OB Exam 3 Questions

A nurse in an obstetrical clinic is teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching?

"A change in the string length of my IUD is expected"

A nurse in a health clinic is reviewing contraceptive use with a group of adolescent clients. Which of the following statements by an adolescent reflects an understanding of the teaching?

"A water-soluble lubricant should be used with condoms"

A nurse is conducting a home visit for a clien who is 1 week postpartum and breastfeeding. The client reports breast engorgement. Which of the following recommendations should the nurse make?

"Apply cold compresses between feedings"

A nurse is teaching a client who is breastfeeding and has mastitis. Which of the following responses should the nurse make?

"Completely empty each breast at each feeding or use a pump"

A nurse is completing postpartum discharge teaching to a client who had no immunity to varicella and was given varicella vaccine. Which of the following statements by the client indicates understanding of the teaching?

"I need a second vaccination at my postpartum visit"

A nurse is providing instructions to a mother who has been diagnosed with mastitis. Which of the following statements if made by the mother indicates a need for further teaching? resolves."

"I need to stop breastfeeding until this condition resolves." In most cases, the mother can continue to breastfeed with both breasts. If the affected breast is too sore, the mother can pump the breast gently. Regular emptying of the breast is important to prevent abscess formation. • Option A: Antibiotic therapy assists in resolving the mastitis within 24-48 hours • Options B and C: Additional supportive measures include ice packs, breast supports, and analgesics.

A nurse is providing discharge teaching to the parents of a newborn regardnig circumcision care. Which of the following statements made by a parent indicates an understanding of the teaching?

"I will clean his penis with each diaper change"

A nurse in a clinic is caring for a client who is to be seen by the provider for a postoperative appointment following a salpingectomy due to an ectopic pregnancy. Which of the following statements by the client requires clarification?

"It is good to know that I won't have a tubal pregnancy in the future"

A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process?

"The man is the easiest to assess, and the provider will usually being there"

A nurse is teaching a newly licensed nurse about neonatal abstinence syndrome. Which of the following statements by the newly licensed nurse indicate understanding of the teaching?

"The newborn will have a continuous high-pitched cry"

A nurse is providing discharge teaching for a nonlactating client. Which of the following instructinos should the nurse include in the teaching?

"Wear a supportive bra continuously for the first 72 hours"

A nurse is caring for a client who is at 42 weeks gestation and in labor. The client asks the nurse what should she expect because her baby is postmature. Which of the following statements should the nurse make?

"Your baby's skin will have a leathery appearance"

A nurse is caring for a client who is 2 days postpartum. The client states, "My 4yo son was toilet trained and now he is frequently wetting himself." Which of the following statements should the nurse provide to the client?

"Your son is showing adverse sibiling response"

A nurse is reviewing discharge teaching with a client who has a UTI. Which of the following statements by the client indicates understanding of the teaching?

-"I will drink cranberry and prune juices to make my urine more acidic" -"I will drink large amounts of fluids to flush the bacter from my urinary tract" -"I will take tylenol for any discomfort"

A nurse in a clinic is teaching a client about her new prescription for medroxyprogesterone. Which of the following information should the nurse include in the teaching?

-"You should increase your intake of calcium" -"Irregular vaginal spotting can occur"

A nurse on the postpartum unit is performing a physical assessment of a client who is being admitted with a suspected DVT. Which of the following clinical findings shouldthe nurse expect?

-Calf tenderness to palpation -Elevated temperature -Area of warmth

A nurse is caring for a client who is 1 hr postpartum following a vaginal birth and experiencing uncontrollable shaking. The nurse should understand that the shaking is due to which of the following factors?

-Change in body fluids -Metabolic effort of labor

A nurse is assessing a client who has postpartum depression. The nurse should expect which of the following findings?

