Ob midterm

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The hormones that inhibit breast response to prolactin and prevent milk production are _______________, ________________, and ________________

estrogen, progesterone, human chorionic somatomammotropin

What are three characteristics of effective uterine activity?

coordinated, strong enough, numerous enough to propel the fetus through the woman's pelvis

During the second postpartum day, a woman asks the nurse, "Why are my afterpains so much worse this time than after the birth of my other child?" The best answer by the nurse would be: a. "Most women forget how strong the afterpains can be." b. "They should not be strong with you because you are breastfeeding." c. "You should not be feeling the pains now; I will notify the physician for you." d. "Afterpains are more severe for women who have already given birth."

d. "Afterpains are more severe for women who have already given birth." Afterpains are more acute for multiparas because repeated stretching of muscle fibers leads to low muscle tone, which results in repeated contraction and relaxation of the uterus. Breastfeeding increases the severity of afterpains. The afterpains are self-limiting and will decrease rapidly after 48 hours.

A woman having her first baby has been observed for 2 hours for labor but is having false labor contractions. Choose the most appropriate teaching before she returns home. a. "It is unlikely that your labor will be fast, so you can stay home until your water breaks." b. "If your water breaks, you can wait until contractions are 5 minutes apart or closer." c. "As long as the baby is active, there is no hurry to return to the birth center." d. "Your contractions will usually be 5 minutes apart or closer for 1 hour if labor is really happening."

d. "Your contractions will usually be 5 minutes apart or closer for 1 hour if labor is really happening."

The maximum length of time that formula should be kept in a refrigerator after preparation is: a. 12 hours. b. 24 hours. c. 36 hours. d. 48 hours.

d. 48 hours.

Which fetal anatomic reference point is used for the breech when stating fetal position?

Sacrum

The development of a strong emotional tie of a parent to a newborn is called _____________

bonding

Why are the sutures and fontanels of the fetal head important during birth?

They allow molding to let the fetal head adapt to the size and shape of the maternal pelvis

The correct order for suctioning an infant's airway with the bulb syringe is to suction the ____ first and the ____ second. Why?

Mouth; nose (only if needed). The infant might gasp when the nose is suctioned, drawing any secretions that are in the mouth into the airway

Entrainment

Movement of the newborn in rhythm with adult speech

uterine resting tone

Muscle tension when the uterus is not contracting

endorphin

Natural substance similar to morphine

Strabismus

"Crossed" eyes

What is the most common cause of early postpartum hemorrhage? Describe the pathophysiology of this cause of hemorrhage

Uterine atony is the most common cause. It occurs when the muscle fibers of the uterus do not contract firmly to compress bleeding endometrial vessels at the placental site

Determine the number of calories per day (cal/day) needed by a 3-day-old infant weighing 3628 g (8 lb) who is breastfed and by the same infant if formula-fed. Calculate the number of ounces of breast milk or formula (each with 20 cal/ounce) that the infant needs daily.

308-363 calories/day (from 85-100 cal/kg) 15.3-18.15 oz

Thrombus

A blood clot within a vessel

Embolism

A clot or amniotic fluid material that may obstruct smaller vessels

Why should the nurse regularly check the woman's bladder during labor?

A full bladder increases pain and interferes with fetal descent

Why should the nurse regularly check the woman's bladder during the early postpartum period?

A full bladder interferes with the uterine contractions that compress open vessels to control bleeding

Explain how a full bladder shortly after birth can lead to excessive postpartum bleeding

A full bladder moves the uterus out of its normal position. This interferes with the ability of the uterus to contract firmly to occlude open vessels at the placental site, allowing them to bleed excessively

Margaret is breastfeeding for the first time. She seems awkward in handling her baby and says that the baby is not feeding well. The baby cries frequently while Margaret tries to feed her. What is the first nursing action to take in this situation? What additional nursing actions can help Margaret?

A good initial action would be to help Margaret calm her fussy baby so that the infant will be more likely to nurse. This action accomplishes two goals: it helps Margaret learn the skill of comforting her infant, and it increases the likelihood that the infant will nurse well when positioned properly at the breast After the infant is calmer, suggest positions that Margaret might use to begin nursing. Support her arm in the chosen position with pillows or blankets. Explain the basics of helping her infant latch on to the breast—stimulating the infant's mouth until it opens wide, then drawing the infant close; inserting the nipple and areola well back into the mouth; checking to see that the lips are flared on the breast tissue. Describe and have Margaret observe for typical patterns that indicate nutritive suckling: smooth rhythmic suckling, interrupted by swallowing with a soft "ka" or "ah" sound

Shawna is an 18-year-old primigravida admitted to the birth center at 27 weeks of gestation in probable preterm labor. Her membranes are intact. The physician writes the following orders: • Nothing by mouth (NPO) except ice chips or clear fluids • Complete blood count • Catheterized urine for routine analysis and culture and sensitivity • Intravenous (IV) fluids: Ringer's lactate at 200 mL/hr for 1 hour, then 125 mL/hr • Routine fetal monitoring and maternal vital signs What position is appropriate for Shawna? Why?

A side-lying position with the head of the bed low increases placental blood flow and reduces pressure of the fetal presenting part on the cervix. Bed rest may reduce uterine activity

The nurse notes that a small amount of fluid with a strong odor is draining from Ann's vagina. Using a speculum examination to obtain fluid, the pH test turns blue-black on contact with the fluid, and a fern test is positive. Maternal vital signs are as follows: temperature, 37.2° C (99° F); pulse, 86 bpm; respirations, 22 breaths/min; and blood pressure, 132/80 mm Hg. The fetal heart rate is 162 to 170 bpm. Ann occasionally has a contraction lasting 20 to 30 seconds. Would you perform a vaginal examination at this point? Why or why not?

A vaginal examination is not advised at this time because the vaginal discharge is typical of amniotic fluid (meaning that the membranes are truly ruptured); there already appears to be an infection, Ann's gestation is preterm, and she is already having contractions. Little information is likely to be gained from the examination, and an examination might introduce more microorganisms into the uterus and may increase contractions. The physician may perform a speculum or vaginal examination or specifically order one

Describe the primary purpose of amnioinfusion. Describe how it is done and explain the basic nursing care involved

Add fluid to create a cushion around the umbilical cord. Its use to dilute thick meconium in amniotic fluid has not been found beneficial. Warm and sterile isotonic fluid is infused into the uterine cavity. Nursing care is to keep the woman dry as fluid leaks continuously from her vagina. Overdistention of the uterus may be relieved by releasing some of the fluid

What are the two powers of labor? When during labor do they come into play?

Uterine contractions, first stage; uterine contractions and maternal pushing, second stage

Describe how contractions feel to the nurse when palpated if they are mild

Uterus is easily indented like the tip of the nose

A vaginal birth after cesarean is often abbreviated __________

VBAC

List possible nursing or medical interventions to correct the cause of a nonreassuring fetal monitor pattern: increasing maternal oxygen saturation

Administer 100% oxygen at 8 to 10 L/min through a snug face mask

What teaching should you provide the postpartum woman to prevent constipation?

Increase activity progressively, drink adequate fluids (at least eight glasses of water daily), and add dietary fiber (found in fruits and vegetables, whole grain cereals, bread, and pasta) to prevent constipation. Prunes are a natural laxative

Why are postpartum women at risk for urinary tract infections?

Increased bladder capacity and decreased bladder tone, along with rapid diuresis, may cause urinary retention. Stasis of urine increases the risk of bacterial growth

Explain the possible significance of each neonatal assessment: drooping of one side of the mouth

Indicates facial nerve injury during birth resulting in paralysis

State the possible significance of skin variance: green-tinged discoloration of skin and vernix. Note whether any special care is needed

Indicates meconium passage in utero; observe infant for associated respiratory difficulties resulting from aspirated meconium

How does infant swallowing sound?

Infant swallowing has a soft "ka" or "ah" sound

Describe the progression of maternal touch

Maternal touch progression is from fingertipping to palm touch to enfolding the infant and bringing him or her close to the mother's body

After 4 hours of labor in the birth center, Erin's cervix is completely dilated and effaced, and the fetal station is 11. Erin feels the need to push during some contractions. What is the safest way to advise Erin to push?

Delayed pushing may be encouraged until Erin has a more intense urge to push. When Erin pushes, she should avoid prolonged breath-holding. She can be taught to take a deep breath and exhale it and then take another deep breath and push for 4 to 6 seconds at a time while exhaling. A final deep breath at the end of the contraction helps her relax

Subinvolution

Delayed return of the uterus to the nonpregnant state

Which nursing interventions are appropriate for the woman with postpartum depression?

Demonstrate caring; help the woman express her feelings and identify stressors; discuss methods to relieve stress, such as relaxation techniques; model ways to respond to the infant; teach the family what to expect and how to help the mother; refer to physician for psychotherapy and medications; and refer to support groups

Why is a woman's previous adverse reaction to dental anesthesia relevant to birth?

Dental anesthesia is related to many of the local anesthetic agents used in regional and local anesthetics such as epidurals

The nurse determines that Erin's contractions are every 5 minutes, of moderate intensity, and last 40 seconds. The fetus is active during the initial assessment. Fetal heart rate is 135 to 150 bpm, and the rate often accelerates. Amniotic fluid is light green with small white flecks in it. Vaginal examination reveals that the cervix is dilated 5 cm and is completely effaced. The fetal presenting part is hard and round, and a small triangular depression on the head can be felt in Erin's right posterior pelvis. What stage (and phase, if applicable) of labor is Erin in?

Active phase of first-stage labor

Choanal atresia

Abnormality of the nasal septum causing obstruction

REEDA

Acronym that helps assess wound healing: redness, edema, ecchymosis, drainage, approximation

Explain how the adrenal glands influences the fetal heart rate

Adrenal glands secrete epinephrine and norepinephrine in response to stress and release aldosterone to cause retention of sodium and water, thus increasing the blood volume

What is the central principle of nursing actions when dysfunctional labor is a result of ineffective maternal pushing?

All nursing actions center on helping the woman make each push most effective. Examples include laboring down or delayed pushing, pushing with every other contraction, use of upright positions to push, explaining the expected sensations, coaching her if she cannot feel the urge to push, and reassuring her that there is not an absolute deadline for delivery

What anatomic features of the woman's reproductive tract make infection there potentially serious?

All the parts of the female reproductive tract are connected to each other and to the peritoneal cavity. The area is richly supplied with blood vessels and lymphatics, providing a well-nourished, dark, warm environment that favors bacterial growth

Milk ejection reflex

Allows milk to let down

Why can anaphylactoid syndrome result in disseminated intravascular coagulation?

Amniotic fluid is rich in thromboplastin, initiating uncontrolled clotting that consumes normal clotting factors

What changes of uncomplicated childbirth further increase a woman's risk for reproductive tract infection? What are her protective factors?

Amniotic fluid, blood, and lochia make the normally acidic vagina more alkaline, fostering the growth of organisms. The necrotic endometrial lining and lochia promote growth of anaerobic organisms. Small areas of trauma allow microorganisms to enter the tissues. However, granulocytes in the endometrium and lochia help prevent infection

Describe possible responses of toddlers to a new baby. How can parents help these toddlers?

During the mother's pregnancy, toddlers may not understand that a new baby is coming. Jealousy may be shown by negative or hostile behaviors. Sleep problems and regression may also occur. Parents need to show their continued love to help the toddler understand that he or she will not be displaced by the new baby. Changes in routines should be postponed until after adjustments are complete

Preauricular sinus

Ear *Abnormal variation

What maternal and fetal conditions can reduce fetal tolerance for the intermittent interruption in placental blood flow that occurs during contractions?

Any maternal condition that reduces perfusion of the placenta, such as diabetes, hypertension, or fetal anemia, which reduces oxygen-carrying capacity, can reduce tolerance for even normal labor contractions

crowning

Appearance of the fetal presenting part at the vaginal opening

What liquids can help acidify urine? Why is this acidity helpful in preventing or treating urinary tract infection?

Apricot, plum, prune, and cranberry juices help acidify urine, which makes the urine less friendly to microorganisms

What added assessments and interventions should the nurse perform if an infant has a subnormal temperature?

Assess for and correct sources of heat loss, such as wet clothing, drafts, or exposed skin. Place the infant skin to skin with the mother or wrap the flexed infant snugly in warm blankets. Apply a hat and a shirt, and use another shirt with the sleeves over the legs. A radiant warmer, regulated by a skin probe, may be needed for very low temperatures. Have the mother breastfeed or feed the infant formula if it is near feeding time. Teach parents about maintaining the infant's temperature, particularly if their actions have contributed to the low temperature

Subinvolution

Failure of the uterus to return to its prepregnant state in the time expected

Describe additional nursing abdomen assessments and care for the woman who has given birth by cesarean

Assess for return of peristalsis by auscultating bowel sounds; observe for abdominal distention and passage of flatus; observe surgical dressing for intactness and drainage; observe incision line after dressing removal for signs of infection (REEDA [redness, ecchymosis, edema, drainage, approximation]); palpate fundus gently

What are the primary nursing assessments related to corticosteroids in the treatment of preterm labor?

Assess lung sounds; teach woman to report chest pain or heaviness or any difficulty in breathing

Explain the possible significance of each neonatal assessment: ears below the level of the outer canthi of the eyes

Associated with chromosomal disorders

Explain the possible significance of each neonatal assessment: two-vessel umbilical cord

Associated with other anomalies; assess infant carefully

Erin complains of back discomfort during each contraction. What interventions might make this discomfort more tolerable?

Assuming any of several upright positions and leaning forward during contractions; hands and knees; firm sacral pressure

Alice progresses to 6-cm cervical dilation, effacement 100%, and fetal station 0. Maternal and fetal vital signs remain stable. Alice wants "something stronger" for the pain. What pharmacologic options are possible for Alice, based on the information given?

At this point, Alice could probably receive an opioid analgesic or epidural block

Explain how the baroreceptors influences the fetal heart rate

Baroreceptors sense blood pressure increases in the carotid arch and major arteries to slow the heart and reduce the blood pressure, thus reducing cardiac output

List methods to relieve the pain of a spinal headache

Bed rest with oral or IV hydration; blood patch

List components in breast milk that help prevent infant infections and describe the purpose of those components

Bifidus factor promotes the growth of Lactobacillus bifidus, which increases acidity in the gastrointestinal tract. Leukocytes (macrophages) secrete lysozyme, which acts against gram-positive and enteric bacteria. Lactoferrin inhibits the growth of iron-dependent bacteria. Immunoglobulins, particularly IgA, help protect against gastrointestinal infections

What are the three primary nursing observations after circumcision?

Bleeding, urination, and infection

How do calcium channel blockers stop preterm labor? Give an example

Block the action of calcium, which is necessary for muscle contraction; an example is nifedipine (Adalat, Procardia)

How do prostaglandin synthesis inhibitors stop preterm labor? Give an example

Block the action of prostaglandins, which stimulate uterine contractions; an example is indomethacin (Indocin)

antagonist

Blocking effect of a drug

sellick maneuver

Blocking the esophagus by pressing the trachea against it

What maternal vital signs might indicate problems?

Blood pressure, 140/90 mm Hg or higher Temperature, 38° C (100.4° F) or higher

Which breathing technique can help a woman avoid pushing too early?

Blowing prevents glottis closure and breath-holding

Acrocyanosis

Bluish color of the hands and feet

Describe the processes of bonding and attachment

Bonding describes the initial attraction felt by parents toward their newborn infant. It is a one-way process, from parent to infant. Attachment describes a long-term, two-way process that binds parent and infant with mutual affection. Attachment is facilitated by positive feedback from the infant and by mutually satisfying experiences

What is the significance of bradycardia during the early postpartum period?

Bradycardia is normal. Blood volume and cardiac output increase as blood from the uteroplacental unit returns to the central circulation and as excess extracellular fluid enters the vascular compartment for excretion. Because stroke volume increases, pulse decreases

Describe common premonitory signs of labor. Note any differences between a nullipara and a parous woman

Braxton Hicks contractions—irregular, mild contractions intensify near term; more noticeable to parous women. Lightening—descent of fetus toward pelvic inlet increases pressure on bladder but allows easier breathing; more noticeable in nulliparas. Increased vaginal secretions—with congestion of vaginal mucosa caused by fetal pressure. Bloody show—mixture of cervical mucus and blood as the mucus plug is released; seen earlier and in greater quantity in nulliparas. Energy spurt—nesting. Weight loss—2.2 to 6.6 kg (1 to 3 lb)

Engorgement

Breast

Mastitis

Breast inflammation

Describe the effect of breastfeeding on uterine involution

Breastfeeding stimulates release of oxytocin from the pituitary gland, which tends to intensify afterpains but also maintains better uterine contraction; this facilitates involution

Explain what a new mother should be taught about the frequency of formula feeding

Feed the infant every 3 to 4 hours, following the infant's hunger cues instead of a rigid schedule

State the possible significance of skin variance: light brown spots. Note whether any special care is needed

Café-au-lait spots; six or more spots or spots larger than 0.5 cm are associated with neurofibromatosis and should be reported to the physician

Homan's sign

Calf pain that occurs when the foot is dorsiflexed

baseline fetal heart rate

Fetal heart rate when the uterus is at rest

Describe how contractions feel to the nurse when palpated if they are moderate

Can be indented, but with more difficulty like the chin

agonist

Causing a physiologic effect

Cephalic; right occiput posterior (ROP)

List possible nursing or medical interventions to correct the cause of a nonreassuring fetal monitor pattern: increasing placental perfusion

Change position to reduce aortocaval compression; discontinue oxytocin or administer tocolytics to reduce uterine activity; increase nonadditive intravenous (IV) fluid to correct hypovolemia or vasodilation

ferning

Characteristic appearance of dry amniotic fluid when viewed under a microscope

List possible nursing or medical interventions to identify the cause of a nonreassuring fetal monitor pattern

Check blood pressure to identify hypotension or hypertension, contractions to identify uterine hyperactivity, and recent maternal medications to identify sedative effects; perform vaginal examination to identify prolapsed cord; initiate internal monitoring to provide more accuracy

What can be done to prevent or correct bladder distention?

Check the bladder for distention, and catheterize as needed

Explain how the chemoreceptors influences the fetal heart rate

Chemoreceptors in the medulla oblongata, aortic arch, and carotid bodies sense changes in oxygen, carbon dioxide, and pH to increase the heart rate if hypoxia, hypercapnia, and acidosis, respectively, are not prolonged

Which fetal anatomic reference point is used for the face when stating fetal position?

Chin (mentum)

What signs suggest that a mother may be developing endometritis?

Fever, lochia with a foul odor, chills, malaise, anorexia, abdominal pain, cramping, uterine tenderness, malaise, tachycardia, subinvolution

List nursing measures to promote normal labor when maternal pushing is ineffective for epidural block analgesia

Coach her about when \to push and stop pushing if she cannot feel contractions well. Help her understand that effective pain management by any method, including nonpharmacologic measures, promotes the progress of labor

What can be done to prevent or correct prolonged second stage?

Coach the woman to push if she does not have an urge to push

Describe changes in the composition and appearance of colostrum

Colostrum is produced during lactogenesis I. It is a thick yellow substance that is rich in immunoglobulins, especially IgA. It has laxative effects and is high in protein, some vitamins, and minerals. It is lower in carbohydrates, fat, lactose, and some vitamins than mature milk

List the two nursing priority determinations when a woman enters a birth center

Condition of the mother and fetus; nearness to birth

What type of heat loss can occur in forgetting to turn the radiant warmer on before placing the infant under it?

Conduction

What type of heat loss can occur in placing the newborn on a cold, unpadded surface?

Conduction

What type of heat loss can occur in using a cold stethoscope to listen to breath sounds?

Conduction

Explain why coordinated uterine contractions is important during birth

Contractions must be stronger in the upper uterus than in the lower uterus to propel the fetus toward the outside

What type of heat loss can occur in placing the infant's crib near an air conditioner vent?

Convection

Catabolism

Conversion of living cellular substances to simpler compounds

nuchal cord

Cord around the fetus's neck

Explain why hepatitis B immunization is typically given to newborns

Hepatitis B immunization is given to promote the infant's manufacture of antibodies against this viral infection of the liver

cleansing breath

Deep breath taken at the beginning and end of each contraction

shoulder dystocia

Delayed or difficult birth of the shoulders after the head has emerged

Bonding

Development of an emotional tie to the infant

Pulse pressure

Difference between the systolic and diastolic blood pressure

What are the expected average rates for dilation and fetal descent for the nulliparas women after the active phase of labor has been reached?

Dilation at least 1.2 cm/hr, descent at least 1.0 cm/hr

What are the expected average rates for dilation and fetal descent for the parous women after the active phase of labor has been reached?

Dilation at least 1.5 cm/hr, descent at least 2.0 cm/hr

Describe use and precautions associated with powdered formula

Dilute formula in a clean bottle exactly as directed, usually one scoop for each 2 oz of water. Mix well. As in concentrated liquid formula, do not overdilute or underdilute. Cover opened cans of powder and use within 4 weeks of opening

Describe use and precautions associated with concentrated liquid formula

Dilute the concentrated liquid with an equal part of water. Do not overdilute or underdilute. Fill clean bottles with diluted formula as in ready to feed

Explain what a new mother should be taught about leftover formula feeding

Discard all remaining formula after 1 hour of use

How does the change in maternal progesterone and estrogen relationship affect the onset of labor?

Higher estrogen levels make the uterus more sensitive to substances that stimulate it to contract, whereas lower progesterone levels allow it to be stimulated more easily; estrogen also increases the number of gap junctions, connections that allow the uterus to contract in a coordinated manner

Explain what a new mother should be taught about microwaving formula feeding

Do not microwave formula, because it might have hot spots that would burn the infant. Heat by placing bottle in warm water

Explain what a new mother should be taught about propping the bottle for formula feeding

Do not prop the bottle. Propping can cause aspiration of formula and increases the incidence of ear infections and dental caries (when the primary teeth erupt)

tocolytic

Drug that reduces uterine muscle contractions

What are the priority nursing measures for the infant in relation to temperature regulation?

Dry the baby quickly, including the head; place in a prewarmed radiant warmer or in skin to skin contact with a parent, which can be used to position the baby's head favorably; use a cap on the baby's dry head to reduce heat loss from that area when not in the radiant warmer

Hindmilk

Higher fat milk

List methods to prevent and treat engorgement

Early and frequent nursing (every 2 to 3 hours) for adequate lengths of time during the day and night helps prevent engorgement. Avoiding formula or water supplements causes the infant to eat more often than if formula is used Treatment includes feeding every 1½ to 2 hours; cold applications between feedings; heat application shortly before feeding; massage to speed milk release; softening the areola by using a pump or expressing milk to begin flow or pressing gently on the areola to move swelling back. Give medication for discomfort; advise the mother to wear a wellfitting (but not tight) bra 24 hours a day

What is the time difference between early and late postpartum hemorrhage?

Early postpartum hemorrhage occurs within 24 hours of birth; late hemorrhage occurs after 24 hours or up to 6 to 12 weeks after birth

List signs and symptoms of wound infection

Edema, warmth, redness, pain, separation of edges, seropurulent drainage

The nurse decides that Erin may be in true labor and tells her to come to the birth center. On arrival, Erin says that she thinks her "water broke." What tests might the nurse use to verify that Erin's membranes have indeed ruptured?

Either a pH or fern test or both are the two tests that are often used to evaluate whether the membranes have ruptured. Commercial tests to test for membrane rupture may be used at the birth center

Why is it important that the breastfeeding mother with mastitis avoid engorgement?

Engorgement causes stasis of milk, which promotes growth of infecting microorganisms, possibly leading to abscess

State the possible significance of skin variance: red blotchy areas with white or yellow papules in center. Note whether any special care is needed

Erythema toxicum; differentiate from infection; teach parents that rash is self-limiting

Explain why erythromycin eye ointment is typically given to newborns

Erythromycin ointment is required by state law to prevent gonorrhea acquired in the mother's birth canal

Describe the influence of estrogen on lactation

Estrogen prepares the breasts for lactation and prevent lactation during pregnancy

What are the priorities during the initial treatment of a pregnant woman who has had a traumatic injury?

Evaluation and stabilization of maternal injuries; following basic resuscitation rules; arresting hemorrhage; avoiding prolonged supine positioning; evaluating injuries to mother and fetus; expecting large fluid resuscitation needs; providing Rh immune globulin if a fetal to maternal hemorrhage is suspected in the Rho(D)-negative woman

What type of heat loss can occur in partially drying the infant's hait after the bath?

Evaporation

Except for the greenish color, the amniotic fluid is normal. The amniotic fluid is green because the fetus passed meconium before birth. Fetal problems may or may not exist

How can excessive maternal pain reduce fetal oxygenation?

Excess maternal pain can result in fear and anxiety, which stimulate the mother's sympathetic nervous system to release substances that simultaneously cause vasoconstriction and pooling of blood in the mother's vascular system, plus a higher uterine muscle tone with reduction of effective contractions. The net effect is that blood flow to and from the placenta falls and labor contractions are less effective, thus prolonging labor

What signs typically distinguish postpartum hemorrhage caused by uterine atony from hemorrhage caused by lacerations of the birth canal?

Excess, usually brighter red, bleeding that may be heavy or slow but steady in the presence of a firmly contracted uterus that is in the expected location suggests a laceration

Subconjunctival hemorrhage

Eye

Cataract

Eye *Abnormal variation

List signs and symptoms that the postpartum woman should report to her physician or nurse-midwife

Fever; localized area of redness, swelling, or pain in the breasts that is unrelieved by support or analgesics; persistent abdominal tenderness or feelings of pelvic fullness or pelvic pressure; persistent perineal pain; frequency, urgency, or burning when urinating; change in lochia character (increased amount, return to red color, passage of clots, or foul odor); localized tenderness, redness, edema, or warmth of the legs; an abdominal incision with redness, edema, separation of edges, or foul drainage

Why is it important that the uterus remain firmly contracted after birth?

Firm uterine contraction compresses bleeding vessels at the placental site to prevent hemorrhage

What nursing assessments are needed to observe for hemorrhage?

Firmness, height, and position of the uterine fundus, vital signs, amount of lochia, and observing and intervening for a full bladder help prevent hemorrhage caused by the bladder's interference with uterine contraction

How does average duration of labor vary between nulliparas and parous women for each phase of Stage I labor?

First stage, latent phase, nullipara (7.3 to 8.6 hours); multipara (4.1 to 5.3 hours). First stage, active phase, nullipara (7.7 to 13.3 hours if no epidural; 10.2 hours with epidural); multipara (5.7 to 7.5 hours with no epidural; 7.4 hours with epidural). First stage transition, nullipara (3.6 hours) and multipara (varying length)

variability

Fluctuations in the baseline fetal heart rate

The nurse notes that a small amount of fluid with a strong odor is draining from Ann's vagina. Using a speculum examination to obtain fluid, the pH test turns blue-black on contact with the fluid, and a fern test is positive. Maternal vital signs are as follows: temperature, 37.2° C (99° F); pulse, 86 bpm; respirations, 22 breaths/min; and blood pressure, 132/80 mm Hg. The fetal heart rate is 162 to 170 bpm. Ann occasionally has a contraction lasting 20 to 30 seconds. Which data from these assessments are most relevant?

Fluid draining from the vagina; positive pH (7.5) and fern tests; fluid with a strong odor; fetal tachycardia; occasional contraction

patterned paced breathing

Focus on pattern of breathing interferes with pain impulse transmission; some may make a special sound ("hee" and "hoo"); the woman may vary number of breaths before blowing

The nurse performs a blood glucose level determination on an infant according to agency protocol. The results are 42 mg/dL. What should the nurse do?

Follow hospital protocol for low blood glucose levels. The nurse will probably feed the infant and recheck the glucose level 30 to 60 minutes after the feeding. The blood glucose level may continue to be checked before feedings, according to hospital policy, until the results are normal

What should the mother be taught about burping the infant? When to burp? Removing the infant from breast?

