help care for women who are less than 24 hours post-cesarean birth. The nurse realizes that some areas will not be assessed. What would the nurse leave out of the client assessments? breasts perineum lower extremities respiratory status
perineum
The nurse is assessing a client at a postpartum visit and notes the client is emotionally sensitive, complains about being a failure, and appears extremely sad. The nurse concludes the client is presenting with which potential condition? postpartum blues postpartum depression postpartum psychosis anxiety disorders
postpartum depression
The nurse is assessing a client at a postpartum visit. Which hemodynamic change will the nurse expect the client to exhibit? rise in hematocrit transient tachycardia increase in circulatory blood volume increase in cardiac output
rise in hematocrit
While providing care to a postpartum client on her first day at home, the nurse observes which behavior that would indicate the new mother is in the taking-hold phase? showing increased confidence when caring for the newborn talking about her labor experience to others around her pointing out specific features in the newborn having feelings of grief or guilt
showing increased confidence when caring for the newborn Explanation: Showing increased confidence when caring for the newborn is an important aspect of the taking-hold phase. Recounting her labor experience is usually part of the taking-in phase. Identifying specific features of the newborn is typical of the taking-in phase. Feelings of grief, guilt, and anxiety are part of the letting-go phase where the mother accepts the infant as it is and lets go of any fantasie
A client gave birth 1 day ago and the nurse is monitoring the client's blood pressure. In which position will the nurse place the client to get the most accurate reading? lying flat in the bed on the back lying on the right side for 5 minutes standing next to the bed after 3 minutes sitting on the side of the bed for 2 minutes
sitting on the side of the bed for 2 minutes
During the second day postpartum, a nurse notices that a client is initiating breastfeeding with her infant and changing her infant's diapers with some assistance from her partner. Which phase does the nurse recognize that the woman is experiencing? the taking-in phase the taking-hold phase the binding-in phase the letting-go phase
the taking-hold phase
A nurse provides care to pregnant women and their families from a wide range of cultural backgrounds and considers their culture and traditions when providing care. As the nurse communicates with the families, the nurse integrates understanding of communication as being more than just speaking and listening. Which aspect must the nurse also consider? touching writing pictures recognizing the meaning of words
touching Explanation: Nurses caring for families should consider all aspects of culture, including communication. Communication is more than just an understanding of the person's language but also the meaning of touch and gestures. Nurses must be sensitive to how people respond when being touched and should refrain from it if the client's response indicates that it is unwelcomed.
A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply. uterine infection prolonged labor hydramnios breastfeeding early ambulation empty bladder
uterine infection prolonged labor hydramnios
The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? lochia serosa edematous vagina uterus 1 cm below umbilicus diaphoresis
uterus 1 cm below umbilicus
The nurse is preparing discharge training for a G2P2 client who will breastfeed her infant. The client mentions she wants more children but wants to wait a couple of years and asks about birth control. Which time frame for using a birth control method should the nurse point out will best help the client achieve her goals? when she stops breastfeeding within 18 months within 6 weeks when she resumes sexual activity
when she resumes sexual activity
A woman comes to the clinic for her first postpartum visit. She gave birth to a healthy term neonate 2 weeks ago. As part of this visit, the woman has a complete blood count drawn. Which result would the nurse identify as a potential problem? hematocrit 42% (0.42) white blood cell count 14,000/mm3 (14 ×109/L) hemoglobin 12.5 g/dL (125 g/L) platelets 350,000/µL (350 ×109/L)
white blood cell count 14,000/mm3 (14 ×109/L) Explanation: The white blood cell count, which increases in labor, remains elevated for the first 4 to 6 days after birth but then falls to 6,000 to 10,000/mm3 (6 to 10 ×109/L). An elevated white blood cell count would be suspicious for infection. The hemoglobin, hematocrit and platelet levels are within normal parameters for this woman.
While visiting a client at home on the 10th day postpartum, the nurse assesses the client's lochia. Which color would the nurse expect the lochia to be? red pink yellowish white yellowish pink
yellowish white