-Concerns about lack of income to pay bills -Anxiety about assuming a new role as a mother -Rapid decline in estrogen and progesterone -Feeling of inadequacy with the new role as a mother

A nurse is caring for a client who is 1 day postpartum. The nurse is assessing for maternal adaption and mother-infant bonding. Which of the following behaviors by the client indicates a need for the nurse to intervene?

-Demonstrates apathy when the infant cries -Views the infants behavior as uncooperative during diaper changing

A nurse is discussing risks factors UTI with a newly licensed nurse. Which of the following conditions should the nurse include in the teaching?

-Epidural anesthesia -Urinary bladder catheterization -Frequent pelvic examinations -History of UTIs

A nurse is caring for a postpartum client who delivered her third infant 2 days ago. The nurse recognizes that which of the following findings are suggestive of postpartum depression?

-Fatigue -Insomnia -Flat affect

A nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following conditions are contraindications?

-Hypospadias -Family history of hemophilia -Epispadias

A nurse is teaching a client about potential adverse effects of implantable progestins. Which of the following adverse effects should the nurse include?

-Irregular vaginal bleeding -Weight gain -Breast changes

A nurse is called to the birthing room to assist with the assessment of a newborn who was born at 32wks of gestation. The newnorn's birth weight is 1,100g. Which of the following are expected findings in this newborn?

-Lanugo -Weak grasp reflex -Translucent skin

A nurse is an infertility clinic is providing care to a couple who has been unable to conceive for 18 months. Which of the following data should be included in the assessment?

-Occupation -Mentrual history -Childhood infectious diseases

A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching?

-Precipitous delivery -Inversion of the uterus -Retained placental fragments

A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse instructs the mother that she should expect normal bowel elimination to return:

3 days PP. After birth, the nurse should auscultate the woman's abdomen in all four quadrants to determine the return of bowel sounds. Normal bowel elimination usually returns 2 to 3 days PP. Surgery, anesthesia, and the use of narcotics and pain control agents also contribute to the longer period of altered bowel function.

A PP nurse is providing instructions to a woman after delivery of a healthy newborn infant. The nurse instructs the mother that she should expect normal bowel elimination to return:

A and C. In the PP period, cervical healing occurs rapidly and cervical involution occurs. After 1 week the muscle begins to regenerate and the cervix feels firm and the external os, is the width of a pencil. The fundus begins to descent into the pelvic cavity after 24 hours, a process known as involution. • Option B: Although the vaginal mucosa heals and vaginal distention decreases, it takes the entire PP period for complete involution to occur and muscle tone is never restored to the pregravid state. • Option D: Despite blood loss that occurs during delivery of the baby, a transient increase in cardiac output occurs. The increase in cardiac output, which persists about 48 hours after childbirth, is probably caused by an increase in stroke volume because Bradycardia is often noted during the PP period. • Option E: Soon after childbirth, digestion begins to begin to be active, and the new mother is usually hungry because of the energy expended during labor.

A nurse is providing care for 4 clients on the postpartum unit. Which of the following clients is at greatest risk for developing a post partum infection?

A client who does not wash her hands between perineal care and breastfeeding

A nurse on the postpartum unit is caring for four clients. Which of the following clients should the nurse recognize as the greatest risk for development of a postpartum infection?

A client who had premature rupture of membranes and prolonged labor

A nurse in a clinic is caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor?

A client whose partner has von Willebrand disease

During ambulation to the bathroom, a postpartum client experiences s agush of dark red blood that soon stops. On assessment, a nurse finds the uterus to be firm, midline, and at the level of the umbilicus. Which of the following findings should the nurse interpret this data as being?

A normal postural discharge of lochia

A nurse is caring for a PP client with a diagnosis of DVT who is receiving a continuous intravenous infusion of heparin sodium. Which of the following laboratory results will the nurse specifically review to determine if an effective and appropriate dose of the heparin is being delivered? D. Platelet count

Activated partial thromboplastin time. Anticoagulation therapy may be used to prevent the extension of thrombus by delaying the clotting time of the blood. Activated partial thromboplastin time should be monitored, and a heparin dose should be adjusted to maintain a therapeutic level of 1.5 to 2.5 times the control. • Options A and B: The prothrombin time and the INR are used to monitor coagulation time when warfarin (Coumadin) is used.

