OB Exam 2 PrepU Mod4 Questions
A postpartum woman tells the home care nurse, "My hemorrhoids are really uncomfortable. Is there anything I can do?" Which suggestion(s) by the nurse would be appropriate? Select all that apply. "You might think anesthetic sprays help but they do not." "Witch hazel pads can have a cooling effect." "You should pour cold water over the area with your peribottle." "I will show you how to use a sitz bath." "Applying ice to the area can help."
"Applying ice to the area can help." "Witch hazel pads can have a cooling effect." "I will show you how to use a sitz bath."
A nurse on the postpartum floor is conducting a class on danger signs for postpartum women after discharge. The nurse recognizes that further teaching is needed when a new mother makes which statement? "My episiotomy should begin to heal and feel better over the next few weeks" "I am breastfeeding so I can anticipate that there will be reddened, painful areas in my breasts when I am engorged." "I need to let the doctor know if my lochia begins to have a foul smell." "If I develop chills or my fever goes above 100.4℉ (38℃), I need to let someone know."
"I am breastfeeding so I can anticipate that there will be reddened, painful areas in my breasts when I am engorged."
A nurse is providing care to a postpartum woman who gave birth about 2 days ago. The client asks the nurse, "I haven't moved my bowels yet. Is this a problem?" Which response by the nurse would be most appropriate? "It might take up to a week for your bowels to return to their normal pattern." "I'll get a laxative prescribed so that you can move your bowels." "That's unusual. Are you making sure to eat enough?" "Let me call your health care provider about this problem."
"It might take up to a week for your bowels to return to their normal pattern."
A mother just gave birth 3 hours ago. The nurse enters the room to continue hourly assessments and finds the client on the phone telling the listener about her fear while driving to the hospital and not making it in time. The mother finishes the call, and the nurse begins her assessment with which phrase? "I need to assess your fundus now." "It sounded like you had quite a time getting here. Would you like to continue your story?" "If you plan to breastfeed, you need to calm down." "You have a beautiful baby, why worry about that now?"
"It sounded like you had quite a time getting here. Would you like to continue your story?"
A new mother is concerned because it is 24 hours after birth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in." "You may have developed mastitis. I'll ask the primary care provider to examine you." "It takes about 3 days after birth for milk to begin forming." "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs."
"It takes about 3 days after birth for milk to begin forming."
A 2-day old newborn is crying after being circumcised and the mother is attempting to comfort the infant but he continues to be fussy. Which statement by the nurse would best support the mother's actions? "You would probably be more successful if you wrapped him in on a warm blanket." "Many mothers find that offering a nipple dipped in sugar water helps soothe a baby after a painful procedure." "Let me show you how to calm him down. I've been doing this for many years." "Maybe you your husband will have better luck calming him down. Why don't you let him hold him?"
"Many mothers find that offering a nipple dipped in sugar water helps soothe a baby after a painful procedure."
A woman who is breastfeeding her newborn says, "He doesn't seem to want to nurse. I must be doing something wrong." After teaching the woman about breastfeeding and offering suggestions, which statement by the mother indicates the need for additional teaching? "Breastfeeding takes time and practice." "Some women just can't breastfeed. Maybe I'm one of these women." "Maybe a lactation specialist can help me work through this." "Some babies latch on and catch on quickly; others take a little more time."
"Some women just can't breastfeed. Maybe I'm one of these women."
The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambulate until the next day. What response by the nurse is most appropriate? "If you do not get up to walk you will not recover." "As long as you walk more tomorrow to make up for the delay in walking today you should be fine." "Maybe you will feel better after you take pain medication." "Walking is the best way to prevent complications such as blood clots."
"Walking is the best way to prevent complications such as blood clots."
