OB Exam 3 Testbank

Much of a woman's behavior during the postpartum period is strongly influenced by her cultural background. Nurses are likely to come into contact with women from many different countries and cultures. All cultures have developed safe and satisfying methods of caring for new mothers and their babies. Match the cultural norm with the nationality of origin. a. Prefer not to give babies colostrum. b. Eat only warm foods and hot drinks. c. Take the placenta home to bury. d. Will not eat pork or pork products. e. Have an intrauterine device (IUD) inserted after the first child.

1. Muslim countries --> Will not eat pork or pork products. 2. Korean or other South East Asian countries --> Prefer not to give babies colostrum. 3. Chinese --> Have an intrauterine device (IUD) inserted after the first child. 4. Haitian --> Take the placenta home to bury. 5. Mexican --> Eat only warm foods and hot drinks.

The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period, the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Match the vital signs finding that the postpartum nurse may encounter with its probable cause. a. Elevated temperature within the first 24 hours b. Rapid pulse c. Elevated temperature at 36 hours postpartum d. Hypertension e. Hypoventilation

1. Puerperal sepsis --> Elevated temperature at 36 hours postpartum 2. Unusually high epidural or spinal block --> Hypoventilation 3. Dehydrating effects of labor --> Elevated temperature within the first 24 hours 4. Hypovolemia resulting from hemorrhage --> Rapid pulse 5. Excessive use of oxytocin --> Hypertension

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this black, sticky stuff in her diaper?" What is the nurse's best response? a. "That's meconium, which is your baby's first stool. It's normal." b. "That's transitional stool." c. "That means your baby is bleeding internally." d. "Oh, don't worry about that. It's okay."

ANS: A - "That's meconium, which is your baby's first stool. It's normal." Explaining what meconium is and that it is normal is an accurate statement and the most appropriate response. Transitional stool is greenish-brown to yellowish-brown and usually appears by the third day after the initiation of feeding. Telling the father that the baby is internally bleeding is not an accurate statement. Telling the father not to worry is not appropriate. Such responses are belittling to the father and do not teach him about the normal stool patterns of his daughter.

A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this woman's fundus? a. 1 centimeter above the umbilicus b. 2 centimeters below the umbilicus c. Midway between the umbilicus and the symphysis pubis d. Nonpalpable abdominally

ANS: A - 1 centimeter above the umbilicus The fundus descends approximately 1 to 2 cm every 24 hours. Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. By the sixth postpartum week the fundus is normally halfway between the symphysis pubis and the umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference point

What are the most common causes for subinvolution of the uterus? a. Postpartum hemorrhage and infection b. Multiple gestation and postpartum hemorrhage c. Uterine tetany and overproduction of oxytocin d. Retained placental fragments and infection

ANS: D - Retained placental fragments and infection Subinvolution is the failure of the uterus to return to a nonpregnant state. The most common causes of subinvolution are retained placental fragments and infection. Subinvolution may be caused by an infection and result in hemorrhage. Multiple gestations may cause uterine atony, resulting in postpartum hemorrhaging. Uterine tetany and overproduction of oxytocin do not cause subinvolution

Which infant response to cool environmental conditions is either not effective or not available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position

ANS: D - Unflexing from the normal position The newborn's flexed position guards against heat loss, because it reduces the amount of body surface exposed to the environment. The newborn's body is able to constrict the peripheral blood vessels to reduce heat loss. Burning brown fat generates heat. The respiratory rate may rise to stimulate muscular activity, which generates heat.

Which societal factors have a strong influence on parental response to their infant? (Select all that apply.) a. An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively. b. An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers. c. Adolescent mothers have a higher documented incidence of child abuse. d. Mothers older than 35 years of age often deal with more stress related to work and career issues, as well as decreasing libido. e. Relationships between adolescent mothers and fathers are more stable than older adults.

ANS: A - An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively. B - An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers. D - Mothers older than 35 years of age often deal with more stress related to work and career issues, as well as decreasing libido. Adolescent mothers are more inclined to have a number of parenting difficulties that can benefit from counseling, but a higher incidence of child abuse is not one of them. As adolescent mothers move through the transition to parenthood, they can feel different from their peers, excluded from fun activities, and prematurely forced to enter the adult role. The conflict between their own desires and the infant's demands further contribute to the normal psychosocial stress of childbirth and parenting. Adolescent mothers provide warm and attentive physical care; however, they use less verbal interaction than older parents, and adolescents tend to be less responsive and to interact less positively with their infants than older mothers. Midlife mothers have many competencies; however, they are more likely to have to deal with career and sexual issues than are younger mothers. Relationships between adolescent parents tend to be less stable than among adults.

Many new mothers experience some type of nipple pain during the first weeks of initiating breastfeeding. Should this pain be severe or persistent, it may discourage or inhibit breastfeeding altogether. Which factors might contribute to this pain? (Select all that apply.) a. Improper feeding position b. Large-for-gestational age infant c. Fair skin d. Progesterone deficiency e. Flat or retracted nipples

ANS: A - Improper feeding position C - Fair skin E - Flat or retracted nipples Nipple lesions may manifest as chapped, cracked, bleeding, sore, erythematous, edematous, or blistered nipples. Factors that contribute to nipple pain include improper positioning or a failure to break suction before removing the baby from the breast. Flat or retracted nipples along with the use of nipple shields, breast shells, or plastic breast pads also contribute to nipple pain. Women with fair skin are more likely to develop sore and cracked nipples. Preventing nipple soreness is preferable to treating soreness after it appears. Vigorous feeding may be a contributing factor, which may be the case with any size infant, not just infants who are large for gestational age. Estrogen or dietary deficiencies can contribute to nipple soreness.

Which concerns regarding parenthood are often expressed by visually impaired mothers? (Select all that apply.) a. Infant safety b. Transportation c. Ability to care for the infant d. Visually missing out e. Needing extra time for parenting activities to accommodate the visual limitations

ANS: A - Infant safety B - Transportation D - Visually missing out E - Needing extra time for parenting activities to accommodate the visual limitations Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other people's reactions, providing proper discipline, and missing out visually. Blind people sense a reluctance on the part of others to acknowledge that they have a right to be parents. However, blind parents are fully capable of caring for their infants.

Which practices contribute to the prevention of postpartum infection? (Select all that apply.) a. Not allowing the mother to walk barefoot at the hospital b. Educating the client to wipe from back to front after voiding c. Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay home d. Instructing the mother to change her perineal pad from front to back each time she voids or defecates e. Not permitting visitors with cough or colds to enter the postpartum unit

ANS: A - Not allowing the mother to walk barefoot at the hospital C - Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay home D - Instructing the mother to change her perineal pad from front to back each time she voids or defecates Proper perineal care helps prevent infection and aids in the healing process. Educating the woman to wipe from front to back (urethra to anus) after voiding or defecating is a simple first step. Walking barefoot and getting back into bed can contaminate the linens. Clients should wear shoes or slippers. Staff members with infections need to stay home until they are no longer contagious. The client should also wash her hands before and after these functions. Visitors with any signs of illness should not be allowed entry to the postpartum unit.

If a woman is at risk for thrombus and is not ready to ambulate, which nursing intervention would the nurse use? (Select all that apply.) a. Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots b. Having her flex, extend, and rotate her feet, ankles, and legs c. Having her sit in a chair d. Immediately notifying the physician if a positive Homans sign occurs e. Promoting bed rest

ANS: A - Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots B - Having her flex, extend, and rotate her feet, ankles, and legs D - Immediately notifying the physician if a positive Homans sign occurs Sitting immobile in a chair does not help; bed exercise and prophylactic footwear might. TED hose and SCD boots are recommended. The client should be encouraged to ambulate with assistance, not remain in bed. Bed exercises are useful. A positive Homans sign (calf muscle pain or warmth, redness, tenderness) requires the physician's immediate attention

Which physiologic factors are reliable indicators of impending shock from postpartum hemorrhage? (Select all that apply.) a. Respirations b. Skin condition c. Blood pressure d. Level of consciousness e. Urinary output

ANS: A - Respirations B - Skin condition D - Level of consciousness E - Urinary output Blood pressure is not a reliable indicator; several more sensitive signs are available. Blood pressure does not drop until 30% to 40% of blood volume is lost. Respirations, pulse, skin condition, urinary output, and level of consciousness are more sensitive means of identifying hypovolemic shock.

Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security? (Select all that apply.) a. The mother should check the photo identification (ID) of any person who comes to her room. b. The baby should be carried in the parent's arms from the room to the nursery. c. Because of infant security systems, the baby can be left unattended in the client's room. d. Parents should use caution when posting photographs of their infant on the Internet. e. The mom should request that a second staff member verify the identity of any questionable person.

ANS: A - The mother should check the photo identification (ID) of any person who comes to her room. D - Parents should use caution when posting photographs of their infant on the Internet. E - The mom should request that a second staff member verify the identity of any questionable person. Nurses must discuss infant security precautions with the mother and her family because infant abduction continues to be a concern. The mother should be taught to check the identity of any person who comes to remove the baby from her room. Hospital personnel usually wear picture identification patches. On some units, staff members also wear matching scrubs or special badges that are unique to the perinatal unit. As a rule, the baby is never carried in arms between the mother's room and the nursery, but rather the infant is always wheeled in a bassinet. The infant should never be left unattended, even if the facility has an infant security system. Parents should be instructed to use caution when posting photographs of their new baby on the Internet and on other public forums.

The transition to parenting for same-sex couples can present unique challenges. How can the nurse foster adjustment to parenting for these clients? (Select all that apply.) a. Use a supplemental feeding device to simulate breastfeeding. b. Allow the partner to cut the cord. c. Gay fathers should meet their new infant soon after the birth mother has recovered. d. Understand that strong social sanctions remain. e. Provide information regarding support groups.

ANS: A - Use a supplemental feeding device to simulate breastfeeding. B - Allow the partner to cut the cord. D - Understand that strong social sanctions remain. E - Provide information regarding support groups. In a lesbian couple, the nonchildbearing partner may have a desire to breastfeed. This can be achieved using a supplemental nursing device. The female partner should be offered the same right as a heterosexual partner including cutting the cord. A gay couple may adopt a baby or use a surrogate. If the latter method is chosen, then they should be present at the birth if at all possible. The nurse can refer these men to available support groups. Same-sex couples continue to face strong social sanction in their efforts to parent

A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents? (Select all that apply.) a. Using devices that transform sound into light b. Assuming that the client knows sign language c. Speaking quickly and loudly d. Ascertaining whether the client can read lips before teaching e. Writing messages that aid in communication

ANS: A - Using devices that transform sound into light D - Ascertaining whether the client can read lips before teaching E - Writing messages that aid in communication Section 504 of the Rehabilitation Act of 1973 requires that hospitals use various communication techniques and resources with the deaf and hard of hearing client. These resources include devices such as door alarms, cry alarms, and amplifiers. Before initiating communication, the nurse needs to be aware of the parents' preferences for communication. Not all hearing-impaired clients know sign language. Do they wear a hearing aid? Do they read lips? Do they wish to have a sign language interpreter? If the parent relies on lip reading, then the nurse should sit close enough to enable the parent to visualize lip movements. The nurse should speak clearly in a regular voice volume, in short, simple sentences. Written messages such as on a black or white erasable board can be useful. Written materials should be reviewed with the parents before discharge.

The breast-feeding mother should be taught to expect which changes to the condition of the breasts? (Select all that apply.) a. Breast tenderness is likely to persist for approximately 1 week after the start of lactation. b. As lactation is established, a mass may form that can be distinguished from cancer by its positional shift from day to day. c. In nonlactating mothers, colostrum is present for the first few days after childbirth. d. If suckling is never begun or is discontinued, then lactation ceases within a few days to a week. e. Little change occurs to the breasts in the first 48 hours.

ANS: B - As lactation is established, a mass may form that can be distinguished from cancer by its positional shift from day to day. C - In nonlactating mothers, colostrum is present for the first few days after childbirth. D - If suckling is never begun or is discontinued, then lactation ceases within a few days to a week. Breasts become fuller and heavier as colostrum transitions to milk; this fullness should last 72 to 96 hours. The movable, noncancerous mass is a filled milk sac. Colostrum is present for a few days whether or not the mother breastfeeds. A mother who does not want to breastfeed should also avoid stimulating her nipples. Little change to the breasts occurs in the first 24 hours of childbirth.

Postpartum fatigue (PPF) is more than just feeling tired. It is a complex phenomenon affected by physiologic, psychologic, and situational variables. Which factors contribute to this phenomenon? (Select all that apply.) a. Precipitous labor b. Hospital routines c. Bottle feeding d. Anemia e. Excitement

ANS: B - Hospital routines D - Anemia E - Excitement Physical fatigue and exhaustion are often associated with a long labor or cesarean birth, hospital routines, breastfeeding, and infant care. PPF is also attributed to anemia, infection, or thyroid dysfunction. The excitement and exhilaration of delivering a new infant along with well-intentioned visitors may make rest difficult.

In the United States, the en face position is preferred immediately after birth. Which actions by the nurse can facilitate this process? (Select all that apply.) a. Washing both the infant's face and the mother's face b. Placing the infant on the mother's abdomen or breast with their heads on the same plane c. Dimming the lights d. Delaying the instillation of prophylactic antibiotic ointment in the infant's eyes e. Placing the infant in the grandmother's arms

ANS: B - Placing the infant on the mother's abdomen or breast with their heads on the same plane C - Dimming the lights D - Delaying the instillation of prophylactic antibiotic ointment in the infant's eyes As newborns become functionally able to sustain eye contact with their parents, they spend time in mutual gazing, often in the en face position, a position in which the faces of the parent and infant are approximately 20 cm apart and on the same plane. Washing the faces of the infant or mother is not necessary at this time and would interrupt the process. Nurses and physicians or midwives can facilitate eye contact immediately after birth by placing the infant on the mother's abdomen or breasts with the mother and the infant's faces on the same plane. Dimming the lights encourages the infant's eyes to stay open. To promote eye contact, the instillation of prophylactic antibiotic ointment into the infant's eyes can be delayed until after the infant and parents have had some time together during the first hour after birth. Having the grandmother hold the infant is important; however, it will not necessarily promote eye contact between the parent and infant.

Changes in blood volume after childbirth depend on several factors such as blood loss during childbirth and the amount of extravascular water (physiologic edema) mobilized and excreted. What amount of blood loss does the postpartum nurse anticipate? (Select all that apply.) a. 100 ml b. 250 ml or less c. 300 to 500 ml d. 500 to 1000 ml e. 1500 ml or greater

ANS: C - 300 to 500 ml D - 500 to 1000 ml The average blood loss for a vaginal birth of a single fetus ranges from 300 to 500 ml (10% of blood volume). The typical blood loss for women who gave birth by cesarean is 500 to 1000 ml (15% to 30% of blood volume). During the first few days after childbirth, the plasma volume further decreases as a result of diuresis. Pregnancy-induced hypervolemia (i.e., an increase in blood volume of at least 35%) allows most women to tolerate considerable blood loss during childbirth.

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. How would the nurse respond? a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." b. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." c. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." d. "Your baby will easily get cold stressed and needs to be bundled up at all times."

ANS: A - "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." Convection is the flow of heat from the body surface to cooler ambient air. Because of heat loss by convection, all newborns in open bassinets should be wrapped to protect them from the cold. Conduction is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn. Evaporation is a loss of heat that occurs when a liquid is converted into a vapor. In the newborn, heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Cold stress may occur from excessive heat loss; however, this does not imply that the infant will become stressed if not bundled at all times. Furthermore, excessive bundling may result in a rise in the infant's temperature.

