OB TEST 2 EVOLVE Q's

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

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

Which ratio would be used to restore effective circulating volume in a postpartum patient who is experiencing hypovolemic shock? 4:1 2:1 1:1 3:1

3:1 A 3:1 ratio, of 3 ml fluid infused for every 1 ml of estimated blood loss, is recommended to restore circulating volume.

With regard to dysfunctional labor, nurses should be aware that: Women who are underweight are more at risk. Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. Abnormal labor patterns are most common in older women.

Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years.

Which of the following is the most common kind of placental adherence seen in pregnant women? Accreta Placenta previa Percreta Increta

Accreta Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient's risk for painless vaginal bleeding during the pregnancy and/or delivery process. Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Placenta increta leads to deep penetration of the myometrium.

A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. Three thromboembolic conditions are of concern during the postpartum period; which of the following is not? Amniotic fluid embolism (AFE) Superficial venous thrombosis Deep vein thrombosis Pulmonary embolism

Amniotic fluid embolism (AFE) An AFE occurs during the intrapartum period, when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis, the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis, occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs.

Which of the following statements is not used to describe a characteristic of a uterine contraction? Frequency (how often contractions occur) Intensity (the strength of the contraction at its peak) Resting tone (the tension in the uterine muscle) Appearance (shape and height)

Appearance (shape and height) Uterine contractions are described in terms of frequency, intensity, duration, and resting tone.

Which of the following findings would be a cause for concern for a nurse who is monitoring an obstetric patient who is in early labor? Select all that apply. Biparietal diameter of less than 9.25 cm Vertex presenting part Transverse lie General flexion attitude Android pelvis

Biparietal diameter of less than 9.25 cm Transverse lie Android pelvis A biparietal diameter at term is typically noted as 9.25 cm, and the finding of a smaller measurement would cause a concern related to the mode of delivery. A transverse lie would also cause a concern relative to the mode of delivery because a cesarean section would be indicated. An android pelvis would cause a concern related to the mode of delivery. A vertex presenting part and a general flexion attitude are normal findings and would not cause concern.

Health care providers demonstrate a variety of reactions to lesbian couples, including failure to acknowledge the "other mother's" role in pregnancy, birth, and parenting. Integration of the nonchildbearing partner into care includes offering the same opportunities afforded male partners of heterosexual women. Which opportunity could not be provided to male partners? Labor support Cutting the cord Rooming-in during hospitalization Breastfeeding the infant

Breastfeeding the infant An option not available to male partners is to actually breastfeed the infant. The nonchildbearing female partner can stimulate milk production through induced lactation using medications and regular pumping. A supplemental feeding device containing expressed breast milk or formula can be used to provide additional milk to the breastfeeding infant. Labor support is a very appropriate role for the "other mother" or "co-parent." Pregnancy for lesbian couples is an intentional event, and generally both mothers will want to be very involved. As with heterosexual couples, if institutional policy allows, the nonbiologic mother should be allowed to cut the umbilical cord after delivery. Like any heterosexual parents, lesbian couples face challenges in adjusting to life with a new baby. Encouraging rooming-in assists with this transition.

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels rise naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII fall. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: Cryoprecipitate Factor VIII and vWf Desmopressin Hemabate

Desmopressin Desmopressin is the primary treatment of choice. This hormone, which can be administered orally, nasally, and intravenously, promotes the release of factor VIII and vWf from storage. Treatment with cryoprecipitate or with plasma products such as factor VIII and vWf is acceptable, but because of the associated risk of possible viruses from donor blood products, other modalities are considered safer. Although the administration of the synthetic prostaglandin in Hemabate is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.

Which behaviors would be exhibited during the letting-go phase of maternal role adaptation? Select all that apply. Emergence of family unit Dependent behaviors Sexual intimacy relationship continuing Defining one's individual roles Being talkative and excited about becoming a mother

Emergence of family unit Sexual intimacy relationship continuing Defining one's individual roles Emergence of family unit, sexual intimacy relationship continuing, and defining one's individual roles represent interdependent behaviors associated with the letting-go phase. Dependent behaviors are exhibited in the taking-in phase. Being talkative and excited about becoming a mother represents the taking-hold phase and is an example of dependent-independent behaviors.