A nurse is monitoring a new mother in the PP period for signs of hemorrhage. Which of the following signs, if noted in the mother, would be an early sign of excessive blood loss?

An increase in the pulse from 88 to 102 BPM. During the 4th stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. A rising pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. • Option A: A slight rise in temperature is normal. The respiratory rate is increased slightly. • Option D: The blood pressure will fall as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage.

A nurse is caring for a newborn immediately following a circumcision using a Gomco procedure. Which of the following actions should the nurse implement?

Apply petroleum gauze to the site

A nurse is caring for a client who has postpartum psychosis. Which of the following actions is the nurs's priority?

Ask the client if she has thoughts of harming herself or her infant

On completing a fundal assessment, the nurse notes the fundus is situated on the client's left abdomen. Which of the following actions is appropriate?

Ask the client to empty her bladder. A full bladder may displace the uterine fundus to the left or right side of the abdomen. Catheterization is unnecessary invasive if the woman can void on her own.

A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following?

Ask the mother to urinate and empty her bladder. Before starting the fundal assessment, the nurse should ask the mother to empty her bladder so that an accurate assessment can be done. • Options A and B: When the nurse is performing a fundal assessment, the nurse asks the woman to lie flat on her back with the knees flexed. • Option D: Massaging the fundus is not appropriate unless the fundus is boggy and soft, and then it should be massaged gently until firm.

A nurse performs an assessment on a client who is 4 hours PP. The nurse notes that the client has cool, clammy skin and is restless and excessively thirsty. The nurse prepares immediately to:

Assess for hypovolemia and notify the health care provider. Symptoms of hypovolemia include cool, clammy, pale skin, sensations of anxiety or impending doom, restlessness, and thirst. When these symptoms are present, the nurse should further assess for hypovolemia and notify the health care provider.

When performing a postpartum check, the nurse should:

Assist the woman into a lateral position with upper leg flexed forward to facilitate the examination of her perineum. While the supine position is best for examining the abdomen, the woman should keep her arms at her sides and slightly flex her knees in order to relax abdominal muscles and facilitate palpation of the fundus. • Option C: The bladder should be emptied before the check. A full bladder alters the position of the fundus and makes the findings inaccurate. • Option D: Although hands are washed before starting the check, clean (not sterile) gloves are put on just before the perineum and pad are assessed to protect from contact with blood and secretions.

A nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. Select all instructions that would be included on the list.

B, D, and E. Mastitis are an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3 L a day, and taking analgesics to relieve discomfort. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. • Option A: Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. • Option C: Continued decompression of the breast by breastfeeding or pumping is important to empty the breast and prevent formation of an abscess.

A nurse is reviewing car seat safety with the parents of a newborn. Which of the following instructions should the nurse include in the teaching regarding car seat position?

Back seat, rear-facing

Methergine or Pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the:

Blood pressure. Methergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.

Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus?

Cervical laceration. Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting. • Options A and D: Retained placental fragments and uterine atony may cause subinvolution of the uterus, making it soft, boggy, and larger than expected. • Option B: UTI won't cause vaginal bleeding, although hematuria may be present.

A nurse is caring for a PP woman who has received epidural anesthesia and is monitoring the woman for the presence of a vulva hematoma. Which of the following assessment findings would best indicate the presence of a hematoma? D. Signs of heavy bruising

Changes in vital signs. Changes in vitals indicate hypovolemia in the anesthetized PP woman with vulvar hematoma. • Options A and B: Because the woman has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. • Option D: Heavy bruising may be visualized, but vital sign changes indicate hematoma caused by blood collection in the perineal tissues.

On which of the postpartum days can the client expect lochia serosa?