Part of the health assessment of a newborn is observing the infant's breathing pattern. What is the predominate pattern of newborn's breathing? a. Abdominal with synchronous chest movements b. Chest breathing with nasal flaring c. Diaphragmatic with chest retraction d. Deep with a regular rhythm ANS: A - Abdominal with synchronous chest movements In a normal infant respiration, the chest and abdomen synchronously rise and infant breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is also a sign of respiratory distress.

ANS: A - Abdominal with synchronous chest movements In a normal infant respiration, the chest and abdomen synchronously rise and infant breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is also a sign of respiratory distress.

A new mother states that her infant must be cold because the baby's hands and feet are blue. This common and temporary condition is called what? a. Acrocyanosis b. Erythema toxicum neonatorum c. Harlequin sign d. Vernix caseosa

ANS: A - Acrocyanosis Acrocyanosis, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and intermittently appears over the first 7 to 10 days after childbirth. Erythema toxicum neonatorum (also called erythema neonatorum) is a transient newborn rash that resembles flea bites. The harlequin sign is a benign, transient color change in newborns. One half of the body is pale, and the other one half is ruddy or bluish-red with a line of demarcation. Vernix caseosa is a cheeselike, whitish substance that serves as a protective covering for the newborn.

When should discharge instruction, or the teaching plan that tells the woman what she needs to know to care for herself and her newborn, officially begin? a. At the time of admission to the nurse's unit b. When the infant is presented to the mother at birth c. During the first visit with the physician in the unit d. When the take-home information packet is given to the couple

ANS: A - At the time of admission to the nurse's unit Discharge planning, the teaching of maternal and newborn care, begins on the woman's admission to the unit, continues throughout her stay, and actually never ends as long as she has contact with medical personnel.

New parents express concern that because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. Which information should the nurse's response convey? a. Attachment, or bonding, is a process that occurs over time and does not require early contact. b. Time immediately after birth is a critical period for humans. c. Early contact is essential for optimal parent-infant relationships. d. These new parents should just be happy that the infant is healthy.

ANS: A - Attachment, or bonding, is a process that occurs over time and does not require early contact Attachment occurs over time and does not require early contact. Although a delay in contact does not necessarily mean that attachment is inhibited, additional psychologic energy may be necessary to achieve the same effect. The formerly accepted definition of bonding held that the period immediately after birth was critical for bonding to occur. Research since has indicated that parent-infant attachment occurs over time. A delay does not inhibit the process. Parent-infant attachment involves activities such as touching, holding, and gazing; it is not exclusively eye contact. Telling the parents that they should be happy that the infant is healthy is inappropriate; it may be received as derogatory and belittling

After delivery, excess hypertrophied tissue in the uterus undergoes a period of self-destruction. What is the correct term for this process? a. Autolysis b. Subinvolution c. Afterpains d. Diastasis

ANS: A - Autolysis Autolysis is caused by a decrease in hormone levels. Subinvolution is failure of the uterus to return to a nonpregnant state. Afterpains are caused by uterine cramps 2 to 3 days after birth. Diastasis refers to the separation of muscles.

In many hospitals, new mothers are routinely presented with gift bags containing samples of infant formula. This practice is inconsistent with what? a. Baby Friendly Hospital Initiative b. Promotion of longer periods of breastfeeding c. Perception of being supportive to both bottle feeding and breastfeeding mothers d. Association with earlier cessation of breastfeeding

ANS: A - Baby Friendly Hospital Initiative Infant formula should not be given to mothers who are breastfeeding. Such gifts are associated with early cessation of breastfeeding. Baby Friendly USA prohibits the distribution of any gift bags or formula to new mothers.

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby? a. Letting go b. Taking hold c. Taking in d. Taking on

ANS: A - Letting go Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go phase of maternal adjustment. During the taking-hold phase, the mother assumes responsibility for her own care and shifts her attention to the infant. In the taking-in phase, the mother is primarily focused on her own needs. A taking-on phase of maternal adjustment does not exist.

Rho immune globulin will be ordered postpartum if which situation occurs? a. Mother Rh-, baby Rh+ b. Mother Rh-, baby Rh- c. Mother Rh+, baby Rh+ d. Mother Rh+, baby Rh-

ANS: A - Mother Rh-, baby Rh+ An Rh- mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. If mother and baby are both Rh+ or Rh- the blood types are alike, so no antibody formation would be anticipated. If the Rh+ blood of the mother comes in contact with the Rh- blood of the infant, no antibodies would develop because the antigens are in the mother's blood, not in the infant's

When the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, what is the correct term for this behavior? a. Mutuality b. Bonding c. Claiming d. Acquaintance

ANS: A - Mutuality Mutuality extends the concept of attachment and includes a shared set of behaviors as part of the bonding process. Bonding is the process during which parents form an emotional attachment to their infant over time. Claiming is the process during which parents identify their new baby in terms of the infant's likeness to other family members and their differences and uniqueness. Similar to mutuality, acquaintance is part of attachment. It describes how parents get to know their baby during the immediate postpartum period through eye contact, touching, and talking

Several delivery changes in the integumentary system that appear during pregnancy disappear after birth, although not always completely. What change is almost certain to be completely reversed? a. Nail brittleness b. Darker pigmentation of the areolae and linea nigra c. Striae gravidarum on the breasts, abdomen, and thighs d. Spider nevi

ANS: A - Nail brittleness The nails return to their prepregnancy consistency and strength. Some women have permanent darker pigmentation of the areolae and linea nigra. Striae gravidarum (stretch marks) usually do not completely disappear. For some women, spider nevi persist indefinitely.

Which statement by the nurse can assist a new father in his transition to parenthood? a. Pointing out that the infant turned at the sound of his voice b. Encouraging him to go home to get some sleep c. Telling him to tape the infant's diaper a different way d. Suggesting that he let the infant sleep in the bassinet

ANS: A - Pointing out that the infant turned at the sound of his voice Infants respond to the sound of voices. Because attachment involves a reciprocal interchange, observing the interaction between parent and infant is very important. Separation of the parent and infant does not encourage parent-infant attachment. Educating the parent in infant care techniques is important, but the manner in which a diaper is taped is not relevant and does not enhance parent-infant interactions. Parent-infant attachment involves touching, holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby sleeps.

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data? a. Rubella vaccine should be administered. b. Blood transfusion is necessary. c. Rh immune globulin is necessary within 72 hours of childbirth. d. Kleihauer-Betke test should be performed.

ANS: A - Rubella vaccine should be administered. This client's rubella titer indicates that she is not immune and needs to receive a vaccine. These data do not indicate that the client needs a blood transfusion. Rh immune globulin is indicated only if the client has an Rh-negative status and the infant has an Rh-positive status. A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is suspected, especially if the mother is Rh negative. However, the data provided do not indicate a need for performing this test.

A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman's vital signs, which finding would be of greatest concern to the nurse? a. Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg b. Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg c. Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg d. Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg

ANS: A - Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg An EBL of 1500 ml with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss. Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg are normal vital signs except for an increased respiratory rate, which may be secondary to pain from the birth. Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg are normal vital signs except for the temperature, which may increase to 38° C during the first 24 hours as a result of the dehydrating effects of labor. Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg are normal vital signs, although the blood pressure is slightly elevated, which may be attributable to the use of oxytocic medications.

The nurse caring for a newborn checks the record to note clinical findings that occurred before her shift. Which finding related to the renal system would be of increased significance and require further action? a. The pediatrician should be notified if the newborn has not voided in 24 hours. b. Breastfed infants will likely void more often during the first days after birth. c. Brick dust or blood on a diaper is always cause to notify the physician. d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

ANS: A - The pediatrician should be notified if the newborn has not voided in 24 hours. A newborn who has not voided in 24 hours may have any of a number of problems, some of which deserve the attention of the pediatrician. Formula-fed infants tend to void more frequently in the first 3 days; breastfed infants will void less during this time because the mother's breast milk has not yet come in. Brick dust may be uric acid crystals; blood spotting could be attributable to the withdrawal of maternal hormones (pseudomenstruation) or a circumcision. The physician must be notified only if the cause of bleeding is not apparent. Weight loss from fluid loss might take 14 days to regain

A primiparous woman is to be discharged from the hospital the following day with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? a. The woman is disinterested in learning about infant care. b. The woman continues to hold and cuddle her infant after she has fed her. c. The woman reads a magazine while her infant sleeps. d. The woman changes her infant's diaper and then shows the nurse the contents of the diaper.

