Postpartum Care 33-1 Nclex and Pearson Q's

You complete your initial assessment and review the electronic health record (EHR). As you do so, you note that Alexandra has which risk factors for a postpartum psychiatric disorder? SATA A. Childbirth experience B. Primiparity C. Breastfeeding D. Level of education E. Medical hx

A, B & E The client who experienced an unexpected complication, particularly a life-threatening one, during the childbearing experience is at higher risk of a postpartum psychiatric disorder. Primiparas have higher rates of postpartum psychological disorders than do multiparous clients. Alexandra has a history of bulimia. The client with a history of a previous psychiatric disorder is at increased risk for a postpartum psychiatric disorder. Continue

The nurse is teaching a patient who delivered vaginally about the importance of emptying the bladder. Which information should the nurse include in the teaching? A. "A full bladder places you at risk for increased bleeding." B. "A full bladder increases uterine cramping C. "A full bladder will worsen constipation." D. "A full bladder delays the healing of your perineum."

A. "A full bladder places you at risk for increased bleeding." A full bladder will cause the uterus to relax by displacing the uterus and interfering with its contractility, leading to hemorrhage. The bladder has no relationship to the perineal healing, constipation, and will not necessarily increase uterine cramping.

A laboring patient is due to deliver within the next few hours. Which factor should the nurse consider will influence how the mother will first react to the newborn? A. Philosophy of childrearing B. Displayed dependency after birth C. Involvement of the father of the baby D. The ability to make choices for the baby

A. Philosophy of childrearing The mother's philosophy of childrearing will influence how the mother first reacts to the newborn. Initially after birth during the taking-in period, the woman tends to be passive and somewhat dependent. The involvement of the father of the baby does not influence the mother's first reaction to the newborn. The ability of the mother to make choices for the baby defines the informal stage of the maternal role.

The nurse is caring for a pregnant client beginning her second trimester of pregnancy. Which question is the most appropriate for the nurse to​ ask? A. ​"What is your labor​ plan?" B. ​"How are you getting relief from your lower back​ pain?" C. ​"Have you considering enrolling in childbirth​ classes?" D. ​"Are you aware we will test you for Group B strep​ today?"

​B. ​"How are you getting relief from your lower back​ pain?" Rationale: The​ nurse's role in the second trimester includes providing teaching about the common discomforts of​ pregnancy, such as lower back pain. Questions about childbirth classes and birth plans are appropriate questions for later in the​ pregnancy, during the third trimester. Testing for Group B strep occurs during the third trimester.

The nurse is caring for a couple attending their first prenatal visit. The client​ states, "I have had trouble with anemia in the​ past." Which response by the nurse reflects the most appropriate plan of care in managing the​ pregnancy? A. ​"The results of your blood work will determine what supplements will be​ recommended." B. ​"A health dietary intake should provide you with the iron and vitamins you​ need." C. ​"You will be instructed to take iron and folic acid throughout the​ pregnancy." D. ​"You will be taking an iron supplement throughout your​ pregnancy."

C. ​"You will be instructed to take iron and folic acid throughout the​ pregnancy." Rationale: The goal of healthcare for the client is to prevent anemia so the client will be instructed to take an iron supplement and a folic acid supplement. If the results indicate the client has iron deficiency anemia or megaloblastic anemia caused by a folate​ deficiency, further treatment may be required. Folic acid supplementation also prevents neural tube defects. All pregnant clients are encouraged to take prophylactic supplementation of iron and vitamins in addition to their diets. Iron and folate supplementation is not deferred for laboratory results.

Alexandra is quiet and she falls asleep after you complete her assessment. Erik looks exhausted. He remains at the bedside and anxiously watches Alexandra and Adam as they sleep. You ask if he has slept, and he says he is too worried about Alexandra and the baby to sleep. What is your priority communication with Erik at this time? A. Encouraging Erik to go home and get some rest B. Informing Erik that Alexandra will be at high risk for developing a postpartum psychiatric disorder C. Assessing the availability of family and social support D. Instructing Erik to help Alexandra walk in the hallway after her nap to prevent post-operative complications

C. Assessing the availability of family and social support The priority at this time is to reassure Erik that his wife and baby are safe, to assess their support system, and to encourage Erik to ask for help. Assessment of family and social support is crucial, particularly in clients at high risk for a postpartum psychiatric disorder, because women without a support system are more likely to develop such disorders. The new father who witnessed an unfolding emergency during childbirth will need reassurance that mother and baby are safe. New parents sometimes also need encouragement to reach out to their support system and ask for help.

The nurse is preparing to discharge a 3-day postoperative cesarean birth patient. Which nursing evaluation indicates that the patient has met the expected outcome for comfort? A. The patient rates the pain at a 1 out of 10 when ambulating. B. The patient demonstrates care of the newborn. C. The patient verbalizes how to add more activity over the next week. D. The patient verbalizes community resources available to support parenting.

The patient rates the pain at a 1 out of 10 when ambulating. The nursing evaluation that indicates that the patient has met the expected outcome for comfort is the patient rating the pain a 1 out of 10 when ambulating. A postoperative patient will not be pain-free, but the pain should dissipate over time. Demonstration of newborn care is an evaluation of maternal infant attachment and the ability to provide the necessary physical care for the newborn. The ability to verbalize how to increase activity over the next week reflects an understanding of the healing process. Verbalization of the community resources available to support parenting demonstrates the understanding of additional support available to the family.

The nurse is providing a prenatal class instruction on different exercises that can be done to prepare for childbirth. Which exercise should the nurse include that specifically helps reduce back​ strain? A. Pelvic tilt B. Tailor sitting C. Kegel D. Partial situps

​A. Pelvic tilt Rationale: The pelvic tilt can reduce back strain as it strengthens the abdominal muscles. Kegel exercises strengthen the pelvic floor muscles. Tailor sitting is used to stretch the inner thighs. Partial​ sit-ups strengthen abdominal muscle tone.

