Pospartum Period

Which client statement indicates effective teaching about burping a breastfed neonate?

"When I switch to the other breast, I'll burp the baby."

The mother of a neonate expresses concern about how to continue breastfeeding when she returns to work in 6 weeks. How should the nurse respond?

"You can develop and practice a plan now for expressing milk and feeding so you're ready."

A registered nurse is staff-shared to the maternal-neonatal unit where the RN has never worked before. How can this nurse be best employed?

Assign the RN a client care assignment in the postpartum unit.

The nurse has been assigned to care for several postpartum clients and their neonates on a birthing unit. Which client should the nurse assess first?

a primiparous client at 2 hours postpartum who gave birth to a term neonate vaginally

The nurse evaluates the mothering skills of an adolescent primigravida changing her baby's diaper for the first time. When caring for this client, the nurse should focus on the client's need for which support?

praise and encouragement

A nurse is caring for a woman who gave birth to her baby boy 2 hours ago. The nurse notes the woman's perineal pad contains some small clots and a moderate amount of lochia has accumulated under her buttocks. What is the first action the nurse should take at this time?

Check fundus for position and consistency.

A woman who is Rh negative has given birth to an Rh-positive infant. The nurse explains to the client that she will receive Rho(D) immune globulin. The nurse determines that the client understands the purpose of the treatment when she reports that Rho(D) immune globulin has which action?

preventing antibody formation in her blood

A woman who has given birth to a healthy neonate is being discharged. As part of discharge teaching, the nurse should instruct the client to observe vaginal discharge for postpartum hemorrhage and notify the health care provider (HCP) for which finding?

saturating a pad in less than an hour A postpartum client who saturates a pad in an hour or less at any time in the postpartum period is considered to be hemorrhaging. As the normal postpartum client heals, bleeding changes from red to pink to off-white. It also decreases in amount each day. Passing blood clots the size of a fist or larger is a reportable problem. Lochia varies in how long it lasts and is considered normal up to 6 weeks postpartum.

Why does the nurse plan to use both hands to assess the client's fundus in the immediate postpartum period?

to prevent uterine inversion Using both hands to assess the fundus is useful for the prevention of uterine inversion. With one hand, the nurse should support the position of the lower uterus and cervix, while palpating the fundus with the other hand.

A nurse is giving a shift report about a client in labor. Which of the following information is the least important to include to complete the report at the change of shift?

Bottle- or breastfeeding preference.

A woman who gave birth to a healthy baby 6 hours ago is having cramps in her legs. Upon further assessment, the nurse identifies leg pain on dorsiflexion. What action should the nurse take?

Notify the health care provider (HCP).

A 25-year-old primiparous client who gave birth 2 hours ago has decided to breastfeed her neonate. Which instruction should the nurse address as the highest priority in the teaching plan about preventing nipple soreness?

placing as much of the areola as possible into the baby's mouth

While assisting a primiparous client with her first breastfeeding session, the nurse should instruct the mother to perform which action in order to stimulate the neonate to open the mouth and grasp the nipple?

Brush the neonate's lips lightly with the nipple. Lightly brushing the neonate's lips with the nipple causes the neonate to open the mouth and begin sucking. The neonate should be taught to open the mouth and grasp the nipple on his or her own. The neonate should not be forced to nurse.

A nurse is caring for a client during the first postpartum day. The client asks the nurse how to relieve pain from her episiotomy. What should the nurse instruct the woman to do?

Apply an ice pack to her perineum. A cold pack applied to an episiotomy during the first 24 hours after chidbirth may reduce edema and tension on the incision line, thereby reducing pain. After the first 24 hours, a sitz bath may reduce discomfort by promoting circulation and healing. Although perineal care should be performed after each voiding and bowel movement, its purpose is to prevent infection — not reduce discomfort. Drinking plenty of fluids is also important, especially for the breast-feeding woman, but it doesn't relieve perineal discomfort.