ANS: A - The woman is disinterested in learning about infant care. The client should be excited, happy, and interested or involved in infant care. A woman who is sad, tearful, or disinterested in caring for her infant may be exhibiting signs of depression or postpartum blues and may require further intervention. Holding and cuddling her infant after feeding is an appropriate parent-infant interaction. Taking time for herself while the infant is sleeping is an appropriate maternal action. Showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infant's elimination patterns.

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. What goal is the nurse attempting to achieve by performing this practice? a. To improve the accuracy of blood loss estimation, which usually is a subjective assessment b. To determine which pad is best c. To demonstrate that other nurses usually underestimate blood loss d. To reveal to the nurse supervisor that one of them needs some time off

ANS: A - To improve the accuracy of blood loss estimation, which usually is a subjective assessment Saturation of perineal pads is a critical indicator of excessive blood loss; anything done to help in the assessment is valuable. The nurse is noting the saturation volumes and soaking appearances. Instead of determining which pad is best, the nurse is more likely noting saturation volumes and soaking appearances to improve the accuracy of estimated blood loss. Nurses usually overestimate blood loss. Soaking perineal pads and writing down the results does not indicate the need for time off of work.

What is the correct term for the cheeselike, white substance that fuses with the epidermis and serves as a protective coating? a. Vernix caseosa b. Surfactant c. Caput succedaneum d. Acrocyanosis

ANS: A - Vernix caseosa The protection provided by vernix caseosa is needed because the infant's skin is so thin. Surfactant is a protein that lines the alveoli of the infant's lungs. Caput succedaneum is the swelling of the tissue over the presenting part of the fetal head. Acrocyanosis is cyanosis of the hands and feet, resulting in a blue coloring

A nurse notes that an Eskimo woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. While evaluating this client's behavior with her infant, what realization does the nurse make? a. What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits. b. The woman is inexperienced in caring for a newborn. c. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn. d. Extra time needs to be planned for assisting the woman in bonding with her newborn.

ANS: A - What appears to be a lack of interest in the newborn is, in fact, the cultural way of demonstrating intense love by attempting to ward off evil spirits. The nurse may observe an Eskimo mother who gives minimal care to her infant and refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is this cultural group's attempt to ward off evil spirits and actually reflects an intense love and concern for the infant. Inexperience in caring for newborns is not an issue. Cultural beliefs are important determinates of parenting behaviors. The woman's "lack of interest" is an Eskimo cultural behavior. Referring the woman to a social worker is not necessary in this situation. The lack of infant interaction is not a form of infant neglect; rather, it is a demonstration of love and concern for the infant. The nurse may observe the woman and may be concerned by the apparent lack of interest in the newborn when in fact her behavior is a cultural display of love and concern for the infant. Teaching the woman infant care is important, but acknowledging her cultural beliefs and practices is equally important.

Many first-time parents do not plan on having their parents' help immediately after the newborn arrives. Which statement by the nurse is the most appropriate when counseling new parents regarding the involvement of grandparents? a. "You should tell your parents to leave you alone." b. "Grandparents can help you with parenting skills." c. "Grandparent involvement can be very disruptive to the family." d. "They are getting old. You should let them be involved while they can."

ANS: B - "Grandparents can help you with parenting skills." Telling the parents that grandparents can help with parenting skills and therefore help preserve family traditions is the most appropriate response. Intergenerational help may be perceived as interference, but telling the parents that their parents should be told to leave them alone is not therapeutic to the adaptation of the family. Telling the parents that grandparent involvement can be disruptive to the family is an invalid statement and not an appropriate nursing response. Regardless of age, grandparents can help with parenting skills and preserve family traditions.

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What information provided by the nurse would be most useful to these new parents? a. "Infants can see very little until approximately 3 months of age." b. "Infants can track their parents' eyes and can distinguish patterns; they prefer complex patterns." c. "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes." d. "It's important to shield the newborn's eyes. Overhead lights help them see better."

ANS: B - "Infants can track their parents' eyes and can distinguish patterns; they prefer complex patterns." Telling the parents that infants can track their parents' eyes and can distinguish patterns is an accurate statement. Development of the visual system continues for the first 6 months of life. Visual acuity is difficult to determine, but the clearest visual distance for the newborn appears to be 19 cm. Infants prefer to look at complex patterns, regardless of the color. They prefer low illumination and withdraw from bright lights.

Which statement by a newly delivered woman indicates that she knows what to expect regarding her menstrual activity after childbirth? a. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." b. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." c. "I will not have a menstrual cycle for 6 months after childbirth." d. "My first menstrual cycle will be heavier than normal and then will be light for several months after."

ANS: B - "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles" is an accurate statement and indicates her understanding of her expected menstrual activity. She can expect her first menstrual cycle to be heavier than normal, which occurs by 3 months after childbirth, and the volume of her subsequent cycles will return to prepregnant levels within three to four cycles.

A primiparous woman is watching her newborn sleep. She wants him to wake up and respond to her. The mother asks the nurse how much he will sleep every day. What is an appropriate response by the nurse? a. "He will only wake up to be fed, and you should not bother him between feedings." b. "The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing." c. "He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon." d. "He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night."

ANS: B - "The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing." Telling the woman that the newborn sleeps approximately 17 hours a day with periods of wakefulness that gradually increase is both accurate and the most appropriate response by the nurse. Periods of wakefulness are dictated by hunger, but the need for socializing also appears. Telling the woman that her infant is stubborn and should be kept awake during the daytime is an inappropriate nursing response.

Which client is most likely to experience strong and uncomfortable afterpains? a. A woman who experienced oligohydramnios b. A woman who is a gravida 4, para 4-0-0-4 c. A woman who is bottle-feeding her infant d. A woman whose infant weighed 5 pounds, 3 ounces

ANS: B - A woman who is a gravida 4, para 4-0-0-4 Afterpains are more common in multiparous women. In a woman who experienced polyhydramnios, afterpains are more noticeable because the uterus was greatly distended. Breastfeeding may cause the afterpains to intensify. In a woman who delivered a large infant, afterpains are more noticeable because the uterus was greatly distended

Which statement regarding the postpartum uterus is correct? a. At the end of the third stage of labor, the postpartum uterus weighs approximately 500 g. b. After 2 weeks postpartum, it should be abdominally nonpalpable. c. After 2 weeks postpartum, it weighs 100 g. d. Postpartum uterus returns to its original (prepregnancy) size by 6 weeks postpartum.

ANS: B - After 2 weeks postpartum, it should be abdominally nonpalpable. The uterus does not return to its original size. At the end of the third stage of labor, the uterus weighs approximately 1000 g. After 2 weeks postpartum, the uterus weighs approximately 350 g. The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

Which information about variations in the infant's blood counts is important for the nurse to explain to the new parents? a. A somewhat lower-than-expected red blood cell count could be the result of a delay in clamping the umbilical cord. b. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease. c. Platelet counts are higher in the newborn than in adults for the first few months. d. Even a modest vitamin K deficiency means a problem with the blood's ability to properly clot.

ANS: B - An early high white blood cell (WBC) count is normal at birth and should rapidly decrease. The WBC count is normally high on the first day of birth and then rapidly declines. Delayed cord clamping results in an increase in hemoglobin and the red blood cell count. The platelet count is essentially the same for newborns and adults. Clotting is sufficient to prevent hemorrhage unless the deficiency of vitamin K is significant.