The nurse caring for a pregnant client with diabetes mellitus interprets the results of the​ client's nonstress test​ (NST) as nonreactive. Which intervention should the nurse​ anticipate? A. Arrange for a biophysical profile. B. Provide ordered supplemental oxygen. C. Prepare client for urgent cesarean birth. D. Administer oxytocin.

​A. Arrange for a biophysical profile. Rationale: If the NST is nonreactive a biophysical profile may be performed. A biophysical profile is indicated when there is a risk of placental insufficiency or fetal compromise. Indications for a biophysical profile include material diabetes mellitus and nonreactive NST. Oxytocin is used to induce or augment labor in a pregnant client. It is not standard practice to administer oxygen in this case. There is no indication of fetal distress in the case​ presented, so it is not reasonable to anticipate a cesarean birth delivery.

The nurse is caring for a client who is at 31​ weeks' gestation and admitted for preterm labor. The client expresses concern for her baby and missing work. Which is a nursing priority​? A. Providing emotional support B. Restricting family visitors C. Administering antianxiety medications D. Contacting her employers to secure work release

​A. Providing emotional support Rationale: Based on the​ client's concerns, the​ nurse's priority is to provide the client emotional support. Clients experiencing preterm labor may have a difficult time coping with their concerns regarding the diagnosis. The​ nurse's role does not include restricting family visitors or contacting the​ client's employers. Concern for the unborn baby is a normal response and is not an indication for antianxiety medication.

The nurse is reviewing the histories of four new prenatal clients. Which maternal risk factor indicates the need for antenatal​ testing? A. Twin gestation pregnancy B. Maternal age of 25 C. Vegan dietary preference D. Maternal history of depression

​A. Twin gestation pregnancy Rationale: Obstetrical​ factors, such as multifetal gestation and previous fetal​ loss, are indicators for antenatal testing. Demographic factors such as age younger than 17 or older than 35 years may indicate the need for antenatal testing. Mothers who are vegans may have special nutritional​ needs, but this factor alone does not indicate the need for fetal antenatal testing. A maternal history of depression is not an indicator for antenatal testing.

The nurse is caring for a client who​ asks, "Why do I need an ultrasound and all of these tests while I am​ pregnant?" Which response by the nurse provides the most appropriate explanation for antenatal testing to the​ client? A. ​"Tests such as ultrasounds can help screen for birth​ defects." B. ​"These tests ensure your baby is​ healthy." C. ​"I will ask the doctor to explain these tests to you​ later." D. ​"Ultrasounds are painless and your insurance will pay for​ it."

​A. ​"Tests such as ultrasounds can help screen for birth​ defects." Rationale: Antenatal testing helps ascertain fetal​ well-being, growth, and development during the prenatal period and allows for screening and detection of congenital abnormalities. Antenatal testing does not ensure a baby will be healthy. The​ statements, "These tests ensure your baby is​ healthy," "I will ask the doctor to explain these tests to you​ later," and​ "Ultrasounds are painless and your insurance will pay for​ it" do not address the​ client's question.

The nurse is conducting a dietary assessment for a pregnant adolescent. Assessment of the dietary intake of which nutrient should be a priority​? A. Vitamin K B. Calcium C. Magnesium D. Vitamin B12

​B. Calcium Rationale: Inadequate intake of calcium is frequently a problem for this age group. Adequate calcium is important to continue to support the growth and calcium maintenance of the adolescent as well as the growth and development of the fetus. Vitamin K and magnesium are not found to be deficient in the adolescent. Vitamins B6​, ​A, and D are found to be deficient in this age​ group, not vitamin B12.

he nurse is caring for an obstetrical client during her first visit who states that she is experiencing nausea and vomiting. The nurse should identify which hormone as responsible for this​ change? A. Human placental lactogen​ (hPL) B. Human chorionic gonadotropin​ (hCG) C. Progesterone D. Estrogen

​B. Human chorionic gonadotropin​ (hCG) Rationale: Increased levels of hCG are attributed to the​ client's nausea and vomiting. During​ pregnancy, estrogen enlarges the​ uterus, and causes breast tenderness and nasal stuffiness. Progesterone is essential for maintaining the pregnancy. Human placental lactogen assists in maintaining the​ fetus's glucose levels. Human chorionic gonadotropin preserves the corpus luteum.

The nurse is caring for a client who is 36​ weeks' gestation and diagnosed with gestational diabetes mellitus. Which maternal complication will the client be monitored​ for? A. Preterm labor B. Oligohydramnios C. Preeclampsia D. Anemia

​C. Preeclampsia Rationale: Preeclampsia or eclampsia occurs more often in pregnant women with​ diabetes, especially when​ diabetes-related vascular changes already exist. Clients with gestational diabetes are​ 4?5 times more likely to develop gestational hypertension. Gestational diabetes does not place the client at an increased risk for anemia or preterm labor. The client with diabetes is at risk for hydramnios.

The nurse is caring for a client who is at 28​ weeks' gestation and diagnosed with gestational diabetes. The client expresses fear that the baby will not be healthy. Which response by the nurse provides the necessary reassurance to the​ client? A. ​"You should make an appointment in a few days to talk to the midwife about​ that." B. ​"Your pregnancy will be considered high risk from now on and you should be prepared for potential​ complications." C. ​"We will help you to modify your diet to keep your blood sugar at normal levels to maintain a healthy pregnancy and​ baby." D. ​"The test for diabetes is done primarily to determine your risk of diabetes later in life and has a minimal effect on the​ pregnancy."

