OB Test one

7) A variety of drugs are used either alone or in combination to provide relief of postpartum pain. Which of the following would be an option for pain relief? 1. Nonsteroidal anti-inflammatory agents 2. Proquad 3. Methergine 4. Intravenous oxytocin

1

14) What should the healthcare provider consider when prescribing a medication to a woman who is breastfeeding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Drugs potential effect on hormone production 2. Amount of drug excreted into the mothers blood 3. Drugs potential adverse effects to the infant 4. Infants age and health 5. Mothers need for the medication

3, 4, 5

28) The client delivered vaginally 2 hours ago after receiving an epidural analgesia. She has a slight tingling sensation in both lower extremities, but normal movement. She sustained a second-degree perineal laceration. Her perineum is edematous and ecchymotic. What should the nurse include in the plan of care for this client? 1. Assist the client to the bathroom in 2 hours to void. 2. Place a Foley catheter now. 3. Apply warm packs to the perineum three times a day. 4. Allow the client to rest for the next 8 hours.

1

3) The nurse would expect a physician to prescribe which medication to a postpartum client with heavy bleeding and a boggy uterus? 1. Methylergonovine maleate (Methergine) 2. Rh immune globulin (RhoGAM) 3. Terbutaline (Brethine) 4. Docusate (Colace)

1

4) The client has experienced a postpartum hemorrhage at 6 hours postpartum. After controlling the hemorrhage, the clients partner asks what would cause a hemorrhage. How should the nurse respond? 1. Sometimes the uterus relaxes and excessive bleeding occurs. 2. The blood collected in the vagina and poured out when your partner stood up. 3. Bottle-feeding prevents the uterus from getting enough stimulation to contract. 4. The placenta had embedded in the uterine tissue abnormally.

1

35) What are the nurses responsibilities when teaching the new mother about infant feeding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse should be well informed about infant nutrition and feeding methods. 2. The nurse should provide accurate and consistent information. 3. The nurse should use each interaction to support the parents and promote the familys sense of confidence. 4. The nurse should familiarize the mother with information about community resources that might be helpful after discharge. 5. The nurse should aggressively promote breastfeeding, even if the parents have decided to bottle-feed their infant.

1, 2, 3, 4

28) The nurse is teaching a prenatal class about postpartum changes. The nurse explains that factors that might interfere with uterine involution include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prolonged labor 2. Difficult birth 3. Full bladder 4. Breastfeeding 5. Infection

1, 2, 3, 5

35) The nurse is providing postpartum care to an obese client. As part of care for this client, the nurse should do which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Apply sequential compression devices 2. Have the mother ambulate as early as possible 3. Encourage bottle-feeding over breastfeeding 4. Supervise breastfeeding 5. Instruct the client on signs of infection

1, 2, 4, 5

3) A client is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Methergine 2. Coumadin 3. Misoprostol 4. Serotonin reuptake inhibitors (SSRIs) 5. Nonsteroidal anti-inflammatory drugs

1, 3

11) Which of the following would be considered a clinical sign of hemorrhage? 1. Increased blood pressure 2. Increasing pulse 3. Increased urinary output 4. Hunger

2

16) A new grandmother comments that when her children were born, they stayed in the nursery. The grandmother asks the nurse why her daughters baby stays mostly in the room instead of the nursery. How should the nurse respond? 1. Babies like to be with their mothers more than they like to be in the nursery. 2. Contact between parents and babies increases attachment. 3. Budget cuts have decreased the number of nurses in the nursery. 4. Why do you ask? Do you have concerns about your daughters parenting?

2

17) To prevent the spread of infection, the nurse teaches the postpartum client to do which of the following? 1. Address pain early 2. Change peri-pads frequently 3. Avoid overhydration 4. Report symptoms of uterine cramping

2

4) A client is preparing to take a sitz bath for the first time. What will the nurse do? 1. Allow the client privacy during the sitz bath. 2. Place a call bell well within reach and check on the client frequently. 3. Discourage the client from taking a sitz bath. 4. Check on the client after the sitz bath.

2

27) The postpartum client is suspected of having acute cystitis. Which symptoms would the nurse expect to see in this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. High fever 2. Frequency 3. Suprapubic pain 4. Chills 5. Nausea and vomiting

2, 3

21) The nurse is caring for a client who delivered by cesarean birth. The client received a general anesthetic. To prevent or minimize abdominal distention, which of the following would the nurse encourage? Note: Credit will be given if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased intake of cold beverages 2. Leg exercises every 2 hours 3. Abdominal tightening 4. Ambulation 5. Using a straw when drinking fluids

2, 3, 4

5) What is the primary carbohydrate in mammalian milk that plays a crucial role in the nourishment of the newborn? 1. Colostrum 2. Lactose 3. Lactoferrin 4. Secretory IgA

2. Lactose is the primary carbohydrate in mammalian milk.

23) The postpartum client has developed thrombophlebitis in her right leg. Which finding requires immediate intervention? 1. The client reports she had this condition after her last pregnancy. 2. The client develops pain and swelling in her left lower leg. 3. The client appears anxious, and describes pressure in her chest. 4. The client becomes upset that she cannot go home yet.