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment, the nurse notices that both breasts are swollen, warm, and tender on palpation. Which guidance should the nurse provide to the client at this time? a. Run warm water on her breasts during a shower. b. Apply ice to the breasts for comfort. c. Express small amounts of milk from the breasts to relieve the pressure. d. Wearing a loose-fitting bra to prevent nipple irritation

ANS: B - Apply ice to the breasts for comfort. Applying ice packs and cabbage leaves to the breasts for comfort is an appropriate intervention for treating engorgement in a mother who is bottle feeding. The ice packs should be applied for 15 minutes on and 45 minutes off to avoid rebound engorgement. A bottle-feeding mother should avoid any breast stimulation, including pumping or expressing milk. A bottle-feeding mother should continuously wear a well-fitted support bra or breast binder for at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation.

When caring for a newly delivered woman, what is the best measure to prevent abdominal distention after a cesarean birth? a. Rectal suppositories b. Early and frequent ambulation c. Tightening and relaxing abdominal muscles d. Carbonated beverages

ANS: B - Early and frequent ambulation Activity will aid the movement of accumulated gas in the gastrointestinal tract. Rectal suppositories can be helpful after distention occurs; however, they do not prevent it. Ambulation is the best prevention. Carbonated beverages may increase distention.

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the client place the infant to her breast within 15 minutes after birth. The nurse is aware that the initiation of breastfeeding is most effective during the first 30 minutes after birth. What is the correct term for this phase of alertness? a. Transition period b. First period of reactivity c. Organizational stage d. Second period of reactivity

ANS: B - First period of reactivity The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase. The transition period is the phase between intrauterine and extrauterine existence. An organizational stage is not a valid stage. The second period of reactivity occurs approximately between 4 and 8 hours after birth, after a period of sleep.

In addition to eye contact, other early sensual contacts between the infant and mother involve sound and smell. What other statement regarding the senses is correct? a. High-pitched voices irritate newborns. b. Infants can learn to distinguish their mother's voice from others soon after birth. c. All babies in the hospital smell alike. d. Mother's breast milk has no distinctive odor.

ANS: B - Infants can learn to distinguish their mother's voice Infants know the sound of their mother's voice at an early age. Infants positively respond to high-pitched voices. Each infant has a unique odor. Infants quickly learn to distinguish the odor of their mother's breast milk.

Which statement best describes the transition period between intrauterine and extrauterine existence for the newborn? a. Consists of four phases, two reactive and two of decreased responses b. Lasts from birth to day 28 of life c. Applies to full-term births only d. Varies by socioeconomic status and the mother's age

ANS: B - Lasts from birth to day 28 of life Changes begin immediately after birth; the cutoff time when the transition is considered over (although the baby keeps changing) is 28 days. This transition period has three phases: first reactivity, decreased response, and second reactivity. All newborns experience this transition period, regardless of age or type of birth. Although stress can cause variations in the phases, the mother's age and wealth do not disturb the pattern

The postpartum woman continually repeats the story of her labor, delivery, and recovery experience. What is this new mother attempting to achieve with this behavior? a. Providing others with her knowledge of events b. Making the birth experience real c. Taking hold of the events leading up to her labor and delivery d. Accepting her response to labor and delivery

ANS: B - Making the birth experience real Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual. The retelling of the story satisfies her needs, not the needs of others. This new mother is in the taking-in phase, trying to make the birth experience seem real and separate the infant from herself.

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which is a facilitating behavior? a. Parents have difficulty naming the infant. b. Parents hover around the infant, directing attention to and pointing at the infant. c. Parents make no effort to interpret the actions or needs of the infant. d. Parents do not move from fingertip touch to palmar contact and holding.

ANS: B - Parents hover around the infant, directing attention to and pointing at the infant. Hovering over the infant and obviously paying attention to the baby are facilitating behaviors. Inhibiting behaviors include difficulty naming the infant, making no effort to interpret the actions or needs of the infant, and not moving from fingertip touch to palmar contact and holding.

The postpartum nurse should be cognizant of what with regard to the adaptation of other family members (primarily siblings and grandparents) to the newborn? a. Sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviors can take a long time to blow over. b. Participation in preparation classes helps both siblings and grandparents. c. In the United States, paternal and maternal grandparents consider themselves of equal importance and status. d. Since 1990, the number of grandparents providing permanent care to their grandchildren has been declining.

ANS: B - Participation in preparation classes helps both siblings and grandparents. Preparing older siblings, as well as grandparents, helps with everyone's adaptation. Sibling rivalry should be initially expected, but the negative behaviors associated with it have been overemphasized and stop in a comparatively short time. In the United States, in contrast to other cultures, paternal grandparents frequently consider themselves secondary to maternal grandparents. The number of grandparents providing permanent child care has been rising.

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment after childbirth. Recognizing the needs of women during this stage, how should the nurse respond? a. Foster an active role in the baby's care. b. Provide time for the mother to reflect on the events of her labor and delivery. c. Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session while she is in the hospital. d. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

ANS: B - Provide time for the mother to reflect on the events of her labor and delivery. During this stage, the new mother is excited and talkative. It is important that she be able to fulfill her desire to review her birth experience. During this stage, the new mother still relies upon others to meet her physical needs. Once these are met, she will be more able to take an active role, not only in her own care but also in the care of her newborn, which happens during the taking-hold stage. Short teaching sessions, using written materials to reinforce the content presented, is a more effective approach. The focus of the taking-in or dependency stage is to nurture the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.

The nurse should be cognizant of which postpartum physiologic alteration? a. Cardiac output, pulse rate, and stroke volume all return to prepregnancy normal values within a few hours of childbirth. b. Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth. c. Lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections. d. Hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth.

ANS: B - Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth. Respirations should decrease to within the woman's normal prepregnancy range by 6 to 8 weeks after childbirth. Stroke volume increases and cardiac output remains high for a couple of days. However, the heart rate and blood pressure quickly return to normal. Leukocytosis increases 10 to 12 days after childbirth, which can obscure the diagnosis of acute infections, producing false-negative test results. The hypercoagulable state increases the risk of thromboembolism, especially after a cesarean birth

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? a. The postpartum woman talks and coos to her son. b. She seldom makes eye contact with her son. c. The mother cuddles her son close to her. d. She tells visitors how well her son is feeding.

ANS: B - She seldom makes eye contact with her son. The mother should be encouraged to hold her infant in the en face position and make eye contact with the infant. Normal infant-parent interactions include talking and cooing to her son, cuddling her son close to her, and telling visitors how well her son is feeding.

The nurse observes that a first-time mother appears to ignore her newborn. Which strategy should the nurse use to facilitate mother-infant attachment? a. Tell the mother she must pay attention to her infant. b. Show the mother how the infant initiates interaction and attends to her. c. Demonstrate for the mother different positions for holding her infant while feeding. d. Arrange for the mother to watch a video on parent-infant interaction.

ANS: B - Show the mother how the infant initiates interaction and attends to her. Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment. Telling the mother that she must pay attention to her infant may be perceived as derogatory and is not appropriate. Educating the young mother in infant care is important, but pointing out the responsiveness of her baby is a better tool for facilitating mother-infant attachment. Videos are an educational tool that can demonstrate parent-infant attachment, but encouraging the mother to recognize the infant's responsiveness is more appropriate.

Which description of postpartum restoration or healing times is accurate? a. The cervix shortens, becomes firm, and returns to form within a month postpartum. b. Vaginal rugae reappear by 3 weeks postpartum. c. Most episiotomies heal within a week. d. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

ANS: B - Vaginal rugae reappear by 3 weeks postpartum. Vaginal rugae reappear by 3 weeks postpartum; however, they are never as prominent as in nulliparous women. The cervix regains its form within days; the cervical os may take longer. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size

What information should the nurse understand fully regarding rubella and Rh status? a. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus. b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination. c. Rh immunoglobulin is safely administered intravenously because it cannot harm a nursing infant. d. Rh immunoglobulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

ANS: B - Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination. Women should understand that they must practice contraception for at least 1 month after being vaccinated. Because the live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated. Rh immunoglobulin is administered intramuscular (IM); it should never be administered to an infant. Rh immunoglobulin suppresses the immune system and therefore might thwart the rubella vaccination

The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse range (in beats per minute)? a. 80 to 100 b. 100 to 120 c. 120 to 160 d. 150 to 180

ANS: C - 120 to 160 The average infant heart rate while awake is 120 to 160 beats per minute. The newborn's heart rate may be approximately 85 to 100 beats per minute while sleeping and typically a little higher than 100 to 120 beats per minute when alert but quiet. A heart rate of 150 to 180 beats per minute is typical when the infant cries.