Vitamin K is given to the newborn to: Reduce bilirubin levels. Increase the production of red blood cells. Enhance the ability of blood to clot. Stimulate the formation of surfactant.

Enhance the ability of blood to clot. Newborns have a deficiency of vitamin K until intestinal bacteria that produce it are formed. Vitamin K is required for the production of certain clotting factors. Vitamin K does not reduce bilirubin levels, increase the production of red blood cells, or stimulate the formation of surfactant.

Which test is performed to determine whether membranes are ruptured? Urine analysis Fern test Leopold maneuvers AROM

Fern test In many instances a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery to determine the presence or absence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook.

Parents can facilitate the adjustment of their other children to a new baby by: Having children at home choose or make a gift to give the new baby on his or her arrival home. Emphasizing activities that keep the new baby and other children together. Having the mother carry the new baby into the home so she can show the other children the baby. Reducing stress on the other children by limiting their involvement and care of the new baby.

Having children at home choose or make a gift to give the new baby on his or her arrival home. Because the family is an interactive, open unit, the addition of a new family member affects everyone. Siblings have to assume new positions within the family hierarchy. Parents often face the task of caring for a new child while not neglecting others. Having the siblings choose or make a gift for their new brother or sister is a good way for them to feel included. Parents need to distribute their attention in an equitable manner. One way to ensure that this happens is to set aside special time just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so that she can give her full attention to the other children. Children should be actively involved in the care of the baby, according to their ability, without being overwhelmed.

Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse suspects: Bladder distention Uterine atony Constipation Hematoma formation

Hematoma formation Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation. Bladder distention results in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony results in a boggy fundus. Constipation is unlikely at this time.

Which statement is most likely to be associated with a breech presentation? Least common malpresentation Descent rapid Diagnosis by ultrasound only High rate of neuromuscular disorders

High rate of neuromuscular disorders Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as the fetal head. Diagnosis is made by abdominal palpation and vaginal examination, and is confirmed by ultrasound.

Which PPH conditions are considered medical emergencies that require immediate treatment? Inversion of the uterus and hypovolemic shock Hypotonic uterus and coagulopathies Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP) Uterine atony and disseminated intravascular coagulation (DIC).

Inversion of the uterus and hypovolemic shock Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin; coagulopathies should have been identified prior to delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment; ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications but are not medical emergencies requiring immediate intervention.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. There are no important maternal (as opposed to fetal) contraindications. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. If pulmonary edema develops while the client is receiving tocolytics, IV fluids should be given.

Its most important function is to afford the opportunity to administer antenatal glucocorticoids. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.

A nurse examining a newborn infant notes that the infant is jaundiced. Which observation would lead the nurse to continue to monitor but not to intervene and contact the physician? Jaundice appeared within the first 24 hours of life. Jaundice appeared on the third day of life. Preterm infant who is 12 hours old. Infant is being bottle fed and within the first 24 hours of life.

Jaundice appeared on the third day of life. Physiologic jaundice can be seen in a large percentage of newborns, 60% of term and 80% of preterm, but typically resolves without immediate intervention. The critical factor here is the time of appearance, being within the first 24 hours of life. Jaundice appearing at this time is considered pathological and requires further investigation. The timing in C combined with prematurity also requires further investigation.

During rounds, a nurse suspects that a patient who has recently delivered via vaginal route is having excessive postpartum bleeding. Which intervention would be the priority action taken by the nurse at this time? Call the physician. Massage the uterine fundus. Increase the rate of intravenous fluids. Monitor pad count and perform catheterization.

Massage the uterine fundus. Massaging of the uterine fundus would be a priority action to help expel clots and stimulate uterine contractions to constrict blood flow. The other actions described, as well as catheterization (if bladder distention is noted) and lochia flow monitoring, may be needed, but none of them is the priority action required at this time.