For breastfeeding, burp when non-nutritive suckling begins and change to the other breast. For formula feeding, burp after approximately 0.5 ounce of formula in the early days and then midway in the feeding when the infant's intake increases. Break suction before removing the infant from the breast by inserting a finger between the infant's gums or indenting the breast tissue near the infant's mouth

How does frequent breastfeeding help resolve jaundice?

Frequent breastfeeding enhances milk production and stimulates peristalsis, which increases the number of stools and thus helps the body excrete bilirubin

Developmental dysplasia

Hip *Abnormal variation

Hymenal tag

Genitalia *Females only

Pseudomenstruation

Genitalia *Females only

Hydrocele

Genitalia *Males only *Abnormal variation

Hypospadias

Genitalia *Males only *Abnormal variation

What should the mother be taught about the storage of breast milk?

Glass or rigid polypropylene plastic containers with tight caps. Milk can be stored in the refrigerator for 72 hours or in the freezer of a refrigerator for 1 month; it can be kept in a deep freeze at 2178 C (08 F) for 6 to 12 months. Do not microwave. Thaw in the refrigerator or by holding under running water

Crepitus

Grating sensation during palpation

Polydactyly

Hands and feet *Abnormal variation

Syndactyly

Hands and feet *Abnormal variation

Caput succedaneum

Head

Cephalohematomas

Head

Describe characteristics of the fetal heart rate (FHR) that are reassuring when the FHR is auscultated in a term fetus

Heart rate at term with a lower limit of 110 beats per minute (bpm), upper limit of 160 bpm; regular rhythm; presence of accelerations; absence of decelerations. These signs would also be reassuring if the fetus were monitored electronically

Describe additional nursing respiratory assessments and care for the woman who has given birth by cesarean

If epidural narcotics were used, check the pulse oximeter or apnea monitor; auscultate breath sounds for retained secretions; assist the mother to turn, cough, and deep-breathe; use an incentive spirometer

List nursing measures that can be used when a woman has precipitate labor to promote maternal comfort

Help the woman focus on nonpharmacologic pain control methods if analgesia is not possible or has not yet taken effect; remain with the woman

List nursing measures to promote normal labor when maternal pushing is ineffective for fear of injury

Help the woman understand that her tissues can distend to accommodate the fetus; apply warm compresses to the perineum

How is hemorrhage defined?

Hemorrhage may be defined as loss of more than 500 mL of blood after vaginal birth, loss of more than 1000 mL of blood after cesarean birth, decrease in hematocrit of 10% or more since admission, need for blood transfusion, or continued bleeding after usual treatment

What should the nurse teach new parents about holding the baby for burping?

Hold the baby upright against your shoulder or in a sitting position on your lap, with the head and chest supported while you pat the back

valsalva maneuver

Holding the breath while pushing against a closed glottis

Why are nursing measures to manage stress and anxiety important when caring for women with hypotonic or hypertonic labor dysfunction? List some nursing measures

Hypotonic dysfunction may cause anxiety because the woman expects to be progressing faster; hypertonic dysfunction is stressful because of the near-constant discomfort without significant progress. The stress response, associated with anxiety and fear, causes the secretion of catecholamines and consumption of glucose, which interfere with normal uterine contraction. Nursing measures include therapeutic communication, pain relief, promotion of relaxation and rest, and positioning

What is the primary method of identifying the newborn and mother (or other support person)?

Identification is carried out by matching the electronic device or imprinted numbers on the adult's wristband with those on the infant's identification bands or device. The numbers should be matched every time the infant is reunited with the parent. The nurse should visually match the numbers or have the parent or support person read the imprinted numbers from his or her band

K-B test

Identifying presence of fetal erythrocytes in the maternal circulation

The nurse checks Jen's vital signs 30 minutes later. Her blood pressure is near its previous levels, but her pulse is slightly faster. Her fundal height, firmness, and lochia amount are unchanged. Her perineum is intact and has a small amount of edema. She rates her pain as a 7 on a 1 to 10 pain scale. The nurse replaces the ice pack to the perineum that has been in place since Jen's recovery period began. Are any other interventions warranted? If so, what are they and why are they appropriate?

If Jen still has not voided, the nurse should carefully assess her bladder and place her on the bedpan to void. However, Jen's symptoms suggest a concealed hemorrhage with early hypovolemia—unrelieved pain and a rising pulse in the presence of a firm fundus and normal lochia. Unrelieved pain is not typical of a full bladder, although it may worsen the pain of a hematoma. Therefore, Jen should not ambulate to the bathroom because of the higher risk of fainting. If she does not void promptly, it would be appropriate to catheterize her (assuming there is an order) to determine whether emptying her bladder relieves the pain and to determine her urine output, which is an indicator of fluid volume status. The physician or nurse-midwife should be notified promptly of all assessments and interventions

What are the changes in fetal lung fluid during pregnancy and labor and after birth?

In late pregnancy, production of fetal lung fluid decreases and absorption into the interstitium of the lungs increases. During labor, absorption of lung fluid intensifies and compression of the head and thorax causes expulsion of additional fluid. After birth, the remainder is absorbed into the newborn pulmonary and lymphatic circulations

Describe the scissors or V hand position for breastfeeding

In the scissors or V position, the mother places her index and middle fingers above and beneath the areola to guide her nipple to the infant

Explain to parents why it is important for their jaundiced infant to eat frequently and adequately

Infants who do not eat well will be slower in passing stools in which bilirubin is eliminated. When feces remain in the intestines, an enzyme (beta-glucuronidase) that was important during fetal life may change the bilirubin back to a form (unconjugated) that cannot be eliminated in the stools. The bilirubin may be absorbed back into the bloodstream and the liver will have added work in changing it back to a form in which it can be excreted

amnioinfusion

Infusion of a sterile solution into the amniotic cavity to reduce cord compression

Fingertipping

Initial characteristic touch of mother with her newborn

Alice is a 16-year-old primigravida in the latent phase of first-stage labor. She did not attend prepared childbirth classes. She is very anxious and tense, crying during each contraction. Her cervix is dilated to 3 cm, station 21, effacement 90%, and the membranes are ruptured (amniotic fluid is clear). Her baseline vital signs are pulse, 92 beats per minute (bpm); respirations, 24 breaths per minute; and blood pressure, 120/70 mm Hg. Fetal heart rate (FHR) is 126 to 136 bpm with average variability. Her 17-year-old husband is at her side but seems very frustrated and helpless. Her parents live out of state; her husband's parents are with the couple. What initial nursing interventions are appropriate to help Alice cope with her contractions?

Initial interventions are to tell Alice and her husband that her labor pattern is normal right now and show them data that indicate that mother and fetus are doing well. The nurse should speak calmly and in a soothing voice, conveying to Alice and her husband that they can have confidence in their caregivers and that Alice is capable of giving birth

back labor

Intense back pain associated with fetal occiput posterior position

Engrossment

Intense fascination between father and newborn

Explain why intermittent uterine contractions is important during birth

Intervals between contractions allow resumption of blood flow to the placenta to supply oxygen to the fetus and remove wastes

List factors that might decrease variability

Maternal—narcotics or other sedatives; recent alcohol or drug ingestion; acidemia or hypoxemia Fetal—tachycardia; prematurity; decreased central nervous system oxygenation; abnormalities of the central nervous system or heart; anomalies that may affect FHR; fetal sleep

Alice is a 16-year-old primigravida in the latent phase of first-stage labor. She did not attend prepared childbirth classes. She is very anxious and tense, crying during each contraction. Her cervix is dilated to 3 cm, station 21, effacement 90%, and the membranes are ruptured (amniotic fluid is clear). Her baseline vital signs are pulse, 92 beats per minute (bpm); respirations, 24 breaths per minute; and blood pressure, 120/70 mm Hg. Fetal heart rate (FHR) is 126 to 136 bpm with average variability. Her 17-year-old husband is at her side but seems very frustrated and helpless. Her parents live out of state; her husband's parents are with the couple. Are analgesics desirable for Alice at this time? Why or why not?

It would be better for Alice to delay taking medication until labor is in the active phase. Administration of analgesics or epidural block analgesia too early can slow labor progress. However, this must be balanced against the adverse effects of excessive pain and anxiety and the woman's need for pharmacologic pain relief

List signs that suggest neonatal hypoglycemia

Jitteriness, poor muscle tone, sweating, respiratory signs (e.g., dyspnea, apnea, cyanosis, tachypnea, grunting), low temperature, poor suck, high-pitched cry, lethargy, seizures, eventually coma; some show no signs of hypoglycemia

Describe normal assessments of full-term female genitalia

Labia majora darker than surrounding skin and completely covering the clitoris and labia minora; white mucous discharge or pseudomenstruation; hymenal or vaginal tags; urinary meatus and vagina present

Describe the effect of breastfeeding on sexual intercourse

Lactation suppresses ovulation and estrogen secretion, causing more vaginal dryness than nonlactating mothers have. This may cause painful sexual intercourse unless lubrication is added

What are the three labor phases within the first stage of labor? What cervical dilation marks each phase?

Latent phase, up to 3 cm dilation; active phase, 4 to 7 cm; transition phase, 8 to 10 cm

paced breathing

Learned breathing techniques used during labor

Atony

Less than normal muscle tone

How does the leukocyte level change during the early postpartum period? How would a normal leukocyte level for a postpartum woman be interpreted for a nonpregnant woman?

Leukocytes increase up to 30,000/mm3, with an average of 14,000 to 16,000/mm3. If this high leukocyte level occurred in a woman who was not pregnant or postpartum, infection would be suspected

Describe changes in the composition and appearance of mature milk

Mature milk replaces transitional milk during lactogenesis III. It is bluish and provides 20 cal/oz. Immunoglobulins are provided in mature milk throughout lactation

Explain the possible significance of each neonatal assessment: hair tuft on lower spine

May indicate spina bifida occulta, or failure of one or more vertebrae to close fully

Describe how contractions feel to the nurse when palpated if they are strong

Little indentation is possible; woody feel; like the forehead

On a clinic visit 3 days postpartum, the nurse assesses Nita's fundus as firm, midline, and 1 cm below the umbilicus. What kind of lochia should the nurse expect Nita to have at this time?

Lochia flow should be rubra or changing to serosa, scant, and free of foul odor or clots

Describe the changes in lochia and state when these occur

Lochia rubra contains blood, mucus, and bits of decidua, is red or red-brown, and has a duration of approximately 3 days. Lochia serosa contains serous exudate, erythrocytes, leukocytes, and cervical mucus; is pinkish or brown-tinged; its duration is from approximately the third to tenth day. Lochia alba contains leukocytes, decidual cells, epithelial cells, fat, cervical mucus, and bacteria; is white, yellow, or cream-colored; may end by day 14 or last until the end of the third to sixth week

Attachment

Long-term development of affection between the infant and significant other

Describe the most common variations in fetal lie

Longitudinal (common) or transverse (rare); oblique lie is at some angle to a longitudinal or transverse lie

anesthesia

Loss of sensation, with or without loss of consciousness

List five general signs of newborn infection

Low temperature; lethargy; poor feeding; periods of apnea without obvious cause; any unexplained change in behavior; drainage from the eyes, cord, or circumcision

Contractions stop, and Shawna will begin taking oral terbutaline. What nursing observations are essential related to the use of oral terbutaline?

Maintain even spacing of the drug; expect side effects such as palpitations, tremors, restlessness, weakness, or headache. Report heart rate greater than 110 bpm, chest pain, or dyspnea

Nita is a multipara who vaginally delivered twin boys 4 hours ago. One weighed 6 lb and the other weighed 5 lb, 6 oz. She is admitted to the mother-baby unit after an uneventful recovery. Your initial assessment reveals the following data: temperature, 37.6° C (97.9° F); pulse, 60 beats per minute (bpm); respirations, 20 breaths per minute; blood pressure, 110/70 mm Hg; fundus slightly soft and located to the right of the umbilicus; lochia moderate; midline episiotomy intact with slight edema. What is your first intervention? Why? What should you do next?

Massage the uterus to cause it to contract firmly and control bleeding. The next intervention should be to assist Nita to empty her bladder or catheterize her (with an order) if she is unable to void. Otherwise, the uterus will relax again

List side effects that may occur with beta-adrenergic drugs, such as terbutaline

Maternal and fetal tachycardia, decreased blood pressure, wide pulse pressure, dysrhythmias, myocardial ischemia, chest pain, pulmonary edema, hyperglycemia and hypokalemia, headache, tremors, and restlessness

Candidiasis

Mouth *Abnormal variation

tocolytic

Medication to stop preterm or hypertonic uterine contractions

Kegel exercises

Method to increase tone of muscles around the vagina and urinary meatus

modified paced breathing

Modified-paced breathing uses shallow but rapid breathing, and may be combined with slow paced breathing

State the possible significance of skin variance: bluish-gray marks over the sacra area. Note whether any special care is needed

Mongolian spots; more common in dark-skinned infants; most disappear during early years; teach parents who are unfamiliar with these

Describe additional nursing intake and output assessments and care for the woman who has given birth by cesarean

Monitor IV for rate of flow and site condition; observe urine for amount, color, and clarity

Do infants of mothers with hepatitis B need any additional medication? Why?

Mothers who are positive for hepatitis B (carriers) may transmit the organism to their infant at birth. The first dose of a series of three doses of vaccine is given within 12 hours of birth to infants of mothers who are hepatitis carriers. These infants also receive hepatitis B immune globulin within 12 hours to provide passive antibody protection until the infant manufactures his or her own active antibodies to the virus

Epstein's pearls

Mouth

State the possible significance of skin variance: flat pink to dark reddish-purple area that does not blanch with pressure. Note whether any special care is needed

Nevus flammeus (port wine stain); permanent; large or obvious ones can later be removed by laser surgery

State the possible significance of skin variance: red, raised, rough lesions on the head. Note whether any special care is needed

Nevus vasculosus (strawberry hemangioma); grows larger for 6 months, then gradually disappears

Nita will receive Rho(D) immune globulin (RhoGAM), rubella vaccine, and a diphtheria, tetanus, pertussis (Tdap) vaccine before discharge. What precautions should the nurse teach Nita? Why?

Nita should be cautioned to avoid another pregnancy for at least 4 weeks because a fetus may be harmed by the live virus in rubella vaccine

Nita's fundus is not well contracted and is positioned to the right of the umbilicus, probably because of a full bladder. Her multifetal birth and multiparity increase the risk of postpartum hemorrhage

On a clinic visit 3 days postpartum, the nurse assesses Nita's fundus as firm, midline, and 1 cm below the umbilicus. Are these assessments normal? Why or why not? If they are not normal, is there an explanation?

Nita's fundus is slightly higher than usual, but this is explained by her delivery of twins

Nita's vital signs 8 hours after birth are blood pressure, 112/80 mm Hg, temperature, 37.2° C (99° F), pulse, 52 bpm, and respirations, 18 breaths per minute. Are any nursing interventions needed based on these vital signs? What is the rationale for your judgment?

No interventions are needed. Bradycardia and a slight elevation in temperature are common at this time

Choanal atresia

Nose *Abnormal variation

What circumcision problems should parents be taught to report?

Notify the physician if there is no urinary output within 6 to 8 hours, bleeding more than a few drops with first diaper changes, or displacement of the Plastibell. Apply pressure if any bleeding occurs. Report signs of infection, such as redness, edema, tenderness, and discharge (a yellow exudate that dries is normal)

Describe differences between nutritive and non-nutritive suckling

Nutritive suckling is evidenced by smooth continuous movements, with occasional pauses to rest. Swallowing may follow each suck or after two or three sucks. Non-nutritive sucking produces fluttery or choppy motions without the sound of swallowing

List fetal nursing measures for a woman having prolonged labor and for her fetus

Observation for signs of intrauterine infection and for compromised fetal oxygenation

What can be done to prevent or correct catheter migration?

Observe for excess anesthesia, one-sided block, a too-high block, or loss of anesthesia after its initiation. Report if he or she questions the intactness of the epidural

What are the primary nursing assessments related to indomethacin in the treatment of preterm labor?

Observe for nausea, vomiting, heartburn, skin rash, and prolonged bleeding; observe for signs of infection other than fever; check fundal height; have woman do kick counts to identify fetal movements

What are the primary nursing assessments related to magnesium sulfate in the treatment of preterm labor?

Observe for urine output of at least 30 mL/hr, presence of deep tendon reflexes, and respirations of at least 12 breaths/min; assess heart and lung sounds; observe bowel sounds and assess for constipation; have calcium gluconate available

What are the primary nursing assessments related to terbutaline in the treatment of preterm labor?

Observe maternal blood pressure, pulse, and respirations and fetal heart rate to identify tachycardia or hypotension; assess lung sounds; assess for the presence of dyspnea or chest pain to identify pulmonary edema or myocardial ischemia; obtain ordered glucose and potassium levels

What can be done to prevent or correct fever?

Observe the maternal temperature every 2 hours after membranes rupture and report a temperature of 38° C (100.4° F) or higher. Although slight temperature elevations are common with epidurals, observe for signs of infection, such as foul- or strong-smelling amniotic fluid or fluid that is cloudy or yellow

Which fetal anatomic reference point is used for the vertex when stating fetal position?

Occiput

What are the three variations of prolapsed cord?

Occult prolapsed cord cannot be seen or felt on vaginal examination but is suspected based on fetal heart rate The cord may slip into the vagina, where it can be felt as a pulsating mass during vaginal examination Complete prolapsed cord slips outside the vagina, where it is visible

Describe use and precautions associated with ready to use formula

Open the bottle and add a cap for single-serving containers. For multiserving cans, wash the top of the can and the can opener just before opening and shake the can. Pour into washed bottles and cap. Do not dilute. Refrigerate an open can and discard any remaining milk after 48 hours

Describe the influence of oxytocin on lactation

Oxytocin causes milk ejection from the alveoli into the lactiferous ducts

Describe the purposes of oxytocin in breastfeeding. What can enhance or interfere with its secretion?

Oxytocin causes the milk ejection reflex. It is enhanced by comfort, thinking about the infant, and the stimulation of suckling. It is inhibited by discomfort or inadequate suckling

How does oxytocin receptors affect the onset of labor?

Oxytocin receptors increase as labor begins, continue to increase during labor, and peak at delivery

Explain the difference between pain threshold and pain tolerance. What factors can influence a woman's pain tolerance during labor, positively or negatively?

Pain threshold is the minimum stimulus that a person perceives as painful; it is relatively constant under different conditions. Pain tolerance is the maximum amount of pain that a person is willing to endure; it may change with the circumstances. Factors influencing pain tolerance during labor include intensity of labor, readiness of the cervix to dilate with the force of contractions, fetal position, pelvic size and shape, maternal fatigue and hunger, or interventions of caregivers (a positive or negative influence)

Dyspareunia

Painful intercourse

pH test

Paper or swab used to detect ruptured membranes

Describe postpartum blues. What is the best response to the blues?

Postpartum blues describes a mild temporary depression that affects 60% to 80% of U.S. women. It begins in the first week and lasts no longer than 2 weeks. The woman has fatigue, insomnia, tearfulness, mood instability, irritability, and anxiety but is able to care for her baby. The primary nursing care is to provide empathy and support and let the woman and her family know that the condition is normal and self-limiting. They should be instructed to call the healthcare provider if depression is severe or prolonged, or the mother is unable to cope with her daily life

Describe normal assessments of full-term male genitalia

Pendulous scrotum that is darker than surrounding skin and covered with rugae; testes palpable in the scrotal sac; meatus centered at the tip of the glans penis; prepuce covering the glans and adherent to it

Puerperium

Period from childbirth until the return of the reproductive organs to their nonpregnancy state

What facial marks may be present if the infant had a nuchal cord?

Petechiae or bruising on the face may be present when the infant had a nuchal cord at birth

Brick dust stain

Pinkish color on a wet diaper

List nursing measures that can be used when a woman has precipitate labor to promote fetal oxygenation

Place her in a side-lying position, administer oxygen, maintain blood volume with nonoxytocin IV fluids, stop oxytocin if in use, administer terbutaline or other tocolytic drug that may be ordered

Placenta accreta

Placenta that adheres abnormally to the uterine wall

En face

Position that facilitates eye-to-eye contact between parent and newborn

What is the key difference between postpartum blues and postpartum depression?

Postpartum depression symptoms are more intense and persistent (lasting at least 2 weeks) than those of postpartum blues, which is temporary and mild. Postpartum depression lasts at least 2 weeks. Symptoms of postpartum depression include changes in appetite, weight, sleep, and psychomotor activity, decreased energy, feelings of worthlessness or guilt, difficulty thinking, concentrating, or making decisions, or recurrent thoughts of death or suicide, plans or attempts

Colostrum

Precedes true milk

What makes any pregnant or postpartum woman at risk for venous thrombosis? What factors increase this risk?

Pregnant and postpartum women have higher fibrinogen levels, which increase their ability to form clots. Factors that lyse clots are not increased, however. Women with varicose veins, history of thrombophlebitis, or prior cesarean birth have additional risks above the baseline risk

What can be done to prevent or correct hypotension?

Prehydrate the woman with a minimum of 500 to 1000 mL of intravenous (IV) solution. Ephedrine in 5- to 10-mg increments may be needed

Nita plans to breastfeed her twins. She successfully breastfed her other two children. However, she says, "I want to breastfeed, but I really have a lot of cramping when I nurse. I don't remember having that with the other two children." What intervention can help with this problem?

Prescribed analgesics given for postpartum discomfort will not harm the infant if taken for a short time. Lying in a prone position with a small pillow or folded blanket under the abdomen often helps

The nurse decides that Erin may be in true labor and tells her to come to the birth center. On arrival, Erin says that she thinks her "water broke." What is the priority nursing care at this time?

Priorities are to assess the FHR and, if membranes have ruptured, the color, odor, and character of the amniotic fluid; to assess Erin's vital signs; and to determine the nearness to birth by evaluating contractions and cervical dilation.

Describe the influence of progesterone on lactation

Progesterone prepares the breasts for lactation and prevent lactation during pregnancy

Describe the influence of prolactin on lactation

Prolactin initiates milk production in the alveoli after the placenta is expelled

Describe the purposes of prolactin in breastfeeding. What can enhance or interfere with its secretion?

Prolactin stimulates the breasts to produce milk. It is enhanced by suckling and removal of milk from the breasts. It is inhibited by estrogen, progesterone, and human chorionic somatomammotropin during pregnancy and by inadequate removal of milk after nursing begins

List maternal nursing measures for a woman having prolonged labor and for her fetus

Promotion of comfort, conservation of energy, emotional support, position changes that favor normal progress, and assessments for infection

What is the definition of the term puerperal infection?

Puerperal infection is an infection associated with childbirth in which the woman has a fever of 38° C (100.4° F) or higher after the first 24 hours, occurring on at least 2 days during the first 10 days following birth

Why is it important that the nurse not push on the uncontracted uterine fundus after birth? What is the correct procedure?

Pushing on an uncontracted uterus to expel clots after birth may result in uterine inversion. Massage the uterus until it is firm before expelling clots with fundal pressure. Support the lower uterus with one hand just above the symphysis

What type of heat loss can occur in placing the infant's crib by a window on a snowy day?

Radiation

Describe hyperventilation and nursing interventions to help a woman correct the problem

Rapid deep breathing results in loss of carbon dioxide, eventually resulting in respiratory alkalosis. The woman feels dizzy or lightheaded, with numbness and tingling of fingers and lips; tetany, stiffness of the face and lips, or carpopedal spasm may occur. Breathing into a paper bag or cupped hands causes rebreathing of carbon dioxide and correction of alkalosis

habituation

Reduced effectiveness of a pain management method after prolonged use

Erin is an 18-year-old primigravida who calls the intrapartum unit because she thinks that she might be in labor. What information should the nurse obtain to help determine whether Erin is in true labor?

Regular contractions that have increased in duration, intensity, and frequency suggest true labor. Irregular contractions and those that do not intensify suggest false labor. In addition, discomfort is usually felt in her back or sweeping around to her lower abdomen. Erin should be instructed to come to the birth center if she thinks that her membranes may have ruptured, even if she is not having contractions

analgesia

Relief of pain without loss of consciousness

What are the two objectives if umbilical cord prolapse occurs or is suspected? Why should the nurse avoid handling the prolapsed cord?

Relieve pressure on the cord by any of several measures, including positioning the woman so that her hips are higher than her head and pushing the fetal presenting part upward; increase oxygen delivery to the placenta. Handling the cord may induce arterial spasm in the cord vessels

List possible nursing or medical interventions to correct the cause of a nonreassuring fetal monitor pattern: reducing umbilical cord compression

Reposition or perform amnioinfusion to reduce umbilical cord compression

The three immediate newborn assessments after birth are for

Respiratory problems; thermoregulation; obvious anomalies

turtle sign

Retraction of fetal head against the mother's perineum after it emerges

Involution

Retrogressive changes that return the reproductive organs to their nonpregnancy state

Nita will receive Rho(D) immune globulin (RhoGAM), rubella vaccine, and a diphtheria, tetanus, pertussis (Tdap) vaccine before discharge. Under what circumstances are these drugs given?

Rho(D) immune globulin is given to the Rh-negative mother if her infant is Rh-positive and if she has not previously built up anti-Rh antibodies. Rubella vaccine is given to the nonimmune postpartum woman to prevent the mother from getting rubella during another pregnancy, which could cause injury to a fetus. The postpartum period is a good time to give the vaccine because it is highly unlikely that she will get pregnant soon, and she is then protected from the disease. Tdap is recommended for all adults who have close contact with infants to prevent their contracting pertussis and giving it to infants

When pressure is applied to the fetal chin through the perineum at the same time pressure is applied to the occiput of the fetal head, it is termed the _______________

Ritgen maneuver

What care can help the mother who has flat or inverted nipples? Are any precautions needed?

Rolling flat nipples stimulates them to become more erect. Pumping breasts for a few minutes before nursing or using a breast shield draws inverted nipples out so that the infant can grasp them. The use of breast shells in late pregnancy or between feedings to help draw nipples is controversial. Stretching or other manipulation of the nipples is unnecessary and should be avoided during pregnancy because it may cause uterine contraction

preterm premature rupture of the membranes (PPROM)

Rupture of the membranes before the end of week 37

premature rupture of the membranes (PROM)

Rupture of the membranes before the onset of labor

Rugae

Scrotal skin creases

In which maternal conditions is breastfeeding not advised?

Serious infections such as untreated tuberculosis, HIV infection, galactosemia, and maternal chemotherapy. Maternal substance abuse is usually also a contraindication to breastfeeding although some women taking methadone or buprenorphine may be allowed to breastfeed. Mothers with infectious conditions or who take medications unsafe for the infant also should not breastfeed

What are the signs and symptoms of pulmonary embolism?

Signs and symptoms vary according to the degree of pulmonary blood flow obstruction, but include dyspnea, chest pain, tachycardia, tachypnea, rales, cough, hemoptysis, abdominal pain, low grade fever, and decreased oxygen saturation and partial pressure of oxygen. Atelectasis and pleural effusion may be seen on x-ray films

List signs that suggest infection at the umbilical cord. What measures can prevent cord infection?

Signs of infection include redness or edema at the cord base and purulent drainage. Keep the cord area dry by folding the diaper below the area. Check with the health care provider regarding tub bathing before the cord has detached and the area is fully healed. Care generally includes cleaning the cord with water if necessary and allowing it to dry naturally

New parents may not recognize signals from the infant that he or she has had enough stimulation and now needs to rest. What signals should the nurse teach parents to recognize?