​C. ​"We will help you to modify your diet to keep your blood sugar at normal levels to maintain a healthy pregnancy and​ baby." Rationale: The response by the nurse that provides the most reassurance to the client​ is, "We will help you to modify your diet to keep your blood sugar at normal levels to maintain a healthy pregnancy and​ baby." Gestational diabetes mellitus is controlled by diet and exercise. Referring the client to the midwife negates the​ client's concern for her baby. Telling the client to be prepared for complications is not good therapeutic​ communication, nor does it provide reassurance to the client. Gestational diabetes can have a significant effect on the pregnancy and may be associated with serious outcomes for the​ fetus, which include intrauterine growth​ restriction, macrosomia, symptomatic neonatal​ hypoglycemia, and fetal demise if left untreated.

A pregnant client asks the nurse when the​ 1-hour oral glucose tolerance test​ (OGTT) will be performed to screen for gestational diabetes. Which response by the nurse is the most​ accurate? A. ​"Your screening is generally prescribed between 20 and 24​ weeks' gestation." B. ​"You will only need to be screened if you have any risk​ factors." C. ​"You will be screened between 24 and 28​ weeks' gestation." D. ​"Screening is initiated between 16 and 20​ weeks' gestation."

​C. ​"You will be screened between 24 and 28​ weeks' gestation." Rationale: The​ 1-hour OGTT screening test for gestational diabetes is performed at between 24 and 28​ weeks' gestation. All clients are screened for gestational diabetes.

The nurse is caring for a client who is at 28​ weeks' gestation and diagnosed with heart disease. Which condition should prompt the nurse to contact the healthcare provider​ immediately? A. Weight gain of 1 pound in a week B. Emotional stress on the job C. Mild ankle edema D. Increased dyspnea at rest

​D. Increased dyspnea at rest Rationale: Increased dyspnea at rest must be reported immediately because it may be an indication of congestive heart failure. Mild ankle edema and weight gain of 1 pound a week are expected physical findings during the third trimester. Emotional stress on the job can increase cardiac demand and should be reported only if the client experiences symptoms such as palpations or an irregular heart rate.

The nurse is caring for a client who has had a positive pregnancy test. The nurse reviews the​ client's history and notes the client smokes half a pack of cigarettes a day. Which information should the nurse include in the plan of​ care? A. Encourage her to chew gum instead of smoke. B. Inform her that less than 10 cigarettes per day has not been proven harmful to the baby. C. Provide information on a​ 12-step rehabilitation program. D. Refer her to a smoking cessation program.

​D. Refer her to a smoking cessation program. Rationale: The information that is important to include in the plan of care for the client that smokes half a pack of cigarettes a day is a referral to a smoking cessation program. Chewing gum is not a replacement for smoking cessation. A​ 12-step rehabilitation program is for drug or alcohol abuse. Any smoking adversely affects the fetus.

You inform Erik that you will monitor Alexandra for signs of psychological adjustment throughout your shift. Which assessments would be most important in this regard? A. Appetite and tolerance of food B. Consistency of responses to the newborn's cues C. Personal hygiene D. Eye contact E. Breastfeeding success

A, B, C & D The client who is developing a postpartum psychiatric disorder may experience loss of appetite and decreased or absent interest in food. Also, assessment of Alexandra's appetite and food tolerance is especially important due to her history of bulimia. Alexandra will need a diet that provides adequate protein, extra iron, and 500 calories above baseline to support post-operative healing, production of red blood cells, and production of breast milk. The RN must determine whether the new mother consistently demonstrates responsiveness to her newborn's needs prior to discharge. This assessment should not be made on the basis of one or two encounters, especially those that occur early in the post-operative period. Rather, the assessment should be made after observing maternal-newborn interactions throughout the entire hospital stay. The client who is developing a postpartum psychiatric disorder may experience lack of energy or ability to organize her day and perform self-care activities. Assessment of Alexandra's ability to perform self-care should include consideration of post-operative pain and fatigue, which may impact her efforts as well. Evaluating the client's ability to make eye contact and engage in conversation is essential to the assessment of postpartum psychological adjustment. Inability to make eye contact and engage with others may be a sign of a postpartum psychiatric disorder. Continue

You develop a plan of care to support Alexandra's psychological adjustment. Which priority nursing interventions should be included in this plan? A. Administering ibuprofen on a regular schedule as ordered and offering oxycodone for pain that is unrelieved by ibuprofen B. Encouraging Alexandra to rest skin-to-skin with Adam for periods of time while she is awake or observed by a family member. C. Encouraging Alexandra to perform all care for Adam throughout their hospital stay to increase her confidence as a mother D. Emphasizing the importance of taking iron supplements and eating a diet rich in iron for the next 6-8 weeks E. Reinforcing and praising Alexandra's mothering and breastfeeding efforts