The nurse is preparing to assess a client who is 1 day postpartum. The nurse predicts the client's fundus will be at which location on assessment? At the symphysis pubis 1 cm above the umbilicus At level of umbilicus 1 cm below the umbilicus
1 cm below the umbilicus
A G1 P1001 mother is just home after giving birth to her first child 5 days ago. Her birth was complicated by an emergency cesarean birth resulting from incomplete cervical dilation (dilatation) and hemorrhage. The nurse determines that the mother has not slept longer than 3 hours at one time. The appropriate nursing diagnosis for this client care issue is: At risk for inadequate healing due to decreased nutrition. At risk for interruption of tissue integrity. At risk for safety due to low hemoglobin. At risk for postpartum depression due to inadequate rest.
At risk for postpartum depression due to inadequate rest.
A nurse notes a woman's prelabor vital signs were: temperature 98.8° F (37.1° C); blood pressure 120/70 mm Hg; heart rate 80 beats/min; and respirations 20 breaths/min. Which assessment findings during the early postpartum period should the nurse prioritize? BP 90/50 mm Hg, heart rate 120 bpm, respirations 24 breaths/min. shaking chills with a fever of 99° F (37.2° C) heart rate 70 bpm and excessive, soaking diaphoresis blood loss of 250 mL and WBC 25,000 cells/mL
BP 90/50 mm Hg, heart rate 120 bpm, respirations 24 breaths/min.
The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? Uterine atony Poor bladder tone Bladder distention Full bowel
Bladder distention
A woman gave birth vaginally approximately 12 hours ago, and her temperature is now 100° F (37.8° C). Which action would be most appropriate? Continue to monitor the woman's temperature every 4 hours; this finding is normal. Notify the health care provider about this elevation; this finding reflects infection. Obtain a urine culture; the woman most likely has a urinary tract infection. Inspect the perineum for hematoma formation. TAKE ANOTHER QUIZ
Continue to monitor the woman's temperature every 4 hours; this finding is normal.
A nurse is applying ice packs to the perineal area of a client who has had a vaginal birth. Which intervention should the nurse perform to ensure that the client gets the optimum benefits of the procedure? Ensure ice pack is changed frequently. Use ice packs for a week after birth. Apply ice packs directly to the perineal area. Apply ice packs for 40 minutes continuously. SUBMIT ANSWER
Ensure ice pack is changed frequently.
A postpartum client is having difficulty stopping her urine stream. Which should the nurse do next? Educate the client on how to perform Kegel exercises. Determine if the client is emptying her bladder. Perform an "in and out" catheter on the client. Ask the client when she last urinated.
Educate the client on how to perform Kegel exercises.
The nurse has received the results of a client's postpartum hemoglobin and hematocrit. Review of the client's history reveals a prepartum hemoglobin of 14 g/dl (140 g/L) and hematocrit of 42% (0.42). Which result should the nurse prioritize? Hemoglobin 13 g/dl (130 g/L) and hematocrit 40% (0.40) in a woman who has given birth vaginally Hemoglobin 11 g/dl (110 g/L) and hematocrit 34% (0.34) in a woman who has given birth by cesarean Hemoglobin 12 g/dl (120 g/L) and hematocrit 38% (0.38) in a woman who has given birth vaginally Hemoglobin 9 g/dl (90 g/L) and hematocrit 32% (0.32) in a woman who has given birth by cesarean
Hemoglobin 9 g/dl (90 g/L) and hematocrit 32% (0.32) in a woman who has given birth by cesarean
A concerned client tells the nurse that her husband, who was very excited about the baby before its birth, is apparently happy but seems to be afraid of caring for the baby. What suggestion should the nurse give to the client's husband to resolve the issue? Speak to his friends who have children. Read up on parental care. Have the client speak to the primary care provider on her husband's behalf Hold the baby frequently.
Hold the baby frequently.