Under the Newborns' and Mothers' Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth. What is the correct interpretation of this legislation? a. 24; 72 b. 24; 96 c. 48; 96 d. 48; 120

ANS: C - 48; 96 The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge. A client may be discharged either 24 hours after a vaginal birth or 72 hours after a cesarean birth if she is stable and her provider is in agreement. A client is unlikely to remain in the hospital for 120 hours after a cesarean birth unless complications have developed.

A nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad's. This statement is most descriptive of which process? a. Mutuality b. Synchrony c. Claiming d. Reciprocity

ANS: C - Claiming Claiming refers to the process by which the child is identified in terms of likeness to other family members. Mutuality occurs when the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics. Synchrony refers to the "fit" between the infant's cues and the parent's responses. Reciprocity is a type of body movement or behavior that provides the observer with cues.

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink papular rash with vesicles superimposed on the thorax, back, and abdomen. What action is the highest priority for the nurse to take at this time? a. Immediately notify the physician. b. Move the newborn to an isolation nursery. c. Document the finding as erythema toxicum neonatorum. d. Take the newborn's temperature, and obtain a culture of one of the vesicles.

ANS: C - Document the finding as erythema toxicum neonatorum. Erythema toxicum neonatorum (or erythema neonatorum) is a newborn rash that resembles flea bites. Notification of the physician, isolation of the newborn, or additional interventions are not necessary when erythema toxicum neonatorum is present

Which statement, related to the reconditioning of the urinary system after childbirth, should the nurse understand? a. Kidney function returns to normal a few days after birth. b. Diastasis recti abdominis is a common condition that alters the voiding reflex. c. Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium. d. With adequate emptying of the bladder, bladder tone is usually restored 2 to 3 weeks after childbirth.

ANS: C - Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium. Excess fluid loss through other means besides perspiration and increased urinary output occurs as well. Kidney function usually returns to normal in approximately 1 month. Diastasis recti abdominis is the separation of muscles in the abdominal wall and has no effect on the voiding reflex. Bladder tone is usually restored 5 to 7 days after childbirth

Which documentation on a woman's chart on postpartum day 14 indicates a normal involution process? a. Moderate bright red lochial flow b. Breasts firm and tender c. Fundus below the symphysis and nonpalpable d. Episiotomy slightly red and puffy

ANS: C - Fundus below the symphysis and nonpalpable The fundus descends 1 cm per day; consequently, it is no longer palpable by postpartum day 14. The lochia should be changed by this day to serosa. Breasts are not part of the involution process. The episiotomy should not be red or puffy at this stage

While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a clunk when performing the Ortolani maneuver. These findings are likely indicative of what? a. Polydactyly b. Clubfoot c. Hip dysplasia d. Webbing

ANS: C - Hip dysplasia The Ortolani maneuver is used to detect the presence of hip dysplasia. Polydactyly is the presence of extra digits. Clubfoot (talipes equinovarus) is a deformity in which the foot turns inward and is fixed in a plantar-flexion position. Webbing, or syndactyly, is a fusing of the fingers or toes.

Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is experiencing? a. Elevated temperature caused by postpartum infection b. Increased basal metabolic rate after giving birth c. Loss of increased blood volume associated with pregnancy d. Increased venous pressure in the lower extremities

ANS: C - Loss of increased blood volume associated with pregnancy Within 12 hours of birth, women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. An elevated temperature causes chills and possibly dehydration, not diaphoresis and diuresis. Diaphoresis and diuresis are sometimes referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.

A newborn is placed under a radiant heat warmer. The nurse understands that thermoregulation presents a problem for the newborn. What is the rationale for this difficulty? a. The renal function of a newborn is not fully developed, and heat is lost in the urine. b. The small body surface area of a newborn favors more rapid heat loss than does an adult's body surface area. c. Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation. d. Their normal flexed posture favors heat loss through perspiration.

ANS: C - Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation. The newborn has little thermal insulation. Furthermore, the blood vessels are closer to the surface of the skin. Changes in environmental temperature alter the temperature of the blood, thereby influencing temperature regulation centers in the hypothalamus. Heat loss does not occur through urination. Newborns have a higher body surface-to-weight ratio than adults. The flexed position of the newborn helps guard against heat loss, because it diminishes the amount of body surface exposed to the environment

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, approximately 500,000 women in America experience a more severe syndrome known as PPD. Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis? a. PPD symptoms are consistently severe. b. This syndrome affects only new mothers. c. PPD can easily go undetected. d. Only mental health professionals should teach new parents about this condition.

ANS: C - PPD can easily go undetected. PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having both good and bad days. PPD may also affect new fathers. Therefore, both mothers and fathers should be screened. The nurse should include information on PPD and how to differentiate it from the baby blues for all clients before discharge. Nurses can also urge new parents to report symptoms and to seek follow-up care promptly if symptoms occur.

What marks on a baby's skin may indicate an underlying problem that requires notification of a physician? a. Mongolian spots on the back b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infant's body d. Erythema toxicum neonatorum anywhere on the body

ANS: C - Petechiae scattered over the infant's body Petechiae (bruises) scattered over the infant's body should be reported to the pediatrician because they may indicate underlying problems. Mongolian spots are bluish-black spots that resemble bruises but gradually fade over months and have no clinical significance. Telangiectatic nevi (stork bites, angel kisses) fade by the second year and have no clinical significance. Erythema toxicum neonatorum is an appalling-looking rash; however, it has no clinical significance and requires no treatment

During a telephone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" Which condition might this new mother be experiencing? a. Letting-go b. Postpartum depression (PPD) c. Postpartum blues d. Attachment difficulty

ANS: C - Postpartum blues During the postpartum blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth postpartum day. The letting-go phase is the period that occurs several weeks after childbirth. During this phase the woman wants to move forward as a family unit with all members, appropriately interacting to their new roles. PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the postpartum blues. Crying is not a maladaptive attachment response; it indicates postpartum blues

Postpartum overdistention of the bladder and urinary retention can lead to which complications? a. Postpartum hemorrhage and eclampsia b. Fever and increased blood pressure c. Postpartum hemorrhage and urinary tract infection d. Urinary tract infection and uterine rupture

ANS: C - Postpartum hemorrhage and urinary tract infection Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle, thus leading to postpartum hemorrhage. No correlation exists between bladder distention and high blood pressure or eclampsia. The risk of uterine rupture decreases after the birth of the infant.

Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman? a. Estrogen b. Progesterone c. Prolactin d. Human placental lactogen

ANS: C - Prolactin Prolactin levels in the blood progressively increase throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen levels decrease significantly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. Progesterone levels decrease significantly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period. Human placental lactogen levels dramatically decrease after expulsion of the placenta.

What should the nurse's next action be if the client's white blood cell (WBC) count is 25,000/mm3 on her second postpartum day? a. Immediately inform the physician. b. Have the laboratory draw blood for reanalysis. c. Recognize that this count is an acceptable range at this point postpartum. d. Immediately begin antibiotic therapy.

ANS: C - Recognize that this count is an acceptable range at this point postpartum. During the first 10 to 12 days after childbirth, WBC values between 20,000 and 25,000/mm3 are common. Because a WBC count of 25,000/mm3 on her second postpartum day is normal, alerting the physician is not warranted nor is reassessment or antibiotics needed; the WBC count is not elevated.

Which information related to the newborn's developing cardiovascular system should the nurse fully comprehend? a. The heart rate of a crying infant may rise to 120 beats per minute. b. Heart murmurs heard after the first few hours are a cause for concern. c. The point of maximal impulse (PMI) is often visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).