Days 3 to 10 PP. On the third and fourth PP days, the lochia becomes a pale pink or brown and contains old blood, serum, leukocytes, and tissue debris. This type of lochia usually lasts until PP day 10. Lochia rubra usually last for the first 3 to 4 days PP. Lochia alba, which contain leukocytes, decidua, epithelial cells, mucus, and bacteria, may continue for 2 to 6 weeks PP.

Which of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications?

Decrease. The placenta produces the hormone human placental lactogen, an insulin antagonist. After birth, the placenta, the major source of insulin resistance, is gone. Insulin needs decrease and women with type 1 diabetes may only need one-half to two-thirds of the prenatal insulin during the first few PP days.

A nurse in a PP unit is instructing a mother regarding lochia and the amount of expected lochia drainage. The nurse instructs the mother that the normal amount of lochia may vary but should never exceed the need for:

Eight peripads per day. The normal amount of lochia may vary with the individual but should never exceed 4 to 8 peripads per day. The average number of peripads is 6 per day.

A PP nurse is assessing a mother who delivered a healthy newborn infant by C-section. The nurse is assessing for signs and symptoms of superficial venous thrombosis. Which of the following signs or symptoms would the nurse note if superficial venous thrombosis were present?

Enlarged, hardened veins. Thrombosis of the superficial veins is usually accompanied by signs and symptoms of inflammation. These include swelling of the involved extremity and redness, tenderness, and warmth.

A PP nurse is preparing to care for a woman who has just delivered a healthy newborn infant. In the immediate PP period the nurse plans to take the woman's vital signs every?

Every 15 minutes during the first hour and then every 30 minutes for the next two hours.

When making a visit to the home of a postpartum woman one week after birth, the nurse should recognize that the woman would characteristically:

Express a strong need to review events and her behavior during the process of labor and birth. One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage as described in response C. This stage lasts for as long as 4 to 5 weeks after birth. • Options A and B are characteristic of the taking-in stage, which lasts for the first few days after birth. • Option D reflects the letting-go stage, which indicates that psychosocial recovery is complete.

Which of the following findings would be expected when assessing the postpartum client?

Fundus 1 cm above the umbilicus 1 hour postpartum. Within the first 12 hours postpartum, the fundus usually is approximately 1 cm above the umbilicus. The fundus should be below the umbilicus by PP day 3. The fundus shouldn't be palpated in the abdomen after day 10.

A client in early postpartum period is very excited and talkative. She is repeatedly telling the nurse every detail of her labor and birth. Because the client will not stop talking, the nurse is having difficulty completing the postpartum assessments. Which of the following actions should the nurse take?

Give the client time to express her feelings

Parents can facilitate the adjustment of their other children to a new baby by:

Having the children choose or make a gift to give to the new baby upon its arrival home. • Option B: Special time should be set aside just for the other children without interruption from the newborn. • Option C: Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. • Option D: Children should be actively involved in the care of the baby according to their ability without overwhelming them.

A PP client is being treated for DVT. The nurse understands that the client's response to treatment will be evaluated by regularly assessing the client for:

Hematuria, ecchymosis, and epistaxis. The treatment for DVT is anticoagulant therapy. The nurse assesses for bleeding, which is an adverse effect of anticoagulants. This includes hematuria, ecchymosis, and epistaxis. Dysuria and vertigo are not associated specifically with bleeding.

A PP nurse is taking the VS of a woman who delivers a healthy newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.2F. Which of the following actions would be most appropriate?

Increase hydration by encouraging oral fluids. The mother's temperature may be taken every 4 hours while she is awake. Temperatures up to 100.4 F (38 C) in the first 24 hours after birth are often related to the dehydrating effects of labor. The most appropriate action is to increase hydration by encouraging oral fluids, which should bring the temperature to a normal reading. • Option C: Although the nurse would document the findings, the most appropriate action would be to increase the hydration.

A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypobolemia caused by hemorrhage?