A, B, D & E Skin-to-skin contact promotes maternal-newborn bonding, increases maternal sense of well-being, assists the newborn to self-quiet, and enhances breastmilk production. For safety, the new mother who is fatigued or taking pain medications should be observed by an adult who is awake and alert while she and her baby rest skin-to-skin. Additional nursing interventions that facilitate the new mother's psychological adjustment include the following: ● Praising the woman's mothering efforts ● Encouraging the woman to ask for help ● Managing the woman's pain ● Instructing the woman about healthy diet and iron supplements. Unrelieved pain places the postpartum client at increased risk for postpartum depression. Alexandra needs effective pain management in order to perform self- and newborn care. The breastfeeding client may also need reassurance from the RN that pain medications will not harm her newborn. Additional nursing interventions that facilitate the new mother's psychological adjustment include the following: ● Praising the woman's mothering efforts ● Encouraging the woman to ask for help ● Instructing the woman about healthy diet and iron supplements ● Promoting skin-to-skin contact between mother and baby. Alexandra's blood loss and anemia place her at increased risk for postpartum fatigue and depression. It is essential that she consume enough iron to build red blood cells and regain her energy. Additional nursing interventions that facilitate the new mother's psychological adjustment include the following: ● Praising the woman's mothering efforts ● Encouraging the woman to ask for help ● Managing the woman's pain ● Promoting skin-to-skin contact between mother and baby. Alexandra is an educated professional who is undergoing a monumental role transition. The process of becoming a mother (BAM) may be accompanied by feelings of inadequacy, particularly in a client who is accustomed to a high level of professional success and control. The RN can promote maternal psychological adjustment by anticipating the mother's concerns, providing newborn care instructions, and reassuring the mother that she is providing effective newborn care during each nurse-client interaction. Additional nursing interventions that facilitate the new mother's psychological adjustment include the following: ● Encouraging the woman to ask for help ● Managing the woman's pain ● Instructing the woman about healthy diet and iron supplements ● Promoting skin-to-skin contact between mother and baby Continue

A patient requests information about birth control that can be initiated before discharge from the hospital. Which question asked by the nurse is the most appropriate? A. "Are you breastfeeding?" B. "Have you discussed this with your healthcare provider?" C. "Are aware that you are not supposed to have intercourse until 6 weeks postpartum?" D. "What type of birth control were you using prior to getting pregnant?"

A. "Are you breastfeeding?" Information on contraception is an important part of postpartum care. Prior to providing information to the patient, it is important to ascertain whether the patient is breastfeeding. Breastfeeding women should be given available options and choose the method that best fits their lifestyle, financial situation, and personal preference. Asking the patient if they had discussed birth control with their healthcare provider does not answer the patient's question. The patient should be instructed to abstain from intercourse until cleared by the healthcare practitioner, but this question does not address the patient's concern about birth control. The nurse should objectively offer the patient information on all of the different forms of birth control available.

You return to assist Alexandra with breastfeeding when she awakens. Adam is sleepy and Alexandra has difficulty getting him to awaken and latch. You help Alexandra and Adam eventually latches onto her breast. You teach Erik how to assist Alexandra when she breastfeeds in the side-lying position. Alexandra becomes tearful and states that nothing has gone as she expected. "I don't think he wants me," she says when Adam doesn't immediately latch. "I feel as though I have failed at everything so far," she says softly to Erik. What is your best response to Alexandra? A. "Having an emergency cesarean birth can be a very intense experience. Can you tell me what you remember about it?" B. "Many new mothers feel this way after having an emergency cesarean birth. The important thing is that you and your baby are safe and healthy now." C. "I'm not sure what you mean by that. Can you tell me why you think you have failed?" D. "You shouldn't feel that way. You gave birth to a beautiful baby!"

A. "Having an emergency cesarean birth can be a very intense experience. Can you tell me what you remember about it?" This response validates Alexandra's feelings and encourages her to talk about what happened. This is important, because the woman who experienced an emergency delivery should be encouraged to tell her birth story. The process of talking through a traumatic childbearing experience may help the client come to terms with the experience. The process also allows the RN to assess the woman's perception of the event and to offer information and clarification—particularly if the client's perception differs from reality.

The nurse is providing self-care discharge teaching for a patient who delivered vaginally 3 days prior. Which patient statement indicates the need for further teaching A. "I can strengthen my abdominal muscles by holding my urine." B."I will call my healthcare provider if I start bleeding." C. "I am ready to start eating lots of fruits and vegetables and begin walking for exercise. D. "I will keep my peribottle in sight when I am going to the bathroom so I do not forget to use it."

A. "I can strengthen my abdominal muscles by holding my urine." The patient should be encouraged to void every 2 hours to prevent residual urine that can contribute to a urinary tract infection. The patient should notify the healthcare provider if bleeding begins, if they increase the consumption of fruits and vegetables and exercise to avoid constipation, and if they continue to use the peribottle to prevent infection.

The nurse is performing an assessment on each of the four assigned postpartum patients. Which patient statement requires further assessment of maternal infant bonding? A. "This baby keeps screaming. Can you just please take it to the nursery?" B. "I am really nervous about my ability to care for my baby. He is so tiny." C. "When you have a minute, I would like to talk to you about how to continue to breastfeed when I go back to work. D. "Thank goodness you're here. My baby is really fussy, and I am afraid that she is not getting enough to eat."

A. "This baby keeps screaming. Can you just please take it to the nursery?" The statement made by the patient that requires further assessment of maternal infant bonding is, "This baby keeps screaming. Can you just please take it to the nursery." Referring to the baby as "it" is a detached response that can indicate a disordered attachment. The remaining statements express a concern for the baby's well-being.

The nurse is providing dietary teaching to a patient who is breastfeeding. The patient asks the nurse, "How will I know if my baby is allergic to something that I am eating?" Which response by the nurse is appropriate? A. "You should avoid foods that you suspect bother your infant." B. "Avoid chocolate and spices." C. "Avoid cabbage and other gas-producing foods." D. "Avoid any foods containing lysine (for example, tomatoes)."

A. "You should avoid foods that you suspect bother your infant." The best advice to give the nursing mother is to avoid those foods that she suspects cause distress in the baby. Occasionally, some nursing mothers find that certain foods may cause the baby to be colicky or to develop a skin rash. Onions, turnips, cabbage, chocolate, spices, and seasonings are common offenders.

The nurse is caring for a patient who delivered vaginally at 2:00 p.m. The patient was straight catheterized after delivery but has not voided since. At which time should the nurse report the patient's inability to void? A. 8:00 p.m. B. 4:00 p.m. C. 12:00 a.m. D. 2:00 a.m.