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? Endometritis Wound infections Mastitis Urinary tract infections (UTIs)

Mastitis Mastitis is infection in a breast, usually confined to a milk duct. Most women who get it are first-timers who are breastfeeding. Endometritis is the most common postpartum infection. Its incidence is higher after a cesarean birth, not in first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal exams, and epidural anesthesia.

The process in which the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics is called: Mutuality. Bonding. Claiming. Acquaintance.

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

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? Call for help. Insert a Foley catheter. Start oxytocin (Pitocin). Notify the primary health care provider immediately.

Notify the primary health care provider immediately. To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also, if oxytocin is being infused, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately. Although it is always a good idea to have extra help during any unanticipated obstetric event, calling for help is not the most important nursing measure at this time. If the FHR were to continue in an abnormal or nonreassuring pattern, a cesarean section might be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? Fetal heart rate of 116 beats/min Cervix dilated 2 cm and 50% effaced Score of 8 on the biophysical profile One fetal movement noted in 1 hour of assessment by the mother

One fetal movement noted in 1 hour of assessment by the mother Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If she feels fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. The findings described in the other choices are normal at 42 weeks of gestation.

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

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

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: Call the woman's primary health care provider. Administer the standing order for an oxytocic. Palpate the uterus and massage it if it is boggy. Assess maternal blood pressure and pulse for signs of hypovolemic shock.

Palpate the uterus and massage it if it is boggy. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus to stop the bleeding. This is the most important nursing intervention. Then the primary health care provider should be notified or the nurse can delegate this task to another staff member. Administering an oxytocic and ascertaining vital signs are appropriate after assessment has been made and immediate steps have been taken to control the bleeding.

Which indicator would lead the nurse to suspect that a postpartum patient experiencing hemorrhagic shock is getting worse? Restoration of blood pressure levels to normal range Capillary refill brisk Patient complaint of headache and increased reaction time to questioning Patient statement that she sees "stars"

Patient complaint of headache and increased reaction time to questioning Patient complaint of a headache accompanied by an increased reaction (response) time indicates that cerebral hypoxia is getting worse. Return of blood pressure to normal range would indicate resolving symptoms. Brisk capillary refill is a normal finding. The patient may see "stars" early on in decreased blood flow states.

In which situations would the use of Methergine or prostaglandin be contraindicated even if the patient was experiencing a postpartum significant bleed? Select all that apply. Patient has delivered twin pregnancies. Patient's blood pressure postpartum is 180/90. Patient has a history of asthma. Patient has a mitral valve prolapse. Patient is a grand multip.

Patient's blood pressure postpartum is 180/90. Patient has a history of asthma. Patient has a mitral valve prolapse. Twin pregnancies successfully delivered and grand multiparity are not contraindications to the use of these medications. If a patient is hypertensive or has cardiovascular disease, these medications would not be used. If a patient has a history of asthma, prostaglandin medication would not be used.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? Place the woman in the knee-chest position. Cover the cord in a sterile towel saturated with warm normal saline. Prepare the woman for a cesarean birth. Start oxygen by face mask.

Place the woman in the knee-chest position. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. Relieving pressure on the cord is the nursing priority. The nurse may also use her gloved hand or two fingers to lift the presenting part off the cord. If the cord is protruding from the vagina it may be covered with a sterile towel soaked in saline. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete.

Which test result would provide evidence of fetal blood in maternal circulation? Positive Fern test result Positive Coombs test result Positive Kleihauer-Betke test result Negative Coombs test result

Positive Kleihauer-Betke test result A Kleihauer-Betke test determines the presence of fetal blood in maternal circulation.A positive fern test result would indicate the presence of amniotic fluid, noting that membranes had ruptured. A positive Coombs test result would indicate that the mother has Rh antibodies, and a negative result would indicate no presence of Rh antibodies.