Increasing pulse and decreasing blood pressure

The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is:

Indicates the presence of infection. Lochia, the discharge present after birth, is red for the first 1 to 3 days and gradually decreases in amount. Foul smelling or purulent lochia usually indicates infection, and these findings are not normal. • Option A: Normal lochia has a fleshy odor. • Options C and D: Encouraging the woman to drink fluids or increase ambulation is not an accurate nursing intervention.

The nurse is assessing a client who is 6 hours PP after delivering a full-term healthy infant. The client complains to the nurse of feelings of faintness and dizziness. Which of the following nursing actions would be most appropriate? lightheadedness and dizziness have subsided.

Instruct the mother to request help when getting out of bed. Orthostatic hypotension may be evident during the first 8 hours after birth. Feelings of faintness or dizziness are signs that should caution the nurse to be aware of the client's safety. The nurse should advise the mother to get help the first few times the mother gets out of bed. • Option A: Obtaining an H/H requires a physician's order.

A nurse is reviewing care of the umbilical cord with the parent of a newborn. Which of the following instructions should the nurse include in the teaching?

Keep the diaper folded below the cord

A nurse is providing discharge instructions to a postpartum client following a cesarian birth. The client reports leaking urine every time she sneezes or coughs. Which of the following interventions should the nurse suggest?

Kegel exercises

Which type of lochia should the nurse expect to find in a client 2 days PP?

Lochia rubra

The nurse is about the give a Type 2 diabetic her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum?

Lower than before she became pregnant. PP insulin requirements are usually significantly lower than pre pregnancy requirements. Occasionally, clients may require little to no insulin during the first 24 to 48 hours postpartum.

The nurse examines a woman one hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to:

Massage her fundus. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm, followed by options C and D, especially if the fundus does not become or remain firm with massage. • Option A: There is no indication of a distended bladder since the fundus is midline and below the umbilicus.

Which measure would be least effective in preventing postpartum hemorrhage?

Massage the fundus every hour for the first 24 hours following birth. The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. • Options A, B, and D are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.

A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. When the nurse locates the fundus, she notes that the uterus feels soft and boggy. Which of the following nursing interventions would be most appropriate initially?

Massage the fundus until it is firm. If the uterus is not contracted firmly, the first intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. • Options B and D: Elevating the client's legs and encouraging the client to void will not assist in managing uterine atony. If the uterus does not remain contracted as a result of the uterine massage, the problem may be distended bladder and the nurse should assist the mother to urinate, but this would not be the initial action. • Option C: Pushing on an uncontracted uterus can invert the uterus and cause massive hemorrhage.

A nurse on the postpartum unit is planning care for a client who has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care?

Measure leg circumferences

A nurse is performing a fundal assessment for a client who is 2 days postpartum and observes the perineal pad for lochia. She notes the pad to be saturated approximately 12cm with lochia that is bright red and contains small clots. Which of the following findings should the nurse document?

Moderate lochia rubra

Which of the following responses is most appropriate for a mother with diabetes who wants to breastfeed her infant but is concerned about the effects of breastfeeding on her health?

Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding. Breastfeeding has an antidiabetogenic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding mothers are at a higher risk of hypoglycemia in the first PP days after birth because the glucose levels are lower. Mothers with diabetes should be encouraged to breastfeed.

After the expulsion of the placenta in a client who has six living children, an infusion of lactated ringer's solution with 10 units of Pitocin is ordered. The nurse understands that this is indicated for this client because:

Multigravidas are at increased risk for uterine atony. Multiple full-term pregnancies and deliveries result in overstretched uterine muscles that do not contract efficiently and bleeding may ensue.

A client is complaining of painful contractions, or after pains, on postpartum day 2. Which of the following conditions could increase the severity of afterpains?

Multiple gestation. Multiple gestation, breastfeeding, multiparity, and conditions that cause overdistention of the uterus will increase the intensity of after-pains. • Options A and B: Bottle-feeding and diabetes aren't directly associated with increasing severity of afterpains unless the client has delivered a macrosomic infant.