3

31) The postpartum client is about to go home. The nurse includes which subject in the teaching plan? 1. Replacement of fluids 2. Striae 3. Diastasis of the recti muscles 4. REEDA scale

3

9) A postpartum client reports sharp, shooting pains in her nipple during breastfeeding and flaky, itchy skin on her breasts. Which of the following does the nurse suspect? 1. Nipple soreness 2. Engorgement 3. Mastitis 4. Letdown reflex

3

22) The client delivered her first child vaginally 7 hours ago. She has not voided since delivery. She has an IV of lactated Ringers solution running at 100 mL/hr. Her fundus is firm and to the right of midline. What is the best nursing action? 1. To massage the fundus vigorously 2. To assess the clients pain level 3. To increase the rate of the IV 4. To assist the client to the bathroom

4

2) The nurse is caring for a premature infant in the NICU, and is going to attempt a bottle feeding with thawed breast milk. How long can thawed breast milk be stored in the refrigerator before the nurse must discard it? 1. 4 hours 2. 8 hours 3. 12 hours 4. 24 hours

4. Previously frozen thawed breast milk is good in the refrigerator for 24 hours only.

15) The community nurse is working with a client from Southeast Asia who has delivered her first child. Her mother has come to live with the family for several months. The nurse understands that the main role of the grandmother while visiting is to do which of the following? 1. Help the new mother by allowing her to focus on resting and caring for the baby. 2. Teach her son-in-law the right way to be a father because this is his first child. 3. Make sure that her daughter does not become abusive towards the infant. 4. Pass on the cultural values and beliefs to the newborn grandchild.

1

16) The home health nurse is visiting a new mother whose baby was delivered by emergency cesarean after a car accident. The mother seems dazed, irritable, and unaware of her surroundings. She tells the nurse she has had trouble sleeping. What would the nurse suspect that the mother has? 1. Post-traumatic stress disorder 2. Postpartum blues 3. Postpartum psychosis 4. Disenfranchised grief

1

19) The postpartum multipara is breastfeeding her new baby. The client states that she developed mastitis with her first child, and asks whether there is something she can do to prevent mastitis this time. What would the best response of the nurse be? 1. Massage your breasts on a daily basis, and if you find a hardened area, massage it towards the nipple. 2. Most first-time moms experience mastitis. It is really quite unusual for a woman having her second baby to get it again. 3. Apply cabbage leaves to any areas that feel thickened or firm to relieve the swelling. 4. Take your temperature once a day. This will help you to pick up the infection early, before it becomes severe.

1

24) Which of the following behaviors noted in the postpartum client would require the nurse to assess further? 1. Responds hesitantly to infant cries. 2. Expresses satisfaction about the sex of the baby. 3. Friends and family visit the client and give advice. 4. Talks to and cuddles with the infant frequently.

1

25) The postpartum client who delivered 2 days ago has developed endometritis. Which entry would the nurse expect to find in this clients chart? 1. Cesarean birth after extended labor with ruptured membranes. 2. Unassisted childbirth and afterbirth. 3. External fetal monitoring used throughout labor. 4. The client has history of pregnancy-induced hypertension.

1

26) Which of the following conditions would predispose a client for thrombophlebitis? 1. Severe anemia 2. Cesarean delivery 3. Anorexia 4. Hypocoagulability

1

11) What are some of the advantages and disadvantages of formula-feeding that a nurse should discuss with new parents? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nutritional value of formula depends on the proper preparation/dilution. 2. There is a potential for bacterial contamination during preparation and storage. 3. Both parents can participate in positive parent-infant interaction during feeding. 4. Refrigeration is not necessary if preparing more than one bottle at a time. 5. Formula has higher levels of essential fatty acids, lactose, cystine, and cholesterol than does breast milk.

1, 2, 3

18) A postpartal client recovering from deep vein thrombosis is being discharged. What areas of teaching on self-care and anticipatory guidance should the nurse discuss with the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Avoid crossing the legs. 2. Avoid prolonged standing or sitting. 3. Take frequent walks. 4. Take a daily aspirin dose of 650 mg. 5. Avoid long car trips.