One hour after birth the nurse is assessing a neonate in the nursery. The nurse begins by assessing which parameters? Inspecting posture, color, and respiratory effort Checking for identifying birthmarks or skin injuries Auscultating bowel sounds, and measuring urine output Determining chest and head circumference
Inspecting posture, color, and respiratory effort
The nurse is screening a woman during a home visit following birth. The nurse identifies which risk factors for developing postpartum depression? Select all that apply. Low socioeconomic status Lack of social support Low self-esteem Feeling overwhelmed and out of control Involving family in infant care
Low self-esteem Feeling overwhelmed and out of control Low socioeconomic status Lack of social support
A client reports pain in the lower back, hips, and joints 10 days after the birth of her baby. What instruction should the nurse give the client after birth to prevent low back pain and injury to the joints? Soak in a warm bath several times a day. Try to avoid carrying the baby for a few days. Maintain correct posture and positioning. Apply ice to the sore joints.
Maintain correct posture and positioning.
A client who gave birth about 12 hours ago informs the nurse that she has been voiding small amounts of urine frequently. The nurse examines the client and notes the displacement of the uterus from the midline to the right. As long as there is a prescription, what intervention would the nurse perform next? Administer oxytocin IV. Insert a 20 gauge IV. Perform urinary catheterization. Notify the health care provider.
Perform urinary catheterization.
During the discharge planning for new parents, what would the case manager do to help provide the positive reinforcement and ensure multiple assessments are conducted? Encourage frequent clinic visits for high-risk families. Ask family members to monitor the parents' progress. Schedule home visits for high-risk families. Provide phone numbers for call centers for questions.
Schedule home visits for high-risk families.
A first-time mother is nervous about breastfeeding. Which intervention would the nurse perform to reduce maternal anxiety about breastfeeding? Ensure that the mother breastfeeds the newborn using the cradle method. Tell her that breastfeeding is a mechanical procedure that involves burping once in a while and that she should try finishing it quickly. Reassure the mother that some newborns "latch on and catch on" right away, and some newborns take more time and patience. Explain that breastfeeding comes naturally to all mothers.
Reassure the mother that some newborns "latch on and catch on" right away, and some newborns take more time and patience.
The nurse is planning care for a client at risk for postpartum depression. Which statement regarding postpartum depression does the nurse need to be aware of when attempting to formulate a plan of care? Symptoms occur within a week after giving birth. Only mental health professionals can detect postpartum depression. Symptoms of postpartum depression can easily go undetected. Postpartum depression only impacts women with two or more children.
Symptoms of postpartum depression can easily go undetected.
A new mother tells the postpartum nurse that she thinks her baby does not like her since it cries often when she holds it. How should the nurse respond to this statement? Recommend that she talk to the unit social worker to get the mother some counseling prior to discharge. Recommend rooming-in to foster attachment and confidence by the mother. Dismiss the mother's concerns by telling her that you are sure she doesn't really mean it. Tell the mother that it is natural to have feelings of uncertainty when adjusting to a new baby.
Tell the mother that it is natural to have feelings of uncertainty when adjusting to a new baby.
A woman states that she still feels exhausted on her second postpartum day. The nurse's best advice for her would be to do which action? Walk with the nurse the length of her room. Avoid getting out of bed for another 2 days. Avoid elevating her feet when she rests in a chair. Walk the length of the hallway to regain her strength.
Walk with the nurse the length of her room.
A nurse is caring for a non-breastfeeding client in the postpartum period. The client reports engorgement. What suggestion should the nurse provide to alleviate breast discomfort? Wear a well-fitting bra. Express milk frequently. Apply hydrogel dressing. Apply warm compresses.
Wear a well-fitting bra.
When assessing the uterus of a 2-day postpartum client, which finding would the nurse evaluate as normal? a scant amount of lochia serosa a scant amount of lochia alba a moderate amount of lochia rubra a moderate amount of lochia alba
a moderate amount of lochia rubra
A client has come to the office for her first postpartum visit. On evaluating her blood work, the nurse would be concerned if the hematocrit is noted to have: slightly increased. acutely increased. acutely decreased. slightly decreased.
acutely decreased.