A nurse is assessing a client in the 4th stage if labor and notes that the fundus is firm but that bleeding is excessive. The initial nursing action would be which of the following?

Notify the physician. If the bleeding is excessive, the cause may be laceration of the cervix or birth canal. Massaging the fundus if it is firm will not assist in controlling the bleeding. Trendelenburg's position is to be avoided because it may interfere with cardiac function.

When performing a PP assessment on a client, the nurse notes the presence of clots in the lochia. The nurse examines the clots and notes that they are larger than 1 cm. Which of the following nursing actions is most appropriate? D. Encourage increased intake of fluids.

Notify the physician. Normally, one may find a few small clots in the first 1 to 2 days after birth from pooling of blood in the vagina. Clots larger than 1 cm are considered abnormal. The cause of these clots, such as uterine atony or retained placental fragments, needs to be determined and treated to prevent further blood loss. Although the findings would be documented, the most appropriate action is to notify the physician.

A nurse is caring for a newborn who is preterm and has respiratory distress syndrome. Which of the following should the nurse monitor to evaluate the newborn's condition following administration of synthetic surfactant?

Oxygen saturation

Which of the following findings would be a source of concern if noted during the assessment of a woman who is 12 hours postpartum?

Pain in left calf with dorsiflexion of left foot. Pain in left calf with dorsiflexion of left foot indicate a positive Homan sign and are suggestive of thrombophlebitis and should be investigated further. • Options A and C are expected related to circulatory changes after birth. • Option B: A temperature of 100.4°F in the first 24 hours is most likely indicative of dehydration which is easily corrected by increasing oral fluid intake.

Which of the following behaviors characterizes the PP mother in the taking in phase?

Passive and dependant. During the taking in phase, which usually lasts 1-3 days, the mother is passive and dependent and expresses her own needs rather than the neonate's needs. • Options B, C, and D: The taking hold phase usually lasts from days 3-10 PP. During this stage, the mother strives for independence and autonomy; she also becomes curious and interested in the care of the baby and is most ready to learn.

Methergine or Pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client's medical history?

Peripheral vascular disease. These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.

All of the following are important in the immediate care of the premature neonate. Which nursing activity should have the greatest priority?

Placement in a warm environment

A nurse in the delivery room is planning to promote maternal-infant bonding for a client who just delivered. Which of the following is the priority action by the nurse?

Position the neonate skin-to-skin on the client's chest

A nurse is assessing a postpartum client who is exhibiting tearfullness, insomnia, lack of appetite, and a feeling of letdown. Which of the following conditions are associated with these clinical findings?

Postpartum blues

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

Preeclampsia

A nurse is developing a plan of care for a PP woman with a small vulvar hematoma. The nurse includes which specific intervention in the plan during the first 12 hours following the delivery of this client?

Prepare an ice pack for application to the area. Application of ice will reduce swelling caused by hematoma formation in the vulvar area. • Options A, B, and C: The other options are not interventions that are specific to the plan of care for a client with a small vulvar hematoma.

A new mother received epidural anesthesia during labor and had a forceps delivery after pushing 2 hours. At 6 hours PP, her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse immediately plans to:

Prepare the client for surgery. The use of an epidural, prolonged second stage labor and forceps delivery are predisposing factors for hematoma formation, and a collection of up to 500 ml of blood can occur in the vaginal area. Although the other options may be implemented, the immediate action would be to prepare the client for surgery to stop the bleeding.

A nurse concludes that the father of an infant is not showing positive signs of parent-infant bonding. He appears very anxious and nervous when the infant's mother asks him to bring her the infant. Which of the following actions should the nurse use to promote father-infant bonding?

Provide education about infant care when the father is present

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing the needs of women during this stage, should:

Provide time for the mother to reflect on the events of and her behavior during childbirth. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition. Once they are met, she is more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach.