A. 8:00 p.m. The nurse will report the patient's inability to void at 8:00 p.m. A patient who has had a vaginal delivery should spontaneously void within 6 hours after giving birth; 4:00 p.m. is still within normal limits. Waiting to intervene until 12:00 a.m. or 2:00 a.m. places the patient at risk for bladder distention and postpartum hemorrhage.

The postpartum nurse is reviewing charts of patients who have delivered. Which patient should the nurse identify as having the greatest risk factor for developing a thromboembolism? A. A patient of advanced maternal age that delivered vaginally 1 day prior B. An adolescent patient 2 days post vaginal delivery C. A patient with vaginal delivery of twins 18 hours prior D. A patient with gestational diabetes that delivered vaginally 1 day prior

A. A patient of advanced maternal age that delivered vaginally 1 day prior Pregnancy-associated activation of coagulation factors may continue for variable amounts of time after birth. This condition, in conjunction with advanced maternal age, increase the patient's risk for a thromboembolism after delivery. Adolescence, multiple gestation, and gestational diabetes are not risk factors associated with a thromboembolism.

The nurse is reviewing the vital signs of four postpartum mothers on the unit. Which patient should the nurse identify as requiring an immediate assessment? A. A patient with a respiratory rate of 8 breaths/min B. A patient with an oxygen saturation of 96% on room air C. A patient with a temperature of 100.5° F (38° C) D. A patient with a heart rate of 74 beats/min

A. A patient with a respiratory rate of 8 breaths/min The patient who requires an immediate assessment by the nurse is the patient with a respiratory rate of 10 breaths/min because this indicates respiratory depression. An oxygen saturation of 96% and heart rate of 74 beats/min are normal findings. A temperature of 100.5°F (38° C) may indicate a possible infection, but respiratory depression requires an immediate assessment by the nurse.

The nurse is caring for a 3-day postpartum breastfeeding patient that states, "I wonder when my milk will come in?" Which best describes the nurse's understanding of transitional milk production in breastfeeding patients? A. By day 5, mothers produce approximately 500 mL/day. B. By day 10, the mother is producing approximately 800 mL/day. C. Transitional milk production begins after 24 hours of breastfeeding. D. The initial milk is immediately available to the baby after birth.

A. By day 5, mothers produce approximately 500 mL/day By day 5, mothers produce approximately 500 mL/day of transitional milk. By 6 months postpartum, the mother produces 800 mL/day of mature milk. The transitional milk production does not begin 24 hours after breastfeeding and colostrum is immediately available to the newborn after birth.

The nurse is receiving a report on a mother who is laboring. The nurse understands that maternal infant bonding is very important. In order to promote bonding, which timeframe should the nurse limit interventions to only necessary ones? A. During the first 30-60 minutes after birth B. Bonding occurred during pregnancy, no limitation needed C. Immediately prior to discharge from the hospital D. After the baby has had their first bath

A. During the first 30-60 minutes after birth The nurse caring for a newly delivered patient understands that maternal infant bonding is very significant during the first 30-60 minutes after birth. Attachment begins during a mother's pregnancy, but is further enhanced through touch, and continues for months after birth. During those first 30-60 minutes, the infant should be skin-to-skin with the mother or father, and unnecessary interventions should be limited. It does not take place just prior to discharge from the hospital. The newborn does not need to be bathed right after birth, this can be stressful for the baby and can impair maternal infant bonding. Characteristics of attachment include such behaviors as direct face-to-face contact with the newborn.

The nurse is caring for a patient in the recovery room following a cesarean birth. Which teaching point should the nurse focus on at this time? A. Expectations during the postpartum period B. Follow-up care with the healthcare provider C. Birth control options D. Bathing the newborn

A. Expectations during the postpartum period The nurse's focus on teaching in the recovery room after a cesarean delivery includes teaching the patient on what to expect during the postpartum period. Included in the teaching is the time frame for the removal of the indwelling urinary catheter and the plan of care for postoperative ambulation. Newborn care, follow-up care, and birth-control options will be addressed throughout the patient's remaining hospitalization.

A postpartum patient demonstrates decision making regarding mothering. Which stage of maternal role attainment should the nurse note the mother has achieved? A. Informal stage B. Personal stage C. Formal stage D. Anticipatory stage

A. Informal stage The stage the mother has achieved when making decisions about the baby is the informal stage. The informal stage begins when the mother starts making choices about mothering. The personal, formal, and anticipatory stages are defined by other characteristics.

The nurse caring for a patient who delivered 8 hours prior notes upon assessment that the fundus is midline, firm, and at the umbilicus, but the patient is experiencing heavy vaginal bleeding. Which causative factor for the bleeding should the nurse suspect? A. Laceration B. Hematoma C. Uterine atony D. Endometritis

A. Laceration Lacerations should be suspected when vaginal bleeding persists in the presence of a firmly contracted uterus. The assessment finding of a firm uterus with heavy vaginal bleeding is not associated with a hematoma, uterine atony, or endometritis.

A newly delivered patient experienced a prolonged second stage of delivery. The baby was not able to breastfeed after delivery. Which action by the nurse is most appropriate? A. Reassuring the patient that the baby will learn to breastfeed B. Bottle feeding the newborn, so the patient can sleep C. Taking the baby to the nursery, so the patient can sleep D. Contacting the lactation consultant to provide breastfeeding support

A. Reassuring the patient that the baby will learn to breastfeed The action by the nurse that is most appropriate is to reassure the patient that the baby will learn to breastfeed. There is no medical indication to bottle-feed the baby or separate the mother and baby. The lactation consultant can provide support to the patient, but the nurse is responsible for assisting the patient with breastfeeding.