Signs of overstimulation of the infant include looking away, splaying the fingers, arching the back, and fussiness. These are clues that the infant needs some quiet time

Explain the possible significance of each neonatal assessment: simian crease or line

Single palmar crease that often occurs in infants who have chromosomal abnormalities such as Down syndrome but may be normal

Lanugo

Skin *Suggests infant is preterm if excessive

Vernix caseosa

Skin *Suggests that infant is preterm if excessive

Jaundice

Skin, eye (sclera) *Abnormal if present before 24 hrs

Nita's episiotomy is slightly reddened along the suture line; the edges are closely approximated, and there is no edema, bruising, or drainage. Do these data support the supposition that the episiotomy is healing properly? Why or why not? What nursing actions are appropriate?

Slight reddening is typical of normal healing at this early stage. Close approximation of the edges and lack of drainage confirm that healing seems to be taking place normally. Proper perineal cleansing and pad application should be reinforced. The nurse should also review signs and symptoms of infection to report

slow-paced breathing

Slow-paced breathing enhances relaxation and allows the woman to concentrate on relaxation rather than number of breaths; she may use nose, mouth, or combination breathing

Describe differences in breast fullness: soft, filling, engorged

Soft feels like a cheek. Filling feels slightly firmer than a cheek. Engorged feels and looks like a hard, shiny, tender, taut tissue

funic souffle

Sound of blood going through the umbilical cord

uterine souffle

Sound of blood going through the uterine blood vessels

Spina bifida

Spine *Abnormal variation

What laboratory tests should the nurse expect if the woman is undergoing heparin anticoagulation? If the woman is undergoing warfarin anticoagulation?

Standard unfractionated heparin: activated partial thromboplastin time (aPTT) and platelets. Lowmolecular-weight heparin: antifactor Xa and platelets; warfarin: international normalized ratio (INR)

Describe postpartum changes in the uterine muscle

Stretched uterine muscle fibers contract and gradually regain their former size and contour

What are the priority nursing measures for the infant in relation to respiration?

Suction to remove excess secretions as needed; position infant flat or on one side with the head flat or slightly elevated

State the possible significance of skin variance: ruddiness. Note whether any special care is needed

Suggests polycythemia; may cause higher bilirubin levels as the excessive erythrocytes break down, so observe for more severe jaundice and explain need for observation to parents

Explain the possible significance of each neonatal assessment: unequal gluteal creases

Suggests that one leg is shorter than the other; often associated with developmental hip dysplasia

Scaphoid

Sunken appearance

What is the correct nursing action if uterine atony is discovered?

Support the lower uterus with one hand while using the other hand to massage the fundus gently but firmly until it contracts. Press down on the fundus toward the vagina after the uterus is firm to express clots that have accumulated in the uterine cavity and could interfere with continued uterine contraction. Check for a distended bladder, often indicated when the uterus is displaced to one side (usually the right). Have the woman urinate or catheterize her if necessary. Maintain intravenous access. If the problem continues, notify the health care provider. The physician may order drugs such as oxytocin, methylergonovine, prostaglandin F2 alpha, dinoprostone vaginal suppository (Prostin E2), or misoprostol to maintain uterine contraction

Explain how the autonomic nervous system influences the fetal heart rate

Sympathetic stimulation increases the heart rate and strengthens the heart contractions to increase cardiac output by releasing epinephrine and norepinephrine

List at least five signs that suggest neonatal respiratory distress

Tachypnea (sustained); retractions that continue after the first hour; nasal flaring after the first hour; cyanosis involving the lips, tongue, and trunk (central cyanosis); grunting; seesaw respirations; asymmetry of chest expansion

Why should the nurse avoid taking a rectal temperature on newborns?

Taking a rectal temperature on newborns may irritate the mucosa or perforate the rectum, which turns at a right angle 3 cm (1.2 inches) from the anal sphincter

After your nursing actions, the infant latches onto the breast and begins suckling vigorously. Margaret begins to relax. She says, "I thought this would be easy, but it isn't." After about 3 minutes, Margaret asks, "Shouldn't I change breasts now? I don't want to have sore nipples." Discuss the following topics with Margaret: duration and frequency of feeding

Teach Margaret that the milk ejection reflex can take as long as 5 minutes to occur and nursing periods that are too short will provide only the foremilk, which has a lower fat content, is less satisfying, and does not promote the infant's growth. If the infant receives only the foremilk regularly, she will want to nurse often and will be less satisfied. Engorgement is also more likely. Duration is generally at least 10 to 15 minutes on each breast. Infants usually feed every 1.5 to 3 hours, and the mother should plan on nursing 8 to 12 times in each 24-hour period

Nita is worried about constipation because she had the same problem after her previous births and has been constipated during the last months of this pregnancy. What interventions and teaching can help Nita avoid constipation?

Teach Nita to increase her ambulation gradually, drink additional fluids (at least eight glasses of water daily), and increase dietary fiber. Prunes are a natural laxative, and she can consult her birth attendant for recommended laxatives if natural remedies do not work

What are the primary nursing assessments related to nifedipine in the treatment of preterm labor?

Teach about flushing of the skin and headache; observe maternal pulse rate (report if over 120 bpm), fetal heart rate, and maternal blood pressure; warn of postural hypotension, and teach woman to assume a sitting or standing position slowly after lying down

List client teaching related to long-term anticoagulation

Teach heparin injection technique to client and a family member, as appropriate. Teach client to report unusual bruising or petechiae, nosebleeds, blood in urine or stools, bleeding gums, or increased vaginal bleeding. Instruct her to use a soft toothbrush and not to go barefoot. Explain side effects of the specific anticoagulant. Caution about drug interactions and avoiding alcohol. Teach when to return for laboratory studies and their importance. Teach client to use contraception and avoid large amounts of foods high in vitamin K if taking warfarin. She should not go barefoot and should not use a blade razor

List nursing measures to promote normal labor when maternal pushing is ineffective for exhaustion

Teach the woman to push only when she feels the urge or with every other contraction; administer fluids as ordered; offer reassurance

What nursing measures help suppress lactation and manage the discomfort of breast engorgement?

Tell the mother to wear a well-fitting bra or sports bra 24 hours a day. Ice applications and analgesics reduce discomfort. She should avoid actions that stimulate milk production, such as spraying with warm water during showers and pumping or massaging the breasts

periodic fetal heart rate changes

Temporary recurrent changes in the fetal heart rate

How long should a mother breastfeed?

The American Academy of Pediatrics and American Dietetics Association recommend breast milk only for infants during the first 6 months. Although solid foods are added at approximately 6 months, the recommendation is for breastfeeding to continue for at least 1 year. However, the decision of how long to breastfeed is up to the mother

The FHR is normal for a term fetus, and it is reassuring that the FHR accelerates

What should the nurse teach new parents about infant urination?

The baby will have at least one or two wet diapers per day on the first day or two, increasing to at least six wet diapers by the fourth day. Notify the physician if there are no wet diapers in 12 hours

Why are pregnant and postpartum women prone to develop venous thrombosis?

They have stasis of blood in the veins of the lower extremities and have higher levels of clotting factors and suppression of factors that prevent clot formation. Injury to the vessels may occur during birth

cleansing breath

The cleansing breath releases tension, provides oxygen, clears the mind to focus on relaxing, signals the labor partner of contraction's beginning or end; may be taken in any way comfortable

How can nursing measures help increase a woman's sense of control during labor?

They promote relaxation and ability to work with her body's efforts rather than working against the natural forces

If an infant receives naloxone (Narcan), why should the nurse continue to monitor the infant for respiratory depression?

The duration of action for naloxone is shorter than for most of the opioids it reverses. Respiratory depression could recur until effects of the opioid drug have abated

After 4 hours of labor in the birth center, Erin's cervix is completely dilated and effaced, and the fetal station is 11. Erin feels the need to push during some contractions. When should Erin be positioned for birth?

The exact time to position Erin for birth will depend on how fast she has labored thus far. In general, a woman having her first baby is positioned for the birth when the fetal head crowns and remains visible between contractions

Explain how the central nervous system influences the fetal heart rate

The fetal cerebral cortex causes the fetal heart rate (FHR) to increase during fetal movement and decrease during fetal sleep; the hypothalamus coordinates the branches of the autonomic nervous system. The medulla oblongata maintains balance between forces that speed and slow the FHR

Why must the fetal head and shoulders undergo rotation within the pelvis?

The fetal head begins descent with the sagittal suture oriented in a transverse (crosswise) or oblique orientation to the woman's pelvis. As the head descends, it rotates so that the head is oriented with the sagittal suture in an anterior-posterior orientation to the woman's pelvis. After the fetal head is born, the fetal shoulders are then transverse in the pelvis and must rotate to pass under the pubic arch and be born

How is labor affected when the fetus is in an occiput posterior (OP) position?

The fetal occiput is pushed against the woman's sacral promontory with each contraction, causing intense back pain. In addition, the fetus must usually rotate into the occiput anterior position to be born, so labor is often longer

How does fetal hormone production affect the onset of labor?

The fetus appears to secrete oxytocin and cortisol, hormones that stimulate uterine contractions. The fetal membranes also release prostaglandins during labor

What time period does the fourth stage involve?

The first 1 to 4 hours after the placenta delivers is the fourth stage of labor

What should the nurse teach new parents about infant stools?

The first stools are called meconium (tarry, greenish-black, and sticky), followed by transitional stools, followed by milk stools. The stools of breastfed babies are mustard yellow, soft, and seedy and have a sweet-sour smell. Stools of formula-fed babies are pale yellow to light brown and formed. The baby is not constipated unless the stools are dry and hard like marbles. A water ring around the stool in the diaper indicates diarrhea and should be reported to the physician

Why is it particularly important that the infant's head be dried promptly?

The head makes up a large part of the newborn's body and thus is a large surface for heat loss. Damp hair presents a continuing source for evaporative heat loss

Jen is a gravida 1, para 1, who had a vaginal birth of a 9-lb baby 1½ hours ago. Her fundus has remained firm, midline, and 1 fingerbreadth below the umbilicus. She has not yet voided. Vital signs are stable, and she is afebrile. She received two tablets of hydrocodone with acetaminophen (Vicodin) for perineal pain 30 minutes after birth. She now requests "something stronger" for pain because the previous analgesic has been ineffective. Does the nurse need more information? If so, what?

The nurse needs more information about the pain—location, intensity on a 1 to 10 scale (comparing its present level with the level before she took the analgesic), character, and if anything worsens or improves it. In addition, the nurse must look at Jen's perineal area for evidence of a hematoma

How can you tell whether the infant needs more of the areola in the mouth? How much areola should be inside?

The infant's cheeks will show dimpling, and he or she will make smacking or clicking sounds if more of the areola should be in the mouth. The infant's lips should be 2.5 to 3.8 cm (1 to 1½ inches) from the base of the nipple if there is enough of the areola in the mouth

The medication could be taking longer than usual to exert its analgesic properties, it could be outdated, Jen's pain tolerance at this time could be very low, or other birth trauma may have occurred. In addition, although Jen's fundal height is appropriate, she may need to urinate because it has been 1½ hours since birth and her bladder may be fuller than it seems

Describe useful techniques to teach the mother if the infant seems to have trouble breathing while nursing

The mother can bring the infant into a more horizontal position and nearer to her body. She should not indent the breast tissue, because this could interfere with milk flow or change the position of the nipple in the infant's mouth and lead to sore nipples.

Describe the palmar or C hand position for breastfeeding

The mother cups the breast in her palm with her thumb on top and fingers underneath and behind the areola

Describe the progression of maternal verbal behaviors

The mother progresses from calling the infant "it" to referring to the infant as "he" or "she" to using the infant's given name

What nursing measures can help the mother of twins attach to her babies?

The nurse provides opportunities for frequent contact with each infant to help parents interact with each twin individually rather than interacting with them as a "package." It is essential to point out unique qualities and characteristics of each infant individually

The infant develops shaking of the hands. How can the nurse tell if the infant is demonstrating tremors or seizures?

Tremors will stop when the hands are held firmly in a flexed position. Seizures continue when the extremities are held and may be accompanied by abnormal mouth or eye movements

Describe postpartum changes in the uterine muscle cells

The number of uterine muscle cells remains the same, but each cell decreases in size through catabolism

Alice is a 16-year-old primigravida in the latent phase of first-stage labor. She did not attend prepared childbirth classes. She is very anxious and tense, crying during each contraction. Her cervix is dilated to 3 cm, station 21, effacement 90%, and the membranes are ruptured (amniotic fluid is clear). Her baseline vital signs are pulse, 92 beats per minute (bpm); respirations, 24 breaths per minute; and blood pressure, 120/70 mm Hg. Fetal heart rate (FHR) is 126 to 136 bpm with average variability. Her 17-year-old husband is at her side but seems very frustrated and helpless. Her parents live out of state; her husband's parents are with the couple. What assumptions must the nurse be careful to avoid when caring for Alice?

The nurse must be careful to avoid assumptions (e.g., the pregnancy was unplanned), that Alice did not have prenatal care, that she and her husband cannot learn nonpharmacologic pain management methods, or that she would want an epidural right away. Think of other assumptions that nurses should avoid. Consider assumptions nurses might have about teenage parents being married. Look up the most recent statistics for married parents of any age

Alice gives birth to a 2380-g (6-lb, 2-oz) girl. Apgar scores are 7 at 1 minute and 9 at 5 minutes. What are appropriate nursing measures related to Alice's epidural while she is in the recovery area with her baby, husband, and grandparents?

The nurse must continue to observe for bladder distention during first- and second-stage labor, which can result in poor uterine contraction and postpartum hemorrhage. Return of sensation must be documented. The nurse must assist Alice to the bathroom at first in case she still has reduced sensation or hypotension that could result in a fall. If catheterization is needed at any time during labor, the nurse should first explain the reasons and procedures simply

Ann is admitted at 33 weeks of gestation saying that she thinks her "water broke." This is her fourth pregnancy. Two of her infants were preterm, born at 32 and 27 weeks of gestation, and she has had one elective termination of pregnancy. She has had regular prenatal care since 6 weeks of gestation. What are the most important additional assessments that the nurse should make?

The nurse must do the following: attempt to verify whether Ann's membranes have ruptured, but without performing a vaginal examination; determine when they ruptured; assess maternal vital signs and fetal heart rate, looking specifically for signs of infection; assess for contractions that may indicate preterm labor and preterm premature rupture of membranes

Alice receives epidural block analgesia when given that choice. She follows the nurse's instructions as it is done. What nursing care is essential related to the block? Why?

The nurse must prehydrate Alice with a minimum of 500 to 1000 mL of IV solution, check her blood pressure frequently to detect hypotension, and observe the fetal heart rate (FHR) for signs of reduced placental perfusion that can occur with maternal hypotension. The nurse must also observe for bladder distention related to loss of sensation and high volumes of IV fluids. Alice may need coaching to push during the second stage if she cannot feel the urge. In addition, the nurse must be alert for signs of catheter migration or maternal fever or infection. The nurse should explain every intervention and its rationale simply

How should the nurse respond to the parents who are disappointed about the sex of their newborn?

The nurse should help the parents acknowledge and talk about their feelings to help them cope with their disappointment and facilitate their attachment with the child

How can the nurse help the new father adapt to his role?

The nurse should involve the father in infant care teaching and decisions. Fathers may not know what to expect from newborns and benefit from information about growth and development. A review of any prenatal teaching is also helpful

The nurse should reassure Nita that the afterpains are normal, are typically short term, and that analgesics can ease them

Alice is a 16-year-old primigravida in the latent phase of first-stage labor. She did not attend prepared childbirth classes. She is very anxious and tense, crying during each contraction. Her cervix is dilated to 3 cm, station 21, effacement 90%, and the membranes are ruptured (amniotic fluid is clear). Her baseline vital signs are pulse, 92 beats per minute (bpm); respirations, 24 breaths per minute; and blood pressure, 120/70 mm Hg. Fetal heart rate (FHR) is 126 to 136 bpm with average variability. Her 17-year-old husband is at her side but seems very frustrated and helpless. Her parents live out of state; her husband's parents are with the couple. Can Alice be taught breathing techniques at this time? If so, how should the nurse approach the teaching?

The nurse should teach Alice simple breathing and relaxation techniques between contractions. Say something such as, "I'm going to teach you how to breathe so that you can cope with labor better," in a positive manner to convey the expectation that the techniques will work, rather than doing the teaching in a tentative manner. Give liberal positive feedback when Alice uses the techniques taught, and give her husband positive feedback for his coaching

Describe postpartum changes in the uterine lining

The outer area of endometrium (decidua) is expelled with the placenta. Remaining decidua separates into two layers: the superficial layer is shed in lochia and the basal layer regenerates new endothelium

Under what two circumstances should butorphanol (Stadol) or nalbuphine (Nubain) be avoided when a laboring woman is being medicated?

These drugs have combined opioid agonist-antagonist effects and should not be given to a woman who has had a recent dose of a pure opioid agonist (may reverse effectiveness of first drug) or to a woman who is addicted to opiates such as heroin (may precipitate acute withdrawal). These drugs also have a ceiling effect and are unlikely to provide sufficient analgesia for the entire labor

What must the nurse consider when evaluating intrauterine pressures from a solid catheter versus a fluid-filled catheter?

The pressures from a solid intrauterine pressure catheter are slightly higher than those of the fluid-filled catheter. A fluid-filled catheter is sensitive to the height of the catheter tip in relation to the transducer

In which regional anesthesia method is it desirable to obtain cerebrospinal fluid (CSF)? Why?

The subarachnoid block (SAB) punctures the dura and arachnoid membranes, entering the space that contains cerebrospinal fluid (CSF). Appearance of a few drops of CSF confirms the correct location for injection of the anesthetic drug for this block

What is the purpose of giving a test dose before performing an epidural block? What would be signs of problems after the test dose, and what causes these signs?

The test dose is given to identify inadvertent dural or intravascular puncture before injection of the full dose of the anesthetic drug. Evidence of these problems includes rapid and intense motor and sensory block (subdural or subarachnoid injection) or numbness of the tongue and lips, lightheadedness, dizziness, and tinnitus (intravascular injection)

Describe differences in how the upper and lower parts of the uterus contract during labor. Why is it important that the parts have different contraction characteristics?

The upper uterus contracts actively to push the fetus downward, whereas the lower uterus is more passive to reduce resistance to fetal passage into and through the pelvis. Any other pattern would be ineffective at pushing the fetus out

How will the nurse recognize uterine atony?

The uterus is difficult to locate and, when found, it is soft rather than firm and higher than the expected level in the abdomen. It may become firm with massage but may fail to remain firm. Lochia and clots are excessive

The nurse notes that a small amount of fluid with a strong odor is draining from Ann's vagina. Using a speculum examination to obtain fluid, the pH test turns blue-black on contact with the fluid, and a fern test is positive. Maternal vital signs are as follows: temperature, 37.2° C (99° F); pulse, 86 bpm; respirations, 22 breaths/min; and blood pressure, 132/80 mm Hg. The fetal heart rate is 162 to 170 bpm. Ann occasionally has a contraction lasting 20 to 30 seconds. What is the main judgment that you would make from these data? What is the basis for that judgment?

The vaginal fluid drainage and the positive pH and fern test results suggest that Ann's membranes have ruptured. Infection is suggested by the strong fluid odor and fetal tachycardia. Contractions suggest possible preterm labor

Foremilk

Thirst-quenching milk

Thrombophlebitis

Thrombus formation with inflammation

List important nursing assessments after the membranes rupture. Describe normal and abnormal assessment results

Time of rupture; whether rupture was spontaneous or artificial; quantity of fluid; fetal heart rate (FHR) for at least 1 minute; color of fluid (clear, possibly with bits of vernix, is normal; green indicates fetal meconium passage; yellow or cloudy suggests infection); odor (foul or strong odor suggests infection)

Petechiae

Tiny purplish-red spots on the skin caused by intradermal or submucosal hemorrhage

Why is it important to place a small pillow under one hip if the mother must lie briefly on her back?

To prevent supine hypotension from aortocaval compression by the heavy uterus

Compare and contrast open glottis pushing with closed glottis pushing

Traditional closed-glottis pushing may result in impaired blood flow to the uterus, is fatiguing for the woman, and has not proven to significantly shorten second stage. Open-glottis pushing improves maternalfetal oxygenation and is more physiologic, but the second stage may be longer

Describe changes in the composition and appearance of transitional milk

Transitional milk is produced during lactogenesis II. It is lower in immunoglobulins and proteins but higher in lactose, fat, and calories than colostrum. The vitamin content is similar to that of mature milk

Two factors increase afterpains in Nita's case, multiparity and uterine overdistention with two fetuses

Why are upright positions good for women who have ineffective second-stage pushing?

Upright positions add the force of gravity to maternal pushes

Why are upright maternal positions best to relieve persistent occiput posterior positions? List positions that might be effective, including those other than upright

Upright positions favor fetal descent (gravity) and, with that descent, fetal head rotation. Effective positions for pushing may include squatting, semisitting, side-lying, pushing on the toilet, and/or lunging

What factors might make a woman think that her membranes have ruptured when they have not?

Urinary incontinence, increased vaginal discharge, loss of the mucous plug

Urinary tract infection is associated with preterm labor and reduces the effectiveness of measures to stop preterm labor. Antibiotics may be ordered after collection of sterile urine for tests

Shawna will receive magnesium sulfate for tocolysis. Which nursing observations are essential in relation to magnesium sulfate? Why?

Urine output of at least 30 mL/hr, presence of deep tendon reflexes, and respiratory rate of at least 12 breaths/min suggest that the magnesium is within safe limits. Serum magnesium levels will also be ordered

Describe basic comfort measures that the nurse can provide during labor

Use soft, indirect lighting. Keep the temperature comfortable with a fan or damp cool washcloths. Have the woman wear socks for cold feet. Keep the woman reasonably clean by changing her underpad as often as needed. Offer ice chips or wet washcloth to wet her lips. Remind her to empty her bladder at least every 2 hours. Encourage her to change positions frequently, assuming the position of comfort (except the supine position). Offer a shower, whirlpool, or other water therapy

When should the nurse not perform a vaginal examination at a woman's admission? Why?

Vaginal examination should not be routinely performed if the woman is bleeding actively, because the examination may increase bleeding; bloody show is not contraindication to vaginal examination; if fetal gestation is 36 weeks or less because of stimulation of preterm labor or preterm membrane rupture

Why is variability an important component of fetal heart pattern evaluation? Under what circumstances might variability normally be minimal? Why?

Variability reflects normal function of the autonomic nervous system, which helps the fetus adapt to the stress of labor. Minimal variability might be normal in prematurity or fetal sleep or after maternal narcotic or sedative administration because these conditions do not reflect reduced nervous system oxygenation. Fetal sleep would be temporary, and variability should reappear when the fetus awakens, usually in approximately 40 minutes at term. Narcotic effects would last longer but would still be temporary

Chordee

Ventral curvature of the penis

What are some examples of suspicious behavior in a visitor that should cause the nurse to think about the possibility of abduction?

Visitors who go from one room to another, visitors who ask many questions regarding hospital routines and floor plan (e.g., about location of exits), anyone carrying an infant in the hallway or taking a crib to areas where it should not be taken, anyone carrying a bag or package large enough to hide an infant

Explain why vitamin K is typically given to newborns

Vitamin K, which is necessary for normal blood coagulation, is given because the infant's gastrointestinal tract is sterile at birth and temporarily lacks the microorganisms that will make this vitamin

After your nursing actions, the infant latches onto the breast and begins suckling vigorously. Margaret begins to relax. She says, "I thought this would be easy, but it isn't." After about 3 minutes, Margaret asks, "Shouldn't I change breasts now? I don't want to have sore nipples." What should you tell her about caring for her breasts?

Wear a well-fitting bra day and night. Avoid creams, ointments, or soaps on the breasts. Wash the nipples with plain water. Wear absorbent pads in the bra if breasts are leaking, but do not allow the wet pad to have prolonged contact with the breast. Leave bra flaps down after nursing

How do the signs and symptoms of a hematoma differ from those of uterine atony or a bleeding laceration?

With hematoma, pain is the greatest distinction, because confined bleeding exerts pressure on sensory nerves. The uterus is firm, excluding uterine atony as the cause. Lochia is normal because the bleeding is concealed, excluding a bleeding laceration. A bulging discolored mass may be visible. Tachycardia and falling blood pressure are signs of hypovolemia that may occur with any type of hemorrhage

Explain why involuntary uterine contractions is important during birth

Woman cannot consciously cause labor to start or stop; otherwise, many infants would be born early because the woman became tired of being pregnant, or labor might be suspended when it became intense

What discharge teaching related to late postpartum hemorrhage is essential?

Women should be told the normal sequence, amount, and duration of lochia. They should be taught assessment and expected descent of the fundus. Guidelines should be provided for reporting deviations from normal

When can women expect their menses to resume if they are breastfeeding? If they are not planning to breastfeed?

Women who are breastfeeding may not resume menses for 12 weeks to 18 months, depending on the length and frequency of breastfeeding. Contraception should be used by lactating women by 6 months after giving birth or earlier. Many women who formula-feed will begin menses between 6 and 12 weeks postpartum

A woman who is 4 hours postpartum ambulates to the bathroom and suddenly has a large gush of lochia rubra. The nurse's first action should be to: a. Determine whether the bleeding slows to normal or remains as a large volume. b. Observe vital signs for signs of hypovolemic shock. c. Check to see what her previous lochia flow has been. d. Identify the type of pain relief that was given when she was in labor.

a. Determine whether the bleeding slows to normal or remains as a large volume.

Breast milk is produced in the ____________ of the breasts

alveoli

You should immediately teach Nita how to assess her uterus for firmness and the effect of a full bladder, her multiparity, and her multifetal birth on uterine contraction

When reading the postpartum chart the nurse notices that the patient's fundus is recorded as "u+1." The nurse understands that this means the fundus is a. 1 cm above the umbilicus b. 1 cm below the umbilicus c. 1 in above the umbilicus d. 1 in below the umbilicus

a. 1 cm above the umbilicus Descent of the fundus is documented in relation to the umbilicus and is measured in centimeters. Numbers with a plus sign mean that the fundus is above the umbilicus; numbers with a minus sign mean that the fundus is below the umbilicus.

Parents often have questions about pacifiers. Select all the following that is correct information to teach the parents. (Select all that apply.) a. All infants have an urge to suck. b. Pacifiers will cause malocclusion of the teeth only if they are used after the secondary teeth begin to erupt. c. Pacifiers should be replaced every 1 or 2 months. d. Pacifiers can be placed on a string around the infant's neck. e. If the infant uses thumb sucking instead of a pacifier, it will be easier to give up as the child grows.

a. All infants have an urge to suck. b. Pacifiers will cause malocclusion of the teeth only if they are used after the secondary teeth begin to erupt. c. Pacifiers should be replaced every 1 or 2 months. All infants have a need to suck, although the amount of sucking needed varies among infants. The AAP recommends the use of pacifiers for sleep to help prevent SIDS. Use of pacifiers should be delayed until 1 month in breastfeeding infants. Use of a pacifier for part of the day, not using an upside down pacifier, and stopping sucking on a pacifier before the secondary teeth begin to erupt is unlikely to cause malocclusion. Pacifiers should be replaced every month or two and should never be placed on a string around the infant's neck. Pacifiers are easier to give up than thumb sucking because they are not as easily accessible as a thumb.

If the nurse notices one artery and one vein in the cord during the initial assessment of a newborn, which one of the following actions should be carried out? a. Assess for other anomalies. b. Document this as a normal finding. c. The finding is not normal; however, it has no significance.

a. Assess for other anomalies. A two-vessel cord is associated with chromosomal, renal, and gastrointestinal defects. Therefore the newborn should be assessed for other anomalies.

A woman's membranes rupture during a contraction. The priority nursing action is to: a. Assess the fetal heart rate. b. Note the color of the discharge. c. Check the woman's vital signs. d. Determine whether the fluid has a foul odor.

a. Assess the fetal heart rate.