On a client's second postpartum visit, a physician reviews the chart. What's the best term for the lochia described?

Rubra Lochia rubra is a red discharge that occurs 1 to 3 days after birth. It consists almost entirely of blood with only small clots and mucus. Lochia alba is a creamy white or colorless discharge that occurs up to 14 days postpartum and may continue for up to 6 weeks. Lochia serosa is a pink or brownish discharge that occurs 3 to 10 days postpartum. Thrombic isn't a term used to describe lochia.

A client gave birth to a healthy full-term girl 2 hours ago by cesarean birth. When assessing this client which finding requires immediate nursing action?

tachycardia and hypotension

During a postpartum parenting class, a client tells the nurse that to save on the cost of formula, the client has switched her 6-month infant from formula to cow's milk. Which one of the following statements made by the nurse would be the best?

"Cow's milk can be safely given to an infant older than one year of age."

A nurse is teaching a client how to use a diaphragm. Which statement about using a diaphragm is appropriate?

"Leave the diaphragm in place for at least 6 hours after intercourse."

The clinic nurse is assessing a postpartum client's fundus at the umbilicus 2 weeks after giving birth. Which of the following would the nurse include in the client's plan of care?

Assess the client's bleeding flow and color.

A nurse coming onto the night shift assesses a client who gave birth vaginally that morning. The nurse finds that the client's vaginal bleeding has saturated two perineal pads within 30 minutes. What is the first action the nurse should take?

Assess the fundus and massage it if it's boggy.

Twelve hours after a vaginal birth with epidural anesthesia, the nurse palpates the fundus of a primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. What should the nurse do next?

Encourage the client to ambulate to the bathroom and void.

A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform mole. Which expected outcome takes highest priority for this client?

Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and her hCG level is negative.

A 30-year-old multigravida with prolonged rupture of membranes is diagnosed with endometritis 36 hours after birth of a viable neonate. While assessing the client after intravenous antibiotic therapy is initiated, the nurse notes that the client's temperature is 100° F (37.8° C), pulse rate is 124 bpm, and respirations are 24 breaths/minute. The nurse should:

Contact the primary care provider.

On the first postpartum day after a cesarean birth, the client is prescribed a full liquid diet as tolerated. Before providing a full liquid breakfast, the nurse should assess which factor?

bowel sounds Before providing the client with a full liquid meal, the nurse should first assess for the presence of bowel sounds to evaluate the functioning of the client's gastrointestinal tract. After cesarean birth, the client is at risk for paralytic ileus or intestinal obstruction due to the effects of the surgery or anesthesia used.Assessing breath sounds, although an important assessment, would be indicated if the client was experiencing a respiratory problem. It has no relevance related to the client's eating.The client's desire to eat may or may not be present. The client's gastrointestinal function manifested by active bowel sounds indicates that the client can be allowed to eat.The degree of pain is an important assessment but not in relation to the client's diet.

A breastfeeding primiparous client with a midline episiotomy is prescribed ibuprofen orally. When does the nurse instruct the client to take the medication?

immediately after a feeding Taking ibuprofen 200 mg orally immediately after breastfeeding helps minimize the neonate's exposure to the drug because drugs are most highly concentrated in the body soon after they are taken. Most mothers breastfeed on demand or every 2 to 3 hours, so the effects of the ibuprofen should be decreased by the next breastfeeding session. Taking the medication before going to bed is inappropriate because, although the mother may go to bed at a certain time, the neonate may wish to breastfeed soon after the mother goes to bed. If the mother takes the medication midway between feedings, then its peak action may occur midway between feedings. Breast milk is sufficient for the neonate's nutritional needs. Most breastfeeding mothers should not be encouraged to provide supplemental feedings to the infant because this may result in nipple confusion.