1, 2, 3

24) A nurse suspects that a postpartum client has mastitis. Which data support this assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Shooting pain between breastfeedings 2. Late onset of nipple pain 3. Pink, flaking, pruritic skin of the affected nipple 4. Nipple soreness when the infant latches on 5. Pain radiating to the underarm area from the breast

1, 2, 3

3) The postpartum nurse provides anticipatory guidance for the new mother as well as teaching on self-care and infant care before discharge. Which topics should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Role changes brought on by the addition to the family unit 2. The realities of having a new baby, and how it affects previous lifestyle 3. Potential complications such as infant colic and postpartum issues 4. Sexuality and contraception 5. Toilet-training and preschool options

1, 2, 3, 4

34) At her 6-week postpartum checkup, a new mother voices concerns to the nurse. She states that she is finding it hard to have time alone to even talk on the phone without interruption. Her family lives in another state, and she has contact with them only by phone. She is still having difficulty getting enough sleep and worries that she will not be a good mother. Appropriate nursing interventions would include providing which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Anticipatory guidance about the realities of being a parent. 2. Parenting literature and reference manuals. 3. Phone numbers and locations of local parenting groups. 4. Referral for specialized interventions related to postpartum blues. 5. Phone numbers and names of postpartum doulas.

1, 2, 3, 5

34) Which interventions can the nurse utilize to provide continuity of care for the postpartal client who experienced a complication and is now ready to return home? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Encourage the client to take advantage of home visits. 2. Make telephone calls as a follow-up to check on the client and newborn. 3. Provide information about postpartal support groups. 4. Refer to mental health professionals to help screen the client for any mental health problems as a result of the complications experienced in the hospital. 5. Supply information about postpartum expectations designed to meet the specific needs of a variety of families.

1, 2, 3, 5

17) What maternity unit policies promote postpartal family wellness and shared parenting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Mother-baby care or couplet care on the postpartum unit 2. Skin-to-skin contact between the mother and baby and the father and baby 3. Newborn kept in the nursery to allow mother to rest between feedings 4. On-demand feeding schedule for both breastfed and bottle-fed infants 5. Limited visiting hours for the father so that the mother can sleep as needed

1, 2, 4

12) Which findings would indicate the presence of a perineal wound infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Redness 2. Tender at the margins 3. Vaginal bleeding 4. Hardened tissue 5. Purulent drainage

1, 2, 4, 5

29) When preparing for and performing an assessment of the postpartum client, which of the following would the nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Ask the client to void before assessing the uterus. 2. Inform the client of the need for regular assessments. 3. Defer client teaching to another time. 4. Perform the procedures as gently as possible. 5. Take precautions to prevent exposure to body fluids.

1, 2, 4, 5

10) A new mother is questioning the nurse about the advantages of breastfeeding her newborn. Which information should the nurse include in the teaching session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Breast milk has immunological advantages, including varying degrees of protection from bacterial and viral infections. 2. Breastfeeding has been shown to increase maternal-infant attachment. 3. Breastfeeding can be initially supplemented with bottle feedings so that the father does not feel left out of the infants care. 4. Breastfeeding often causes nipple tenderness, and may be discouraged until healing occurs. 5. Breastfeeding provides a psychologic advantage to the mother, who derives satisfaction knowing that she is providing her infant with the optimal nutritional start in life.

1, 2, 5

13) Which of the following are potential disadvantages to breastfeeding? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Pain with breastfeeding 2. Leaking milk 3. Equal feeding responsibilities with fathers 4. Vaginal wetness 5. Embarrassment

1, 2, 5

29) Risk factors associated with increased risk of thromboembolic disease include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diabetes mellitus 2. Varicose veins 3. Hypertension 4. Adolescent pregnancy 5. Malignancy

1, 2, 5

12) What interventions would the nurse apply to support the breastfeeding mother? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assist the mother to begin breastfeeding within the first hour after birth. 2. Have the baby returned to the nursery after feeding so that the mother can get adequate rest. 3. Teach the mother to recognize and respond to early infant feeding cues. 4. Inform the mother about community resources that support breastfeeding. 5. Instruct the mother to avoid eating foods that might upset the newborns stomach

1, 3, 4

32) The nurse encourages a new mother to feed the newborn as soon as the newborn shows interest. The nurse bases this recommendation on which benefits of early feedings? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Early feedings stimulate peristalsis. 2. Colostrum is thinner than mature milk. 3. Early feedings enhance maternal-infant bonding. 4. Early feedings promote the passage of meconium. 5. Colostrum contains a high number of calories.

1, 3, 4

6) The incidence of complications and discomforts in the first year postpartum is common and women may experience which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Pain 2. Excess energy 3. Urinary incontinence 4. Changes in mental health status 5. Sleep deprivation

1, 3, 4, 5

9) The nurse is caring for a client who had a cesarean birth 4 hours ago. Which interventions would the nurse implement at this time? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Administer analgesics as needed. 2. Encourage the client to ambulate to the bathroom to void. 3. Encourage leg exercises every 2 hours. 4. Encourage the client to cough and deep-breathe every 2 to 4 hours. 5. Encourage the use of breathing, relaxation, and distraction.