While performing an admission assessment on a term newborn, the nurse notes poor muscle tone and slight jitteriness. There are no other findings. The appropriate nursing action is to: a. Assess the infant's blood glucose level. b. Wrap the infant tightly in blankets. c. Check the chart for narcotics given in labor. d. Give supplemental oxygen by face mask.

a. Assess the infant's blood glucose level.

Nursing measures to promote bonding and attachment include which of the following? (Select all that apply.) a. Assist the parents in unwrapping the baby to inspect. b. Point out that the infant grasping the mother's or father's finger is a natural reflex. c. Explain the physical changes in the newborn, such as molding, as being normal. d. Encourage the mother to let the infant stay in the nursery as much as possible so the mother can rest. e. Position the infant in a face to face position with the mother.

a. Assist the parents in unwrapping the baby to inspect. e. Position the infant in a face to face position with the mother. Nursing measures to promote bonding and attachment include: Assist the parents in unwrapping the baby to inspect the toes, fingers, and body. Inspection fosters identification and allows the parents to become acquainted with the "real" baby, which must replace the fantasy baby that many parents imagined during the pregnancy. Position the infant in an en face position and discuss the infant's ability to see the parent's face. Face-to-face and eye-to-eye contact is a first step in establishing mutual interaction between the infant and parent.

A new mother wants to breastfeed, but plans occasional formula feedings. The nurse should teach her to: a. Avoid using bottles for 3 to 4 weeks to establish her milk supply, if possible. b. Make a clear choice to feed by one method to avoid nipple confusion. c. Limit formula feeding to once each day until her milk supply is well established. d. Alternate formula and nursing to allow the infant to become accustomed to both.

a. Avoid using bottles for 3 to 4 weeks to establish her milk supply, if possible.

Which one(s) of the following tests assess for developmental hip dysplasia and instability? (Select all that apply.) a. Barlow's test b. Ortolani's test c. Bending the knees and comparing height d. Comparing gluteal creases e. Comparing leg lengths f. Ritgen's maneuver

a. Barlow's test b. Ortolani's test c. Bending the knees and comparing height d. Comparing gluteal creases e. Comparing leg lengths In the Barlow test, adduct the hips, and apply gentle pressure down and back with the thumbs. In hip dysplasia the examiner can feel the femoral head move out of the acetabulum. In the Ortolani test, abduct the thighs, and apply gentle pressure forward over the greater trochanter. A "clunking" sensation indicates a dislocated femoral head moving into the acetabulum. The symmetry of gluteal and thigh creases are noted; the knees are bent and the height compared, and the equality of leg lengths are noted. The Ritgen maneuver is used during birth to extend the head and protect the perineum.

Which one(s) of the following are important points when teaching a patient the proper method for pushing during the second stage of labor? (Select all that apply.) a. Begin and end by taking a deep breath and exhaling. b. Push for 4 to 6 seconds at a time. c. Take a deep breath and then push while holding her breath. d. Push at least five or six times with each contraction.

a. Begin and end by taking a deep breath and exhaling. b. Push for 4 to 6 seconds at a time. Support the woman's spontaneous pushing techniques if they are effective. The woman should push with her abdominal muscles while relaxing her perineum. If she needs coaching, teach her to begin by taking a breath and exhaling and then to take another breath and exhale while pushing for 6 seconds at a time. Sustained pushing while holding a breath (Valsalva maneuver or "purple pushing") or pushing more than four times per contraction reduces blood flow to the placenta, increases intrathoracic pressure, is fatiguing and should be discouraged.

Which one(s) of the following are considered abnormal (Category III) heart rate patterns? (Select all that apply.) a. Bradycardia b. Absent variability c. Early decelerations d. Recurrent variable decelerations

a. Bradycardia b. Absent variability d. Recurrent variable decelerations Category III or abnormal fetal heart rate patterns include: absent variability AND recurrent late decelerations OR recurrent variable decelerations OR bradycardia OR sinusoidal pattern.

A multigravida at 37 weeks of gestation is admitted to the labor room. She has contractions every 3 to 4 minutes lasting 40 to 50 seconds and no history of clear fluid leakage from the vagina, but complains of bright red bleeding for the past hour. The fetal heart rate is 145 beats/minute (bpm). What should be the nurse's next intervention? a. Call the physician promptly. b. Perform a vaginal exam to determine imminence of birth. c. Continue to monitor contractions and fetal heart rate. d. Administer an enema according to protocol of the agency.

a. Call the physician promptly. Bright red bleeding is a sign of complications, and the physician or primary health care provider should be notified immediately. Vaginal exams or enemas are contraindicated in the presence of bleeding. Continuing to monitor the mother and fetus is important after notifying the health care provider.

Which one(s) of the following are considered theories about the onset of labor? (Select all that apply.) a. Changes in the relative effects of estrogen and progesterone b. An increase in prostaglandins c. Increased secretion of prolactin d. Decreased secretion of oxytocin e. Stretching and irritation of the uterus and cervix

a. Changes in the relative effects of estrogen and progesterone b. An increase in prostaglandins e. Stretching and irritation of the uterus and cervix Factors that appear to have a role in starting labor include: (1) changes in the ratio of maternal estrogen to progesterone so that estrogen levels are higher than progesterone levels, (2) prostaglandins produced by the decidua and membranes may have a role in preparing the uterus for oxytocin stimulation at term, (3) increased secretion of natural oxytocin does not appear to start labor but appears to maintain labor once it has begun, (4) the fetal membranes release prostaglandin in high concentrations during labor and large quantities of cortisol are secreted by the fetal adrenal glands, possibly acting as a uterine stimulant, and (5) stretching, pressure, and irritation of the uterus and cervix increase as the fetus reaches term size.

During the labor process, the patient's membranes rupture. Select all the assessments that are necessary for the nurse to carry out at this time. (Select all that apply.) a. Color of amniotic fluid b. Odor of amniotic fluid c. Fetal heart rate d. Cervical dilation e. Cervical effacement f. Time the membranes ruptured

a. Color of amniotic fluid b. Odor of amniotic fluid c. Fetal heart rate f. Time the membranes ruptured The time of rupture of membranes, fetal heart rate, color, odor, and quantity of the amniotic fluid are noted and charted.

The nurse notes the following contraction pattern. Beginning of Contraction End of Contraction 11:15:00 11:15:40 11:20:00 11:20:45 11:24:00 11:24:50 11:28:30 11:29:10 11:33:00 11:33:35 Choose the correct documentation for the pattern. a. Contractions every 4 to 5 minutes, duration 35 to 50 seconds b. Contractions every 5 minutes, duration 35 to 40 seconds c. Contractions every 3 to 5 minutes, duration 30 to 50 seconds d. Contractions every 3 to 4 minutes, duration 30 to 40 seconds

a. Contractions every 4 to 5 minutes, duration 35 to 50 seconds

Labor pain management may include which one(s) of the following interventions? (Select all that apply.) a. Cool, damp washcloths on the face and neck b. Decreasing bright lights in the room c. Keeping the woman clean and dry d. Administering pain medication as ordered e. Offering simple snacks every 2 hours

a. Cool, damp washcloths on the face and neck b. Decreasing bright lights in the room c. Keeping the woman clean and dry d. Administering pain medication as ordered Providing comfort measures are important during labor. A laboring woman may have clear liquids by mouth but no solid food during active labor.

When giving an initial bath to a newborn, which one(s) of the following techniques are appropriate? (Select all that apply.) a. Do not bathe the infant until the newborn's temperature is stable. b. Wash all the vernix and blood off of the skin and hair. c. Gloves should be worn. d. The bath should be performed quickly and the infant dried. e. After the bath, the infant may be wrapped in blankets and placed in an open crib.

a. Do not bathe the infant until the newborn's temperature is stable. c. Gloves should be worn. d. The bath should be performed quickly and the infant dried. Gloves should be worn when handling a newborn until the initial bath has been given. A sponge bath is given with the infant under the radiant warmer to help maintain the infant's temperature. The bath should be performed quickly and the infant thoroughly dried to prevent heat loss by evaporation. While shampooing the hair, the nurse combs through it to remove dried blood. Vernix need not be removed. Combing the infant's hair hastens drying. The infant remains under the radiant warmer until the hair is dry and the temperature returns to the previous level. The infant is dressed and wrapped in two warm blankets, and a warm cap is placed on the infant's head before he or she is removed from the radiant warmer. The temperature should be rechecked within 1 hour to ensure that the infant is maintaining thermoregulation adequately.

When checking a woman's fundus 24 hours after the cesarean birth of her first baby, the nurse finds her fundus at the level of her umbilicus, firm, and in the midline. The appropriate nursing action related to this assessment is to: a. Document the normal assessment. b. Determine when she last urinated. c. Limit her intake of oral fluids. d. Massage her fundus vigorously.

a. Document the normal assessment

A breastfeeding woman develops mastitis. She tells the nurse that she will feed her baby formula instead of breastfeeding until the infection is healed. The best nursing response is that: a. Emptying the breast is important to prevent an abscess. b. A tight breast binder or bra will help reduce engorgement. c. She should continue to drink extra fluids while weaning. d. Breastfeeding can continue when her temperature is normal.

a. Emptying the breast is important to prevent an abscess.

Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, ?2-1. Which one of the following is a correct interpretation of the data? a. Fetal presenting part is 1 cm above the ischial spines. b. Effacement is 4 cm from completion. c. Dilation is 50% completed. d. Fetus has passed through the ischial spines.

a. Fetal presenting part is 1 cm above the ischial spines. A station of ?2-1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. A station of 0 would indicate that the presenting part has passed through the inlet and is at the level of the ischial spines or is engaged. Passage through the ischial spines with internal rotation would be indicated by a plus station, such as +1. Progress of effacement is referred to by percentages, with 100% indicating full effacement, and dilation by centimeters (cm), with 10 cm indicating full dilation.

Choose the correct parent teaching about cord care. a. Fold the diaper below the cord to speed drying. b. Expect the cord to detach in no more than 7 days. c. Scrub the area with soap each day. d. Skin near the cord site may be red until it detaches.

a. Fold the diaper below the cord to speed drying.

A nursing student has been caring for a woman and her newborn all morning. The student takes the infant to the nursery for screening tests before discharge. When the infant is returned to the mother, the correct procedure is to: a. Have the mother read her printed band number, and verify that it matches the infant's band number. b. Ask the mother to state her name and the name of her infant, c. Call out the mother's full name before leaving the infant with her, d. Explain the screening tests and give the infant to the mother,

a. Have the mother read her printed band number, and verify that it matches the infant's band number.

Why is a cleansing breath at the beginning and end of contractions important? (Select all that apply.) a. Helps the woman release tension b. Provides oxygen to reduce myometrial hypoxia c. Provides a diversional activity for the woman d. Helps the fetus to release tension

a. Helps the woman release tension b. Provides oxygen to reduce myometrial hypoxia Each contraction begins and ends with a deep inspiration and expiration known as the cleansing breath. Like a sigh, a cleansing breath helps the woman release tension. It provides oxygen to help reduce myometrial hypoxia, one cause of pain in labor. The cleansing breath also helps the woman clear her mind to focus on relaxing and signals her labor partner that the contraction is beginning or ending.

A woman with active herpes asks whether she can breastfeed her infant. The nurse should tell her that: a. She can breastfeed the infant if she does not have any lesions on her breasts. b. She should not breastfeed the infant because the virus can infect the infant. c. She can breastfeed after the infant has received vaccination against herpes. d. The infant has antibodies against herpes and is unlikely to become infected.

a. She can breastfeed the infant if she does not have any lesions on her breasts.

How does childbirth pain differs from other types of pain? (Select all that apply.) a. It is a normal process. b. There is preparation time. c. It is stronger than most other types of pain. d. It is self-limiting e. It is intermittent. f. It is always a dull, achy type of pain.

a. It is a normal process. b. There is preparation time. d. It is self-limiting e. It is intermittent. Childbirth pain differs from other types of pain in several important respects: (1) it is part of a normal process, whereas other types of pain relate to injury or illness, (2) preparation time exists; the pregnant woman has several months to prepare for labor, including acquiring skills to help manage pain; (3) it is self-limiting and has a foreseeable end, (4) labor pain is not constant, but intermittent, and (5) labor ends with the birth of a baby.

Which one(s) of the following are true concerning colic in an infant? (Select all that apply.) a. It is characterized by irritable crying for no obvious reason for 3 hours/day or longer. b. It occurs only in formula-fed infants. c. Infants will draw their knees onto the abdomen. d. One cause may be an allergic reaction to the type of formula used.

a. It is characterized by irritable crying for no obvious reason for 3 hours/day or longer. c. Infants will draw their knees onto the abdomen. d. One cause may be an allergic reaction to the type of formula used. Colic is described as inconsolable paroxysmal crying periods that occur daily for several days a week. It can last several months. Both breast fed and formula fed infants can have colic. Infants with colic cry as though in pain and draw their knees onto the abdomen, rigidly extend the legs, and may pass flatus. The cause is unknown but allergies to cow's milk or substances in the breastfeeding mother's diet may be a factor.

What is the primary benefit of the stress of labor to the newborn? a. It stimulates breathing and elimination of lung fluid. b. It increases alertness and enhances parent-infant bonding. c. It speeds peristalsis to eliminate meconium quickly. d. It enhances tolerance of microorganisms from others.

a. It stimulates breathing and elimination of lung fluid.

Choose the abbreviation that represents the fetal presentation and position that is most favorable for vaginal birth. a. LOA b. RMP c. LST d. ROP

a. LOA

A woman is receiving magnesium sulfate intravenously to control preterm labor. She is at the maximum dose and the contractions have slowed to eight/hr. The nurse is assessing the woman's vital signs every hour. In addition to blood pressure, pulse, and respirations, what other assessments should be carried out hourly? a. Lung sounds b. Edema in lower extremities c. Bowel sounds d. Range of motion to the lower extremities

a. Lung sounds Magnesium sulfate can lead to fluid overload, which can cause pulmonary edema. Assessing lung sounds every hour will alert the nurse to changes. Bowel sounds should be checked every 4 to 8 hours. Magnesium sulfate should not affect the lower extremities.

Which one(s) of these conditions might cause late decelerations in the fetal heart rate? (Select all that apply.) a. Maternal hypotension b. Excessive uterine activity c. Maternal hypertension d. Fever e. Maternal overhydration f. Prolapsed cord

a. Maternal hypotension b. Excessive uterine activity c. Maternal hypertension Late decelerations are thought to occur with decreased blood flow through the intervillous space due to maternal, fetal factors, or placental factors resulting in fetal hypoxia. They can be a reflex to transient fetal hypoxia caused by an interruption anywhere along the oxygen pathway such as maternal hypotension. The peak of a uterine contraction produces a temporary cessation of uterine blood flow and oxygen delivery to the intervillous space. Uterine hypertonus may also impact oxygen delivery. Typically, residual oxygen in the intervillous space is adequate enough for the fetus to tolerate these changes. Tachysystole, prolonged contractions, hypertonus, or inadequate relaxation time between contractions may result in FHR changes that are the result of fetal hypoxia. Fever and maternal overhydration would not affect FHR. Prolapsed cord would result in an absence of FHR.

A breastfeeding mother is reluctant to take a prescribed analgesic because she does not want to pass it to the baby. The nurse should teach her that: a. Medications prescribed for postpartum discomfort are safe for use in lactation. b. She should feed less often so that she can limit transfer of medication to the baby. c. It is important to avoid all nonessential medications during nursing, including analgesics. d. Formula feeding as long as she needs analgesics may be best for the baby.

a. Medications prescribed for postpartum discomfort are safe for use in lactation.

To ensure adequate fetal oxygenation, which one(s) of the following are needed? (Select all that apply.) a. Normal maternal blood flow and volume to the placenta b. Normal oxygen saturation in maternal blood c. Normal carbon dioxide saturation in the maternal blood d. Adequate exchange of oxygen and carbon dioxide in the placenta e. Normal fetal circulatory and oxygen-carrying functions f. Normal blood glucose levels in the fetal circulation

a. Normal maternal blood flow and volume to the placenta b. Normal oxygen saturation in maternal blood d. Adequate exchange of oxygen and carbon dioxide in the placenta e. Normal fetal circulatory and oxygen-carrying functions Fetal oxygenation involves (1) oxygen transfer from the environment to the fetus, and (2) the fetus responses to this interruption of oxygen transfer. This necessitates normal maternal blood flow of oxygenated blood, exchange of oxygen and carbon dioxide in the placenta, and normal fetal circulation of oxygen-carrying blood components.

The nurse should teach the different ways new mothers can assess if the newborn is receiving sufficient milk. Select all that are appropriate to assess. (Select all that apply.) a. Nutritive suckling b. Number of wet diapers c. Number of stools d. Length of time newborn is attached to the breast

a. Nutritive suckling b. Number of wet diapers c. Number of stools Ways to determine if the infant is receiving enough milk include noting nutritive suckling (sucking) during which the infant sucks with smooth, continuous movements with occasional pauses to rest. The infant may swallow after each suck or may suck several times before swallowing. Counting the number of wet and soiled diapers helps determine whether the infant is receiving enough milk.

Which one(s) of the following actions should be included in nursing care during labor? (Select all that apply.) a. Offer ice chips in small amounts to relieve a dry mouth. b. Monitor for a full bladder because the woman may have a decreased sensation of the urge to void. c. Keep the woman in a side-lying position to prevent supine hypotension. d. Offer small bland meals if the woman is in early labor to help maintain proper blood sugar levels. e. Monitor the fetal heart rate for changes from normal.

a. Offer ice chips in small amounts to relieve a dry mouth. b. Monitor for a full bladder because the woman may have a decreased sensation of the urge to void. c. Keep the woman in a side-lying position to prevent supine hypotension. e. Monitor the fetal heart rate for changes from normal. Oral intake of clear liquids such as ice chips, juices, and popsicles is appropriate in low risk laboring women; solid foods should be avoided. A full bladder can inhibit fetal descent because it occupies space in the pelvis. Bladder status should be evaluated throughout labor for distention. Alterations in the rate and rhythm of the fetal heart may result from normal labor effects or suggest fetal intolerance to the stress of labor and should be monitored. Supine hypotension may occur during labor if the woman lies on her back due to aortocaval compression. The woman should be encouraged to rest in lateral positions to promote blood return to her heart and thus enhance blood flow to the placenta and promote fetal oxygenation.

A newborn is in the crib in his mother's room. The teenage mother is watching TV. When the nurse notes that the baby is awake and quiet, the best nursing action is to: a. Pick the baby up and point out his alert behavior to the mother. b. Tell the mother to pick up her baby and talk to him while he is awake. c. Focus care on the mother, rather than the infant, so that the mother can recuperate. d. Encourage the mother to feed the infant before he begins crying.

a. Pick the baby up and point out his alert behavior to the mother.

A young mother is excited about her first baby. Choose the best teaching to help her obtain adequate rest after discharge. a. Plan to sleep or rest any time the infant sleeps. b. Do all housecleaning while the infant sleeps. c. Cook several meals at once and freeze for later use. d. Tell family and friends not to visit for the first month.

a. Plan to sleep or rest any time the infant sleeps.

Relaxation of the mother during labor is important for several reasons. Which one(s) of the following are reasons that promoting relaxation is important? (Select all that apply.) a. Promotes uterine blood flow b. Improves fetal oxygenation c. Promotes efficient uterine contractions d. Reduces tension that increases pain e. Inhibits rapid fetal descent

a. Promotes uterine blood flow b. Improves fetal oxygenation c. Promotes efficient uterine contractions d. Reduces tension that increases pain Promoting relaxation is a basis for all other methods, both nonpharmacologic and pharmacologic, because it achieves the following: (1) promotes uterine blood flow, improving fetal oxygenation, (2) promotes efficient uterine contractions, (3) reduces tension that increases pain perception and decreases pain tolerance (maximum pain one is willing to endure), and (4) reduces tension that can inhibit fetal descent.

Which one(s) of the following are used to assist with the cervical ripening process prior to induction of labor? (Select all that apply.) a. Prostaglandin b. Oxytocin c. Misoprostol (Cytotec) d. Laminaria tents e. Terbutaline

a. Prostaglandin c. Misoprostol (Cytotec) d. Laminaria tents Prostaglandin E2 (PGE2) preparations may be given as an intravaginal gel, an intracervical gel, or a timed-release vaginal insert to ripen the cervix. Misoprostol can be used for both cervical ripening and induction of labor. Mechanical methods for cervical ripening are efficacious and have decreased risk of excessive uterine activity. These methods include placement of a transcervical balloon catheter, membrane stripping, or placement of hydroscopic inserts (i.e., Laminaria—sterile cone-shaped preparations of dried seaweed).

Choose the signs and symptoms that suggest postpartum hemorrhage causing a hematoma. a. Rectal pain accompanied by a rising pulse b. Cramping accompanied by a steady trickle of blood c. Soft uterine fundus and falling blood pressure d. Heavy lochia accompanied by tachypnea and dyspnea

a. Rectal pain accompanied by a rising pulse

A resident physician orders meperidine (Demerol), 35 mg, and hydroxyzine (Vistaril), 25 mg, by slow IV push for a laboring woman. The appropriate nursing action is to: a. Remind the physician that hydroxyzine is not given by IV push. b. Give the meperidine by IV push and the hydroxyzine by deep intramuscular (IM) administration. c. Dilute the two drugs before giving them by slow IV push. d. Give the drugs as ordered by the physician.

a. Remind the physician that hydroxyzine is not given by IV push.

Choose the primary nursing measure to promote fetal descent. a. Remind the woman to empty her bladder every 1 to 2 hours. b. Assist fetal head rotation while doing a vaginal examination. c. Have the woman push at least three times with each contraction. d. Promote the intake of glucose-containing fluids during labor

a. Remind the woman to empty her bladder every 1 to 2 hours.

A woman has an 8-lb, 9-oz baby after an 18-hour labor that required a vacuum extraction. Her membranes have been ruptured for 15 hours. Based on these facts, client teaching should emphasize: a. Reporting foul-smelling lochia and fever. b. Delaying intercourse for at least 6 weeks. c. Eating a diet that is high in iron and vitamin C. d. Losing weight over at least a 6-month period.

a. Reporting foul-smelling lochia and fever.

The nurse notes a pattern of variable decelerations to 75 bpm on the fetal monitor. The initial nursing action should be to: a. Reposition the woman. b. Administer oxygen. c. Increase the intravenous (IV) infusion. d. Stimulate the fetal scalp.

a. Reposition the woman.

Reports and studies have shown that infants who are breast-fed for even short periods have a decreased incidence of infection. Select all the infections that may be prevented. (Select all that apply.) a. Respiratory b. Cord c. Gastrointestinal d. Ear e. Eye

a. Respiratory c. Gastrointestinal d. Ear Infants who are not breastfed have an increased incidence of respiratory, GI, and urinary tract infections, otitis media, asthma, diabetes, some cancers, obesity, sudden infant death syndrome (SIDS), and necrotizing enterocolitis.

Parent teaching is an important aspect of care of the newborn and family. Which one(s) of the following are appropriate teaching techniques during the first 2 days after birth? (Select all that apply.) a. Setting priorities b. Giving written material to the family to reinforce learning c. Using audiovisual materials to reinforce learning d. Modeling behavior for the new family e. Teaching as much as possible in one setting to allow more rest time f. Including the father g. Being sensitive to cultural differences

a. Setting priorities b. Giving written material to the family to reinforce learning c. Using audiovisual materials to reinforce learning d. Modeling behavior for the new family f. Including the father To effectively teach parents, priorities should be set and a teaching plan developed. Use a variety of teaching methods to increase effectiveness, make the subject more interesting, and increase retention of the material. Use verbal and written methods, demonstrations, and return demonstrations. Parents often learn best by seeing skills performed correctly and then practicing them while the nurse gives suggestions. To increase the likelihood that parents will follow instructions, explain the rationale for each point made during teaching sessions. Use audiovisual materials, including pamphlets, magazines, television programs, and Internet sites. Highlight the most important areas in written material, discuss the programs with the new parents, and clarify information, as necessary, to reinforce learning.

Twelve hours after birth, a mother lies in bed resting. Although she has only one more day in the hospital, she does not ask about her baby or provide any care. What is the probable reason for her behavior? a. She is still in the taking-in phase of maternal adaptation. b. She shows behaviors that may lead to postpartum depression. c. She is still affected by medications given during labor. d. She may be dissatisfied with some aspect of the newborn.

a. She is still in the taking-in phase of maternal adaptation.

Variability can be reduced by which one(s) of the following factors? (Select all that apply.) a. Sleep b. Narcotics c. Gestation longer than 39 weeks d. Fetal anomalies that affect the central nervous system

a. Sleep b. Narcotics d. Fetal anomalies that affect the central nervous system The fetal sleep cycle, fetal tachycardia, general anesthesia, prematurity and preexisting neurologic injury can reduce variability. Gestation at or near term by itself has no effect on variability.

During active labor, a woman complains of tingly stiff fingers when using patterned paced breathing. In response, the nurse should focus primarily on helping her: a. Slow her respiratory rate. b. Maintain a focal point. c. Relax her upper extremities. d. Push with an open glottis.

a. Slow her respiratory rate.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be a. Soft, nontender; colostrum is present. b. Leakage of milk at let-down. c. Swollen, warm, and tender on palpation. d. A few blisters and a bruise on each areola.

a. Soft, nontender; colostrum is present. Breasts are essentially unchanged for the first 2 or 3 days after birth. Colostrum is present and may leak from the nipples. On day 3 or 4 lactation begins and engorgement can occur, resulting in the findings of b and c. Response d indicates problems with the breastfeeding techniques used.

A woman is fully dilated, and the fetal station is 0. The fetus is in a right occiput posterior position. She is using Lamaze breathing techniques only. Choose the ideal maternal position for pushing. a. Squatting b. Left side-lying c. Hands and knees d. Semisitting

a. Squatting

Select all the causes of decreased milk supply in a lactating mother. (Select all that apply.) a. Supplementation with formula b. Multivitamin use c. Feedings that are too short d. Chocolate e. Some oral contraceptives f. Certain foods

a. Supplementation with formula c. Feedings that are too short e. Some oral contraceptives Common causes of decreased milk supply include ineffective suckling by the infant, feedings that are infrequent or too short, feeding formula, maternal fatigue, low maternal thyroid function, preterm or late preterm infants, and some medications including oral contraceptives containing estrogen.

After a cesarean birth, the woman needs to be assessed routinely. Select all the assessments necessary for this woman. (Select all that apply.) a. Vital signs b. Return of motion and sensation (if regional block was given) c. Abdominal dressing d. Pupil dilation e. Uterine firmness and position f. Urine output g. Deep tendon reflexes h. IV infusion

a. Vital signs b. Return of motion and sensation (if regional block was given) c. Abdominal dressing e. Uterine firmness and position f. Urine output h. IV infusion In addition to the usual postpartum evaluation, following cesarean birth, the mother must be assessed as any other postoperative patient: vital signs including pain, uterine position, dressing, abdomen for distention, lochia, intake (IV and oral) and output (voiding or catheter).

Which of the following are appropriate goals for a newborn for the first 2 to 3 days of life? (Select all that apply.) a. The infant will maintain a patent airway as evidenced by a respiratory rate within the range of 30 to 60 breaths per minute. b. The infant will show no signs of respiratory distress. c. The infant will maintain an axillary temperature between 34.5 and 35.5°C. d. The infant will show no signs of hypoglycemia.

a. The infant will maintain a patent airway as evidenced by a respiratory rate within the range of 30 to 60 breaths per minute. b. The infant will show no signs of respiratory distress. d. The infant will show no signs of hypoglycemia. Goals for a newborn are that the infant will maintain a patent airway, a respiratory rate of 30 to 60 breaths per minute with no respiratory distress, an axillary temperature between 36.5 and 37.5°C, will feed well and show no signs of hypoglycemia.