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? Talks and coos to her son Seldom makes eye contact with her son Cuddles her son close to her Tells visitors how well her son is feeding

Seldom makes eye contact with her son The woman should be encouraged to hold her infant in the en face position and make eye contact with him. Talking and cooing to her son, cuddling, and sharing her son's success at feeding are all normal infant-parent interactions or actions.

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? Semirecumbent Sitting Squatting Side-laying

Squatting Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. Sitting may assist with fetal descent, but like a semirecumbent or side-lying position, it does not increase the size of the pelvic outlet.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: The examiner's hand should be placed over the fundus before, during, and after contractions. The frequency and duration of contractions are measured in seconds for consistency. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. The resting tone between contractions is described as either placid or turbulent.

The examiner's hand should be placed over the fundus before, during, and after contractions. The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

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

The parents hover around the infant, directing attention to and pointing at the infant. Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior. The other choices are inhibiting behaviors.

With regard to umbilical cord care, nurses should be aware that: The stump can easily become infected. A nurse noting bleeding from the vessels of the cord should immediately call for assistance. The cord clamp is removed at cord separation. The average cord separation time is 5 to 7 days.

The stump can easily become infected. The cord stump is an excellent medium for bacterial growth. If bleeding occurs, the nurse should first check the clamp (or tie) and apply a second one; if the bleeding does not stop, then the nurse calls for assistance. The cord clamp is removed after 24 hours when it is dry. The average cord separation time is 10 to 14 days.

Which statement accurately reflects the La cuarentena ritual for a Hispanic patient? No restrictions are placed on the mother during this ritual period. This ritual occurs over a period of 40 days. Spicy foods are encouraged as part of the maternal diet. The ritual is limited to preparing the woman to become a good mother.

This ritual occurs over a period of 40 days. The La cuarentena ritual occurs during a period of 40 days. The La cuarentena ritual period involves certain dietary and behavioral restrictions—spicy foods are restricted—and involves an intergenerational family approach toward integrating the family unit.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: Uses soap and warm water to wash the vulva and perineum. Washes from symphysis pubis back to the episiotomy. Changes her perineal pad every 2 to 3 hours. Uses the peribottle to rinse upward into her vagina.

Uses the peribottle to rinse upward into her vagina. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina because debris would be forced upward into the uterus through the still-open cervix. Using soap and warm water to wash the vulva and perineum is an appropriate measure. Washing from the symphysis pubis back to the episiotomy is an appropriate infection control measure. The client should be instructed to change her perineal pad every 2 to 3 hours.

While making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: Express a strong need to review the events and her behavior during the process of labor and birth. Exhibit a reduced attention span, limiting readiness to learn. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. Have reestablished her role as a spouse or partner.

Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. One week after birth the woman should exhibit behaviors characteristic of the dependent-independent or taking-hold stage. She still has needs for nurturing and acceptance by others. Wanting to discuss the events of her labor and delivery are characteristics of the taking-in stage, as are a limited readiness to learn and reduced attention span; this stage lasts from the first 24 hours until 2 days after delivery. Having reestablished her role as a spouse reflects the letting-go stage, which indicates that psychosocial recovery is complete.

Fetal bradycardia is most common during: Maternal hyperthyroidism. Fetal anemia. Viral infection. Tocolytic treatment using ritodrine.

Viral infection. Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, viral infections such as cytomegalovirus (CMV), maternal hypothermia, and maternal hypothermia. Maternal hyperthyroidism, fetal anemia, and tocolytic treatment using ritodrine will most likely result in fetal tachycardia.

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is: Vision. Hearing. Smell. Taste.

Vision. The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant's hearing is similar to that of an adult. Newborns have a highly developed sense of smell and can distinguish and react to various tastes.

Which statement is inaccurate with regard to a nurse working with parents who have a sensory impairment? One of the major difficulties visually impaired parents experience is the skepticism of health care professionals. Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact. The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities. Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information.

Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact. Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. The skepticism, open or hidden, of health care professionals throws up an additional and unneeded hurdle for the parents. After the parents' capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help a pick up a child's cry. Sign language is acquired readily by young children.

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: Tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. Alerts the physician that the infant has a dislocated hip. Informs the parents and physician that molding has not taken place. Suggests that if the condition does not change, surgery to correct vision problems might be needed.

Alerts the physician that the infant has a dislocated hip. The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified. The statement in B is inappropriate and may result in unnecessary anxiety for the new parents. Molding refers to movement of the cranial bones and has nothing to do with the infant's hips.

The concept of tandem feeding is based on: Adequate nutritional stores for the mother and infant. Using both breasts to nurse the baby. Breastfeeding an infant and an older sibling during the same period. Supplementing breastfeeding with bottle feeding to maintain adequate weight gain.

Breastfeeding an infant and an older sibling during the same period. In tandem feeding, a mother nurses both an infant and an older child during the same period.

A group of fetal monitoring experts (National Institute of Child Health and Human Development, 2008) recommends that fetal heart rate (FHR) tracings demonstrate certain characteristics to be described as reassuring or normal (category I). These characteristics include: Bradycardia not accompanied by baseline variability. Early decelerations, either present or absent. Sinusoidal pattern. Tachycardia.

Early decelerations, either present or absent. Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing. Bradycardia not accompanied by variability is a category II tracing, as is fetal tachycardia. A sinusoidal pattern is considered an ominous sign and is definitely an abnormal category III tracing.

Which description of postpartum restoration or healing times is accurate? The cervix shortens, becomes firm, and returns to form within a month postpartum. Rugae reappear within 3 to 4 weeks. Most episiotomies heal within a week. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

Rugae reappear within 3 to 4 weeks. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. The cervix regains its form within days; the cervical os may take longer. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? 1.The healthy newborn should be taken to the nursery for a complete assessment. 2. After drying, the infant should be given to the mother wrapped in a receiving blanket. 3. Skin-to-skin contact of mother and baby should be encouraged. 4. The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.

Skin-to-skin contact of mother and baby should be encouraged. The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding. Although complete assessment in the nursery is the practice in many facilities, it is neither evidence-based nor supportive of family-centered care. Handing the mother the blanket-wrapped baby is a common practice and more family friendly than separating mother and baby; however, ideally the baby should be placed on the mother skin to skin. The father or support person is likely also anxious to hold and admire the newborn. This can happen after the infant has been placed skin to skin with the mother and breastfeeding has been initiated.

A newborn male, estimated to be 39 weeks of gestation, exhibits: Testes descended into the scrotum. Extended posture when at rest. Abundant lanugo over his entire body. Ability to move his elbow past his sternum.

Testes descended into the scrotum. A full-term male infant has both testes descended into his scrotum and rugae appear on the anterior portion. A full-term infant's good muscle tone results in a more flexed posture when at rest. A full-term infant exhibits only a moderate amount of lanugo, usually on the shoulders and back. Preterm infants have an abundance of lanugo over the entire body. The muscle tone of a full-term newborn prevents him from being able to move his elbow past midline.

The nurse knows that the second stage of labor, the descent phase, has begun when: 1. The amniotic membranes rupture. 2. The cervix cannot be felt during a vaginal examination. 3. The woman experiences a strong urge to bear down. 4. The presenting part is below the ischial spines.

The cervix cannot be felt during a vaginal examination. The second stage of labor begins with full cervical dilation. During the active pushing phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as at 5 cm dilation.

Which statement regarding infant weaning is correct? Weaning should proceed from breast to bottle to cup. The feeding of most interest should be eliminated first. Abrupt weaning is easier than gradual weaning. Weaning can be mother or infant initiated.

Weaning can be mother or infant initiated. Weaning is initiated by the mother or the infant. With infant-led weaning, the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother's milk supply. In mother-led weaning, the mother decides which feedings to drop. Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants younger than 6 months. If the infant is weaned prior to 1 year of age, iron-fortified formula rather than cow's milk should be offered. The feeding of least interest to the baby or the one through which the infant is likely to sleep should be eliminated first. Every few days thereafter the mother drops another feeding. Gradual weaning over a period of weeks or months is easier for both the mother and the infant than an abrupt weaning.