1, 3, 4, 5

35) Clinical features of posttraumatic stress disorder (PTSD) include which of the following? 1. Difficulty sleeping 2. Acute awareness 3. Flashbacks 4. The need to be constantly around others 5. Irritability

1, 3, 5

6) The nurse is caring for a postpartum client who is at risk for developing early postpartum hemorrhage. What interventions would be included in the plan of care to detect this complication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Weigh perineal pads if the client has a slow, steady, free flow of blood from the vagina. 2. Massage the uterus every 2 hours. 3. Maintain vascular access. 4. Obtain blood specimens for hemoglobin and hematocrit. 5. Encourage the client to void if the fundus is displaced upward or to one side.

1, 4

2) The nurse is caring for a postpartum client who is experiencing afterpains following the birth of her third child. Which comfort measure should the nurse implement to decrease her pain? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Offer a warm water bottle for her abdomen. 2. Call the physician to report this finding. 3. Inform her that this is not normal, and she will need an oxytocic agent. 4. Administer a mild analgesic to help with breastfeeding. 5. Administer a mild analgesic at bedtime to ensure rest.

1, 4, 5

39) Which factors would the nurse observe that would indicate a new mothers early attachment to the newborn? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Face-to-face contact and eye contact 2. Failure to choose a name for the baby 3. Decreased interest in the infants cues 4. Pointing out familial traits of the newborn 5. Displaying satisfaction with the infants sex

1, 4, 5

5) The nurse is assessing a client who has been diagnosed with an early postpartum hemorrhage. Which findings would the nurse expect? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A boggy fundus that does not respond to massage 2. Small clots and a moderate amount of lochia rubra on the pad 3. Decreased pulse and increased blood pressure 4. Hematoma formation or bulging/shiny skin in the perineal area 5. Rise in the level of the fundus of the uterus

1, 4, 5

3) The nurse is teaching a prenatal class about feeding methods. A father-to-be asks the nurse which method, breast or formula, leads to the fastest infant growth and weight gain. Which response by the nurse is best? 1. In the first 3 to 4 months breastfed babies tend to gain weight faster. 2. In the first 3 to 4 months there is no difference in weight gain. 3. In the first 3 to 4 months bottle-fed babies grow faster. 4. In the first 3 to 4 months growth isnt as important as your comfort with the method.

1. Exclusively breastfed infants have the same or slightly higher weight gain than their formula-fed and combination-fed peers in the first 3 to 4 months.

8) Which statements by a breastfeeding class participant indicate that teaching by the nurse was effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Breastfed infants get more skin-to-skin contact and sleep better. 2. Breastfeeding raises the level of a hormone that makes me feel good. 3. Breastfeeding is complex and difficult, and I probably wont succeed. 4. Breastfeeding is worthwhile, even if it costs more overall. 5. Breastfed infants have fewer digestive and respiratory illnesses.

1. Skin-to-skin contact after birth helps the baby maintain his or her body temperature, helps with self-regulation, increases maternal oxytocin levels, helps the mother to notice subtle feeding cues, and promotes bonding. 2. Hormones of lactation promote maternal feelings and sense of well-being. 5. This is a true statement. The immunologic advantages of human milk include varying degrees of protection from respiratory tract and gastrointestinal tract infections.

10) Every time the nurse enters the room of a postpartum client who gave birth 3 hours ago, the client asks something else about her birth experience. What action should the nurse take? 1. Answer questions quickly and try to divert her attention to other subjects. 2. Review the documentation of the birth experience and discuss it with her. 3. Contact the physician to warn him the client might want to file a lawsuit, based on her preoccupation with the birth experience. 4. Submit a referral to Social Services because of possible obsessive behavior.

2

12) The postpartum client expresses concern about getting back to her prepregnant shape, and asks the nurse when she will be able to run again. Which statement by the client indicates that teaching was effective? 1. I can start running in 2 weeks, and can breastfeed as soon as I am done. 2. I should see how my energy level is at home, and increase my activity slowly. 3. Running is not recommended for breastfeeding women. 4. If I am getting 8 hours of sleep per day, I can start running.

2

13) A postpartum woman is at increased risk for developing urinary tract problems because of which of the following? 1. Decreased bladder capacity 2. Inhibited neural control of the bladder following the use of anesthetic agents 3. Increased bladder sensitivity 4. Abnormal postpartum diuresis

2

13) The nursing instructor is conducting a class about attachment behaviors. Which statement by a student indicates the need for further instruction? 1. The en face position promotes bonding and attachment. 2. Ideally, initial skin-to-skin contact occurs after the baby has been assessed and bathed. 3. In reciprocity, the interaction of mother and infant is mutually satisfying and synchronous. 4. The needs of the mother and of her infant are balanced during the phase of mutual regulation.