Choose the important precaution to be taken when a solid intrauterine pressure catheter is used to monitor uterine contractions during labor. a. The pressure reflects the pressure of the fluid above, as well as the pressure of the contraction. b. The fluid that fills the catheter must be warmed to room temperature. c. Understand that pressures within the fluid-filled catheter are higher than those in the solid catheter. d. Fluid-filled catheters cannot be used when a spiral electrode is applied.

a. The pressure reflects the pressure of the fluid above, as well as the pressure of the contraction.

A new mother anxiously summons the nurse to her room because the baby has sneezed twice. A brief assessment shows nothing unusual. The appropriate teaching is that: a. This may indicate overstimulation, and the infant may need a quiet time. b. Multiple sneezes are characteristic of the second period of reactivity. c. The baby may be developing a cold, so the pediatrician will be notified. d. Sneezing may indicate sensitivity to the drugs given to the mother during labor.

a. This may indicate overstimulation, and the infant may need a quiet time.

Which physical factors contribute to pain during labor and birth? (Select all that apply.) a. Tissue ischemia b. Cutting of the nerves with dilation c. Cervical dilation d. Distention of the vagina and perineum e. Height of the woman in relation to fetal size.

a. Tissue ischemia c. Cervical dilation d. Distention of the vagina and perineum A variety of physical factors such as tissue ischemia, cervical dilation, pressure and pulling on pelvic structures, and distention of the vagina and perineum contribute to pain in labor and birth. Nerves will not be cut during dilation and height of the mother in relation to fetal size is not a factor.

An intravenous access is started in most labor patients because of which one(s) of the following? (Select all that apply.) a. To have quick access if drugs are needed b. To provide fluids to prevent dehydration c. In case an epidural block is administered d. To provide a route for pain medications for the 48-hour postpartum period

a. To have quick access if drugs are needed b. To provide fluids to prevent dehydration c. In case an epidural block is administered An IV line provides quick access if fluids or medications are needed. Continuous fluid infusion prevents and reduces dehydration and is necessary if epidural analgesia is used. By 48 hours postpartum, mothers are expected to be on oral pain medication.

Techniques the nurse can use to prevent heat loss in a newborn include which one(s) of the following? (Select all that apply.) a. Turning on the radiant warmer before the infant's birth b. Drying the wet infant quickly c. Changing wet linens with warm dry linens d. Covering the infant's head with a cap after placing it under the radiant warmer

a. Turning on the radiant warmer before the infant's birth b. Drying the wet infant quickly c. Changing wet linens with warm dry linens The radiant warmer should be turned on and be warm before placing a newborn in the warmer. Dry the wet infant quickly with warm towels to prevent heat loss by evaporation. Pay particular attention to drying the hair because the head has a large surface area and hair that remains damp increases heat loss. Remove towels or blankets as soon as they become wet and replace them with dry, warmed linens. Cover the head with a prewarmed cap when the infant is not under a radiant warmer. Do not use a hat when the infant is under the warmer because it interferes with transfer of heat to the infant's head.

Choose the nursing observation that is most important if the nurse notes a two-vessel umbilical cord. a. Urine output b. Onset of jaundice c. Respiratory rate d. Heart rhythm

a. Urine output

Choose the nursing assessment that most clearly suggests hypovolemia. a. Urine output of 20 mL/hr b. Fetal heart rate of 155 to 165 bpm c. Blood pressure of 108/84 mm Hg d. Maternal heart rate of 90 to 100 bpm

a. Urine output of 20 mL/hr

A nurse is assessing a new mother on her first postpartum day. The nurse notes tenderness in both legs, slight redness in the calf of the left leg, and edema in both feet, with the left foot being larger (when measured, the right ankle was 29 cm and the left ankle was 32 cm in diameter). The nurse's next action should be to a. ask the mother to stay in bed until the physician can assess her. b. ask the mother to walk around for the next few minutes and to ambulate once every 2 hours. c. explain to the mother that the pain is from the strain of labor and the edema will disappear in about 48 hours. d. assess the vital signs.

a. ask the mother to stay in bed until the physician can assess her. Deep vein thrombosis (DVT) may have symptoms of leg swelling, with the affected leg larger than the opposite leg, and erythema, heat, and tenderness. The tenderness in both legs may be strained muscles from the birth. Edema in both feet is expected during the early postpartum period prior to diuresis. The treatment for DVT is bed rest and medication, which would require a physician's assessment.

A woman with an epidural has been pushing for the past 2 hours with very little progression. An appropriate nursing action at this point is to a. assess for a full bladder. b. assess for a full colon. c. allow the woman to rest for two or three contractions before starting to push again. d change positions of the woman and attempt to push again.

a. assess for a full bladder. During labor, a full bladder is a common soft tissue obstruction. Bladder distention reduces available space in the pelvis and intensifies maternal discomfort. An epidural decreases the woman's sensation of the need to void, and the extra fluids administered in preparation for the epidural increase her urinary output.

A newborn has just been circumcised. The nurse's first priority would be to a. assess the penis for bleeding. b. apply a lubricant such as Vaseline or KY jelly to the site at every diaper change. c. note time of first voiding after the procedure. d. take the newborn to his mother for comfort and feeding.

a. assess the penis for bleeding. Although options B, C, and D are appropriate actions, observation for bleeding is the priority.

When checking the fundus on a mother who delivered 1 hour ago, the nurse notices that it is 3 cm above the umbilicus, displaced to the right, and slightly boggy. The nurse should massage the fundus until firm and then a. assist the mother to empty her bladder. b. assist the mother to walk around in the room. c. reassess the fundus in 5 minutes. d. monitor the blood pressure and pulse for changes.

a. assist the mother to empty her bladder. If the fundus is above the level of the umbilicus and displaced, a full bladder may be the cause of the excessive bleeding and a boggy uterus.

A new mother wants to breastfeed but also wants to feed her infant formula occasionally. The nurse should teach her to a. avoid using any bottles the first month to establish her milk supply. b. make a clear choice to feed by one method or the other to avoid nipple confusion. c. limit formula feeding to once each day until her milk supply is well established. d. alternate formula and nursing to allow the infant to become accustomed to both.

a. avoid using any bottles the first month to establish her milk supply. If the mother chooses combination feeding, it is best to delay giving formula until lactation has been well established at 3 to 4 weeks of age. Giving formula to breastfeeding infants leads to a decrease in breastfeeding frequency and milk production, making successful breastfeeding less likely.

To obtain an accurate blood pressure of a woman in labor, the nurse should assess the blood pressure a. between contractions, with the woman lying on her side. b. between contractions, with the woman lying on her back. c. with a contraction while the woman is lying on her side. d. with a contraction while the woman is lying on her back.

a. between contractions, with the woman lying on her side. During uterine contractions, blood flow to the placenta gradually decreases, causing a relative increase in the woman's blood volume. This temporary change increases her blood pressure slightly. If the woman lies on her back, the weight of the fetus, placenta, and fluid may decrease blood flow, causing supine hypotension. Therefore her blood pressure is more accurate when taken between contractions, with her lying on her side.

A woman delivered a baby boy 30 minutes ago. The labor and birth were uneventful. The nurse is assessing the woman's vital signs when the woman suddenly complains of chest pain and difficulty breathing. The vital signs show a decreased blood pressure and a slightly increased pulse. The nurse's next action should be to a. call for assistance. b. have the woman sit up and assist her to take deep breaths to help her relax. c. administer pain medication. d. increase the routine assessments to every 15 minutes until the vital signs stabilize.

a. call for assistance. These are symptoms of an anaphylactoid syndrome or an embolism. The nurse should remain with the woman, but needs assistance to notify the health care provider and start oxygen. The woman may be in need of cardiopulmonary resuscitation and support, so it is important not to leave her at this time.

The nurse is assessing the patient's vaginal discharge. It is red and has about a 2-inch stain on the peripad. The nurse will record this finding as a a. light amount of lochia rubra. b. scant amount of lochia alba. c. moderate amount of lochia rubra. d. heavy amount of lochia alba.

a. light amount of lochia rubra. Lochia rubra is red in color and occurs the first 3 or 4 days after birth. A light amount of discharge is classified as a 1- to 4-inch stain on the peripad.

To promote bonding during the first hour after birth, the nurse can do which of the following? (Select all that apply.) a. delay procedures if appropriate b. allow the father to hold the newborn c. demonstrate proper bottle feeding techniques d. allow as much contact with the newborn as possible e. use the time to do parent teaching on newborn characteristics

a. delay procedures if appropriate b. allow the father to hold the newborn d. allow as much contact with the newborn as possible Early, unlimited and prolonged contact between parents and infants is of primary importance to facilitate the bonding and attachment process. Procedures should be delayed to allow parents uninterrupted time with the newborn.

On review of a fetal monitor tracing, the nurse notes that for several contractions the FHR decelerates as a contraction begins and returns to baseline just before it ends. The nurse should a. describe the finding in the notes. b. reposition the woman onto her side. c. call the physician for instructions. d. administer oxygen at 8 to10 L/minute with a tight face mask.

a. describe the finding in the notes. An early deceleration pattern from head compression is described. No action other than documentation of the finding is required because this is an expected reaction to compression of the fetal head as it passes through the cervix. The other responses would be implemented when ominous changes are noted.

Constipation is a common problem during the postpartum period. Select all the reasons for constipation during this period. (Select all that apply.) a. diminished bowel tone b. overhydration during labor c. episiotomy that causes the fear of pain with elimination d. iron supplementation e. some pain medications

a. diminished bowel tone c. episiotomy that causes the fear of pain with elimination d. iron supplementation e. some pain medications Constipation may occur from decreased food and fluid intake during labor, reduced activity, iron intake, decreased muscle and bowel tone, and fear of pain during defecation.

A nurse is reviewing the charts of antepartal patients. A 28-week-gestation woman's fetal fibronectin report has returned, with negative results. The nurse should a. document this report. b. notify the health care provider. c. document the need to do patient teaching on the signs of preterm labor during the woman's next visit. d. alter this woman's plan of care to include teaching about increasing protein intake in her diet.

a. document this report. Fetal fibronectin is normally found in the vaginal secretions until about 20 weeks' gestation and again at term. If it is found between those dates, it suggests early labor. A negative report indicates that the woman is at low risk for labor at this time.

Clinical signs and symptoms of pulmonary embolism may include which of the following? (Select all that apply.) a. dyspnea b. sudden sharp chest pain c. bradycardia d. syncope e. tachypnea f. hemoptysis

a. dyspnea b. sudden sharp chest pain d. syncope e. tachypnea f. hemoptysis Dyspnea, chest pain, tachycardia, tachypnea, and hemoptysis are the most common signs of pulmonary embolism. Syncope is uncommon and may indicate massive emboli. Pulmonary rales, cough, abdominal pain and low-grade fever may also occur.

A breastfeeding woman develops mastitis. She tells the nurse that she will just feed her baby formula instead of breastfeeding. The best nursing response is that a. emptying the breast is important to prevent an abscess. b. a tight breast binder or bra will help reduce engorgement. c. she should continue to drink extra fluids while weaning. d. breastfeeding can continue when her temperature is normal.

a. emptying the breast is important to prevent an abscess. Continued emptying of the breast by breastfeeding or a breast pump constitutes the first line of treatment for mastitis. This helps prevent a breast abscess.

The patient is admitted in early labor. Her support person tells the nurse that the contractions have the following pattern: started 1232, ended 1233; started 1235, ended 1236; started 1239, ended 1240; started 1243, ended 1244. From this information, the nurse determines that the frequency of the contractions is a. every 3 to 4 minutes. b. every 2 to 3 minutes. c. lasting a minute. d. unable to be determined with this information.

a. every 3 to 4 minutes. The frequency of a contraction is measured from the beginning of one contraction until the beginning of the next contraction. The contractions started at 1232, 1235, 1239, and 1243. This would put the contractions every 3 to 4 minutes. The duration of the contractions is from the beginning of a contraction until the end of the same contraction. The duration for this pattern would be 1 minute.

Immediately following an amniotomy to observe for complications, the nurse must assess the a. fetal heart rate. b. maternal blood pressure. c. maternal pulse. d. fetal heart rate variability.

a. fetal heart rate. One complication of an amniotomy is prolapse of the umbilical cord. Cord compression can be diagnosed by observing for variable decelerations or a decrease in the fetal heart rate. Maternal blood pressure, pulse, and fetal variability are all necessary to assess, but are not the immediate concerns.

When assessing the lochia of a new mother for the last time before discharge, the nurse notes a foul smell from the vaginal discharge. The mother states that she noticed it for the first time a couple of hours ago. The nurse should assess for a. fever b. uterine atony c. bradycardia d. lack of proper peri care by the mother

a. fever With endometritis, the mother will have signs and symptoms of fever, chills, malaise, lethargy, anorexia, abdominal pain, abdominal cramping, uterine tenderness, and a purulent, foul-smelling lochia. Other signs include tachycardia and subinvolution.

A woman who is 27 weeks pregnant calls the clinic and complains of constant low backache. The nurse should a. have the woman come in to be evaluated. b. have the woman call back in 1 day if the backache does not improve. c. have the woman call back if the pain increases. d. tell the woman to drink plenty of fluids and maintain bed rest.

a. have the woman come in to be evaluated. A constant low backache is a common symptom of preterm labor. She needs to be evaluated as soon as possible. Drinking fluids has not been proven to stop preterm labor but decreases uterine irritability.

During active labor, the woman complains about tingling in her hands. The nurse's next action should be to a. help the woman slow down her breathing and breathe into her cupped hands. b. assess vital signs for changes. c. check cervical dilation. d. change the woman's position.

a. help the woman slow down her breathing and breathe into her cupped hands. Hyperventilation may occur during active labor as the woman breathes rapidly. She may feel tingling in her hands and feet and dizziness. By having the woman slow her breathing and breathe into a paper bag or her cupped hands, her carbon dioxide levels will return to normal and relieve the symptoms.

During an initial assessment of a newborn, the nurse notices that the left arm does not move as freely as the right arm. When assessing the clavicle, crepitus is noted. The nurse's next action should be to a. notify the newborn's health care provider. b. swaddle the newborn loosely. c. document this normal finding. d. check range of motion on the left arm.

a. notify the newborn's health care provider. Signs of a fractured clavicle are crepitus over the bone, swelling of the area, and decreased movement of the arm on the affected side. Treatment should start as soon as possible and the fracture should heal in a short time.

After a planned cesarean section, the woman is being admitted back to the postpartum unit. The nurse notices that the patient is rubbing her nose and eyes continually. Being aware that the woman has been given epidural opioids, the nurse's next action should be to a. offer the woman some medication to relieve the itching. b. notify the anesthesiologist immediately. c. monitor for signs of respiratory depression. d. monitor the patient's temperature.

a. offer the woman some medication to relieve the itching. Pruritus of the face and neck is an annoying side effect that may occur with epidural opioids. Medications may be used to relieve the itching and make the woman more comfortable.

The new mother comments that the newborn "has his father's eyes." The nurse recognizes this as a. part of the bonding process termed claiming. b. the mother trying to find signs of the baby's paternity. c. the mother trying to include the father in the bonding process. d. part of the letting-go phase of maternal adaptation.

a. part of the bonding process termed claiming. Claiming or binding-in begins when the mother begins to identify specific features of the newborn. She then begins to relate features to family members.

A newborn is rooming-in with his teenage mother, who is watching TV. The nurse notes that the baby is awake and quiet. The best nursing action is to a. pick the baby up and point out his alert behaviors to the mother. b. tell the mother to pick up her baby and talk with him while he is awake. c. focus care on the mother, rather than the infant so she can recuperate. d. encourage the mother to feed the infant before he begins crying.

a. pick the baby up and point out his alert behaviors to the mother. Modeling behavior by the nurse is an excellent way to teach infant care. The inexperienced teenage mother can observe the proper skills and then the nurse can encourage her to try those skills.

A fetus is in the posterior position. The woman is complaining of back labor and the labor is prolonged. The nurse can best assist the mother with this problem by a. placing her in a hands and knees position. b. placing her in a prone position. c. massaging her back. d. encouraging her to use the whirlpool bath.

a. placing her in a hands and knees position. The hands and knees position encourages the fetus to rotate into an anterior position. This will decrease the back pain and increase the descent of the fetal head. A prone position is contraindicated with a pregnant woman. Massaging her back and the whirlpool are comfort measures, but will not help correct the problem.

During the early post-cesarean section phase, it is important for the woman to turn, cough, and deep breathe. The rationale for this is to prevent a. pooling of secretions in the airway. b. thrombus formation in the lower legs. c. gas formation in the intestinal tract. d. urinary retention.

a. pooling of secretions in the airway. The post-cesarean section woman is usually on bed rest for the first 8 to 12 hours. She is at risk for pooling of secretions in the airway. By assisting her to turn, cough, and expand her lungs by breathing deeply at least every 2 hours, the pooling of secretions will be decreased.

Which one(s) of the following newborns are at risk for hypoglycemia? (Select all that apply.) a. premature b. postmature c. appropriate-for-gestational-age d. cold stressed e. mother is a diabetic f. mother was treated with terbutaline

a. premature b. postmature d. cold stressed e. mother is a diabetic f. mother was treated with terbutaline Risk factors for hypoglycemia include prematurity, postmaturity, late preterm infant, intrauterine growth restriction, large or small for gestational age, asphyxia, problems at birth, cold stress, maternal diabetes, and maternal intake of terbutaline.

The nurse should tell a primigravida that the definitive sign indicating labor has begun is a. progressive uterine contractions. b. lightening. c. rupture of membranes. d. passage of the mucus plug.

a. progressive uterine contractions. Regular, progressive uterine contractions that increase in intensity and frequency are a sign of true labor. Responses b and d are premonitory signs indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself.

During a vaginal exam, the physician stimulates the fetal scalp. The fetal heart rate accelerated from 140 to 155 bpm for about 30 seconds. The nurse should a. record this fetal reaction. b. notify the physician because this reaction is normal. c. assist the woman into a side-lying position. d. administer oxygen at 8 to 10 L/minute.

a. record this fetal reaction. It is normal for the heart rate to elevate 15 bpm for at least 15 seconds with fetal scalp stimulation. The nurse should record the finding. No other intervention is necessary at this time.

When assessing the perineum, episiotomy site, or surgical site, the nurse should assess for specific signs. Select all the signs that are appropriate when assessing a surgical site. (Select all that apply.) a. redness b. edema c. ecchymosis d. discharge e. asymmetry

a. redness b. edema c. ecchymosis d. discharge The acronym REEDA is used as a reminder that the site of an episiotomy or a perineal laceration should be assessed for five signs: redness (R), edema (E), ecchymosis (E), discharge (D), and approximation (A).

The first time a woman ambulates after the birth of the newborn, she has a nursing diagnosis of Risk for injury because of the a. risk for developing orthostatic hypotension. b. development of bradycardia. c. increase in cardiac output. d. increase in circulatory volume.

a. risk for developing orthostatic hypotension. After birth a rapid decrease in intraabdominal pressure results in dilation of the blood vessels supplying the viscera. The resulting engorgement of abdominal blood vessels contributes to a rapid fall in blood pressure when the woman moves from a recumbent to a sitting position. The mother feels dizzy or lightheaded and may faint when she stands. Bradycardia is a normal change during the postpartum period. The cardiac output increases during the postpartum period, but does not produce orthostatic hypotension.

When doing the initial measurements of a newborn, the nurse records the head diameter as 34 cm and the chest diameter as 32 cm. The nurse is aware that a. these measurements are within normal limits. b. the chest is too large for the head. c. the head is too large for the chest.

a. these measurements are within normal limits. The head diameter should be between 32 and 38 cm; the chest diameter should be 30 to 34 cm. The chest is usually 2 to 3 cm smaller than the head.

A new mother asks the nurse about the red stains in her baby boy's wet diapers. The nurse explains this as being a. uric acid crystals. b. pseudomenstruation. c. meconium stains.

a. uric acid crystals. Uric acid crystals may be in a newborn's urine for the first few days of life. They will cause a reddish or pink stain on the diaper. This is known as brick dust staining. Pseudomenstruation occurs only in females. Meconium stains would be greenish.

Major signs of uterine atony immediately following birth include which one(s) of the following? (Select all that apply.) a. uterine fundus that is difficult to locate b. soft fundus c. uterus that becomes firm with massage d. excessive lochia e. excessive clots f. uterus located near the umbilicus

a. uterine fundus that is difficult to locate b. soft fundus d. excessive lochia e. excessive clots Major signs of uterine atony include: a uterine fundus that is difficult to locate; a soft or "boggy" feel when the fundus is located; a uterus that becomes firm as it is massaged but loses its tone when massage is stopped; a fundus that is located above the expected level; excessive lochia, especially if it is bright red; and excessive clots expelled, either with or without uterine massage.

A mother is at high risk for thromboembolic disease in the postpartum period. Select all the reasons that may put this mother at high risk for clot formation. (Select all that apply.) a. walking around during labor b. prolonged period of time in the stirrups for birth and repair c. the elevated levels of coagulation factors during pregnancy d. cesarean birth e. smoking f. being a primigravida

a. walking around during labor c. the elevated levels of coagulation factors during pregnancy d. cesarean birth e. smoking Cesarean birth, varicose veins, obesity, a history of thrombophlebitis, age over 35, and smoking are risk factors for thromboembolic disease. Prolonged time in stirrups for birth and repair of the episiotomy also may promote venous stasis and increase the risk of thrombus formation.

List the five factors that affect fetal oxygenation

adequate maternal blood volume and flow to the placenta; adequate oxygen saturation in the maternal blood; adequate exchange of oxygen and carbon dioxide in the placenta; open circulatory path between the placenta and fetus through umbilical cord vessels; normal fetal circulatory and oxygen-carrying functions

After birth, the nurse assesses the newborn. The heart rate is 90 bpm, the body is flexed, there is vigorous movement, the newborn is actively crying when stimulated, and has bluish coloration in the feet and hands. The proper Apgar score for this newborn should be a. 7. b. 8. c. 9. d. 10.

b. 8. The heart rate less than 100 bpm gets a score of 1, a lusty cry will give a score of 2 for both respiratory effort and reflex response, the flexed posture and vigorous movements give a score of 2, and the bluish coloration of the hands and feet will give a score of 1.

Which one of the following women can the nurse anticipate having difficulty dealing with labor pain? a. Primigravida who has attended childbirth preparation classes b. A woman having her second baby; the first child was in a posterior position and the labor lasted 18 hours. c. A woman having her sixth child and who has not attended any prenatal teaching classes d. Primigravida who has her mother as her birth support person. The mother is encouraging her with every contraction.

b. A woman having her second baby; the first child was in a posterior position and the labor lasted 18 hours. Previous experiences with pain can alter a woman's perception of labor pain. The woman with a prolonged labor and posterior position with the last birth will come to this labor anxious about the outcome and amount of pain. Preparation for labor and previous positive experiences will help the woman tolerate the pain. A support person who has been through the process and is encouraging can also assist the woman in a positive way.

The expected response of the fetal heart rate of a term fetus to movement is: a. Suppression of normal variability for at least 15 seconds. b. Acceleration of 15 or more beats per minute (bpm) for 15 seconds. c. Increase in variability by 15 bpm for 10 minutes. d. Acceleration followed by deceleration of the heart rate.

b. Acceleration of 15 or more beats per minute (bpm) for 15 seconds.

A 39-week-gestation gravida 1 is 6 cm dilated. Membranes are intact. The labor contractions have decreased in intensity, and she has not dilated in the past 2 hours. A diagnosis of hypotonic dysfunctional labor has been made. The nurse can anticipate which of the following actions? a. Immediate cesarean section b. Amniotomy c. Narcotic administration d. Having her walk around

b. Amniotomy Amniotomy may be used to stimulate labor that slows after it is established.

A woman has shoulder dystocia when giving birth. The nurse should expect: a. Immediate forceps delivery. b. Application of suprapubic pressure. c. Oxytocin labor augmentation. d. Turning into a hands and knees position.

b. Application of suprapubic pressure.

The nurse is assessing a newborn for gestational age. Which technique should be used when performing the scarf sign? a. Fold the lower leg against the abdomen, and straighten out the leg. Measure the angle at the popliteal space. b. Bring the arm across the body to the opposite side, and note the position of the elbow in relation to the midline. c. Pull the foot straight up alongside the body toward the ear. Note the position of the foot in relation to the head. d. Bend the hand at the wrist until the palm is as flat against the forearm as possible with gentle pressure. Measure the angle between the palm and forearm.

b. Bring the arm across the body to the opposite side, and note the position of the elbow in relation to the midline. Option a measures the popliteal angle, c is the heel to ear assessment, and d is the square window.

Choose the most reliable evidence that true labor has begun. a. Regular contractions that occur every 15 minutes b. Change in the amount of cervical thinning c. Increased ease of breathing with frequent urination d. A sudden urge to do household tasks

b. Change in the amount of cervical thinning

When assessing a laboring woman's blood pressure, the nurse should: a. Inflate the cuff at the beginning of a contraction. b. Check the blood pressure between two contractions. c. Expect a slight elevation of the blood pressure. d. Position the woman on her back with her knees bent.

b. Check the blood pressure between two contractions.

Choose the nursing assessment that most clearly suggests intrauterine infection. a. Fetal heart rate of 145 to 155 beats per minute (bpm) b. Cloudy amniotic fluid c. Maternal temperature of 37.8° C (100° F) d. Increased bloody show

b. Cloudy amniotic fluid

Which one of the following measures will help prevent complications from an episiotomy? a. Pain medication every 3 to 4 hours as needed b. Cold applications after birth c. Warm applications after birth d. Early ambulation

b. Cold applications after birth Cold applications for the first 12 hours after birth may help prevent hematomas and edema. Pain medication helps treat, not prevent, the complication of pain. Early ambulation helps prevent other complications. Warm applications are contraindicated after birth; they may be used after 12 hours.

When performing an admission assessment on a term newborn, the nurse notes that the lung sounds are slightly moist. The skin color is pink except for acrocyanosis. Pulse is 156 beats per minute (bpm) and respirations are 55 breaths per minute and unlabored. The appropriate nursing action is to: a. Notify the pediatrician of the abnormal lung sounds. b. Continue to observe the infant's respiratory status. c. Recheck the high respiratory and pulse rates in 30 minutes. d. Keep the infant in the newborn nursery until stable.

b. Continue to observe the infant's respiratory status.

The new parents of their first child tell the nurse that the crib they will be using is the same crib that the father used as a baby. The nurse should teach them which of the following safety considerations to assess in this older crib? (Select all that apply.) a. Crib slats must be no more than 5 inches apart. b. Corner posts should not extend more than 1/16th inch above the end panel. c. The crib mattress should fit snugly, with less than two fingers able to fit into the space between the mattress and sides of the crib. d. Check that all nuts, screws, bolts, and hooks are tight.

b. Corner posts should not extend more than 1/16th inch above the end panel. c. The crib mattress should fit snugly, with less than two fingers able to fit into the space between the mattress and sides of the crib. d. Check that all nuts, screws, bolts, and hooks are tight. The crib mattress should be firm and fit snugly, there should be no more than 2 3/8 inches between crib slats, no corner posts over 1/16th inch high so the baby's clothing cannot catch, no cutouts in the headboard or foot board, have no missing, loose, broken or improperly installed screws or brackets, and the paint should be lead free.

Which one of the following characteristics is associated with false labor contractions? a. Painless b. Decrease in intensity with ambulation c. Regular pattern of frequency is established d. Progressive in terms of intensity and duration

b. Decrease in intensity with ambulation False labor contractions decrease with activity, but true labor contractions are enhanced or stimulated with activity such as ambulation. False labor contractions are painful. Responses c and d are characteristics of true labor contractions, which increase in intensity with activities such as ambulation.

As the nurse is admitting a woman in labor, she notices that the woman is happy and excited that she is in labor. The contractions are 5 minutes apart, lasting 30 to 35 seconds. The nurse can anticipate that the patient is in which phase of labor? a. Second b. Latent c. Active d. Transition

b. Latent During the latent phase of the first stage of labor, the woman is usually sociable, excited, and cooperative. The contractions are about 5 minutes apart.