Which of the following physiological responses is considered normal in the early postpartum period?

Rapid diuresis. In the early PP period, there's an increase in the glomerular filtration rate and a drop in the progesterone levels, which result in rapid diuresis. • Options A: There should be no urinary urgency, though a woman may feel anxious about voiding. • Options C and D: There's a minimal change in blood pressure following childbirth, and a residual decrease in GI motility.

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should:

Recognize this as a behavior of the taking-hold stage. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby. • Option A does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking-in stage.

A nurse is instructing a client who is taking an oral contraceptive about danger signs to report to her provider. The nurse determines the client understands the teaching when the client states the need to report which of the following?

Shortness of breath

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is one day postpartum. An expected finding would be:

Soft, non-tender; colostrum is present. Breasts are essentially unchanged for the first two to three days after birth. Colostrum is present and may leak from the nipples.

A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact her provider for which of the following client findings?

Sore nipple with cracks and fissures

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

Staphylococcus aureus

A nurse is caring for an infant who has a high bilirubin level and is receiving phototherapy. Which of the following is the pirority findings in the newborn?

Sunken fontanels

Which of the following factors might result in a decreased supply of breastmilk in a PP mother?

Supplemental feedings with formula. Routine formula supplementation may interfere with establishing an adequate milk volume because decreased stimulation to the mother's nipples affects hormonal levels and milk production.

On the first PP night, a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases?

Taking-in phase. The taking-in phase occurs in the first 24 hours after birth. The mother is concerned with her own needs and requires support from staff and relatives. • Option B: The letting-go phase begins several weeks later when the mother incorporates the new infant into the family unit. • Option C: The taking-hold phase occurs when the mother is ready to take responsibility for her care as well as the infant's care.

Which of the following interventions would be helpful to a breastfeeding mother who is experiencing engorged breasts?

Teaching how to express her breasts in a warm shower. Teaching the client how to express her breasts in a warm shower aids with let-down and will give temporary relief. Ice can promote comfort by vasoconstriction, numbing, and discouraging further letdown of milk.

During the 3rd PP day, which of the following observations about the client would the nurse be most likely to make?

The client appears interested in learning about neonatal care. The third to tenth days of PP care are the "taking-hold" phase, in which the new mother strives for independence and is eager for her neonate. The other options describe the phase in which the mother relives her birth experience.

Before giving a PP client the rubella vaccine, which of the following facts should the nurse include in client teaching? effects

The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects. The client must understand that she must not become pregnant for 3 months after the vaccination because of its potential teratogenic effects. • Option A: The rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies. • Option B: The virus is not transmitted into the breast milk, so clients may continue to breastfeed after the vaccination. • Option C: Transient arthralgia and rash are common adverse effects of the vaccine.

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that:

The expected weight loss immediately after birth averages about 11 to 13 pounds. Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 pounds. Weight loss continues during breastfeeding since fat stores developed during pregnancy and extra calories consumed are used as part of the lactation process.

What type of milk is present in the breasts 7 to 10 days PP?

Transitional milk. Transitional milk comes after colostrum and usually lasts until 2 weeks PP.

A nurse is assessing a postpartum client for fundal height, location, and consistency. The fundus is noted to be displaced laterally to the right, and there is uterine atony. The nurse should identify which of the following conditions as the cause of the uterine atony?

Urinary retention

Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage?

Urine retention. Urine retention causes a distended bladder to displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. The uterus needs to remain contracted if bleeding is to stay within normal limits. Cervical and vaginal tears can cause PP hemorrhage but are less common occurrences in the PP period.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman:

Uses the peribottle to rinse upward into her vagina. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still-open cervix.

Which of the following complications is most likely responsible for a delayed postpartum hemorrhage?

Uterine subinvolution. Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution. • Options A and C: Cervical or perineal lacerations can cause an immediate postpartum hemorrhage. • Option B: A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn't corrected at the time of delivery.