A client who is 12 hours postbirth is reporting perineal pain. After the assessment reveals no signs of an infection, which measure could the nurse offer the client? a sitz bath opioid pain medication a heating pad applied to the perineum an ice pack applied to the perineum SUBMIT ANSWER
an ice pack applied to the perineum
Seven hours ago, a multigravida woman gave birth to a male infant weighing 4,133 g. She has voided once and calls for a nurse to check because she states that she feels "really wet" now. Upon examination, her perineal pad is saturated. The immediate nursing action is to: assess and massage the fundus. inspect the perineum for lacerations. call the primary care provider or the nurse-midwife. increase the flow of an IV.
assess and massage the fundus.
A new mother tells the nurse at the baby's 3 month check-up, "When she cries, it seems like I am the only one who can calm her down." This is an example of which behavior? bonding attachment being spoiled none of the above
attachment
An adolescent primipara was cautious at first when holding and touching her newborn. She seemed almost afraid to make contact with the baby and only touched it lightly and briefly. However, 48 hours after the birth, the nurse now notices that the new mother is pressing the newborn's cheek against her own and kissing her on the forehead. The nurse recognizes these actions as: attachment. engrossment. involution. engorgement.
attachment.
A client who gave birth by cesarean birth 3 days ago is bottle-feeding her neonate. While collecting data the nurse notes that vital signs are stable, the fundus is four fingerbreadths below the umbilicus, lochia are small and red, and the client reports discomfort in her breasts, which are hard and warm to touch. The best nursing intervention based on this data would be: informing the primary care provider that the client is showing early signs of breast infection. using a breast pump to facilitate removal of stagnant breast milk. encouraging the client to wear a supportive bra. having the client stand facing in a warm shower.
encouraging the client to wear a supportive bra.
Which nursing intervention is appropriate for prevention of a urinary tract infection (UTI) in the postpartum woman? screening for bacteriuria in the urine encouraging the woman to empty her bladder completely every 2 to 4 hours increasing intravenous fluids increasing oral fluid intake
encouraging the woman to empty her bladder completely every 2 to 4 hours
A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration? second degree fourth degree third degree first degree
fourth degree The nurse should classify the laceration as fourth degree because it continues through the anterior rectal wall. First-degree laceration involves only skin and superficial structures above muscle; second-degree laceration extends through perineal muscles; and third-degree laceration extends through the anal sphincter muscle but not through the anterior rectal wall.
During a routine home visit, the couple asks the nurse when it will be safe to resume full sexual relations. Which answer would be the best? generally within 3 to 6 weeks whenever the couple wishes usually within a couple weeks generally after 12 weeks
generally within 3 to 6 weeks
The nurse is caring for a client is who 24-hours post-delivery of an infant. Which assessment does the nurse predict the health care provider will prioritize for the mother at this time? iron level hemoglobin and hematocrit blood type folic acid level
hemoglobin and hematocrit
A woman who is breastfeeding her newborn reports that her breasts seem quite full. Assessment reveals that her breasts are engorged. Which factor would the nurse identify as the most likely cause for this development? cracking of the nipple improper positioning of infant inability of infant to empty breasts inadequate secretion of prolactin
inability of infant to empty breasts
The nurse is assessing a postpartum woman and is concerned the client may be hemorrhaging. Which assessment finding is the nurse finding most concerning? increased hematocrit level increased heart rate increased blood pressure increased cardiac output
increased heart rate
The nurse is preparing a new mother to be discharged home after an uncomplicated delivery. During discharge education, which type of lochia pattern should the nurse tell the woman is abnormal and needs to be reported to her health care provider immediately? lochia progresses from rubra to serosa to alba within 10 days moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5 moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5 moderate lochia rubra on day 3, mixed serosa and rubra on day 4, light serosa on day 5
moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5
A nurse is inspecting the perineal pad of a client who gave birth vaginally to a healthy newborn 6 hours ago. The nurse observes a 5-inch stain of lochia on the pad. The nurse would document this as: heavy. light. moderate. scant.
moderate. Typically, the amount of lochia is described as follows: scant-a 1- to 2-inch lochia stain on the perineal pad or approximately a 10-ml loss; light or small- an approximately 4-inch stain or a 10- to 25-ml loss; moderate- a 4- to 6-inch stain with an estimated loss of 25 to 50 ml; and large or heavy-a pad is saturated within 1 hour after changing it.