The appropriate nursing action for a woman who has a postspinal headache is to: a. Keep her bed in a semi-Fowler's position. b. Encourage intake of fluids that she enjoys. c. Have her ambulate at least every 4 hours. d. Restrict intake of high-carbohydrate foods.

b. Encourage intake of fluids that she enjoys.

When weighing an infant, the nurse places a covering on the scale tray to: a. Avoid causing multiple Moro reflexes when weighing. b. Ensure that conductive heat loss from the infant is minimal. c. Compensate for negative weight balance to ensure correct weight. d. Avoid contaminating the scale with body substances.

b. Ensure that conductive heat loss from the infant is minimal.

Which nutrients are added to formula to make it closer to the composition of breast milk? (Select all that apply.) a. Lactose b. Fatty acids c. Vitamin C d. Vitamin D e. Iron

b. Fatty acids c. Vitamin C d. Vitamin D e. Iron Modified cow's milk is the source of most commercial formulas. Manufacturers specifically formulate it for infants by reducing protein content to decrease renal solute load. Saturated fat is removed and replaced with vegetable fats. Vitamins and other nutrients are added to simulate the contents of breast milk. Formula with added iron should be used for all infants receiving formula.

Firm sacral pressure is likely to be most helpful in which situation? a. Rapid labor and birth b. Fetal occiput posterior position c. Oxytocin induction of labor d. If analgesics should be avoided

b. Fetal occiput posterior position

Firm sacral pressure is likely to be most helpful in which situation? a. Rapid labor and birth b. Fetal occiput posterior position c. Oxytocin induction of labor d. If analgesics should be avoided

b. Fetal occiput posterior position A posterior position of the vertex will cause pressure against the sacrum. This pressure increases back pain during and between contractions. Firm sacral pressure may help relieve some of the pressure.

A woman who is 18 hours postpartum says she is having "hot flashes" and "sweats all the time." The appropriate nursing response is to: a. Report her signs and symptoms of hypovolemic shock. b. Tell her that her body is getting rid of unneeded fluid. c. Notify her nurse-midwife that she may have an infection. d. Limit her intake of caffeine-containing fluids.

b. Tell her that her body is getting rid of unneeded fluid.

Which stage of maternal role attainment is focused on getting acquainted with the infant's individual personality? a. Anticipatory b. Formal c. Informal d. Personal

b. Formal

Which one of the following findings during the fourth stage would require immediate interventions by the nurse? a. Fundus firm and at midline b. Fundus firm, deviated to the right, with slight distention over the symphysis pubis c. Blood pressure and pulse slightly lower than reading during second stage of labor d. Lochia is bright red, with a few small clots

b. Fundus firm, deviated to the right, with slight distention over the symphysis pubis Even though the fundus is firm, it is not midline and the bladder is filling. A full bladder will interfere with contraction of the uterus and lead to increased bleeding. The rest of the answer choices are within normal limits for this stage.

Which one of the following laboring women is at highest risk for a prolapsed cord? All the women have intact membranes and are cephalic presentations. a. Gravida 3, station +2, cervix 7 cm, and 100% effaced b. Gravida 1, station ?2-2, cervix 3 cm, and 50% effaced c. Gravida 2, station 0, cervix 2 cm, and 60% effaced d. Gravida 6, station 0, cervix 9 cm, and 100% effaced

b. Gravida 1, station ?2-2, cervix 3 cm, and 50% effaced A fetus that is in a high station is at high risk for a prolapsed cord when the membranes rupture.

The new parents express concern that their 4-year-old son is jealous of the new baby. They are planning on going home tomorrow and are not sure how the preschooler will react when they bring the baby home. Which one of the following suggestions by the nurse will be most helpful? a. Be aware that the child may regress to an earlier stage. b. Have the mother spend time with the child while the father cares for the baby. c. Have the child stay with a grandparent until the parents adjust to the new baby. d. Tell the child that he is a "big boy" now and doesn't need his crib so the new baby will be using it for a while.

b. Have the mother spend time with the child while the father cares for the baby. The child needs to have the mother's love reaffirmed. By giving the child some private time with the mother, he will get the extra attention and reassurance he needs at this point.

One hour after a woman gives birth vaginally, the nurse notes that her fundus is firm, 2 fingerbreadths above the umbilicus, and deviated to the right. Lochia rubra is moderate. Her perineum is slightly edematous, with no bruising; an ice pack is in place. The priority nursing action is to: a. Chart these expected normal assessments. b. Have the woman empty her bladder. c. Remove the perineal ice pack for 20 minutes. d. Increase the rate of the oxytocin infusion.

b. Have the woman empty her bladder.

The postpartum woman who had a long labor induced by oxytocin is at higher risk for which complication? a. Thrombophlebitis b. Hemorrhage c. Lacerations of the vaginal area d. Altered urinary elimination

b. Hemorrhage Prolonged use of oxytocin can produce uterine atony. This will increase the risk of hemorrhaging because the uterine muscle becomes fatigued and will not contract effectively to compress vessels at the placental site. The other choices are all complications of the postpartum period, but this mother is at no higher risk than other mothers.

The tocotransducer should be placed: a. In the suprapubic area. b. In the fundal area. c. Over the xiphoid process. d. Within the uterus.

b. In the fundal area.

The abbreviation LOA means that the fetal occiput is: a. On the examiner's left and in the front of the pelvis. b. In the left front part of the mother's pelvis. c. Anterior to the fetal breech. d. Lower than the fetal breech.

b. In the left front part of the mother's pelvis.

Bloody show differs from active vaginal bleeding in that bloody show: a. Quickly clots on the perineal pad. b. Is dark red and mixed with mucus. c. Flows freely during vaginal examination. d. Decreases in quantity as labor progresses.

b. Is dark red and mixed with mucus.

A new mother wants to nurse her infant only 5 minutes at each breast to avoid sore nipples. Choose the appropriate teaching. a. Limiting time at the breast during the early days can lessen trauma to the nipples and allow them time to toughen. b. Limiting time at the breast can cause frequent infant hunger because the baby does not receive richer milk. c. Limiting time at the breast does not reduce sore nipples but does reduce engorgement. d. Limiting time at the breast delays the transition from colostrum to transitional and true milk.

b. Limiting time at the breast can cause frequent infant hunger because the baby does not receive richer milk. When feedings are too short, infants receive little or no colostrum or milk. It may take as long as 5 minutes for the milk-ejection reflex to occur during the early days after birth. The infant will receive mostly foremilk with these short feedings, which has a higher fluid content. The hindmilk has a higher fat content.

A woman is receiving magnesium sulfate to stop preterm labor. In addition to fetal heart rate, the essential nursing assessment related to this drug is: a. Determining intensity and duration of uterine contractions. b. Monitoring hourly vital signs, heart sounds, and lung sounds. c. Validating the presence of fetal movements with contractions. d. Performing vaginal examination for cervical dilation, effacement, and station

b. Monitoring hourly vital signs, heart sounds, and lung sounds.

The nurse should teach the parents to position the infant's hospital crib: a. Next to the windows to be exposed to the sun. b. Near the mother's bed, on the side opposite the door. c. At the foot of the bed so the mother can get out of bed easily. d. Near the door of the bathroom, next to the sink.

b. Near the mother's bed, on the side opposite the door.

The postpartum woman has a blood pressure of 150/90 mm Hg, pulse of 72 bpm, and respirations of 14 breaths per minute. She continues to bleed heavily. The order states she may have methylergonovine (Methergine), 0.2 mg IM, or oxytocin (Pitocin), 10 units IM for heavy bleeding. The nurse should administer which medication? a. Methylergonovine b. Oxytocin

b. Oxytocin Methylergonovine is contraindicated if the woman has an elevated blood pressure.

The nurse's initial response if a pulmonary embolism is suspected should be to: a. Start a second intravenous (IV) line and prepare for transfusion. b. Raise the head of the bed and administer oxygen. c. Insert a catheter to monitor urine output. d. Lower the head of the bed and elevate the legs.

b. Raise the head of the bed and administer oxygen.

On discharge from the birthing center the nurse should assess the type of car seat the new parents are using. For a newborn, the seat should be a. No car seat is necessary for infants younger than 3 months of age; they can be placed in an adult's lap. b. Rear-facing in the back seat of the car. c. Front-facing. d. Sitting straight up.

b. Rear-facing in the back seat of the car. Infants who are younger than 1 year old must ride in a rear-facing seat to protect them. Car restraints are required in all 50 states and Canada for all infants and young children. The seat should recline at approximately a 45-degree angle for an infant.

Which reflex normally present in full-term newborns is most helpful with the latching-on process? a. Moro b. Rooting c. Babinski d. Tonic neck

b. Rooting By brushing the nipple of the breast around the infant's month, the infant will turn toward the stimulus and open the mouth. This is the rooting reflex. The Moro reflex occurs when the infant is startled and reacts. The Babinski reflex is the flaring of the toes with stimulation. The tonic neck reflex is the position of the arms, with the head turned to the side.

The midwife has just examined a labor patient and states that she is 10 cm dilated. The nurse is aware that this patient is in which stage of labor? a. First b. Second c. Third d. Fourth

b. Second The second stage begins with complete dilation (10 cm) and ends with the birth of the baby.

Choose the best independent nursing action to aid episiotomy healing in the woman who is 24 hours postpartum. a. Apply antibiotic cream to the area three times each day. b. Squirt warm water over the perineum after voiding or stooling. c. Maintain cold packs to the area at all times for the first 3 days. d. Check the leukocyte level daily and report changes.

b. Squirt warm water over the perineum after voiding or stooling.

Throughout the assessment, the nurse must be alert for signs of respiratory distress. Select all of the following that are signs of respiratory distress. (Select all that apply.) a. Respiratory rate of 55 breaths per minute b. Substernal retractions c. Nasal constriction d. Cyanosis of the hands and feet e. Grunting f. Seesaw respirations

b. Substernal retractions e. Grunting f. Seesaw respirations Signs of respiratory distress include tachypnea, retractions, flaring, cyanosis, grunting, seesawing, apneic periods, and asymmetry of chest movements.

A new mother is worried because her 2-day-old baby is taking only 0.5 to 1.5 oz of formula at most feedings. The nurse should teach her that: a. Her baby should be taking 3 to 4 oz at each feeding by the next day. b. The amount that the baby is taking at each feeding is normal at this time. c. The baby might take more if she tries using a different formula. d. The nipple may be too firm for the baby to suck easily and should be changed.

b. The amount that the baby is taking at each feeding is normal at this time.

A new mother should be taught to support her baby's head when holding the infant because: a. Doing so will promote better eye contact and bonding. b. The baby's muscles are too weak to support his or her heavy head. c. It allows better guidance of the head toward the breast. d. Less regurgitation of gastric contents will occur.

b. The baby's muscles are too weak to support his or her heavy head.

When performing the fourth Leopold's maneuver, the nurse determines that the cephalic prominence is on the same side as the fetal back. How should this assessment be interpreted? a. The fetus is in a breech presentation, with the head extended. b. The fetus is in a face presentation, with the head extended. c. The fetus is in a transverse lie, with the face toward the mother's back. d. The fetus is in a cephalic presentation, with the head well flexed.

b. The fetus is in a face presentation, with the head extended.

A woman having her third baby has planned epidural analgesia for labor and birth. However, her labor was so rapid that she did not have the epidural. What is the best initial nursing approach in this case? a. Congratulate her on having a labor that was quicker than expected. b. Use open-ended questions to clarify her true feelings about the experience. c. Tactfully explain why a nonepidural labor and birth are actually better. d. Explain that it is often difficult to time epidural analgesia for labor

b. Use open-ended questions to clarify her true feelings about the experience.

A new mother wants to nurse her infant only 5 minutes at each breast to avoid sore nipples. Choose the appropriate teaching. a. Keeping early feedings short lessens nipple trauma and helps toughen nipples. b. Very short feedings reduce hindmilk and may interfere with the infant's weight gain. c. Limiting time at the breast does not reduce sore nipples but does reduce engorgement. d. Delay in the transition from colostrum to true milk will result from this practice

b. Very short feedings reduce hindmilk and may interfere with the infant's weight gain.

To care for the uncircumcised penis, parents should be taught to: a. Retract the foreskin with each diaper change. b. Wash under the foreskin as far as it will retract when the child is older. c. Use an emollient cream to hasten foreskin separation. d. Avoid putting soap on the foreskin before separation.

b. Wash under the foreskin as far as it will retract when the child is older.

A newborn's mother has tested positive for hepatitis B. When should the newborn receive the hepatitis B vaccine? a. By 2 months b. Within 12 hour c. Within 1 week d. By 6 months

b. Within 12 hour For infants of hepatitis B-positive mothers, the vaccine is given within 12 hours of birth and then at 1 to 2 months and 6 months. Hepatitis B immune globulin is also given within 12 hours of birth.

While caring for a woman who is 10 cm dilated, is pushing, but is fatigued and her pushing efforts are ineffective, the nurse notices that the fetal heart rate has dropped to 85 bpm. The station is +3. The nurse can anticipate a. a cesarean section. b. a low operative vaginal birth. c. a midpelvis operative vaginal birth. d. no change in the birth plan.

b. a low operative vaginal birth. Because of the drop in the fetal heart rate, the fetus should be delivered quickly. Since the woman is fatigued and no longer pushing effectively, assistance is needed. The head is at +3 station, so a low operative vaginal birth is quicker than preparing the woman for a cesarean section. The fetal head is too low for a midpelvis operative vaginal birth.

The nurse notices a soft swollen area over the 1-day-old newborn's skull. It is approximately 3 × 2 cm and has clear edges that stop at the suture line. The nurse may document this finding as being a. caput succedaneum. b. cephalohematoma.

b. cephalohematoma. Cephalohematoma does not cross the suture line; caput succedaneum will cross the suture line.

A 39-week primigravida calls the birthing center and tells the nurse she has contractions that are 10 to 15 minutes apart and had a small gush of fluid about 1 hour ago. The nurse should tell her to a. wait until the contractions are about 5 minutes apart and come to the center. b. come to the birthing center now. c. come to the birthing center in about an hour if she lives farther than 1 hour away. d. come to the birthing center if the baby stops moving.

b. come to the birthing center now. A gush or trickle of fluid from the vagina should be evaluated as soon as possible. Waiting until the contractions are 5 minutes apart is appropriate for a primigravida if the membranes have not ruptured.

While observing a 3-hour-old newborn, the nurse counted respirations of 45 breaths per minute, irregular, with one episode of periodic breathing lasting 10 seconds. The newborn had no cyanosis during this time, no retractions, and no grunting. The nurse's next action is to a. notify the pediatrician. b. document the normal findings. c. administer oxygen. d. stimulate the newborn to cry.

b. document the normal findings. The normal respiratory rate of a newborn is 30 to 60 breaths per minute. It is not unusual for a newborn to have periodic breathing episodes lasting 5 to 10 seconds. Apnea lasting longer than 20 seconds accompanied by cyanosis, heart rate changes, or other signs of difficult breathing is abnormal.

To treat a woman with a urinary tract infection (UTI), the nurse should encourage her to a. drink 1000 mL of fluid/day. b. drink fluids such as apricot, prune, or cranberry juice. c. drink fluids such as ginger ale and colas. d. urinate frequently.

b. drink fluids such as apricot, prune, or cranberry juice. To treat a UTI, the mother should be encouraged to drink at least 2500 to 3000 mL of fluid each day to help dilute the bacterial count and flush the infection from the bladder. Acidification of the urine inhibits multiplication of bacteria, and drinks that acidify urine, such as apricot, plum, prune, or cranberry juice, should be encouraged. Carbonated drinks should be avoided because they increase urine alkalinity.

In caring for a low-risk woman in the active phase of labor, the nurse realizes the assessment of fetal well-being should occur a. every 15 minutes. b. every 30 minutes. c. every 5 minutes. d. every hour

b. every 30 minutes. For low-risk women, the nurse should evaluate the fetal monitoring strip or assessment fetal well-being at least every 30 minutes during the active phase of labor and every 15 minutes during the second stage. For the high-risk woman, monitoring should occur every 15 minutes during the active phase and every 5 minutes during the second stage.

A newborn's blood glucose reading is 38 mg/dL. The nurse should a. reassess in 30 minutes. b. feed the infant and reassess in 30 minutes. c. start an intravenous feeding of 10% glucose. d. notify the health care provider.

b. feed the infant and reassess in 30 minutes. Normal blood glucose for the term infant during the first day of life is 40 to 60 mg/dL and 50 to 90 mg/dL thereafter. If the glucose reading is around 40 to 45 mg/dL, the infant is usually fed and the glucose is reassessed in 30 to 60 minutes.

During each contraction, the nurse notices that the woman stops talking and stares at a picture on the wall. The nurse realizes that the woman is using the picture as a a. point of imagery. b. focal point. c. distraction.

b. focal point. The focal point is an object on which the woman centers her attention during contractions. It helps her direct her thoughts away from the contractions. Imagery is a technique for relaxation when the woman imagines specific scenes that are relaxing. Distraction can be used in the early phase of labor. The woman concentrates on something else, such as playing cards or watching a favorite movie.

The nurse notices on the admission record that the fetus is in a cephalic military presentation. The nurse realizes that the fetus a. is coming feet first into the birth canal. b. has the head in the birth canal first, but the head is not flexed. c. has the head in the birth canal first, and the head is in a flexed presentation. d. has both feet coming into the birth canal first.

b. has the head in the birth canal first, but the head is not flexed. Cephalic presentation shows that the head is coming into the birth canal first. The military presentation means that the head is in a neutral position, neither flexed nor extended.

When assessing a newly delivered mother, the nurse notes that the fundus is firm, 1 cm below the umbilicus, and midline. However, there is a continuous stream of blood coming from the vaginal area. The nurse is aware that these signs may indicate a. a fundus that is not properly contracting over the placental site. b. lacerations along the birth canal. c. a full bladder interfering with the control of bleeding. d. a sign of cardiovascular compromise.

b. lacerations along the birth canal. If the fundus is firm but bleeding is excessive, the cause may be lacerations of the cervix or birth canal.

The nurse is preparing to auscultate the fetal heart rate using a Doppler transducer. When performing the Leopold maneuver, the nurse felt the buttocks near the fundus and the back along the left side of the mother. The best position for the Doppler would be in the mother's a. left upper quadrant. b. left lower quadrant. c. right upper quadrant. d. right lower quadrant.

b. left lower quadrant. The fetal heart is best heard through the fetus's upper back. Because this fetus is in a cephalic position, with the back toward the mother's left side, the Doppler should be placed in the left lower quadrant of the mother's abdomen.

A woman has reached 10 cm and is attempting to push. She had an epidural and is unable to feel the urge to push. The nurse can best assist her by a. allowing the epidural to wear off and then have her push. b. letting her labor down, that is delaying pushing until she feels the reflexive urge to push. c. changing her position to a side-lying. d. preparing her for a forceps birth.

b. letting her labor down, that is delaying pushing until she feels the reflexive urge to push. Epidural analgesia may cause a loss of sensation, so the woman cannot feel the urge to push. The practice of laboring down, or delayed pushing—encouraging the woman to wait until she feels the reflexive urge to push—has shown a lower incidence of adverse effects than pushing immediately on full cervical dilation. She can later be coached to push with each contraction and feedback given on the effectiveness of the pushing.

A shrill, high-pitched cry in a newborn may indicate a. hunger. b. neurologic disorder. c. cardiac disorder. d. no significance.

b. neurologic disorder. Newborn cries that are shrill, high-pitched, hoarse, or catlike are abnormal. These may indicate neurologic disorders or other problems.

A new mother with no hospitalization insurance asks to be discharged with her baby at 24 hours after birth. To assist this new mother best after discharge, the nurse can a. allow the mother time to ask all her questions about newborn care just before discharge. b. plan for a home visit within 48 hours of discharge. c. give the mother plenty of pamphlets about newborn care before discharge. d. inform the mother about the dangers of early discharge.

b. plan for a home visit within 48 hours of discharge. Home visits have been found to be a cost-effective way to avoid hospital admissions or emergency department visits. The home visit allows for assessment, intervention, and follow-up teaching. It is important to allow the mother time to ask questions before discharge, but at 24 hours after birth she may not be prepared to do so. Giving the mother pamphlets before discharge is helpful; however, nursing assessments or follow-up teaching will not be done.

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing women's needs during this stage, should a. foster an active role in the baby's care. b. provide time for the mother to reflect on the events of the childbirth. 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 now. d. promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

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

The amount of breast milk produced depends primarily on adequate a. amounts of estrogen and progesterone. b. stimulation of the breast. c. amounts of oxytocin. d. stimulation of the fundus.

b. stimulation of the breast. The amount of milk produced depends primarily on adequate stimulation of the breast and removal of the milk by suckling or a breast pump. The stimulation causes production of prolactin, which produces the milk. Estrogen and progesterone inhibit prolactin. Oxytocin aids in the let-down reflex and contraction of the fundus.

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of oxytocin (Pitocin). The woman is in a side-lying position and her vital signs are stable and within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to a. change the woman's position. b. stop the oxytocin. c. elevate the woman's legs. d. administer oxygen via a tight mask at 8 to 10 L/minute.

b. stop the oxytocin. The late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the oxytocin infusion because oxytocin stimulates the uterus to contract. The woman is already in an appropriate position for uteroplacental perfusion. Elevating her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

A woman came in for a prenatal check up on March 15. She tells the nurse that her last normal menstrual period was June 2. The nurse is aware that she will be scheduled for a. immediate birth. b. testing to determine fetal well-being. c. follow-up appointments every week until birth. d. ultrasound to determine fetal age.

b. testing to determine fetal well-being. By dates, her EDD was March 9. To determine proper management of her pregnancy, it will be necessary to determine whether the fetus is thriving in the uterus. Ultrasounds at this stage are not accurate for fetal age.

During the latent phase of labor, the nurse suggests that the woman play cards with her husband. The nurse is aware that this will help the woman deal with the pain of contractions. The effectiveness of this technique is explained by a. cutaneous stimulation. b. the gate control theory. c. thermal stimulation. d. hydrotherapy.

b. the gate control theory. In the gate control theory of pain, the use of visual and auditory stimulation techniques such as playing cards can affect the perception of stimuli as painful. Diversional activities in early labor and focal points or breathing techniques later in labor are examples of the gate control theory of pain. Other examples of gate control theory are cutaneous stimulation using touch to relax muscles, thermal stimulation using warmth to relax muscles, and hydrotherapy using water for relaxation.

The new mother is complaining of pain at the episiotomy site; however, because she is breastfeeding, she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain? a. ambulation b. topical anesthetics c. hot fluids to drink d. stool softeners

b. topical anesthetics Topical anesthetics can be applied directly to the site to numb the area. This will not cause systemic effects like pain medications. Sitz baths may also be soothing.

The home care nurse is visiting a new mother who delivered 1 week ago. The mother complains about not being able to sleep and that she is tired and cries easily. The best response by the nurse would be: a. "Having a baby is difficult; it will be a long time before you get a good night's sleep." b. "Maybe your mother can come in and help you out." c. "It is normal for this to happen and should go away in 2 weeks. It must be very difficult for you to feel this way with a new baby." d. "The hospital nurses must not have taught you enough information about the changes you will experience during these first 6 weeks."

c. "It is normal for this to happen and should go away in 2 weeks. It must be very difficult for you to feel this way with a new baby." Postpartum blues begins in the first week and usually last no longer than 2 weeks. The mother needs to be supported during this time and given accurate information about the process. Responses a and b belittle the mother and may make her feel inadequate. Response d places blame on someone else and does not deal with the problem.

A newborn weighed 7 lb, 8 oz at birth. What is the least this newborn can weigh and still be within the guidelines of weight loss during the first 7 to 10 days of life? a. 7 lb, 4 oz b. 7 lb c. 6 lb, 12 oz d. 6 lb, 8 oz

c. 6 lb, 12 oz A newborn can lose up to 10% of its birth weight during the first 7 to 10 days of life. The 7 lb, 8 oz newborn can lose 12 oz and still be within the guidelines. The lowest weight would be 6 lb, 12 oz.

A woman with an otherwise uncomplicated pregnancy is very frustrated because of hypotonic labor. What nursing measure is most appropriate for her? a. Do not allow any oral intake. b. Start oxytocin at a low rate. c. Offer her a warm shower. d. Reassure her that her problem is common.

c. Offer her a warm shower.

A newborn's pulse should be assessed using which pulse point? a. Brachial b. Radial c. Apical d. Femoral

c. Apical The brachial, radial, and femoral pulses may be felt but are difficult to count. The apical pulse can be assessed, not only for the heart rate but also for the heart sounds. The nurse should assess for arrhythmias, murmurs, and other abnormal sounds.

The nurse notes that a woman has excess lochia 2 hours after the vaginal birth of an 8-lb baby. The priority nursing action is to: a. Catheterize her to check urine output. b. Check her blood pressure, pulse, and respirations. c. Assess the firmness of her uterus. d. Notify her physician or nurse-midwife.

c. Assess the firmness of her uterus.

A woman who is 3 hours postpartum has had difficulty in urinating. She finally urinates 100 mL. The initial nursing action is to: a. Insert an indwelling catheter. b. Have her drink additional fluids. c. Assess the height of her fundus. d. Chart the urination amount.

c. Assess the height of her fundus.

A newborn is 2 days old and scheduled for discharge. The hospital stay has been uneventful. The nurse is preparing to assess the newborn's temperature. Which method would be the best choice? a. Tympanic b. Rectal c. Axillary d. Oral

c. Axillary Axillary temperature is the most common method of taking a newborn's temperature because it is safer than taking a rectal temperature. Rectal temperatures have the risk of irritating or damaging the rectum. Tympanic thermometers are less accurate in newborns. Some agencies use temporal artery thermometers.

A breastfeeding mother is encouraged to nurse her infant 30 minutes after birth. The infant is awake, licks her nipple, and makes occasional suckling efforts, but does not latch on. The mother says, "Maybe I should just bottle feed him, since he doesn't want to nurse." The best reply should emphasize that: a. Formula feeding is usually much easier than breastfeeding. b. The infant's actions suggest that her nipples may be too firm. c. Breast milk production is stimulated by these early actions. d. She will be unable to establish lactation unless the baby nurses early

c. Breast milk production is stimulated by these early actions.

Which one(s) of the following would be an indication for a cesarean birth? (Select all that apply.) a. Maternal coagulation defects b. Fetal death c. Cephalopelvic disproportion d. Active genital herpes e. Persistent nonreassuring FHR patters

c. Cephalopelvic disproportion d. Active genital herpes e. Persistent nonreassuring FHR patters Possible indications for cesarean birth include, but are not limited to, the following: dystocia; cephalopelvic disproportion; hypertension, if prompt delivery is necessary; maternal diseases such as diabetes, heart disease, or cervical cancer, if labor is not advisable; active genital herpes; some previous uterine surgical procedures such as a classic cesarean incision or removal of fibroid tumors; persistent indeterminate or abnormal FHR patterns; prolapsed umbilical cord; fetal malpresentations such as breech or transverse lie; hemorrhagic conditions such as abruptio placentae or placenta previa; and maternal request.

An infant weighing 4394 g (9 lb, 11 oz) was born vaginally. The labor nurse reports that there was shoulder dystocia at birth but that Apgar scores were 8 at 1 minute and 9 at 5 minutes. The nurse should do a focus assessment for: a. Hip dysplasia. b. Head molding. c. Clavicle fracture. d. Cephalohematoma.

c. Clavicle fracture.

Postpartum teaching related to urinary health should emphasize: a. Drinking any type of fluid whenever thirsty. b. Allowing the bladder to fill to promote emptying. c. Cleansing the perineum in a front-to-back direction. d. Eating two servings of acidic fruits or vegetables each day.

c. Cleansing the perineum in a front-to-back direction.