The postpartum nurse observes the interaction of the patient and newborn. Which maternal behavior should the nurse document as a positive indication of maternal infant attachment? A. The patient cuddling the baby after breastfeeding B. The patient encouraging the father to hold the baby C. The patient not making eye contact with the baby D. The patient requesting the nurse to feed the baby in the nursery

A. The patient cuddling the baby after breastfeeding The maternal behavior the nurse will document as a positive indicator of maternal infant attachment is the patient cuddling the baby after breastfeeding. The nurse can also take this moment to discuss newborn care with the parents. Encouraging the father to hold the baby facilitates paternal newborn attachment. The patient who does not make eye contact with the baby or requests the nurse to feed the baby in the nursery is not displaying signs of maternal infant attachment.

The nurse is assessing the taking-in period of a patient. Which patient behavior is expected during this time? A. The patient hesitates to make decisions. B. The patient assumes self-care. C. The patient worries about the baby getting enough to eat. D. The patient requires assurance that she is doing well as a mother.

A. The patient hesitates to make decisions. Initially after birth during the taking-in period, the woman tends to be passive and somewhat dependent. She follows suggestions, hesitates to make decisions, and is still rather preoccupied with the needs. A patient that assumes self-care, worries about the baby getting enough to eat, or requires assurance that she is doing well as a mother is in the taking-hold period that occurs on the second or third day after birth.

A postpartum patient states, "I am anxious to get back to my prepregnancy weight." Which information on prepregnancy weight should the nurse share with the patient? A. Many women are not able to lose all the weight they gained during pregnancy, and they gain more each time they are pregnant. B. Many women may initially gain some weight if they are breastfeeding their infants, and this will continue to provide necessary nutrients for the baby. C. By the sixth to the eighth week after birth, many women have returned to their original weight, provided they have gained the recommended 25-30 pounds. D. A strict, low-calorie diet is best for weight loss since newer mothers will be less active after they go home with the baby.

C. By the sixth to the eighth week after birth, many women have returned to their original weight, provided they have gained the recommended 25-30 pounds. Included in the information the nurse will provide the patient regarding returning to the prepregnancy weight is that by the sixth to the eighth week after birth, many women have returned to their original weight if they gained the recommended 25-30 pounds. Women can lose the weight that they have gained during a pregnancy. A strict, low-calorie diet is not recommended. During the postpartum period it is important for a mother to continue to eat a nutritious diet that supports the physiological changes that occur. Women that are breastfeeding do not initially experience a weight gain and will need extra calories in order to meet the metabolic needs for milk production.

The nurse caring for a postpartum patient is assessing maternal-newborn bonding. Which situation should be most concerning to the nurse? The mother is 24 hours post vaginal delivery and has not fed the baby herself. The mother who has had a cesarean birth 2 hours prior is focused on pain control. The mother expresses excitement over the other children coming for visit. The mother delivered an hour ago and is falling asleep with the baby in the arms.

The mother is 24 hours post vaginal delivery and has not fed the baby herself. The situation of maternal infant bonding that is of most concern to the nurse is that the mother is 24 hours post vaginal delivery and has not fed the baby. A mother feeding the newborn is a sign of maternal nurturing. The patient who has had a cesarean birth 2 hours prior focused on pain control, the mother expressing excitement over the other children coming to visit, and the mother who has delivered an hour ago falling asleep with the baby in the arms should not warrant any concern for impaired maternal newborn bonding. Furthermore, the nurse should address the mother falling asleep holding the baby as a safety concern for accidental positional asphyxiation or overlay.

The nurse has received handoff report for four postpartum patients. Which patient should the nurse assess first? A. Vaginal delivery with an episiotomy delivered 8 hours prior that has not voided B. Cesarean birth delivered 4 hours ago, medicated for pain 30 minutes ago, not tolerating clear liquids C. Vaginal delivery 24 hours prior, ambulating well that has docusate sodium (Colace) due in 30 minutes D. Cesarean birth delivered twins 12 hours prior who is requesting assistance with breastfeeding

Vaginal delivery with an episiotomy delivered 8 hours prior that has not voided The nurse will assess first the vaginal delivery with an episiotomy delivered 8 hours prior who has not voided. It is generally expected that a postpartum patient will void within 6 hours of delivery. The risks of not voiding include hemorrhage or excessive vaginal bleeding or both. The patient at risk for hemorrhage takes priority over the patient who was medicated for pain, the patient with docusate sodium due, and the patient requesting assistance with breastfeeding. Additional Learning

The nurse is caring for a client who is at 10​ weeks' gestation and experiencing​ "some gastrointestinal​ problems." Which symptom should the nurse anticipate specifically in the​ client? A. Urinary frequency B. Diarrhea C. Decreased salivation D. Ptyalism

B. Diarrhea Rationale: Ptyalism, or increased​ salivation, may occur during pregnancy. Urinary frequency is a genitourinary change that occurs during pregnancy. Diarrhea is an abnormal symptom and is not an expected change in the gastrointestinal system during pregnancy.

The nurse caring for a patient who had an uncomplicated vaginal delivery 24 hours prior assesses the patient's fundus and notes that it is above the umbilicus. Which is the priority nursing intervention? Encouraging the patient to void Encouraging ambulation No intervention is necessary Performing fundal massage

Encouraging the patient to void Twenty-four hours after giving birth, the fundal height should be at the umbilicus. Deviation, most commonly to the right or elevation above the umbilicus, is an indication of bladder distention, which places the patient at risk for hemorrhage. Neither fundal massage nor ambulation will promote uterine involution in this circumstance. Involution of the uterus. A. Immediately after delivery of the placenta, the top of the fundus is in the midline and approximately halfway between the symphysis pubis and the umbilicus. Approximately 6-12 hours after birth, the fundus is at the level of the umbilicus. B: The height of the fundus then decreases about one fingerbreadth (approximately 1 cm) each day.