A nurse is assessing a woman who gave birth vaginally approximately 24 hours ago. Which finding would the nurse report to the primary care provider immediately? respiratory rate 16 breaths/minute pulse rate 75 beats per minute oral temperature 100.8° F (38.2° C) uterine fundus 1 cm below umbilicus
oral temperature 100.8° F (38.2° C)
A client gave birth 2 days ago and is preparing for discharge. The nurse assesses respirations to be 26 breaths/min and labored, and the client was short of breath ambulating from the bathroom this morning. Lung sounds are clear. The nurse alerts the primary care provider and the nurse-midwife to her concern that the client may be experiencing: pulmonary embolism. mitral valve collapse. thrombophlebitis. upper respiratory infection.
pulmonary embolism.
Not all mothers express joy at seeing their newborn upon birth and during their hospitalization. A behavior that indicates impaired attachment of the mother to the newborn is: referring to a facial feature as "ugly" bottle feeding giving the child an uncommon name dressing the child in old clothes
referring to a facial feature as "ugly"
A nurse is preparing a class for a group of new parents on the psychological adaptations that occur after the birth. The nurse should include which signs and symptoms that might suggest postpartum depression? Select all that apply. feeling overwhelmed sleeping well hunger feelings of worthlessness restlessness
restlessness feelings of worthlessness feeling overwhelmed
A new mother gave birth to her baby 24 hours ago and today has been content to rest in her hospital bed, hold her baby, allow the nurse to care for her, and to discuss her labor and birth experience with visitors. Which phase of the postpartum restorative period is this client in? taking-in phase taking-hold phase letting-go phase rooming-in phase
taking-in phase
Rubin identified a series of changes that a new mother makes during the postpartum period. The correct sequence of these changes is: taking, holding-on, letting-go. taking-in, holding-on, letting-go. taking-in, taking-hold, letting-go. taking-in, taking-on, letting-go.
taking-in, taking-hold, letting-go.
The client, who has just been walking around her room, sits down and reports leg tightness and achiness. After resting, she states she is feeling much better. The nurse recognizes that this discomfort could be due to which cause? hormonal shifting of relaxin and estrogen infection thromboembolic disorder of the lower extremities normal response to the body converting back to prepregnancy state
thromboembolic disorder of the lower extremities
The nurse who is working with parents and their newborn encourages which action to assist the bonding and attachment between them? touching talking looking feeding
touching
Which factor puts a client on her first postpartum day at risk for hemorrhage? moderate amount of lochia rubra thrombophlebitis hemoglobin level of 12 g/dl (120 g/L) uterine atony
uterine atony
A woman comes to the clinic. She gave birth about 2 months ago to a healthy term male newborn. During the visit, the woman tells the nurse, "I've noticed that I'm a bit uncomfortable now when we have sexual intercourse. Is there anything that I can do?" The woman's menstrual period has not yet resumed. Which suggestion by the nurse would be most appropriate? "This is entirely normal, and many women go through it. It just takes time." "It takes a while to get your body back to its normal function after having a baby." "Try doing Kegel exercises to get your pelvic muscles back in shape." "You might try using a water-soluble lubricant to ease the discomfort."
"You might try using a water-soluble lubricant to ease the discomfort."
A nurse is working with the parents of a newborn girl. The parents have a 2-year-old boy at home. Which statement would the nurse include when teaching these parents? "Ask your 2-year-old to pick out a special toy for his sister." "Have your 2-year-old stay at home while you're here in the hospital." "Talk to your 2-year-old about the baby when you're driving him to day care." "Expect to see your 2-year-old become more independent when the baby gets home."