2

15) The nurse is calling clients at 4 weeks postpartum. Which of the following clients should be seen immediately? 1. The client who describes feeling sad all the time 2. The client who reports hearing voices talking about the baby 3. The client who states she has no appetite and wants to sleep all day 4. The client who says she needs a refill on her sertraline (Zoloft) next week

2

15) The nurse is teaching a new mother how to encourage a sleepy baby to breastfeed. Which of the following instructions would not be included in that teaching? 1. Providing skin-to-skin contact 2. Swaddling the newborn in a blanket 3. Unwrapping the newborn 4. Allowing the newborn to feel and smell the mothers breast

2

15) Which statement by a nursing student preparing to care for a postpartum lesbian mother would indicate the need for further teaching? 1. I cant let the client know Ive never worked with lesbian mothers. 2. I will have to adjust some of my discharge instruction for this mother. 3. I dont need to include the partner when I provide care and instruction. 4. Discharge teaching is exactly the same for lesbian mothers as for all others.

2

2) The nurse is assisting a multiparous woman to the bathroom for the first time since her delivery 3 hours ago. When the client stands up, blood runs down her legs and pools on the floor. The client turns pale and feels weak. What would be the first action of the nurse? 1. Assist the client to empty her bladder 2. Help the client back to bed to check the fundus 3. Assess her blood pressure and pulse 4. Begin an IV of lactated Ringers solution

2

20) The client having her second child is scheduled for a cesarean birth because the baby is in a breech presentation. The client states, Im wondering what will be different this time compared with my first birth, which was vaginal. What response is best? 1. Well take good care of you and your baby. Youll be home before you know it. 2. Youll be wearing a sequential compression device until you start walking. 3. You will have a lot of pain, but there are medications that we give when it gets really bad. 4. You wont be able to nurse until the baby is 12 hours old, because of your epidural.

2

21) The nurse is working with a new mother who delivered yesterday. The mother has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the client understands breastfeeding? 1. She puts the infant to breast when he is asleep to help wake him up. 2. She takes off her gown to achieve skin-to-skin contact. 3. She leans toward the infant so that he turns his head to access the nipple. 4. The infant is crying when he is brought to the breast.

2

22) A new mother who is breastfeeding tells the nurse that her infant is spitting up frequently, has very loose stools and copious gas, and feeds for only short periods of time. The nurse suspects a feeding intolerance and, after questioning the mother about her diet, suggests that she do which of the following? 1. Stop breastfeeding and switch to formula. 2. Eliminate dairy products from her diet. 3. Supplement breastfeeding with a soy-based formula. 4. Offer the baby water between feedings.

2

27) The community nurse is meeting a new mother for the first time. The client delivered her first child 5 days ago after a 12-hour labor. Neither the mother nor the infant had any complications during the birth or postpartum period. Which statement by the client would indicate to the nurse that the client is experiencing postpartum blues? 1. I am so happy and blessed to have my new baby. 2. One minute Im laughing and the next Im crying. 3. My husband is helping out by changing the baby at night. 4. Breastfeeding is going quite well now that the engorgement is gone.

2

5) A postpartum client has just received a rubella vaccination. The client demonstrates understanding of the teaching associated with administration of this vaccine when she states which of the following? 1. I will need another vaccination in 3 months. 2. I must avoid getting pregnant for 1 month. 3. This will prevent me from getting chickenpox. 4. This will protect my newborn from getting the measles.

2

6) The nurse has received the end-of-shift report on the postpartum unit. Which client should the nurse see first? 1. Woman who is 2nd day post-cesarean, moderate lochia serosa 2. Woman day of delivery, fundus firm 2 cm above umbilicus 3. Woman who had a cesarean section, 1st postpartum day, 4 cm diastasis recti abdominis 4. Woman who had a cesarean section, 1st postpartum day, hypoactive bowel sounds all quadrants

2

23) When caring for a new mother after cesarean birth, what complications would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Back pain 2. Pulmonary infection 3. Deep vein thrombosis 4. Pulmonary embolism 5. Perineal edema

2, 3, 4

18) Which of the following symptoms would be an indication of postpartum blues? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Overeating 2. Anger 3. Mood swings 4. Constant sleepiness 5. Crying

2, 3, 5

19) Nursing interventions that foster the process of becoming a mother include which of the following? 1. Encouraging detachment from the nurse-patient relationship 2. Promoting maternal-infant attachment 3. Building awareness of and responsiveness to infant interactive capabilities 4. Instruct about promoting newborn independence 5. Preparing the woman for the maternal social role

2, 3, 5

30) Which physical assessment findings would the nurse consider normal for the postpartum client following a vaginal delivery? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Elevated blood pressure 2. Fundus firm and midline 3. Moderate amount of lochia serosa 4. Edema and bruising of perineum 5. Inflamed hemorrhoids

2, 4

32) During the first several postpartum weeks, the new mother must accomplish certain physical and developmental tasks, including which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Establish a therapeutic relationship with her physician 2. Adapt to altered lifestyles and family structure resulting from the addition of a new member 3. Restore her intellectual abilities 4. Restore physical condition 5. Develop competence in caring for and meeting the needs of her infant

2, 4, 5

1) A nurse is evaluating the diet plan of a breastfeeding mother. Which beverage is most likely to cause intolerance in the infant? 1. Orange juice 2. Milk 3. Decaffeinated tea 4. Water

2. Often fussy breastfeeding or cows milk-based formula-fed infants are switched to a lactose-free formula because of concerns about lactose intolerance.