The nurse notes an infant sleeping on her or his back in the crib in the mother's room. The nurse should: a. Turn the infant to the side to avoid aspiration from regurgitation. b. Suggest that the mother hold the infant to enhance bonding. c. Commend the mother for positioning the infant correctly. d. Explain the importance of the prone position for sleep.

c. Commend the mother for positioning the infant correctly.

The nurse should respond to incomplete uterine relaxation between contractions by: a. Increasing the rate of IV fluid. b. Having the woman push with contractions. c. Contacting the physician for a tocolytic order. d. Initiating an amnioinfusion with Ringer's lactate.

c. Contacting the physician for a tocolytic order.

An infant weighing 3912 g (8 lb, 10 oz) is born vaginally. Shoulder dystocia occurred at birth. Because of this problem, the nurse should assess the infant for: a. Head swelling that does not extend beyond the skull bone. b. Inward turning of the feet or legs. c. Creaking sensation when the clavicles are palpated. d. Limited abduction of one or both hips.

c. Creaking sensation when the clavicles are palpated.

Which type of uterine rupture may go undiagnosed during labor and the postpartum period? a. Complete rupture b. Incomplete rupture c. Dehiscence d. All the ruptures are detectable by electronic uterine monitoring.

c. Dehiscence During a dehiscence of an old uterine scar, little or no bleeding may occur. No signs or symptoms may exist, and the rupture may be found incidentally during a subsequent cesarean birth or other abdominal surgery.

To help the postpartum woman avoid constipation, the nurse should teach her to: a. Avoid intake of foods such as milk, cheese, or yogurt. b. Take a laxative for the first 3 postpartum days. c. Drink at least 1600 mL of noncaffeinated fluids daily. d. Limit her walking until the episiotomy is fully healed.

c. Drink at least 1600 mL of noncaffeinated fluids daily.

The most appropriate time for the nurse to assist a laboring woman to push is: a. During the interval between contractions. b. During first-stage labor. c. During second-stage labor. d. Whenever she feels the need.

c. During second-stage labor.

The nurse can encourage the parents to care for their infant by: a. Staying out of the room for as long as possible. b. Having the grandmother nearby as a backup. c. Giving positive feedback when they provide care. d. Correcting their performance whenever they make a mistake.

c. Giving positive feedback when they provide care.

Which newly delivered mother with an unassisted birth is at greatest risk for lacerations of the cervical area of vagina? a. Primigravida with 10-hour labor, 1-hour pushing stage b. Gravida 2 with an 8-hour labor, 30-minute pushing stage c. Gravida 2 with a 1-hour labor, 10-minute pushing stage d. Gravida 3 with a 5-hour labor, 30-minute pushing stage

c. Gravida 2 with a 1-hour labor, 10-minute pushing stage Cervical lacerations occur frequently when the cervix dilates rapidly during the first stage of labor. Lacerations of the vagina, perineum, and periurethral area usually occur during the second stage of labor, when the fetal head descends rapidly.

All of the following women in labor are requesting pain medication. To which one should the nurse administer an opioid analgesic first? a. Primigravida, 2 cm dilated, 50% effaced, grimacing slightly with each contraction b. Gravida 4, 9 cm dilated, 100% effaced, wants to push with each contraction c. Gravida 2, 6 cm dilated, 100% effaced, rocks back and forth in bed with each contraction d. Primigravida, 1 cm dilated, moans loudly with each contraction, has present history of heroin use

c. Gravida 2, 6 cm dilated, 100% effaced, rocks back and forth in bed with each contraction The gravida 2 is well established into the labor and the medication will not slow the contractions. The primigravida who is 2 cm dilated is too early into the labor; the medication may slow or stop her contractions. The gravida 4 is too near birth and the medication may affect the newborn's respiratory effort. The primigravida who is 1 cm dilated has a history of heroin use; further opioid medication is not recommended.

Which patient would be at the highest risk for postpartum hemorrhage? a. Primigravida who delivered a 6 lb, 3 oz girl b. Gravida 2 who delivered a 8 lb, 6 oz boy c. Gravida 3 who delivered twins, 5 lb, 3 oz and 4 lb, 2 oz d. Gravida 4 who delivered a 4 lb, 3 oz boy

c. Gravida 3 who delivered twins, 5 lb, 3 oz and 4 lb, 2 oz Overdistention of the uterus from any cause—multiple gestations, large infant, hydramnios—makes it more difficult for the uterus to contract with enough firmness to prevent excessive bleeding. Multiparity results in muscle fibers that have been stretched repeatedly, and these flaccid muscle fibers may not remain contracted after birth. The gravida 3 has the problems of multiparity and overdistended uterus with the twins.

The nurse places one hand above the symphysis pubis during uterine massage to: a. Make the massage more comfortable for the woman. b. Increase the effectiveness of the procedure. c. Help prevent the uterus from inverting. d. Help determine the firmness of the uterus.

c. Help prevent the uterus from inverting.

The nurse notices a 4-hour-old newborn developing jitteriness. The next action by the nurse should be to assess a. for maternal drug use. b. the calcium level. c. the blood glucose level.

c. the blood glucose level. Jitteriness can be caused by maternal drug use, low calcium levels, and hypoglycemia. Of these three, hypoglycemia is the most common cause and should be assessed first.

A recent immigrant to this country seems reluctant to care for her infant. She keeps the infant in the crib most of the time and asks the nurse to feed the baby. She stays in bed and seems not to want to get up to ambulate. What is a likely interpretation of this behavior? a. This was an unwanted pregnancy and the mother is not bonding with the infant. b. The woman has severe postpartum depression and needs psychiatric care. c. In her culture, new mothers should rest and have others care for the infant. d. The woman comes from an abusive home situation.

c. In her culture, new mothers should rest and have others care for the infant.

When doing a vaginal exam, the nurse notes a triangular-shaped depression toward the mother's left side and pointing up toward her abdomen. The nurse can record the fetal position as a. LOP. b. ROP. c. LOA. d. ROP.

c. LOA. The triangular shape is the posterior fontanel, which makes the positioning part the occiput. The posterior fontanel is toward the mother's left side and anterior. This makes the position left occiput anterior (LOA).

A woman tells you she has been teary for most of the 2 weeks since the birth of her baby. Although the infant appears to be cared for appropriately, the mother states that she feels too tired to spend as much time with him as she should. She has lost her appetite and cannot sleep at night. She has been too ashamed to tell anyone before now. The nurse's best response is to: a. Tell her that this is normal postpartum blues and she will get over it in a few more days. b. Suggest that she get help to care for the baby and that with more rest she will feel fine. c. Listen to her feelings carefully and then acknowledge that something is wrong. d. Suggest that she spend time away from the baby to rest from the constant infant care.

c. Listen to her feelings carefully and then acknowledge that something is wrong.

A laboring woman just had an amniotomy performed to augment labor. The nurse is aware that the assessment times for which vital signs will be altered? a. Maternal blood pressure b. Maternal pulse c. Maternal temperature d. Maternal respiration

c. Maternal temperature With interruption of the membrane barrier, vaginal organisms have free access to the uterine cavity and may cause chorioamnionitis. Assessing the maternal temperature every 2 to 4 hours will be necessary to monitor for signs of infection.

A mother expresses concern to the nurse that her new baby has blue eyes. She states, "Everyone in my family and my husband's family has brown eyes." The nurse should base the response on which of the following? a. Blue eyes are recessive; therefore it is impossible for this baby to have two brown-eyed parents. b. Brown eyes are dominant, so the baby may have blue eyes. c. Most babies have gray-blue eyes at birth.

c. Most babies have gray-blue eyes at birth. The iris of the eye is dark gray, blue, or brown at birth but may change color by 6 months of age.

The nurse should note how long the interval between contractions lasts because: a. Maternal cells restore their glucose levels during the interval. b. A very short interval requires earlier administration of analgesia. c. Most exchange of fetal oxygen and waste products occurs at that time. d. The interval becomes longer as cervical dilation increases.

c. Most exchange of fetal oxygen and waste products occurs at that time.

Which method is correct for assessing the fontanels of a newborn? a. Newborn lying supine and at rest b. Newborn crying with head slightly elevated c. Newborn quiet and head slightly elevated d. Newborn lying supine and crying

c. Newborn quiet and head slightly elevated When the anterior fontanel is palpated, the infant's head should be elevated for accurate assessment. The fontanel should be palpated when the newborn is quiet because vigorous crying may cause it to protrude.

A patient is being discharged, having been diagnosed with false labor. The nursing diagnosis for her is Deficient Knowledge: characteristics of true labor. An appropriate expected outcome for this diagnosis is that the a. Patient will return to the hospital when she is in true labor. b. Patient will define true labor. c. Patient will describe reasons for returning to the hospital for evaluation. d. Patient will be able to determine false from true labor.

c. Patient will describe reasons for returning to the hospital for evaluation. The patient may not be able to determine true from false labor; however, she should be made aware of what signs to look for that may indicate the need for evaluation.

A few minutes after a woman's membranes rupture during term labor, the fetal heart rate drops from an average of 140 to 150 bpm to 75 to 80 bpm. The priority nursing action is to: a. Contact the physician to report the fetal heart rate. b. Assess for other signs that indicate chorioamnionitis. c. Perform a vaginal examination and palpate for prolapsed cord. d. Insert an indwelling catheter to assess fluid balance.

c. Perform a vaginal examination and palpate for prolapsed cord.

When palpating labor contractions, the nurse should: a. Use the palm of one hand while palpating the lower uterus. b. Avoid palpating during the period of maximum intensity. c. Place the fingertips over the fundus of the uterus. d. Limit palpation to three consecutive contractions.

c. Place the fingertips over the fundus of the uterus.

An infant's axillary temperature is 35.9° C (96.6° F). The priority nursing action is to: a. Recheck the infant's temperature rectally. b. Have the mother breastfeed the infant. c. Place the infant in a radiant warmer. d. Chart the normal axillary temperature.

c. Place the infant in a radiant warmer.

When admitting a patient for induction of labor, the nurse will question the procedure if which one of the following observations is on the patient's prenatal record? a. Spontaneous rupture of membranes 24 hours ago, with no labor b. 42-week gestation c. Placenta previa d. Maternal heart disease that is worsening

c. Placenta previa An induction of labor would be contraindicated in a woman with placenta previa. The labor would most likely result in hemorrhaging. Options a, b, and d are all indications for induction.

A woman must have general anesthesia for planned cesarean birth because of previous back surgery. The nurse should therefore expect to administer: a. Naltrexone (Trexan). b. An oral barbiturate. c. Ranitidine (Zantac). d. Promethazine (Phenergan).

c. Ranitidine (Zantac).

Firm contractions that occur every 2 to 2½ minutes and last 100 seconds (1 minute, 40 seconds) may reduce fetal oxygen supply because they: a. Cause fetal bradycardia and reduce oxygen concentration. b. Activate the fetal sympathetic nervous system. c. Reduce time for oxygen exchange in the placenta. d. Suppress the normal variability of the fetal heart.

c. Reduce time for oxygen exchange in the placenta.

Which is true about breastfeeding? a. Immigrant women are more likely than women born in this country to breastfeed. b. African-American women have the highest rates of breastfeeding. c. Some women do not feed their infants colostrum because they think that it is spoiled. d. American-born women are the most likely to combine breastfeeding and formula feeding.

c. Some women do not feed their infants colostrum because they think that it is spoiled.

To elicit the Babinski reflex, the nurse should: a. Place a finger at the base of the infant's toes and press gently. b. Begin at the middle toe and stroke down the center of the foot. c. Stroke the lateral sole from the heel up and across the ball of the foot. d. Stroke across the dorsal aspect of the toes to the center of the foot.

c. Stroke the lateral sole from the heel up and across the ball of the foot.

When suctioning a newborn, which technique is correct? a. Use of a suction catheter attached to low suction is appropriate for nasal suction. b. The bulb syringe should be used to suction the mouth only. c. The mouth should be suctioned first and then the nose, with the bulb syringe. d. The bulb syringe is placed inside the mouth and then depressed.

c. The mouth should be suctioned first and then the nose, with the bulb syringe. The mouth should be suctioned first because the infant may gasp when the nose is suctioned, causing aspiration of mucus or fluid in the mouth. Then gently suction the nose only if necessary. A bulb syringe should be used for infant suctioning unless deeper suctioning is necessary. The bulb syringe should be depressed first and then put inside the mouth.

When one is stocking a cart for epidural analgesia, the most important nursing action is to: a. Add several 50-mL bags of intravenous (IV) saline. b. Place anticoagulant drugs to allow rapid access. c. Verify that no epidural drugs contain preservatives. d. Provide an indwelling catheterization tray.

c. Verify that no epidural drugs contain preservatives.

A gravida 1 woman who is 39 weeks of gestation and has had no prenatal care is admitted into the labor unit in early labor. During the assessment, the nurse finds the fetal heart tones in the right upper quadrant. The nurse should anticipate a. a precipitous labor. b. a prolonged first stage of labor. c. a cesarean birth. d. rupture of membranes.

c. a cesarean birth. Fetal heart tones are located in the upper quadrants when the fetus is in a breech presentation. A cesarean birth is usually performed for breech presentations in primigravid women to avoid complications, such as a prolapsed cord.

During contractions the fetus has mechanisms in place to protect it from the decrease in blood flow. Those mechanisms include a. fetal hemoglobin levels that are more resistant to oxygen. b. lower hemoglobin and hematocrit levels. c. a high cardiac output level. d. a higher respiratory level.

c. a high cardiac output level. To prepare for labor, the fetus develops hemoglobin levels that readily take on oxygen and release carbon dioxide. The fetal hemoglobin and hematocrit levels are higher to have more oxygen-carrying capacity. The fetus has a higher cardiac output level. The fetus does not breathe yet, so there is no respiratory count.

A pregnant patient walks into the birthing center complaining of contractions. After getting her to bed, the first thing the nurse should do is a. assess the mother's pulse and respirations. b. gather information about her medical history. c. assess the fetal heart rate. d. start an intravenous line.

c. assess the fetal heart rate. Assessment priorities on admission of a labor patient are to determine the condition of the mother and fetus and whether birth is imminent. Checking the fetal heart rate is one of the first assessments that should be carried out. Along with assessing the fetus, the nurse should also check the maternal blood pressure and temperature.

A woman who has been admitted for preterm labor is started on terbutaline (Brethine) to decrease uterine irritability. Within 24 hours, the contractions have stopped and the woman is resting comfortably. During vital sign assessment the nurse records a blood pressure reading of 125/74 mm Hg, pulse, 95 bpm, and respirations, 12 breaths per minute. The blood pressure and respirations are within limits of previous readings, but the pulse has increased from a previous reading of 74 to 80 bpm. The nurse's next action should be to a. assess for internal bleeding. b. continue to monitor the pulse rate at regular intervals. c. assess the fetal heart rate. d. reassess the vital signs in 1 hour.

c. assess the fetal heart rate. The most common side effect of terbutaline is maternal and fetal tachycardia.

When seeing a new mother on her 6-week postpartum checkup, the nurse questions her about feeding techniques with the newborn. The mother confesses that because of lack of money she has been diluting the powdered formula with more water so it lasts longer. The nurse can best assist this mother by a. explaining that diluting the formula more is harmful to the newborn. b. allowing the mother to express her frustrations. c. assisting the mother to find financial assistance for purchasing formula. d. teaching the mother that she can start to breastfeed the newborn and that would save some money.

c. assisting the mother to find financial assistance for purchasing formula. Improper dilution of the formula may cause undernutrition in the newborn. However, that is not the best help for the mother at this point; she is in need of services that will help her purchase the formula needed. She is not able to establish breastfeeding at this time.

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically a. express a strong need to review events and her behavior during the process of labor and birth. b. exhibit a reduced attention span, limiting readiness to learn. c. attempt to meet the needs of the infant and is eager to learn about infant care. d. have reestablished her role as a spouse and partner.

c. attempt to meet the needs of the infant and is eager to learn about infant care. One week after birth the woman should exhibit behaviors characteristic of the taking-hold phase. This stage lasts for as long as 4 to 5 weeks after birth. Responses a and b are characteristic of the taking-in stage, which lasts for the first few days after birth. Response d reflects the letting-go stage, which indicates that psychosocial recovery is complete.

While doing patient teaching, the woman tells the nurse, "I don't have to worry about contraception because I am breastfeeding." The nurse should base her answer on the fact that a. breastfeeding can be considered a reliable system of birth control. b. breastfeeding can be used as a contraceptive method if strict guidelines are followed through. c. breastfeeding is not a reliable contraceptive method.

c. breastfeeding is not a reliable contraceptive method. Menses in a breastfeeding mother may resume between 12 weeks and 18 months. Normally the first few cycles of menses are without ovulation; however, ovulation may occur before the first menses. Therefore other contraceptive measures are important considerations for this mother.

A mother expresses concern about breastfeeding her newborn, who is receiving phototherapy for jaundice. The nurse should teach the mother that a. breastfeeding is discontinued during phototherapy, but she should pump her breasts. b. breastfeeding can continue after the newborn has been under the light for 12 hours. c. breastfeeding should continue and the newborn can be removed from the light to be fed. d. breastfeeding can continue after the bilirubin level decreases.

c. breastfeeding should continue and the newborn can be removed from the light to be fed. Jaundice need not interfere with breastfeeding. Even when infants receive phototherapy, they usually can be removed from the lights for feeding or may be able to breastfeed with a bili blanket in place. Frequent breastfeeding during phototherapy will increase the number of stools, which aids in bilirubin excretion and provides adequate intake of protein and fluid.

A woman is admitted in early labor. The prenatal record states that the fetus is in a transverse lie with a shoulder presentation. The nurse can anticipate a a. frequent change of positions for the mother to alter the fetal position. b. need for early fetal monitoring to assess for fetal heart changes. c. cesarean birth. d. prolonged second stage of labor.

c. cesarean birth. A transverse lie with a shoulder presentation almost always ends with a cesarean birth.

A mother who is breastfeeding puts ice packs on her breast 15 minutes before feeding to "relieve the pain." The nurse should teach the mother that a. this is an appropriate action. b. cold packs should not be used on the breasts of breastfeeding mothers. c. cold packs can be used after feeding to reduce pain. d. hot packs can be used before feeding to reduce pain.

c. cold packs can be used after feeding to reduce pain. Cold packs can be used after feeding to reduce edema and pain. Heat can be applied just before feedings to increase vasodilation and milk flow; it will not decrease the pain.

The midwife records that the patient's cervix is "100%, 5 cm." The nurse understands that the patient's cervix is a. completely dilated and effaced. b. completely dilated and half-effaced. c. completely effaced and half-dilated. d. half-dilated and half-effaced.

c. completely effaced and half-dilated. Effacement is measured in percentages. The fully thinned cervix is 100% effaced. The dilation is measured in centimeters; dilation goes from closed to 10 cm. This patient is completely effaced and halfway dilated.

A mother who is 3 days postpartum calls the clinic and complains of "night sweats." She is afraid that she is going into early menopause. The nurse should base her answer on the fact that a. birth may put some women into early menopause; an appointment is needed to have this checked out. b. night sweats may be an indication of many other problems; an appointment is needed to assess the problem. c. diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. d. diaphoresis is normal only if the mother is breastfeeding.

c. diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. Diaphoresis and diuresis rid the body of excess fluids that accumulated during the pregnancy. Diaphoresis is not clinically significant, but can be unsettling for the mother who is not prepared for it. Explanations of the cause and provision of comfort measures, such as showers and dry clothing, are generally sufficient.

When assessing the heart rate of a sleeping 1-day-old newborn, the nurse counts a rate of 105 beats/min (bpm). The nurse's next action should be to a. notify the pediatrician. b. stimulate the newborn to cry. c. document this normal finding. d. reassess in 10 minutes.

c. document this normal finding. The heart rate of a newborn should range between 120 and 160 beats per minute (bpm) with normal activity. It may elevate to 180 bpm when infants are crying or drop to as low as 100 bpm when they are in deep sleep.

One nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is a. forcing fluids. b. perineal care. c. encouraging voiding every 2 to 3 hours. d. encouraging the use of stool softeners.

c. encouraging voiding every 2 to 3 hours. Urinary retention and overdistention of the bladder may cause urinary tract infection and postpartum hemorrhage. Encouraging the mother to empty her bladder frequently will help prevent retention and overdistention. Forcing fluids and perineal care may assist with preventing urinary tract infections. Stool softeners assist with return of normal bowel elimination.

During birth, shoulder dystocia was diagnosed. After the birth and the newborn has been stabilized, it is important for the nurse to assess the newborn for a. hip dysplasia. b. lung excursion. c. fractured clavicles. d. clubfoot.

c. fractured clavicles. During shoulder dystocia, the shoulders of the fetus are pushed hard against the symphysis and fractures of the clavicle may occur during the birth. The infant's clavicles should be checked for crepitus, deformity, and bruising, which suggest fractures.

During the active stage of labor the woman is using a rapid "pant-blow" breathing pattern. She starts to complain of feeling dizzy and has some numbness in her fingers. The nurse's next action should be to a. notify the physician. b. do a vaginal exam to check for the progression of labor. c. have the woman breathe into a paper bag. d. offer pain medication.

c. have the woman breathe into a paper bag. Hyperventilation is common when breathing techniques are used. It results from rapid deep breathing that causes excessive loss of carbon dioxide and therefore respiratory alkalosis. Having the woman blow into a paper bag or her own cupped hands will increase her carbon dioxide level by having her rebreathe her exhaled air.

A primigravida is admitted in early labor. The nurse notices on the prenatal record that the position of the fetus is left occiput posterior. Because of this information, the nurse can anticipate a. a cesarean section. b. a short labor and birth process. c. increased back pain with labor. d. a short labor with a prolonged birth process.

c. increased back pain with labor. When the fetus is in the posterior position, the labor may be longer and more uncomfortable. Back discomfort increases with contractions and will continue between contractions. The fetus may not be able to deliver until it rotates into the anterior position.

A woman had premature rupture of the membranes at 37 weeks of gestation. She went into labor within 10 hours and delivered a 7 lb, 12 oz boy after a 12-hour labor. In planning care for the newborn, it is important to monitor him for a. respiratory distress syndrome. b. transient tachypnea of the newborn. c. infections. d. cardiac anomalies.

c. infections. Both mother and newborn are at risk for infection during the postpartum period after premature rupture of the membranes.

A primigravida is in the latent phase of labor and is at low risk for complications of labor. She asks the nurse if she may walk for a few minutes. The nurse is aware that this is (is not) possible because a. continuous fetal monitoring is required. b. continuous monitoring of the contractions is necessary at this stage of labor. c. intermittent auscultation of fetal heart rate is appropriate for her. d. there is no need to assess fetal heart rate at this early stage of labor.

c. intermittent auscultation of fetal heart rate is appropriate for her. Continuous fetal and uterine monitoring is not necessary for the latent phase of labor in women who are at low risk for complications.

The day after giving birth, the woman complains that she did not lose all the weight she had gained during the pregnancy. The nurse can best respond to the mother with the knowledge that a. she has lost the most of the weight and the rest will be gone within 1 week. b. she has lost some of the weight and the rest will slowly disappear within 6 weeks. c. it will take about 6 to 12 months for all the weight gained with the pregnancy to disappear. d. most women do not lose all the weight gained with each pregnancy.

c. it will take about 6 to 12 months for all the weight gained with the pregnancy to disappear. Women are very concerned about regaining their normal figure. Nurses must emphasize that weight loss should be gradual and that about 6 to 12 months is usually required to lose most weight gained during pregnancy.

Firm contractions that occur every 3 minutes and last 100 seconds may reduce fetal oxygen supply because they a. cause fetal bradycardia and reduce oxygen concentration. b. activate the fetal sympathetic nervous system. c. limit the time for oxygen exchange in the placenta. d. suppress the normal variability of the fetal heart.

c. limit the time for oxygen exchange in the placenta. The resting time between these contractions is about 80 seconds, which reduces the time available for exchange of oxygen and waste products in the placenta. This will reduce the fetal oxygen supply. The other choices can all be results of the decreased oxygen supply.

Late postpartum hemorrhage occurs usually at 7 to 14 days but can be as late as 12 weeks after birth. The nurse should teach the new mother about to be discharged to notify the health care provider if the a. lochia become pink or brown. b. uterine cramping (after pains) decreases. c. lochia rubra continues and increases. d. lochia stops completely.

c. lochia rubra continues and increases. Mothers should be taught how to assess the fundus and the normal duration of lochia to assess for late postpartum hemorrhage. They should be instructed to notify their health care provider if bleeding persists or becomes unusually heavy.

A woman who is about 37 weeks' gestation tells the nurse that for some reason this morning she can breathe easier. The nurse can best explain this as being a a. concern, and the fetus needs to be assessed. b. normal change toward the end of the pregnancy caused by a decreased use of oxygen by the fetus. c. normal change because of the fetus's dropping down into the pelvis region, relieving the pressure on her diaphragm. d. normal change caused by the maternal cardiac output increasing as she gets closer to labor.

c. normal change because of the fetus's dropping down into the pelvis region, relieving the pressure on her diaphragm. Lightening occurs toward the end of the pregnancy as the fetus descends toward the pelvic inlet. When this occurs, the woman notices that she breathes more easily because upward pressure on her diaphragm is reduced.

A new father of 1 day expresses concern to the nurse that his wife, who is normally very independent, is asking him to make all the decisions. The nurse can best explain this as a(n) a. normal occurrence because the mother is in pain. b. abnormal occurrence that needs to be assessed further. c. normal occurrence because the mother is in the taking-in phase. d. normal occurrence because the mother is frustrated with the care of the newborn.

c. normal occurrence because the mother is in the taking-in phase. During the taking-in phase, the mother is focused primarily on her own need for fluid, food, and sleep. She may be passive and dependent. This is normal and lasts about 2 days.

When assessing a woman who gave birth 2 hours ago, the nurse notices a constant trickle of lochia. The uterus is well contracted. The next nursing action should be to a. massage the fundus. b. continue to monitor. c. notify the physician. d. assess the blood pressure and pulse for changes.

c. notify the physician. Excessive lochia in the presence of a contracted uterus suggests lacerations of the birth canal. The health care provider must be notified so that lacerations can be located and repaired. The uterus is well contracted, so further massage is not necessary.

After birth, the woman complains of chills. The first intervention by the nurse should be to a. monitor the maternal temperature. b. monitor the maternal blood pressure. c. place a warm blanket on the woman. d. explain to the woman this is caused by the excitement of birth and will stop in about 30 minutes.

c. place a warm blanket on the woman. Many women are chilled after birth. The cause of this reaction is unknown but probably relates to the sudden decrease in effort, loss of the heat produced by the fetus, decrease in intraabdominal pressure, and fetal blood cells entering the maternal circulation. The chill lasts for about 20 minutes and subsides spontaneously. A warm blanket may help shorten the chill.

Misoprostol (Cytotec), 50 mcg, has been ordered for a woman to assist with the ripening of the cervix. The nurse's action should be to a. administer the medication vaginally. b. administer the medication orally. c. question the dosage amount. d. monitor for contractions before administering the medication.

c. question the dosage amount. The normal dose of misoprostol for cervical ripening is 25 mcg. A 50-mcg dose is associated with hypertonic contractions.

A woman must have general anesthesia for a planned cesarean birth because of a previous back surgery. The nurse should therefore expect to administer a. naltrexone (Trexan). b. an oral barbiturate. c. ranitidine (Zantac). d. promethazine (Phenergan).

c. ranitidine (Zantac). During general anesthesia, there is a risk for maternal aspiration. To prevent lung injury if aspiration occurs, drugs such as ranitidine may be given to raise the gastric pH and make secretions less acidic. Naltrexone is an opioid antagonist, promethazine is used to relieve nausea, and barbiturates are sedating.