ANS: C - The point of maximal impulse (PMI) is often visible on the chest wall. The newborn's thin chest wall often allows the PMI to be observed. The normal heart rate for infants who are not sleeping is 120 to 160 beats per minute. However, a crying infant could temporarily have a heart rate of 180 beats per minute. Heart murmurs during the first few days of life have no pathologic significance; however, an irregular heart rate beyond the first few hours should be further evaluated. Persistent tachycardia may indicate RDS; bradycardia may be a sign of congenital heart blockage

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. Which response by the client alerts the nurse that psychosocial outcomes have not been met? a. The woman excessively discusses her labor and birth experience. b. The woman feels that her baby is more attractive and clever than any others. c. The woman has not given the baby a name. d. The woman has a partner or family members who react very positively about the baby.

ANS: C - The woman has not given the baby a name. If the mother is having difficulty naming her new infant, it may be a signal that she is not adapting well to parenthood. Other red flags include a refusal to hold or feed the baby, a lack of interaction with the infant, and becoming upset when the baby vomits or needs a diaper change. A new mother who is having difficulty is unwilling to discuss her labor and birth experience. An appropriate nursing diagnosis might be Impaired parenting, related to a long, difficult labor or unmet expectations of birth. A mother who is willing to discuss her birth experience is making a healthy personal adjustment. The mother who is not coping well finds her baby unattractive and messy. She may also be overly disappointed in the baby's sex. The client might voice concern that the baby reminds her of a family member whom she does not like. Having a partner and/or other family members react positively is an indication that this new mother has a good support system in place. This support system helps reduce anxiety related to her new role as a mother.

Pelvic floor exercises, also known as Kegel exercises, will help to strengthen the perineal muscles and encourage healing after childbirth. The nurse requests the client to repeat back instructions for this exercise. Which response by the client indicates successful learning? a. "I contract my thighs, buttocks, and abdomen." b. "I perform 10 of these exercises every day." c. "I stand while practicing this new exercise routine." d. "I pretend that I am trying to stop the flow of urine in midstream."

ANS: D - "I pretend that I am trying to stop the flow of urine in midstream." The woman can pretend that she is attempting to stop the passing of gas or the flow of urine midstream, which will replicate the sensation of the muscles drawing upward and inward. Each contraction should be as intense as possible without contracting the abdomen, buttocks, or thighs. Guidelines suggest that these exercises should be performed 24 to 100 times per day. Positive results are shown with a minimum of 24 to 45 repetitions per day. The best position to learn Kegel exercises is to lie supine with the knees bent. A secondary position is on the hands and knees.

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. What is the nurse's most appropriate response? a. "Didn't you like your lunch?" b. "Does your physician know that you are planning to eat that?" c. "What is that anyway?" d. "I'll warm the soup in the microwave for you."

ANS: D - "I'll warm the soup in the microwave for you." Offering to warm the food shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response. Cultural dietary preferences must be respected. Women may request that family members bring favorite or culturally appropriate foods to the hospital. Asking the woman to identify her food does not show cultural sensitivity

Parents who have not already done so need to make time for newborn follow-up of the discharge. According to the American Academy of Pediatrics (AAP), when should a breastfeeding infant first need to be seen for a follow-up examination? a. 2 weeks of age b. 7 to 10 days after childbirth c. 4 to 5 days after hospital discharge d. 48 to 72 hours after hospital discharge

ANS: D - 48 to 72 hours after hospital discharge Breastfeeding infants are routinely seen by the pediatric health care provider clinic within 3 to 5 days after birth or 48 to 72 hours after hospital discharge and again at 2 weeks of age. Formula-feeding infants may be seen for the first time at 2 weeks of age.

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As the nurse prepares her for discharge, she begins to cry. The nurse's next action should be what? a. Assess her for pain. b. Point out how lucky she is to have a healthy baby. c. Explain that she is experiencing postpartum blues. d. Allow her time to express her feelings.

ANS: D - Allow her time to express her feelings. Although many women experience transient postpartum blues, they need assistance in expressing their feelings. Postpartum blues affects 50% to 80% of new mothers. An assumption that the client is in pain should not be made when, in fact, she may have no pain whatsoever. Making this assumption would be blocking communication and inappropriate in this situation. The client needs the opportunity to express her feelings first; client teaching can occur later

While providing routine mother-baby care, which activities should the nurse encourage to facilitate the parent-infant attachment? a. The baby is able to return to the nursery at night so that the new mother can sleep. b. Routine times for care are established to reassure the parents. c. The father should be encouraged to go home at night to prepare for discharge of the mother and baby. d. An environment that fosters as much privacy as possible should be created.

ANS: D - An environment that fosters as much privacy as possible should be created. Care providers need to knock before gaining entry. Nursing care activities should be grouped. Once the baby has demonstrated an adjustment to extrauterine life (either in the mother's room or the transitional nursery), all care should be provided in one location. This important principle of family-centered maternity care fosters attachment by offering parents the opportunity to learn about their infant 24 hours a day. One nurse should provide care to both mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to return to the nursery at night. In fact, the mother will sleep better with the infant close by. Care should be individualized to meet the parents' needs, not the routines of the staff. Teaching goals should be developed in collaboration with the parents. The father or significant other should be permitted to sleep in the room with the mother. The maternity unit should develop policies that allow for the presence of significant others as much as the new mother desires.

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? a. Notify the physician of an impending hemorrhage. b. Assess the blood pressure and pulse. c. Evaluate the lochia. d. Assist the client in emptying her bladder.

ANS: D - Assist the client in emptying her bladder. Urinary retention may cause overdistention of the urinary bladder, which lifts and displaces the uterus. Nursing actions need to be implemented before notifying the physician. Evaluating blood pressure, pulse, and lochia is important if the bleeding continues; however, the focus at this point is to assist the client in emptying her bladder

After birth, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as what? a. Entrainment b. Reciprocity c. Synchrony d. Biorhythmicity

ANS: D - Biorhythmicity The newborn is in rhythm with the mother. The infant develops a personal biorhythm with the parents' help over time. Entrainment is the movement of a newborn in time to the structure of adult speech. Reciprocity is body movement or behavior that gives cues to the person's desires. These take several weeks to develop with a new baby. Synchrony is the fit between the infant's behavioral cues and the parent's responses.

A client is concerned that her breasts are engorged and uncomfortable. What is the nurse's explanation for this physiologic change? a. Overproduction of colostrum b. Accumulation of milk in the lactiferous ducts and glands c. Hyperplasia of mammary tissue d. Congestion of veins and lymphatic vessels

ANS: D - Congestion of veins and lymphatic vessels Breast engorgement is caused by the temporary congestion of veins and lymphatic vessels. An overproduction of colostrum, an accumulation of milk in the lactiferous ducts and glands, and hyperplasia of mammary tissue do not cause breast engorgement.

Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium? a. Varicosities of the legs b. Carpal tunnel syndrome c. Periodic numbness and tingling of the fingers d. Headaches

ANS: D - Headaches Headaches in the postpartum period can have a number of causes, some of which deserve medical attention. Total or nearly total regression of varicosities is expected after childbirth. Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. Periodic numbness of the fingers usually disappears after childbirth unless carrying the baby aggravates the condition.

A new father states, "I know nothing about babies"; however, he seems to be interested in learning. How would the nurse best respond to this father? a. Continue to observe his interaction with the newborn. b. Tell him when he does something wrong. c. Show no concern; he will learn on his own. d. Include him in teaching sessions.

ANS: D - Include him in teaching sessions. The nurse must be sensitive to the father's needs and include him whenever possible. As fathers take on their new role, the nurse should praise every attempt, even if his early care is awkward. Although noting the bonding process of the mother and the father is important, it does not satisfy the expressed needs of the father. The new father should be encouraged to care for his baby by pointing out the things that he does right. Criticizing him will discourage him

What is the most critical physiologic change required of the newborn after birth? a. Closure of fetal shunts in the circulatory system b. Full function of the immune defense system c. Maintenance of a stable temperature d. Initiation and maintenance of respirations

ANS: D - Initiation and maintenance of respirations The most critical adjustment of a newborn at birth is the establishment of respirations. The cardiovascular system changes significantly after birth as a result of fetal respirations, which reduce pulmonary vascular resistance to the pulmonary blood flow and initiate a chain of cardiac changes that support the cardiovascular system. After the establishment of respirations, heat regulation is critical to newborn survival. The infant relies on passive immunity received from the mother for the first 3 months of life.