4) The community nurse is working with poor women who are formula-feeding their infants. Which statement indicates that the nurses education session was effective? 1. I should use only soy-based formula for the first year. 2. I follow the instructions for mixing the powdered formula exactly. 3. It is okay to add more water to the formula to make it last longer. 4. The mixed formula can be left on the counter for a day.

2. Powdered formula is the least expensive type of formula. Parents will need to be briefed on safety precautions during formula preparation and they should be instructed to follow the directions on the formula package label precisely as written.

1) The charge nurse is assessing several postpartum clients. Which client has the greatest risk for postpartum hemorrhage? 1. The client who was overdue and delivered vaginally 2. The client who delivered by scheduled cesarean delivery 3. The client who had oxytocin augmentation of labor 4. The client who delivered vaginally at 36 weeks

3

1) The nurse determines the fundus of a postpartum client to be boggy. Initially, what should the nurse do? 1. Document the findings. 2. Catheterize the client. 3. Massage the uterine fundus until it is firm. 4. Call the physician immediately.

3

10) Which relief measure would be most appropriate for a postpartum client with superficial thrombophlebitis? 1. Urge ambulation 2. Apply ice to the leg 3. Elevate the affected limb 4. Massage her calf

3

11) Which statement by a new mother 1 week postpartum indicates maternal role attainment? 1. I dont think Ill ever know what Im doing. 2. This baby feels like a real stranger to me. 3. It works better for me to undress the baby and to nurse in the chair rather than the bed. 4. My sister took to mothering in no time. Why cant I?

3

12) On the first postpartum day, the nurse teaches the client about breastfeeding. Two hours later, the mother seems to remember very little of the teaching. The nurse understands this memory lapse to be related to which of the following? 1. The taking-hold phase 2. Postpartum hemorrhage 3. The taking-in period 4. Epidural anesthesia

3

16) A mother states that her breasts leak between feedings. Which of the following can contribute to the letdown reflex in breastfeeding mothers? 1. Pain with breastfeeding 2. Number of hours passed since last feeding 3. The newborns cry 4. Maternal fluid intake

3

17) When a breastfeeding mother complains that her breasts are leaking milk, the nurse can offer which effective intervention? 1. Decrease the number of minutes the newborn is at the breast per feeding. 2. Decrease the mothers fluid intake. 3. Place absorbent pads in the bra. 4. Administer oxytocin.

3

18) When is breastfeeding contraindicated? 1. Infant has hypertension 2. Mother has a history of treated tuberculosis 3. Mother is HIV positive or has AIDS 4. Mother has a history of treated herpes

3

2) The nurse is providing education to the new family. Which question by the nurse is best? 1. Do you know how to give the baby a bath? 2. You have diapers and supplies at home, right? 3. How have your breastfeedings been going? 4. How much formal education do you have?

3

20) The postpartum client states that she doesnt understand why she cant enjoy being with her baby. What would the nurse be concerned about? 1. Postpartum psychosis 2. Postpartum infection 3. Postpartum depression 4. Postpartum blues

3

20) The postpartum nurse is caring for a client who gave birth to full-term twins earlier today. The nurse will know to assess for symptoms of which of the following? 1. Increased blood pressure 2. Hypoglycemia 3. Postpartum hemorrhage 4. Postpartum infection

3

21) The nurse is observing a new graduate perform a postpartum assessment. Which action requires intervention by the nurse? 1. Asking the client to void and donning clean gloves 2. Listening to bowel sounds and then asking when her last bowel movement occurred 3. Offering the patient pre-medication 2 hours before the assessment 4. Completing the assessment and explaining the results to the client

3

22) The client delivered her second child 1 day ago. The clients temperature is 101.4 F, her pulse is 100, and her blood pressure is 110/70. Her lochia is moderate, serosanguinous, and malodorous. She is started on IV antibiotics. The nurse provides education for the client and her partner. Which statement indicates that teaching has been effective? 1. This condition is called parametritis. 2. Gonorrhea is the most common organism that causes this type of infection. 3. My Beta-strep cultures being positive might have contributed to this problem. 4. If I had walked more yesterday, this probably wouldnt have happened.