A primiparous client who is beginning to breastfeed her neonate asks the nurse, "Is it important for my baby to get colostrum?" When instructing the client, the nurse would explain that colostrum provides the neonate with which factor?

passive immunity from maternal antibodies

A nurse is caring for a client in the fourth stage of labor. Based on the nurse's note, which postpartum complication has the client developed?

postpartum hemorrhage

During the second day postpartum, the nurse notices that a client is initiating breastfeeding with her infant and changing her infant's diapers with a little assistance from her partner. According to Reva Rubin's "phases of bonding," which of the following is the appropriate phase the woman is experiencing?

the taking-hold phase

A client who gave birth to her first child 6 weeks ago tells the nurse, "I can't keep up with my housework anymore because I spend so much time caring for the baby." Which response by the nurse is best?

"It sounds like you'd like some help in establishing priorities. Is that right?" If a client feels overwhelmed by the additional tasks brought on by her new role as a mother, the nurse should help her prioritize after confirming that this is the client's goal. Telling the client the stress is normal does not facilitate problem solving or clarify the client's goals. The nurse is making assumptions about the client when asking about a partner and not having asked for help. New mothers are encouraged to rest when the baby sleeps rather than perform other tasks.

A client who gave birth 24 hours ago continues to experience urine retention after several catheterizations. The physician orders bethanechol, 10 mg by mouth three times per day. The client asks, "How does bethanechol act on the bladder?" How should the nurse respond?

"It stimulates the smooth muscle of the bladder." Bethanechol stimulates the smooth muscle of the bladder causing it to release retained urine. Bethanechol doesn't act on the urinary sphincter or dilate the urethra. The bladder contains smooth muscle, not skeletal muscle.

During a home visit to a primiparous client who gave birth vaginally 14 days ago, the client says, "I have been crying a lot the last few days. I just feel so awful. I am a rotten mother. I just do not have any energy. Plus, my husband just got laid off from his job." The nurse observes that the client's appearance is disheveled. What would be the nurse's best response?

"It's not unusual for some mothers to feel depressed after the birth of a baby. I'm going to contact your health care provider."

A 2-day postpartum client tells the nurse that she is experiencing abdominal cramps whenever she breastfeeds her baby. Which is the most appropriate response from the nurse?

"Oxytocin is released when the baby sucks which causes the uterus to contract." Afterpains, which are intermittent cramping of the uterus, tend to be noticed by multiparas rather than primiparas. In this situation, the uterus must contract more forcefully to regain its prepregnancy size. These sensations are noticed most intensely while breastfeeding because the infant's sucking causes a release of oxytocin from the posterior pituitary, increasing the strength of the contractions. After the birth of the placenta, progesterone levels decrease which triggers milk production. Frequency of breastfeeding should not cause hyper-stimulation of the uterus and the woman may continue to feel contractions as long as she is breastfeeding, regardless of the presence or absence of blood clots.

After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least how long?

12 months A client who has experienced a molar pregnancy is at risk for development of choriocarcinoma and requires close monitoring of human chorionic gonadotropin (hCG) levels. Pregnancy would interfere with monitoring these levels. High hCG titers are common for up to 7 weeks after the evacuation of the mole, but then these levels gradually begin to decline. Clients should have a pelvic examination and a blood test for hCG titers every month for 6 months and then every 2 months for 1 year. Gradually declining hCG levels suggest no complications. Increasing levels are indicative of a malignancy and should be treated with methotrexate. If after 1 year the hCG levels are negative, the client is theoretically free of the risk of a malignancy developing and could plan another pregnancy.

When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse should include which information?

Pregnancy should be avoided for 4 weeks after the immunization.

While observing a new mother interact with her first baby, the nurse observes that the client appears hesitant to care for the neonate. Which action would be most important for the nurse to do?

Continue to provide praise and support to the client.

A couple in the antenatal unit is not satisfied with the care they are receiving. They have spent the past 15 minutes expressing dissatisfaction to the nurse about the care the client is receiving today. What is the most appropriate response by the nurse?