A woman was admitted to the ED with her newborn baby. The baby was born 4 days ago at home. The woman had no prenatal care. The nurse is assessing the lab work and sees that the mother has an O-negative blood type, the baby is O-positive, and the Coombs test shows that the mother is not sensitized to the positive blood. The nurse's next action should be a. order Rho(D) immune globulin to be given to the mother. b. order Rho(D) immune globulin to be given to the baby. c. record the findings of the lab work and not plan on any further action at this time.

c. record the findings of the lab work and not plan on any further action at this time. The mother is a candidate for Rho(D) immune globulin; however, it should be given within 72 hours after childbirth to prevent the development of maternal antibodies. Because she gave birth 4 days ago, that time period as passed and she is not sensitized to the positive blood.

A woman admitted with preterm labor is started on nifedipine (Procardia) to reduce uterine muscle contractions. The nurse should include in this woman's care plan a nursing diagnosis of a. risk for deficient fluid volume. b. risk for infection. c. risk for injury. d. activity intolerance

c. risk for injury. Nifedipine is a vasodilator, so the woman may be prone to postural hypotension. She needs to be assisted when sitting or standing and taught about the effects of postural hypotension.

The nurse is graphing the weight, length, and head circumference of a newborn in relationship to the gestational age. The newborn falls within the sixth percentile for the weight, fifth percentile for the length, and ninth percentile for the head circumference. This newborn would be classified as a. large-for-gestational age. b. appropriate-for-gestational age. c. small-for-gestational age.

c. small-for-gestational age. Infants who fall above the 90th percentile are considered large-for-gestational age. Infants between the 10th and 90th percentiles are considered appropriate-for-gestational age. Infants who fall below the 10th percentile are considered small-for-gestational age.

A pregnant woman complains of inverted nipples. She is planning on breastfeeding and thinks that the nipples may be a problem. The nurse should teach her to a. stretch the nipples out once a day to convert the inversion. b. roll the nipples twice a day to pull out the nipple. c. stimulate the breast. d. wear a tighter-fitting bra.

c. stimulate the breast. A breast cup can be worn in the bra during the last several weeks of pregnancy. The cup will exert slight pressure against the areola and help the nipples protrude. Exercises for inverted nipples, such as stretching and manipulation of the nipple, are not recommended during pregnancy because they are not effective and may cause uterine contractions.

molding

change in the shape of the fetal head during birth

A new mother tells the nurse, "I've been told that the milk I have right after the baby is born is not good for the baby." The nurse should base the answer on the fact that a. only the first secretion of milk should be discarded. b. the colostrum is low in vitamins and protein. c. the colostrum is high in immunoglobulin A. d. the mother secretes just small amounts of colostrum.

c. the colostrum is high in immunoglobulin A. Colostrum is high in immunoglobulin A, which helps protect the infant's gastrointestinal tract from infection. Colostrum also helps establish the normal flora in the intestines, and its laxative effect speeds the passage of meconium. Colostrum is high in vitamins and protein.

A new mother expresses concern to the nurse that her 8-hour-old newborn has developed some edema in both eyes. The best response would be based on the fact that a. birth trauma usually will not develop until a few hours after birth. b. the edema is a sign of eye infections and will need to be investigated. c. the eye medication given at birth may cause a mild inflammation and edema. d. this is a sign of lack of rest for the newborn during the labor process.

c. the eye medication given at birth may cause a mild inflammation and edema. Some infants develop a mild inflammation a few hours after prophylactic eye treatment.

A new mother has heard that breast milk may contain as much as 55% of the calories in fat. She is concerned that her infant will be getting a diet too high in fat because the American Heart Association recommends that the diet have less than 30% of its calories from fat. The nurse can best advocate for breastfeeding by stating that a. newborns need the extra fat. b. whole cow's milk provides the same amount of fat. c. the fat in breast milk is important for vision and brain growth. d. the fat is only found in the hindmilk, so the newborn will not get that much.

c. the fat in breast milk is important for vision and brain growth. The fat composition of human milk differs greatly from cow's milk. It provides the type of fat that is important for the newborn's vision and brain growth. It is more easily digested by the newborn than cow's milk and may have antibacterial and antiviral properties. Option a is true, but the mother needs more information to make an informed decision. Hindmilk has two to three times as much fat as the foremilk.

During labor, the nurse notices that the woman's support partner touches her lightly during contractions. When the woman is touched, she relaxes her muscles. The nurse realizes that the couple is using the technique of a. progressive relaxation. b. neuromuscular disassociation. c. touch relaxation. d. relaxation against pain

c. touch relaxation. During touch relaxation, the woman loosens taut muscles when they are touched by her partner. After practice during the pregnancy, the woman becomes conditioned to recognize the touch of her partner as a signal for the release of tension.

A woman is receiving oxytocin for labor induction. The nurse notices the woman is having contractions every 2 minutes lasting for 100 seconds. The fetal heart rate is 120 to 130 bpm, with moderate variability. The nurse's next action should be to a. continue to monitor. b. notify the physician. c. turn off the oxytocin. d. turn the oxytocin up to a stronger level.

c. turn off the oxytocin. The uterine resting tone should have at least 30 seconds between contractions. This woman has a resting time of 20 seconds. The fetal heart rate and variability show no compromise at this time; however, hypertonic contractions can lead to decreased fetal oxygenation. The physician may need to be notified, but after corrective actions have been taken.

On admission to the labor suite, a woman begins to cry out loudly, "Lord help me, I am going to die." She repeats this phrase loudly with each contraction. The nurse's best response would be to a. explain to the woman that she is disturbing other patients. b. praise her between contractions when she is quiet. c. understand that this may be a cultural mannerism and accept her individual response to labor. d. understand that this may be a cultural mannerism and do patient teaching to help her understand other ways of expressing her fear and pain.

c. understand that this may be a cultural mannerism and accept her individual response to labor. Women should be encouraged to express themselves in any way they find comforting. The cultural diversity of their expressions must be respected. Accepting a woman's individual response to labor and pain promotes a therapeutic relationship. Belittling her, praising her falsely, or trying to show her a "better way" of dealing with the pain will interfere with the therapeutic relationship and lower the woman's self-esteem.

A crying infant is a major concern for most new parents. The nurse can teach the parents that answering an infant's cry a. may spoil the infant and the parents need to be cautious. b. usually means attending to an unanswered need, but until the infant is about 6 months old it is difficult to determine what that need may be. c. will help the infant develop trust. d. may become frustrating for the parents; they may need to close the door and ignore the infant at times.

c. will help the infant develop trust. Infants express their needs by crying. These needs must be met in a consistent, warm, and prompt manner for the development of trust to occur. Parents should be taught the importance of consistently and quickly answering infant cries.

Describe the most common variations in fetal presentation

cephalic (common), breech (approximately 3%), or shoulder (rare, less than 0.2%)

The breast fluid secreted during pregnancy and the first week after childbirth is called ____________________

colostrum

Describe three variations of uterine rupture

complete rupture—direct communication between the uterine and peritoneal cavities incomplete rupture—rupture into the peritoneum or broad ligament but not into the peritoneal cavity dehiscence—partial separation of a previous uterine scar

On which infant would the nurse notice the greater amounts of lanugo? a. A postterm, light-skinned infant b. A preterm, light-skinned infant c. A post-term, dark-skinned infant d. A preterm, dark-skinned infant

d. A preterm, dark-skinned infant Lanugo is fine hair that covers the fetus during intrauterine life. As the fetus nears term, the lanugo becomes thinner. Dark-skinned infants often have more lanugo than infants with lighter coloring and their darker hair is more visible.

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe which one of the following? a. Weight gain of 1 to 3 lb b. Quickening c. Fatigue and lethargy d. Bloody show

d. Bloody show Premonitory signs of labor (prodromal labor) include weight loss of 1 to 3 lb, a burst of energy or the nesting instinct, and passage of the mucus plug (also termed pink or bloody show) as the cervix ripens. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks' gestation.

A newborn has been assessed as high risk for hypoglycemia. The nurse assesses the newborn's blood glucose and it is 38 mg/dL. What should be the nurse's next action? a. Notify the pediatrician. b. Feed the newborn approximately 1 ounce of glucose water. c. Keep the newborn in the nursery and reassess the glucose in 30 minutes. d. Breast-feed or bottle-feed formula to the newborn.

d. Breast-feed or bottle-feed formula to the newborn. Glucose water alone is not recommended for newborns because the rapid rise in glucose results in increased insulin production, causing a further drop in blood glucose. Milk provides a longer lasting supply of glucose. Action should be taken prior to notifying the pediatrician or health care provider.

A woman is having very rapid labor with her fourth child. Which nursing measure is most appropriate to help her manage pain? a. Offer butorphanol (Stadol) when she reaches 5 cm cervical dilation. b. Keep her in an upright position until full cervical dilation. c. Avoid vaginal examinations during the peak of a contraction. d. Coach her to use breathing techniques with each contraction as it occurs

d. Coach her to use breathing techniques with each contraction as it occurs

The nurse notes a pattern of decelerations on the fetal monitor that begins shortly after the contraction begins and returns to baseline just before the contraction is over. The correct nursing response is to: a. Give the woman oxygen by face mask at 8 to 10 L/min. b. Position the woman on her opposite side. c. Increase the rate of the woman's IV fluid. d. Continue to observe and record the normal pattern.

d. Continue to observe and record the normal pattern.

The nurse notes that the infant's feet are turned inward. The appropriate initial nursing action is to: a. Apply a splint or harness to the feet and lower legs. b. Notify the pediatrician or nurse-practitioner immediately. c. Explain to the parents that this can be corrected with surgery. d. Determine whether the feet can be moved to a normal position.

d. Determine whether the feet can be moved to a normal position.

Choose the normal circumcision assessment. a. Plastibell positioned well down the shaft of the penis b. Oozing of blood from the site after a Gomco circumcision c. Delay in urination for 12 to 16 hours after the procedure d. Development of a dry yellow crust on the circumcision site

d. Development of a dry yellow crust on the circumcision site

A station of 11 means that the: a. Maternal cervix is open 1 cm. b. Mother's ischial spines project into her pelvis 1 cm. c. Fetus is unlikely to be born vaginally because the pelvis is small. d. Fetal presenting part is 1 cm below the mother's ischial spines.

d. Fetal presenting part is 1 cm below the mother's ischial spines.

The best position for a woman who has postpartum endometritis is a. left lateral. b. trendelenburg. c. supine. d. Fowler's.

d. Fowler's. Fowler's position aids in the drainage of the uterine cavity.

A woman who is having her first baby is trying to use breathing techniques during labor but has difficulty concentrating. She is dilated 3 cm and is 80% effaced, and the station is 0. What nursing measure can best help her? a. Encourage her to change to a different breathing pattern. b. Have a family member other than her husband coach her. c. Give her a very small dose of narcotic that is ordered as needed (prn). d. Help her find a specific point in the room on which to focus.

d. Help her find a specific point in the room on which to focus.

An infant's gestational age assessment reveals that she is SGA. This means that: a. She was born before 37 completed weeks of gestation. b. Her weight falls between the 10th and 90th percentiles. c. She has a low birth weight in relation to her length. d. Her size is smaller than expected for her gestation.

d. Her size is smaller than expected for her gestation.

For the cross-cradle hold, the mother holds the infant's head: a. At the antecubital space, with the infant's body along her arm and holding the breast with the other hand on the other side. b. In the hand on the side of the breast being used, with the infant's body along her side and holding the breast with the other hand. c. And body close to her, facing the breast, as the mother lies on her side. Pillows help position the mother and infant. d. In the hand opposite from the breast being used, with the infant's body across her lap and holding the breast with the other hand.

d. In the hand opposite from the breast being used, with the infant's body across her lap and holding the breast with the other hand.

A nursing student is asked to administer vitamin K to a newborn. The student is aware that vitamin K must be administered within 1 hour of birth but is not sure about which route is appropriate. Vitamin K should be given by which route to this newborn? a. Oral b. Subcutaneous c. Intravascular d. Intramuscular

d. Intramuscular Oral vitamin K has been used for newborn prophylaxis. It is not recommended at this time because it has not been shown to be as effective as parenteral vitamin K. The appropriate route is intramuscular. It is usually given within the first hour after birth but can be delayed until the infant has finished breastfeeding at birth.

The woman who uses cocaine is more likely to have which pattern on the electronic fetal heart monitor? a. Intermittent tachycardia b. Periodic accelerations c. Variable decelerations d. Late decelerations

d. Late decelerations

The best location for an infant's glucose determination is the: a. Great toe of either foot. b. Nondominant heel. c. Midline of the heel. d. Lateral surface of the heel.

d. Lateral surface of the heel.

A laboring woman who has not taken pain medication abruptly stops her previous breathing techniques during a contraction and makes low-pitched grunting sounds. The priority nursing action is to: a. Ask her whether she needs pain medication. b. Turn her to her left side. c. Assess contraction duration. d. Look at her perineum.

d. Look at her perineum.

When assessing a 2-day-old newborn, the nurse notes that the infant's skin color is yellowish to the level of the umbilicus. The most important action is to: a. Teach the mother to nurse the infant at least every 2 to 3 hours. b. Explain that jaundice is common and will resolve without treatment. c. Ask the mother whether she has been feeding the infant supplemental formula. d. Notify the pediatrician or nurse-practitioner of the early intense jaundice.

d. Notify the pediatrician or nurse-practitioner of the early intense jaundice.

What drug should be readily available when a woman is receiving heparin therapy? a. Vitamin K b. Methylergonovine c. Ferrous sulfate d. Protamine sulfate

d. Protamine sulfate

Choose the sign or symptom that the new mother should be taught to report. a. Occasional uterine cramping when the infant nurses b. Oral temperature that is 37.2° C (99° F) in the morning c. Descent of the fundus one fingerbreadth each day d. Reappearance of red lochia after it changes to serous fluid

d. Reappearance of red lochia after it changes to serous fluid

A woman is admitted in active labor. Her leukocyte count is 14,500/mm3. Based on this information, the nurse should: a. Assess the woman for other evidence of infection. b. Promptly inform the nurse-midwife of the results. c. Use isolation techniques to limit the spread of infection. d. Record the expected results in the woman's chart.

d. Record the expected results in the woman's chart.

A woman has had a baby at 29 weeks of gestation. She tells the nurse that she cannot breastfeed because the baby is so small. The nurse should tell her that: a. She will be able to establish lactation when the baby is strong enough to nurse. b. Special formulas are actually better than breast milk for preterm infants. c. Infections are more likely to occur if the infant takes stored breast milk. d. She can use a breast pump to maintain lactation until nursing is possible.

d. She can use a breast pump to maintain lactation until nursing is possible.

A woman calls the labor unit and says that she has been having back discomfort all day. She is at 32 weeks of gestation. The nurse should tell the woman that she: a. Is having discomfort that is typical of the third trimester. b. Should come to the hospital if she has increased vaginal drainage. c. Can increase her fluid intake to reduce Braxton Hicks contractions. d. Should come to the hospital for further evaluation.

d. Should come to the hospital for further evaluation.

While the woman laboring with a twin pregnancy is in bed, a good position for her is: a. Supine. b. Hands and knees. c. Knee-chest. d. Side-lying.

d. Side-lying.

A birthing center is trying to balance its budget and needs to cut down on certain services they have been providing. One concern of the staff is the follow-up care for new mothers. Which of the following provides follow-up care at the least cost? a. Longer hospital stays for the mother and newborn b. Home visits after discharge c. Return clinic visits d. Telephone counseling services

d. Telephone counseling services Telephone calls are much less expensive than home or clinic visits. They can be used for follow-up calls to discharged patients or for parents to call for help with problems or questions. The major disadvantage is that the nurse cannot perform an in-person assessment of the mother, baby, or home environment.

A woman calls the labor unit, saying that she has had an abrupt onset of pain between her shoulder blades that is worse when she breathes in. She is scheduled to have a repeat cesarean birth in 1 week. The nurse should: a. Ask her whether she has had a recent upper respiratory infection. b. Explain that the growing fetus reduces space to breathe. c. Have her palpate her uterus for frequent contractions. d. Tell her that she should come to the hospital promptly.

d. Tell her that she should come to the hospital promptly.

A new father is reluctant to spoil his newborn by picking her up when she cries. The best nursing response is to: a. Teach him that she will eventually stop crying if he waits. b. Take the baby to the nursery to allow the parents to rest. c. Pick the baby up and rock her until she sleeps again. d. Tell the father that the baby cries to communicate a need.

d. Tell the father that the baby cries to communicate a need.

A new father tells a nurse friend that his wife is agitated and acting in a bizarre fashion. She says that she hears voices. Her baby is 2 weeks old. The father is concerned about the care the mother is giving the baby. The nurse should: a. Tell the father that this is severe postpartum blues and will pass in a few days if he shows enough support. b. Suggest that the father try talking to his wife to find out what is bothering her about being a new mother. c. Explain that the mother will probably need psychotherapy and refer him to support groups d. Tell the father to call the physician immediately and not to leave the woman alone with the baby.

d. Tell the father to call the physician immediately and not to leave the woman alone with the baby.

When performing Leopold's maneuvers, the nurse palpates a hard round object in the uterine fundus. A smooth rounded surface is on the mother's right side, and irregular movable parts are felt on her left side. An irregularly shaped fetal part is felt in the suprapubic area and is easily moved upward. How should these findings be interpreted? a. The fetal presentation is cephalic, position is ROA, and the presenting part is engaged. b. The fetal presentation is cephalic, position is LOP, and the presenting part is not engaged. c. The fetal presentation is breech, position is RST, and the presenting part is engaged. d. The fetal presentation is breech, position is RSA, and the presenting part is not engaged.

d. The fetal presentation is breech, position is RSA, and the presenting part is not engaged.

When teaching the postpartum woman about peripads, the nurse should tell her that: a. She can change to tampons when the initial perineal soreness goes away. b. Pads having cold packs within them usually hold more lochia than regular pads. c. Blood-soaked pads must be returned in a plastic bag to the hospital after discharge. d. The pads should be applied and removed in a front to back direction.

d. The pads should be applied and removed in a front to back direction.

A woman is admitted in possible labor at 34 weeks of gestation. She is monitored with the external fetal monitor while on her left side. The nurse should periodically assess the contractions by palpation, primarily because: a. It makes the woman feel more like her pregnancy is normal. b. Palpation identifies whether the fetus has changed its presentation. c. Contractions may not be sensed by the tocotransducer while the woman is on her side. d. The tocotransducer is not accurate for actual intensity and uterine resting tone.

d. The tocotransducer is not accurate for actual intensity and uterine resting tone.

When auscultating the fetal heart rate of a term fetus during labor, the nurse notes a rate of 130 to 140 beats per minute (bpm), with occasional accelerations in the rate. How should the nurse interpret the data? a. The baseline rate is slightly high for a term fetus. b. Accelerations in the rate suggest intermittent hypoxia. c. Labor usually causes the fetal heart rate to be slower. d. These assessments are normal for a term fetus during labor.

d. These assessments are normal for a term fetus during labor.

Which one of the following findings meets the criteria of a Category I FHR pattern? a. The FHR does not change as a result of fetal activity. b. The average baseline rate ranges between 90 and 110 bpm. c. Mild late deceleration patterns occur with some contractions. d. Variability averages between 6 and 25 bpm.

d. Variability averages between 6 and 25 bpm. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. The FHR should accelerate with fetal movement. Baseline range for the FHR is from 110 to 160 bpm. Late deceleration patterns are never reassuring.

The correct site for injection of hepatitis B immunization for a newborn is the: a. Subcutaneous tissue of the thigh. b. Dorsogluteal muscle. c. Deltoid muscle. d. Vastus lateralis muscle.

d. Vastus lateralis muscle.

The nurse should assess all newborns for jaundice every 8 to 12 hours. This is done by a. ordering the appropriate blood work. b. monitoring the color and consistency of the stools. c. monitoring intake and output. d. blanching the newborn's skin.

d. blanching the newborn's skin. Assess for jaundice by blanching the infant's skin on the nose or sternum at least every 8 to 12 hours. Blood work is ordered if changes in color are seen.

Research has found that bed rest as an intervention for preventing preterm labor can result in a. maternal weight gain. b. diarrhea. c. increased maternal plasma volume and cardiac output. d. bone demineralization, with calcium loss.

d. bone demineralization, with calcium loss. Calcium loss from bones can begin as early as 3 days after the onset of bed rest. Weight loss, constipation, and a decrease in plasma volume and cardiac output are associated with bed rest.

During a newborn's first assessment a few minutes after birth, the nurse notes moisture in the left lower lung field. The newborn is having no respiratory difficulty. The nurse's next action should be to a. suction the infant. b. administer oxygen. c. notify the pediatrician. d. document the findings and continue to monitor.

d. document the findings and continue to monitor. Hearing sounds of moisture in the lungs during the first hour or two after birth is not unusual because fetal lung fluid has not been completely absorbed. If the abnormal sounds continue, they should be reported.

A nurse is asked to do a home visit on a woman who delivered 2 weeks ago. When assessing the woman, the nurse was not able to locate the fundus. The next action would be a. massage the fundus until firm. b. monitor for bleeding. c. arrange transportation for the woman to the nearest hospital. d. document this normal finding.

d. document this normal finding. The uterus descends at the rate of about 1 cm/day. By 10 to 14 days, it is no longer palpable above the symphysis pubis. This is a normal finding.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia would be a. severe postpartum headache. b. limited perception of bladder fullness. c. increase in respiratory rate. d. hypotension.

d. hypotension. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure. Headache is not a common side effect because the spinal fluid is not normally disturbed by this anesthetic as it would be with a low spinal anesthetic. Option B is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication.

Immediately after birth, the nurse can anticipate the fundus to be located a. at the umbilicus. b. 2 cm above the umbilicus. c. 1 cm below the umbilicus. d. midway between the symphysis pubis and umbilicus.

d. midway between the symphysis pubis and umbilicus. Immediately after birth the uterus is about the size of a large grapefruit and the fundus can be palpated midway between the symphysis pubis and umbilicus. Within 12 hours the fundus rises to the level of the umbilicus. By the second day, the fundus starts to descend by approximately 1 cm/day.

On the first postpartum day a patient's white blood cell count is 25,000/mm3. The nurse's next action should be to a. notify the physician for an antibiotic order. b. assess the patient's temperature and blood pressure. c. request the count be repeated. d. note the results in the chart.

d. note the results in the chart. Marked leukocytosis occurs during the postpartum period. The WBC count increases to as high as 30,000/mm3. The WBC count should fall to normal values by day 7. Neutrophils, which increase in response to inflammation, pain, and stress to protect against invading organisms, account for the major increase in WBCs. Because this is a normal reading, noting the results in the chart is the appropriate action.

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should a. place the probe on the left side of the chest. b. cover the probe with a nonreflective material. c. recheck the temperature by periodically taking a rectal temperature. d. prewarm the radiant heat warmer and place the undressed newborn under it.

d. prewarm the radiant heat warmer and place the undressed newborn under it. The probe should be placed on the upper abdomen. It should be covered with reflective material. Rectal temperatures should be avoided because rectal thermometers can perforate the intestine. The radiant heat warmer should be preheated to avoid heat loss by conduction.

A postpartum woman had excessive vaginal bleeding after the birth. The bleeding has decreased to a normal rate and the fundus has remained firm for the past 3 hours. She has requested to walk to the bathroom. The nurse should a. offer her a bedpan. b. let her ambulate to the bathroom because it has been 3 hours. c. assess for feeling in her feet before ambulation. d. slowly sit her up and allow her to dangle her legs before standing.

d. slowly sit her up and allow her to dangle her legs before standing. Because of the loss of blood, she is at high risk for orthostatic hypotension. The nurse should assist her in getting out of bed after dangling her legs and assessing for dizziness and low blood pressure.

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should a. tell the woman she can rest after she feeds her baby. b. recognize this as a behavior of the taking-hold stage. c. record the behavior as ineffective maternal-newborn attachment. d. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.

d. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being to care for their baby effectively.

The technique of delaying pushing until the reflex urge to push occurs may be called _____________________

delayed pushing, laboring down, rest and descend, or passive pushing

physiologic retraction ring

division between the upper and lower uterine segments

List three characteristics of tetanic (hypertonic) contractions. Why is it important to watch for this type of contraction?

durations longer than 90 to 120 seconds; intervals shorter than 30 seconds; incomplete uterine relaxation between contractions. If tetanic or hypertonic, contractions are too long or too frequent, or if too little uterine relaxation exists, fetal oxygenation may be reduced

Postpartum hemorrhage that occurs within the first 24 hours after childbirth is termed _______________

early

Ice causes vasoconstriction and is most effective if applied soon after the birth to the perineal area to prevent ______________.

edema

The laboring woman may rub her abdomen during a contraction to counteract discomfort. This is called ______________________

effleurage

When the father develops a bond with the new infant and has an intense interest in how the infant looks and responds, this is called ________________

engrossment

The placental site heals by a process of _______________

exfoliation

Describe three methods that can be used during labor to clarify the fetal condition

fetal scalp stimulation; vibroacoustic stimulation; fetal scalp blood sampling

Describe the most common variations in fetal attitude

flexion (common) or extension (uncommon)

One important and simple measure that can be used to prevent infection in newborns is _____________

handwashing

relaxin

hormone that causes cartilage to soften

If the meatus is located on the underside of the penis, it is called _______________

hypospadias

The maternal adaptation phase in which the mother relinquishes her previous role as being childless and her old lifestyle is called the _______________ phase

letting-go

normal fetal heart rate

lower limit of 110 and upper limit of 160 beats per minute (bpm)

catecholamines

maternal substances secreted in response to stress

station

measurement of descent of the fetal presenting part into the pelvis

Prickly heat develops in infants who are too warmly dressed in any weather. This is called _____________

miliaria

Most infant abductions in a hospital setting occur in the _____________

mother's room

dilation

opening of the cervix

The ruddy, reddish color of the newborn skin caused by polycythemia is called ________________

plethora

When the fingers or toes of a newborn have more than five digits, it is called ____________________

polydactyly

afterpains

postbirth uterine contractions

The term that describes a labor lasting 3 hours or less is ____________

precipitous labor

The hormone that causes the breasts to produce milk is _______________

prolactin

A potentially fatal complication of pregnancy that occurs when the pulmonary artery is obstructed by a blood clot that was swept into circulation from a vein or by amniotic fluid is called a _______________

pulmonary embolism

tachycardia fetal heart rate

rate greater than 160 bpm that persists for at least 10 minutes

bradycardia fetal heart rate

rate less than 110 bpm that persists for at least 10 minutes; rate of 100 to 110 bpm may be normal in the term fetus

As full term nears, the cervix softens because of the effects of the hormone relaxin and increased water content. This cervical change is termed ____________________

ripening

When the mother strokes the side of a newborn's mouth, the newborn will turn the head to the side touched. This reflex is called ______________

rooting

Chronic inflammation of the scalp or other areas of the skin characterized by yellow, scaly, oily lesions is called _________________

seborrheic dermatitis

One of the earliest signs of hypovolemic shock is ______________

tachycardia

effacement

thinning of the cervix

If the head retracts against the perineum after the birth, it is commonly referred to as the __________________

turtle sign

List four intrapartum problems that are more likely if a woman has a multifetal pregnancy

uterine overdistention with hypotonic dysfunction; abnormal fetal presentation(s); fetal hypoxia; postpartum hemorrhage caused by uterine overdistention

List four signs that suggest that the placenta has separated

uterus has spherical shape; uterus rises upward in abdomen; cord descends further from vagina; gush of blood

Fluctuations in the baseline FHR that cause the printed line to have an irregular rather than a smooth appearance is termed ___________________

variability

The thick white substance that resembles cream cheese and provides a protective covering for the fetal skin in utero is called the ______________

vernix caseosa

Diarrhea stools can be identified by a _____________ in the diaper around the stool

Ob midterm

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