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26) The nurse suspects that a client has developed a perineal hematoma. What assessment findings would the nurse have detected to lead to this conclusion? 1. Facial petechiae 2. Large, soft hemorrhoids 3. Tense tissues with severe pain 4. Elevated temperature

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33) The postpartum client who is being discharged from the hospital experienced severe postpartum depression after her last birth. What should the nurse include in the plan of follow-up care for this client? 1. One visit from a homecare nurse, to take place in 2 days 2. Two visits from a public health nurse over the next month 3. An appointment with a mental health counselor 4. Follow-up with the obstetrician in 6 weeks

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35) A nurse is caring for several postpartum clients. Which client is demonstrating a problem attaching to her newborn? 1. The client who is discussing how the baby looks like her father 2. The client who is singing softly to her baby 3. The client who continues to touch her baby with only her fingertips 4. The client who picks her baby up when the baby cries

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37) The community nurse is working with a client whose only child is 8 months old. Which statement does the nurse expect the mother to make? 1. I have a lot more time to myself than I thought I would have. 2. My confidence level in my parenting is higher than I anticipated. 3. I am constantly tired. I feel like I could sleep for a week. 4. My baby likes everyone, and never fusses when shes held by a stranger.

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8) On the 3rd day postpartum, a client who is not breastfeeding experiences engorgement. To relieve her discomfort, the nurse should encourage the client to do which of the following? 1. Remove her bra 2. Apply heat to the breasts 3. Apply cold packs to the breasts 4. Use a breast pump to release the milk

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8) The postpartum client is concerned about mastitis because she experienced it with her last baby. Preventive measures the nurse can teach include which of the following? 1. Wearing a tight-fitting bra 2. Limiting breastfeedings 3. Frequent breastfeedings 4. Restricting fluid intake

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9) The nurse is providing discharge teaching to a woman who delivered her first child 2 days ago. The nurse understands that additional information is needed if the client makes which statement? 1. I should expect a lighter flow next week. 2. The flow will increase if I am too active. 3. My bleeding will remain red for about a month. 4. I will be able to use a pantiliner in a day or two.

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38) The nurse is preparing a class for mothers and their partners who have just recently delivered. One topic of the class is infant attachment. Which statement by a participant indicates an understanding of this concept? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. We should avoid holding the baby too much. 2. Looking directly into the babys eyes might frighten him. 3. Talking to the baby is good because hell recognize our voices. 4. Holding the baby so we have direct face-to-face contact is good. 5. We should only touch the baby with our fingertips for the first month.

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14) Which of the following is a risk factor for urinary retention after childbirth? 1. Multiparity 2. Precipitous labor 3. Unassisted childbirth 4. Not sufficiently recovering from the effects of anesthesia

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17) How does the nurse assess for Homans sign? 1. Extending the foot and inquiring about calf pain. 2. Extending the leg and inquiring about foot pain. 3. Flexing the knee and inquiring about thigh pain. 4. Dorsiflexing the foot and inquiring about calf pain.

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23) During a postpartum examination of a client who delivered an 8-pound newborn 6 hours ago, the following assessment findings are noted: fundus firm and at the umbilicus, and moderate lochia rubra with a steady trickle of blood from the vagina. What is the assessment finding that would necessitate follow-up? 1. Firm fundus 2. Fundus at the umbilical level 3. Moderate lochia rubra 4. Steady trickle of blood

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25) The nurse is explaining the nutritional differences between breast milk and formula to an expectant couple. The mother-to-be asks whether breast milk is nutritionally superior to formula. What should the nurse reply? 1. The vitamins and minerals in formula are more bioavailable to the infant. 2. There is no cholesterol in breast milk. 3. The only carbohydrate in breast milk is lactose. 4. The ratio of whey to casein proteins in breast milk changes to meet the nutritional needs of the growing infant.

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25) The nurse is performing a postpartum assessment on a newly delivered client. When checking the fundus, there is a gush of blood. The client asks why that is happening. What is the nurses best response? 1. We see this from time to time. Its not a big deal. 2. The gush is an indication that your fundus isnt contracting. 3. Dont worry. Ill make sure everything is fine. 4. Blood pooled in the vagina while you were in bed.

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30) A postpartum client with endometritis is being discharged home on antibiotic therapy. The new mother plans to breastfeed her baby. What should the nurses discharge instruction include? 1. The client can douche every other day. 2. Sexual intercourse can be resumed when the client feels up to it. 3. Light housework will provide needed exercise. 4. The babys mouth should be examined for thrush.

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32) The client delivered her second child yesterday, and is preparing to be discharged. She expresses concern to the nurse because she developed an upper urinary tract infection (UTI) after the birth of her first child. Which statement indicates that the client needs additional teaching about this issue? 1. If I start to have burning with urination, I need to call the doctor. 2. Drinking 8 glasses of water each day will help prevent another UTI. 3. I will remember to wipe from front to back after I move my bowels. 4. Voiding 2 or 3 times per day will help prevent a recurrence.

