Postpartum & New Born

A nurse is reinforcing teaching to a mother regarding breastfeeding. Which of the following actions by the mother indicates the need for additional teaching?

The mother places a breast shield over her nipple before placing the nipple in the newborn's mouth.

A nurse is reinforcing discharge teaching to the parents of a newborn. Which of the following statements made by the parents requires additional education?

"I should give my baby some water until my breast milk comes in."

A nurse is reinforcing discharge instructions to a postpartum client following a cesarean birth. The client reports leaking urine every time she sneezes or coughs. Which of the following statements should the nurse include in the teaching.

"Use Kegel exercises to assist with incontinence."

A nurse is collecting data from a newborn and observes small white bumps noted on the bridge of the nose. The nurse should document this finding as

milia spots

Icterus neonatorum

Physiologic jaundice; characterized by a yellow tinge of the skin.,

A nurse is providing care to a newborn after birth. Which of the following mechanisms will prevent heat loss from convection? (Select all that apply)

Placing a cap over the newborn's head, Swaddling the newborn, Placing the newborn in the radiant warmer, Placing the newborn's bassinet away from a fan

Boggy uterus

Poorly contracted uterus.,

Fontanelles

Unossified spaces or soft spots on the cranium of a young infant.,

A charge nurse is educating a newly licensed nurse regarding the administration of vitamin K (Aquamephyton) to a newborn. Which of the following is an appropriate response by the nurse to include in the teaching?

"Vitamin K assists with blood clotting."

A nurse is assisting with the admission of a newborn to the nursery. Which of the following findings indicate that a newborn is experiencing difficulty adapting to extrauterine life? (Select all that apply)

Grunting, Retractions, Nasal flaring

A nurse is reinforcing interventions to promote comfort to a client with a perineal hematoma. Which of the following statements should the nures include in the teaching? (Select all that apply)

"Apply ice to the perineal area for the first 24.", "After 24 hours, sitz baths at least twice a day.", "Use a topical antiseptic cream or spray on the perineal area."

A nurse is reinforcing teaching to a mother about proper techniques for bottle feeding. Which of the following statements made by the mother indicates an understanding of the teaching?

"I will keep the nipple full of formula throughout the feeding."

A nurse is conducting a home visit with a client who is 3 months postpartum and breastfeeding her newborn. Menses has not yet resumed. The client is discussing contraception with the nurse stating that she does not want to have another child for a couple of years. The nurse understands that this client needs further instruction if the client makes which of the following statements?

"I will not need birth control until I stop breastfeeding."

A charge nurse is discussing the risk factors associated with postpartum hemorrhage. Which of the following statements by the nurse indicates a need for additional teaching?

"Oligohydramnios is associated with postpartum hemorrhage."

A nurse is assisting a registered nurse with the care of a newborn following a vaginal delivery. Five minutes after birth, the newborn's heart rate is 110 beats/min. Which of the following Apgar heart rate scores should the newborn receive?

2

A nurse is providing care for four postpartum clients. Which of the following clients is at the greatest risk for postpartum infection?

A client with premature rupture of membranes and prolonged labor.

Surfactant

A mixture of lipoproteins secreted in the alveoli and air passages that reduces the surface tension within the alveoli and contributes to expansion of the lungs.,

Colostrum

A secretion from the breast before onset of true lactation. It has high protein content, provides some immune properties, and cleanses the NB's intestinal tract of mucus and meconium.,

A nurse in the provider's office is caring for a client who is breastfeeding and is 4 days postpartum. The client reports breast engorgement. Which of the following recommendations should the nurse make?

Apply cold cabbage leaves between feedings.

Lanugo

Body covered with fine hair.,

Rooting reflex

Causes the infant's head to turn in the direction of anything that touches the cheek, in anticipation of food.,

Vernix caseosa

Cheese-like substance that covers the skin of the newborn.,

A client who is breastfeeding has mastitis. Which of the following should the nurse reinforce to the client?

Completely empty each breast at each feeding.

A nurse is providing care for a newborn after birth. Which of the following nursing actions is the highest priority?

Covering the newborn's head with a cap

A nurse is caring for a client who is 1 day postpartum. The nurse is collecting data regarding maternal adaptation and mother-infant bonding. Which of the following behaviors indicate the need for nursing intervention?