"Ask your 2-year-old to pick out a special toy for his sister."
After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, the nurse understands there is a need for additional teaching when one of the women makes which statement? "I might lose some hair, but it will grow back." "I can't wait for these stretch marks to disappear after I give birth." "This line on my belly will go away over time." "My nipples won't be so dark after I give birth."
"I can't wait for these stretch marks to disappear after I give birth."
A nurse is conducting a class on various issues that might develop after going home with a new infant. After discussing how to care for hemorrhoids, the nurse understands that which statement by the class would indicate the need for more information? "Sitz baths worked the last time." "I already have some pads with witch hazel at home." "My mom always used dibucaine." "I only eat a low-fiber diet."
"I only eat a low-fiber diet."
A nurse is caring for a client who gave birth about 10 hours earlier. The nurse observes perineal edema in the client. What intervention should the nurse perform to decrease the swelling caused by perineal edema? Apply ice. Apply moist heat. Use a warm sitz bath or tub bath. Use ointments locally.
Apply ice.
A client who is 3 days' postpartum calls the office and reports excessive night sweats. Which explanation should the nurse provide for the client? Change in pregnancy hormone Body secreting the excess fluids from pregnancy The patient may be drinking too much fluid. The body is trying to get rid of the extra blood made during pregnancy.
Body secreting the excess fluids from pregnancy
A multigravida client is still focusing on her difficult labor and discusses it with the nurse at each opportunity, several hours after the birth. Which action should the nurse prioritize after noting the client's partner is spending more time with the infant than the client? Encourage her to discuss her experience of the birth and answer any questions or concerns she may have. Redirect her attention to the baby by reminding her of the details of newborn care. Point out positive features of her baby, and encourage her to hold and cuddle the baby. Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings.
Encourage her to discuss her experience of the birth and answer any questions or concerns she may have.
The nurse is preparing a postpartum client for discharge 72 hours after birth. The client reports bilateral breast pain around the entire breast on assessment. The nurse predicts this is related to which cause after noting the skin is intact and normal coloration? Mastitis Engorgement Excessive oxytocin Blocked milk duct
Engorgement
A nurse is assessing a postpartum client. Which measure is appropriate? Place the client in a supine position with her arms overhead for the examination of her breasts and fundus. Instruct the client to empty her bladder before the examination. Wear sterile gloves when assessing the pad and perineum. Perform the examination as quickly as possible.
Instruct the client to empty her bladder before the examination.
A new mother asks the nurse what she is allowed to do when she goes home from the hospital. Which statement by the nurse would be correct? You should be able to resume normal activities after 2 weeks. You should not lift anything heavier than your infant in its carrier. Only clean half of the house per day to allow yourself more rest. You need to hire a maid for the first month after delivery to help out around the house.
You should not lift anything heavier than your infant in its carrier. New mothers need their rest. They should focus on caring for their newborn and themselves. Nurses should suggest that the mother not overexert herself and limit any heavy lifting. However, mild exercise can be resumed within 1 week after delivery if approved by the physician. Performing postpartum exercises to strengthen muscle groups and walking are good exercises to begin with.
During the early postpartum period, a new parent is displaying dependent behaviors typical of the taking-in phase. What behavior(s) will the nurse recognize as normal for this period? Select all that apply. needing assistance with changing the peripad desiring to hold the newborn telling the nurse about the delivery experience asking the nurse to take the newborn away so the client can rest changing her newborn's diaper with guidance from the nurse
needing assistance with changing the peripad desiring to hold the newborn telling the nurse about the delivery experience asking the nurse to take the newborn away so the client can rest In the early postpartum period, the new parent is focused upon oneself and concerned about one's own needs. During this taking-in period, the client is very dependent, having difficulty making decisions and requesting help with self-care. The client relives the delivery experience and wants to share it with others. This period may last several hours or several days.