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33) The nurse is beginning the postpartum teaching of a mother who has given birth to her first child. What aspect of teaching is most important? 1. Describe the likely reaction of siblings to the new baby. 2. Discuss adaptation to grandparenthood by her parents. 3. Determine whether father-infant attachment is taking place. 4. Assist the mother in identifying the babys behavior cues.

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5) The nurse assesses the postpartum client who has not had a bowel movement by the third postpartum day. Which nursing intervention would be appropriate? 1. Encourage the new mother, saying, It will happen soon. 2. Instruct the client to eat a low-fiber diet. 3. Decrease fluid intake. 4. Obtain an order for a stool softener.

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7) A client had a cesarean birth 3 days ago. She has tenderness, localized heat, and redness of the left leg. She is afebrile. As a result of these symptoms, what would the nurse anticipate would be the next course of action? 1. That the client would be encouraged to ambulate freely 2. That the client would be given aspirin 650 mg by mouth 3. That the client would be given Methergine IM 4. That the client would be placed on bed rest

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8) To assess the healing of the uterus at the placental site, what does the nurse assess? 1. Lab values 2. Blood pressure 3. Uterine size 4. Type, amount, and consistency of lochia

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9) A client at 20 weeks gestation has not decided on a feeding method for her infant. She asks the nurse for advice. The nurse presents information about the advantages and disadvantages of formula-feeding and breastfeeding. Which statements by the client indicate that the teaching was successful?

4. Secretory IgA, an immunoglobulin present in colostrum and mature breast milk, has antiviral, antibacterial, and antigenic-inhibiting properties and plays a role in decreasing the permeability of the small intestine to help prevent large protein molecules from triggering an allergic response.

1) The nurse assesses the postpartum client to have moderate lochia rubra with clots. Which nursing intervention would be appropriate? 1. Assess fundus and bladder status. 2. Catheterize the client. 3. Administer Methergine IM per order. 4. Contact the physician immediately.

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10) A client who delivered 2 hours ago tells the nurse that she is exhausted and feels guilty because her friends told her how euphoric they felt after giving birth. How should the nurse respond? 1. Everyone is different, and both responses are normal. 2. Most mothers do feel euphoria; I dont know why you dont. 3. Its good for me to know that because it might indicate a problem. 4. Let me bring your baby to the nursery so that you can rest.

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21) The nurse understands that the classic symptom of endometritis in a postpartum client is which of the following? 1. Purulent, foul-smelling lochia 2. Decreased blood pressure 3. Flank pain 4. Breast is hot and swollen

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31) The client delivered by cesarean birth 3 days ago and is being discharged. Which statement should the nurse include in the discharge teaching? 1. If your incision becomes increasingly painful, call the doctor. 2. It is normal for the incision to ooze greenish discharge in a few days. 3. Increasing redness around the incision is a part of the healing process. 4. A fever is to be expected because you had a surgical delivery.

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33) The nurse is completing the discharge teaching of a young first-time mother. Which statement by the mother requires immediate intervention? 1. I will put my baby to bed with his bottle so he doesnt get hungry during the night. 2. My baby will probably have a bowel movement each breastfeeding, and will wet often. 3. Nursing every 2 to 3 hours is normal, for a total of 8 to 12 feedings every day. 4. I will drink fenugreek tea from my grandmother to prevent my milk from coming in.

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33) The nurse is performing discharge teaching for a newly delivered first-time mother and her infant on the 2nd postpartum day. Which statement by the mother indicates that teaching has been successful? 1. Taking baths will help my perineum feel less sore each day. 2. If I develop heavy bleeding, I should take my temperature. 3. My bowel movements should resume in a week. 4. I will go back to the doctor in 4 days for my RhoGAM shot.

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34) What information should the nurse include when teaching a new mother how to successfully bottle-feed her newborn? 1. Proper dilution of powdered formula is essential to provide adequate nutrition. 2. Keep formula at room temperature for at least 4 hours to warm it, instead of microwaving it. 3. Use enough water to dilute the nutrient and calorie density so the infant will drink more formula. 4. Freeze newly prepared formula for up to 3 months.

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4) A postpartum client has inflamed hemorrhoids. Which nursing intervention would be appropriate? 1. Encourage sitz baths. 2. Position the client in the supine position. 3. Avoid stool softeners. 4. Decrease fluid intake.

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7) The nurse knows that in some cases, breastfeeding is not advisable. Which mother should be counseled against breastfeeding? 1. A mother with a poorly balanced diet 2. A mother who is overweight 3. A mother who is HIV positive 4. A mother who has twins

3. Women with HIV or AIDS are counseled against breastfeeding.