The nurse is caring for a client at 32​ weeks' gestation who​ asks, "Why do I waddle when I​ walk?" Which explanation by the nurse provides the client with accurate​ information? A. ​"I am concerned you have an underlying musculoskeletal​ disorder." B. ​"A low calcium intake can cause you to walk​ differently." C. ​"You are experiencing a change in the center of​ gravity." D. ​"A hormone causes the pelvic joints to​ relax."

​D. ​"A hormone causes the pelvic joints to​ relax." Rationale: The joints of the pelvis relax due to hormonal​ influences, resulting in a waddling gait. A change in the center of gravity results in lordosis. A low calcium intake will not result in a waddling gait. The changes in the​ client's gait are due to​ hormones, not an underlying musculoskeletal disorder.

The nurse is teaching a pregnant patient who has chosen to breastfeed about milk production. The patient asks the nurse, "When will my milk come in?" Which statement by the nurse is accurate? "It can take 3-5 days for your milk to come in." "Your milk will come in immediately after birth." "Your milk will come in approximately 24 hours after birth." "Your milk will come in approximately 1 week after birth."

"It can take 3-5 days for your milk to come in." By day 5, mothers produce approximately 500 mL/day of transitional milk. The initial milk immediately available to the baby after birth and for the first few days is colostrum, which is described as thick, creamy, and yellowish.

The following day, Erik tells you that he is worried about Alexandra. He says that Alexandra is sleeping a lot, is quieter than usual, and has burst into tears twice for no apparent reason. What is your best response to Erik's statements?

"Alexandra had major surgery and lost a lot of blood, so it is not surprising that she is sleeping a lot. She will need a lot of rest to regain her strength and heal. Alexandra also had an unexpected and frightening childbirth experience. Although many women experience some mood swings after delivery, a traumatic birth experience can make the adjustment more difficult. We will continue to watch her closely for signs of complications." Alexandra's withdrawn behavior and tearfulness may be explained by the taking-in period and/or adjustment reaction with depressed mood (baby blues). However, it is important to remember that Alexandra is at increased risk for a peripartum major mood episode (postpartum depression) and for posttraumatic stress disorder (PTSD)—also known as posttraumatic stress syndrome (PTSS)—as a result of her emergency cesarean birth. Therefore, the RN should monitor Alexandra's behavior closely and inform Alexandra and her family about signs and symptoms of psychiatric complications.

The nurse is conducting a home visit for a patient 10 days postpartum. Upon assessment of the patient's breasts, the nurse notes that the left breast is tender, reddened, and swollen. Which statement by the nurse reflects an appropriate nursing intervention for this patient? A. "I am going to get you in to see your healthcare provider immediately." B. "You will need to stop breastfeeding your newborn." C. "This is normal breast engorgement; there is nothing to worry about." D. "You should mention this when you have your follow-up appointment with the healthcare provider."

"I am going to get you in to see your healthcare provider immediately." Erythema, swelling, and localized tenderness are symptomatic of mastitis. Without intervention, it is likely the condition will worsen, so waiting until a follow-up visit is delaying care. The patient with mastitis should be encouraged to empty the breasts by beginning the baby's feedings on the affected side unless there is an abscess present.

The nurse is teaching a patient who has just delivered about breastfeeding. Which patient statement indicates the need for further teaching? A. "I will feed my baby every 6 hours." B. "I will keep track of my baby's feedings." C. "I will burp my baby after each feeding." D. "I will breastfeed my baby for at least 10-15 minutes on each side."

A. "I will feed my baby every 6 hours." Breastfed babies need to be fed every 2-3 hours. Breastfeeding for 10-15 minutes on each breast, burping the baby after each feeding, and keeping track of the baby's feedings demonstrate an understanding of teaching.

The nurse is caring for a postpartum patient who is bottle-feeding the baby and expresses concern about returning to her prepregnancy weight. Which instruction should the nurse include in the patient teaching? A. Reducing daily caloric intake by 300 calories a day B. Limiting dairy products and protein C. Adhering to a low-carbohydrate, high-protein diet D. Incorporating an additional 200 calories per day to address metabolic needs

A. Reducing daily caloric intake by 300 calories a day After birth, the formula feeding mother's dietary requirements return to prepregnancy levels. If the mother has a good understanding of nutritional principles, it is sufficient to advise the patient to reduce the daily caloric intake by approximately 300 kcal/day and to return to prepregnancy levels for other nutrients. Adding an additional 200 calories a day will contribute to weight gain. A well-balanced diet does not include diets that are low-carbohydrate, high-protein, or limiting dairy and protein products.

The nurse is assessing the maternal-newborn attachment of a 2-day postpartum patient. Which question by the nurse best assesses this attachment? A. "Are you experiencing any pain?" B. "Has the baby been fed recently?" C. "Did you want photos taken of the baby?" D. "Is your husband comfortable changing diapers?"

B. "Has the baby been fed recently?" Feeding the baby is a sign of nurturing and is an important assessment for the nurse to make. The husband's ability to change diapers is a paternal newborn bonding assessment. Inquiring about pain focuses on the patient. Asking the patient if she would like photos taken of the baby is a general question that does not reflect maternal infant attachment.

postpartum patient states, "I am anxious to get back to my prepregnancy weight." Which information on prepregnancy weight should the nurse share with the patient? By the sixth to the eighth week after birth, many women have returned to their original weight, provided they have gained the recommended 25-30 pounds Many women are not able to lose all the weight they gained during pregnancy, and they gain more each time they are pregnant. A strict, low-calorie diet is best for weight loss since newer mothers will be less active after they go home with the baby. Many women may initially gain some weight if they are breastfeeding their infants, and this will continue to provide necessary nutrients for the baby.