Nurses are getting ready for bedside reporting at change of shift. A benefit of this type of change of shift report is that: Information is transparent so that the nurses and patients are aware of all pertinent data and delivery of care aspects. Patients can ask questions of the nurses during change of shift report so that they can better direct the delivery of their health care. Nurses are able to visualize their patient's directly at the time of report leading to better patient satisfaction. There is no need for additional information to be exchanged as the patient is right there to answer questions and voice concerns.

Nurses are able to visualize their patient's directly at the time of report leading to better patient satisfaction. Using a bedside report technique helps the nurse directly visualize the patient in question so as to improve his/her understanding of each patient's clinical situation. The transparency of information is not a benefit of bedside reporting. A bedside report is a change-of-shift report between nurses involved in the delivery of health care to a patient and/or group of patients; it is not mediated by patient questioning. Also, it is not all inclusive because patient care continues and is evolving over the course of the patient's hospitalization. Thus, additional information will be needed.

Which finding would be a source of concern if noted during the assessment of a woman at 12 hours postpartum? Postural hypotension Temperature of 38° C Bradycardia—pulse rate of 55 beats/min Pain in left calf with dorsiflexion of left foot

Pain in left calf with dorsiflexion of left foot These findings indicate presence of Homans sign, are suggestive of thrombophlebitis, and should be investigated. Postural hypotension is an expected finding related to circulatory changes after birth. A heart rate of 55 beats/min is an expected finding in the initial postpartum period. A temperature of 38° C in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake.

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should: Place the thermistor probe on the left side of the chest. Cover the probe with a nonreflective material. Recheck temperature by periodically taking a rectal temperature. Perform all examinations and activities under the warmer.

Perform all examinations and activities under the warmer. During all procedures, heat loss must be avoided or minimized for the newborn. All examinations and activities are performed with the infant under the heat panel. The thermistor probe should be placed on the upper abdomen away from the ribs and should be covered with reflective material. Rectal temperature measurements should be avoided because rectal thermometers can perforate the intestine, and the rectal temperature may remain normal until cold stress is advanced.

With regard to primary and secondary powers, the maternity nurse should understand that: 1. Primary powers are responsible for effacement and dilation of the cervix. 2. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies. 3. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. 4. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

Primary powers are responsible for effacement and dilation of the cervix. The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus. Effacement is generally well ahead of dilation in first-timers; the two are more concurrent in subsequent pregnancies. Scarring of the cervix may slow dilation. Pushing is more effective and less fatiguing when the woman begins to push only after she has the urge to do so.

After change of shift report, the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: Visceral Referred Somatic Afterpain

Referred As labor progresses the woman often experiences referred pain. It occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and the thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Visceral pain predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. Somatic pain is described as intense, sharp, burning, and well localized. It results from stretching of the perineal tissues and the pelvic floor and occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

Nurses should be aware of the difference that experience can make in labor pain, such as: 1.Sensory pain for nulliparous women often is greater than for multiparous women during early labor. 2.Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. 3.Women with a history of substance abuse experience more pain during labor. 4.Multiparous women have more fatigue from labor and therefore experience more pain.

Sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous women during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

Which factors would lead to an increased likelihood of uterine rupture? Select all that apply. Preterm singleton pregnancy G3P3 with all vaginal deliveries Short interval between pregnancies Patient receiving a trial of labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classic incision

Short interval between pregnancies. Patient receiving a trial of labor (TOL) following a VBAC delivery. Patient who had a primary caesarean section with a classic incision. The shorter the interval between pregnancies/deliveries, the higher the risk of uterine rupture. A patient who is having a TOL following a VBAC and a patient who has had a C section with a classic incision into the uterus are at increased risk for uterine rupture. A pregnant woman with a singleton pregnancy (one fetus), even if preterm, is not considered to be at increased risk for uterine rupture; nor is a multipara who has delivered all her infants vaginally.