Demonstrates apathy when the newborn cries.

A nurse is collecting data on a newborn with a blood glucose level of 30 mg/dL. Which of the following findings require intervention?

Diaphoresis

A nurse is collecting data from a postpartum client. Which of the following findings indicate signs of bladder distention? (Select all that apply)

Displaced fundus from midline, Excessive lochia, Bladder tenderness, Bulging bladder above the symphysis pubis.

A nurse is caring for a client who has a urinary tract infection. Which of the following is the typical causative agent of infection?

E coli

A nurse is preparing to administer prophylactic eye ointment into the eyes of a newborn to treat ophthalmia neonatorum. Which of the following medications should the nurse anticipate administering?

Erythromycin (Romycin)

A nurse is caring for a postpartum client that deliverd her third infant 3 days ago. The nurse recognizes that which of the following findings are suggestive of postpartum depression? (Select all that apply)

Fatigue, Insomnia, Flat affect, Crying

Meconium

First stool; Mixture of of amniotic fluid and secrections of the intestinal glands.,

A nurse is caring for a client who has DIC. Which of the following postpartum complictions should the nurse understand is a risk factor for this client?

Hemorrhage

A nurse is aware that which of the following is a contraindication for circumcising a male newborn? (Select all that apply)

Hypospadias, Familiar history of hemophilia, Epispadias

Cold stress

Increases the need for oxygen and glucose.,

A nurse is caring for a postpartum client. Which of the following findings are the earliest indications of hypovolemia caused by hemorrhage?

Increasing pulse and decreasing blood pressure

Moro reflex

Infants draw their legs up and the arms fan out and then come toward midline in an embrace position when the crib is jarred.,

Mastitis

Infection of the breast.,

Endometritis

Inflammation or infection of the uterine lining, usually from bacterial invasion.,

Thermoregulation

Involves maintaining a stable body temperature and preventing hypothermia and hyperthermia.

Atony

Lack of muscle tone and strength.,

A nurse is examining a newborn who was delivered at 42 weeks of gestation. Which of the following characteristics indicates that the newborn is postterm? (Select all that apply)

Macrosomia, Leathery skin, Peeling of the hands and feet

A nurse is checking the reflexes of a newborn. Which of the following should the nurse perform to elicit the startle reflex?

Make a loud noise such as clapping hands together over the newborn's crib.

A nurse is transporting a newborn to his mother following a circumcision. Which of the following security actions should the nurse take?

Match the mother's identification band with the newborn's.

Lochia

Maternal discharge of blood, mucus, and tissue from the uterus; may last several weeks after birth.

A nurse is providing care for a postpartum client who is experiencing a postpartum hemorrhage. Which of the following medications may be prescribed by the provider? (Select all that apply)

Methylergonovine (Methergine), Misoprostol (Cytotec), Carboprost tromethamine (Hemabate), Oxytocin (Pitocin)

A nurse is caring for a family who has a newborn. The father appers to be very anxious and nervous when the newborn's mother asks him to bring her the newborn. Which of the following is an appropriate nursing intervention to promote father-infant bonding.

Provide education about newborn care when the father is present.

Involution

Rolling or turning inward; reduction in the size of uterus after delivery.,

Curettage

Scraping or vacuuming the inner surface of the uterus.,

Subinvolution

Slower-than-expected return of the uterus to its nonpregnant condition. Infection and retained fragments of placenta are common causes.,

A postpartum nurse is caring for a client who has deep vein thrombosis. Which of the following are risk factors for development of this disorder? (Select all that apply)

Smoking, Multiparity, Diabetes mellitus, Maternal age greater than 35

A nurse is reinforcing discharge instructions for a client. Which of the following should the nurse instruct the client to report to the provider?

Sore nipple with cracks and fissures

Cephalohematoma

Subperiosteal swelling containing blood, found on head of some newborns. Swelling does not cross suture lines and therefore often appears unilateral.,

A nurse is caring for a newborn who is 36 hrs of age with a serum bilirubinof 17 mg/dL. Phototherapy is prescribed by the provider. Which of the following findings should the nurse report to the provider?

Sunken fontanels

Caput seccedaneum

Swelling or edema of the newborn scalp that crosses the suture lines.,

A nurse should consider the possibility of neonatal withdrawl syndrome if a newborn

has a continuous high-pitched cry.