By the sixth to the eighth week after birth, many women have returned to their original weight, provided they have gained the recommended 25-30 pounds. Included in the information the nurse will provide the patient regarding returning to the prepregnancy weight is that by the sixth to the eighth week after birth, many women have returned to their original weight if they gained the recommended 25-30 pounds. Women can lose the weight that they have gained during a pregnancy. A strict, low-calorie diet is not recommended. During the postpartum period it is important for a mother to continue to eat a nutritious diet that supports the physiological changes that occur. Women that are breastfeeding do not initially experience a weight gain and will need extra calories in order to meet the metabolic needs for milk production.

The nurse is preparing to provide teaching to a patient on the care for an episiotomy. Which information should the nurse include in the teaching? A. Maternal positioning to promote healing B. Information on the use of warm packs C. Instruction for sitz baths D. Follow-up appointment for the removal of the sutures

C. Instruction for sitz baths The information the nurse will include in the teaching for the care of an episiotomy is the instruction for sitz baths to promote comfort. A peribottle is also used for the care of an episiotomy. Ice packs, not warm packs, are applied to the episiotomy site. Maternal positioning is not used to promote healing, but to promote comfort. The sutures are dissolvable, so no removal is necessary.

A client with type 2 diabetes mellitus requiring insulin has just discovered that she is pregnant. The nurse is teaching the client about insulin requirements during pregnancy. Which guideline should the nurse​ provide? A. ​"Insulin requirements increase during the last two​ trimesters." B. ​"Insulin requirements do not change during​ pregnancy." C. ​"Insulin requirements increase greatly during the first​ trimester." D. ​"Insulin requirements increase greatly during​ labor."

​ A. ​"Insulin requirements increase during the last two​ trimesters." Rationale: Maternal insulin requirements fluctuate throughout​ pregnancy; decreasing during the first​ trimester, then increasing during the second and third trimesters. During the second half of​ pregnancy, fetal growth accelerates and there is an increased utilization of glucose by the fetus. In response to​ this, the placental​ hormone, human placental lactogen​ (hPL), creates insulin resistance in the maternal tissues to have sufficient glucose available for the fetus. This increased insulin resistance may result in an increase in maternal insulin requirements. During​ labor, insulin requirements diminish due to the increased maternal energy expenditure.

The nurse is caring for a client who is at 38​ weeks' gestation who is positive for group B streptococcus​ (GBS). Which information should the nurse provide the​ client? A. ​"You will be taking an antibiotic for the remainder of your​ pregnancy." B. ​"No treatment is necessary because you are​ asymptomatic." C. ​"You will be given an antibiotic treatment during​ labor." D. ​"Your baby will receive treatment after it is​ born."

​C. ​"You will be given an antibiotic treatment during​ labor." Rationale: The client who is GBS positive will be treated with an antibiotic during labor. GBS is one of the major causes of early onset neonatal infection that can be transmitted by vertical transmission from the mother during birth or by horizontal transmission from colonized nursing personnel or colonized babies. If the maternal infection is not resolved prior to​ delivery, IV antibiotics will be prescribed during labor. Treatment is not delayed until after birth. The client will not be prescribed a prophylactic antibiotic throughout the pregnancy.

The nurse is teaching about perineal care for a postpartum patient with a midline episiotomy. Which supplies should the nurse include with the instructions? Peribottle, anesthetic spray, and ice packs Tea bags, emesis basin, and lanolin Cabbage leaves, lanolin, and acetaminophen Toilet paper, perineal pads, and lanolin

Peribottle, anesthetic spray, and ice packs Instruction for perineal care is important in preventing infection and the promotion of wound healing. The nurse providing teaching for perineal care will include a peribottle, anesthetic spray, and ice packs. Tea bags, emesis basin, lanolin, cabbage, and acetaminophen are not used for perineal care.

laboring patient is due to deliver within the next few hours. Which factor should the nurse consider will influence how the mother will first react to the newborn? Philosophy of childrearing Displayed dependency after birth Involvement of the father of the baby The ability to make choices for the baby

Philosophy of childrearing The mother's philosophy of childrearing will influence how the mother first reacts to the newborn. Initially after birth during the taking-in period, the woman tends to be passive and somewhat dependent. The involvement of the father of the baby does not influence the mother's first reaction to the newborn. The ability of the mother to make choices for the baby defines the informal stage of the maternal role.

The nurse is teaching smoking cessation to a newly pregnant client who still smokes. Which fetal complication of cigarette smoking should the nurse​ include? A. Large for gestational age B. Prematurity C. Postterm gestation D. Congenital anomalies

​B. Prematurity Rationale: The nurse will teach the client about the risk of prematurity associated with smoking. Postterm​ gestation, congenital​ anomalies, and newborns who are large for gestational age are not risk factors associated with maternal smoking.

The nurse caring for a client who is at 35​ weeks' gestation is planning to teach the client about the premonitory signs of labor. Which statement is appropriate to include in the​ teaching? A. ​"Your swelling will start to go away​ now." B. ​"You may notice that you breathe easier when the baby drops down into your​ pelvis." C. ​"Expect to see bleeding each day from now​ on." D. ​"You may notice you need to urinate less frequently as you get closer to​ labor."

​B. ​"You may notice that you breathe easier when the baby drops down into your​ pelvis." Rationale: The​ client's session should include the​ statement, "You may notice that you breathe easier when the baby drops down into your​ pelvis." As lightening​ occurs, the pregnant client may experience easier breathing. As the pregnancy​ continues, the client may experience increased dependent​ edema, backache, leg​ pain, urinary​ frequency, and vaginal discharge. Bloody show is the loss of the​ blood-tinged cervical mucus plug. Vaginal bleeding is abnormal and should be reported to the healthcare provider