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? a. Pouring water from a squeeze bottle over the woman's perineum b. Placing oil of peppermint in a bedpan under the woman c. Asking the physician to prescribe analgesic agents d. Inserting a sterile catheter

ANS: D - Inserting a sterile catheter Invasive procedures are usually the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills). Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried first. The oil of peppermint releases vapors that may relax the necessary muscles. It, too, is easy, noninvasive, and should be tried early on. If the woman is anticipating pain from voiding, then pain medications may be helpful. Other nonmedical means should be tried first, but medications still come before the insertion of a catheter.

The nurse is providing instruction to the newly delivered client regarding postbirth uterine and vaginal discharge, called lochia. Which statement is the most appropriate? a. Lochia is similar to a light menstrual period for the first 6 to 12 hours. b. It is usually greater after cesarean births. c. Lochia will usually decrease with ambulation and breastfeeding. d. It should smell like normal menstrual flow unless an infection is present.

ANS: D - It should smell like normal menstrual flow unless an infection is present. An offensive odor usually indicates an infection. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia is usually seen after cesarean births and usually increases with ambulation and breastfeeding.

The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth. Which scenario is not a contributor to this model of care? a. Wellness orientation model of care rather than a sick-care model b. Desire to reduce health care costs c. Consumer demand for fewer medical interventions and more family-focused experiences d. Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

ANS: D - Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information Nursing time and care are in demand as much as ever; the nurse simply has to do things more quickly. A wellness orientation model of care seems to focus on getting clients out the door sooner. In most cases, less hospitalization results in lower costs. People believe that the family gives more nurturing care than the institution.

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse expect to find when evaluating this client? a. Lochia rubra b. Lochia sangra c. Lochia alba d. Lochia serosa

ANS: D - Lochia serosa Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth. Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown. Lochia sangra is not a real term. Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurse's highest priority at this time? a. Beginning an intravenous (IV) infusion of Ringer's lactate solution b. Assessing the woman's vital signs c. Calling the woman's primary health care provider d. Massaging the woman's fundus

ANS: D - Massaging the woman's fundus The nurse should first assess the uterus for atony by massaging the woman's fundus. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be the nurse's first action. The physician would be notified after the nurse completes the assessment of the woman.

An African-American woman noticed some bruises on her newborn daughter's buttocks. The client asks the nurse what causes these. How would the nurse best explain this integumentary finding to the client? a. Lanugo b. Vascular nevus c. Nevus flammeus d. Mongolian spot

ANS: D - Mongolian spot A Mongolian spot is a bluish-black area of pigmentation that may appear over any part of the exterior surface of the infant's body and is more commonly noted on the back and buttocks and most frequently observed on infants whose ethnic origins are Mediterranean, Latin American, Asian, or African. Lanugo is the fine, downy hair observed on a term newborn. A vascular nevus, commonly called a strawberry mark, is a type of capillary hemangioma. A nevus flammeus, commonly called a port wine stain, is most frequently found on the face.

After giving birth to a healthy infant boy, a primiparous client, 16 years of age, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "Deficient knowledge of infant care." What should the nurse be certain to include in the plan of care as he or she prepares the client for discharge? a. Teach the client how to feed and bathe her infant. b. Give the client written information on bathing her infant. c. Advise the client that all mothers instinctively know how to care for their infants. d. Provide time for the client to bathe her infant after she views a demonstration of infant bathing.

ANS: D - Provide time for the client to bathe her infant after she views a demonstration of infant bathing. Having the mother demonstrate infant care is a valuable method of assessing the client's understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child. Although verbalizing how to care for the infant is a form of client education or providing written information might be useful, neither is the most developmentally appropriate teaching method for a teenage mother. Advising the young woman that all mothers instinctively know how to care for their infants is inappropriate; it is belittling and false.

Which term best describes the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state? a. Involutionary period because of what happens to the uterus b. Lochia period because of the nature of the vaginal discharge c. Mini-tri period because it lasts only 3 to 6 weeks d. Puerperium, or fourth trimester of pregnancy

ANS: D - Puerperium, or fourth trimester of pregnancy The puerperium, also called the fourth trimester or the postpartum period of pregnancy, is the final period of pregnancy and lasts approximately 3 to 6 weeks. Involution marks the end of the puerperium. Lochia refers to the various vaginal discharges during the puerperium

A 30-year-old multiparous woman has a boy who is years old and has recently delivered an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home." Which suggestion would assist this new mother in alleviating sibling rivalry? a. Tell the older child that he is a big boy now and should love his new sister. b. Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn. c. Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him. d. Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time.

ANS: D - Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time. The older child may regress in habits or behaviors (e.g., toileting, sleep habits) as a method of seeking attention. Parents need to distribute their attention in an equitable manner. Telling the older child that he should love his new sister is a negative approach to facilitating sibling acceptance of the new infant. Reactions of siblings may result from temporary separation from the mother. Removing the older child from the home when the new infant arrives may enhance negative behaviors from the older child caused by a separation from the mother. Providing small gifts from the infant to the older child is a strategy for facilitating sibling acceptance of the new infant.

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. How should the nurse react to this situation? a. Report the incident to the social services department. b. Advise the parents that the toddler needs to be reprimanded. c. Report to oncoming staff that the mother is probably not a good disciplinarian. d. Realize that this is a normal family unit adjusting to a major family change.

ANS: D - Realize that this is a normal family unit adjusting to a major family change. The observed behaviors are normal variations of a family adjusting to change. Reporting this one incident is not needed. Offering advice at this point would make the parents feel inadequate.

A client asks the nurse when her ovaries will begin working again. Which explanation by the nurse is most accurate? a. Almost 75% of women who do not breastfeed resume menstruating within 1 month after birth. b. Ovulation occurs slightly earlier for breastfeeding women. c. Because of menstruation and ovulation schedules, contraception considerations can be postponed until after the puerperium. d. The first menstrual flow after childbirth usually is heavier than normal.

ANS: D - The first menstrual flow after childbirth usually is heavier than normal. The first flow is heavier, but within three or four cycles, the flow is back to normal. Ovulation can occur within the first month, but for 70% of nonlactating women, it returns in approximately 3 months. Women who are breastfeeding take longer to resume ovulation. Because many women ovulate before their first postpartum menstrual period, contraceptive options need to be discussed early in the puerperium.

In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior? a. The infant cries only when hungry or wet. b. The infant's activity is somewhat predictable. c. The infant clings to the parents. d. The infant seeks attention from any adult in the room.

ANS: D - The infant seeks attention from any adult in the room. Parents want to be the focus of the infant's existence, just as the infant is the focus of their existence. Facilitating and inhibiting behaviors build or discourage bonding (attitudes); they do not reflect any value judgments on what might be healthy or unhealthy. The infant who shows no preference for his or her parents over other adults is exhibiting an inhibiting behavior. An infant who cries only when hungry or wet is exhibiting a facilitating behavior. An infant who has a predictable attention span is exhibiting a facilitating behavior. The infant who clings to his or her parents, enjoys being cuddled and held, and is easily consoled is displaying facilitating behaviors.

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath three times daily, and a stool softener. Which information regarding the client's condition is most closely correlated with these orders? a. Woman is a gravida 2, para 2. b. Woman had a vacuum-assisted birth. c. Woman received epidural anesthesia. d. Woman has an episiotomy.

ANS: D - Woman has an episiotomy. These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids. A multiparous classification is not an indication for these orders. A vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate these interventions. The use of an epidural anesthesia has no correlation with these orders.