Encourage the family to identify their frustrations and fears. This response will assist the family in identifying their frustrations and fears so the nurse can work toward resolving their issues. It is inappropriate to tell the client about staffing-related issues or to give them a time limit for which they are able to express their concerns. The nurse manager may need be brought into the situation but first the nurse should try to work toward resolving the issues with the clients.

A client gives birth to a neonate prematurely at 28 weeks' gestation. The neonate is placed in the neonatal intensive care unit (NICU). Three days later, the client's partner seems withdrawn and barely speaks to the staff when visiting the child in the NICU. Which interpretation of this behavior is most appropriate?

The client's partner has depression because of grieving.

A nurse is preparing to perform a physical examination on a postpartum client. The client asks the nurse why gloves are necessary for the examination. What is the nurse's best response?

"Gloves are required for standard precautions."

The nurse is caring for a client who has decided to bottlefeed her newborn after meeting with the lactation consultant. The client asks how to best reduce breast engorgement. What is the nurse's best response?

"Use ice packs, and avoid stimulating the breasts at all. It should resolve in a few days."

The nurse is caring for a new breastfeeding client who is experiencing poor latching and sore nipples. What direction would the nurse offer to best address this breastfeeding issue?

Ensure the baby's mouth is wide open, and angle the nipple toward the roof of the mouth.

A 24-year-old primipara who has given birth to a healthy neonate plans to bottle-feed her neonate. What information regarding normal weight gain should the nurse include in the teaching plan?

Gaining 30 g/day is a normal weight gain pattern. Gaining 1 oz (30 g) a day is normal for a neonate. Initial weight loss that exceeds 10% of birth weight is abnormal. Adding rice cereal to a bottle without a medical indication increases the risk of aspiration and may promote obesity. Doubling the birth weight is typical at 5 months.

During a home visit to a breastfeeding primiparous client at 1 week postpartum, the client tells the nurse that her nipples have become sore and cracked from the feedings. Which instructions should the nurse give the client?

Position the baby with the entire areola in the baby's mouth.

A nurse is teaching a group of clients about birth control methods. When providing instruction about subdermal contraceptive implants, the nurse should cite which feature as the main advantage of this method?

The implants provide effective, continuous contraception that isn't user dependent.

A primiparous client is on a regular diet 24 hours postpartum. The client's mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds, based on the understanding about which principle?

The mother can bring the daughter any foods that she desires.

A multigravida prenatal client with a history of postpartum depression tells the nurse that she is taking measures to make sure that she does not suffer that complication, including taking St. John's wort. What is the most important assessment for the nurse to make?

current medications

The nurse is caring for a client who has just returned to the postpartum unit after a cesarean birth. Which action is a priority for the nurse to teach the client to perform over the next 24 hours to prevent complications?

deep breathing and coughing exercises every 2 hours

A client whose blood type is A− gives birth to a neonate whose blood type is A+. The client is scheduled to have Rho(D) immune globulin administered. Before administering the medication, which action by the nurse is most important?

ensuring that the client understands the procedure and signs a consent for the vaccination

A primiparous client who gave birth vaginally 8 hours ago desires to take a shower. The nurse anticipates remaining nearby the client to assess for which problem?

fainting

Twenty-four hours after a client has given birth, the nurse documents that involution is progressing normally after palpating the client's fundus at which location?

slightly below the level of the umbilicus Approximately 24 hours after childbirth, the height of the uterus is normally felt slightly below the umbilicus. Unless complications occur, this client can expect the fundus to descend at a rate of about 1 fingerbreadth per day.Immediately after childbirth, the top of the fundus normally is midway between the umbilicus and the symphysis pubis.The fundus is barely palpable above the upper margin of the symphysis pubis 7 to 10 days after childbirth.Palpation of the uterus above the umbilicus may indicate urinary retention or retained placental fragments.