Postbirth uterine/vaginal discharge, called lochia: Is similar to a light menstrual period for the first 6 to 12 hours. Is usually greater after cesarean births. Will usually decrease with ambulation and breastfeeding. Should smell like normal menstrual flow unless an infection is present.

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

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? Estriol is not found in maternal saliva. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm.

The cervix is effacing and dilated to 2 cm. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Irregular, mild contractions that do not cause cervical change are not considered a threat. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes.

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: 1. The woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. 2. Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. 3. Having the woman point her toes reduces leg cramps. 4. The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.

The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second-stage labor because of a number of unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself.

In a variation of rooming-in called couplet care, the mother and infant share a room and the mother shares the care of the infant with: 1. The father of the infant. 2. Her mother (the infant's grandmother). 3. Her eldest daughter (the infant's sister). 4. The nurse.

The nurse. In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care. This may also be known as mother-baby care or single-room maternity care. The father is included in instruction regarding infant care whenever he is present. The grandmother is welcome to stay and take part in the woman's postpartum care, but she is not part of the couplet. An older sibling may stay with the client and her baby but is also not part of the couplet.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular. A gush of dark red blood comes from her vagina. The nurse concludes that: The placenta has separated. A cervical tear occurred during the birth. The woman is beginning to hemorrhage. Clots have formed in the upper uterine segment.

The placenta has separated. Placental separation is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness. Cervical tears that do not extend to the vagina result in minimal blood loss. Signs of hemorrhage are a boggy uterus, bright red vaginal bleeding, alterations in vital signs, pallor, lightheadedness, restlessness, decreased urinary output, and alteration in the level of consciousness. If clots have formed in the upper uterine segment, the nurse would expect to find the uterus boggy and displaced to the side.

Fetal well-being during labor is assessed by: The response of the fetal heart rate (FHR) to uterine contractions (UCs). Maternal pain control. Accelerations in the FHR. An FHR greater than 110 beats/min.

The response of the fetal heart rate (FHR) to uterine contractions (UCs). Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Although FHR accelerations and an FHR greater than 110 beats/min may be reassuring, they are only two components of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.

The nurse taught new parents the guidelines to follow regarding the bottle feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they: Wash the top of can and can opener with soap and water before opening the can. Adjust the amount of water added according to weight gain pattern of the newborn. Add some honey to sweeten the formula and make it more appealing to a fussy newborn. Warm formula in a microwave oven for a couple of minutes prior to feeding.

Wash the top of can and can opener with soap and water before opening the can. Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for parents to get into to prevent contamination. Directions on the can for dilution should be followed exactly and not adjusted according to weight gain to prevent nutritional and fluid imbalances. Honey is not necessary and could contain botulism spores. The formula should be warmed in a container of hot water because a microwave can easily overheat it.

The breasts of a woman who is bottle feeding her baby are engorged. The nurse should instruct her to: Wear a snug, supportive bra. Allow warm water to soothe the breasts during a shower. Express milk from breasts occasionally to relieve discomfort. Place absorbent pads with plastic liners into her bra to absorb leakage.

Wear a snug, supportive bra. A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Ice packs, fresh cabbage leaves, and mild analgesics may also relieve discomfort. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners would keep the nipples and areola moist, leading to excoriation and cracking.

When weighing a newborn, the nurse should: Leave its diaper on for comfort. Place a sterile scale paper on the scale for infection control. Keep a hand on the newborn's abdomen for safety. Weigh the newborn at the same time each day for accuracy.

Weigh the newborn at the same time each day for accuracy. Weighing a newborn at the same time each day allows for the most accurate weight. The baby should be weighed without a diaper or clothes. Clean scale paper is acceptable; it does not need to be sterile. The nurse's hand should be above, not on, the abdomen for safety.

In helping the breastfeeding mother position the baby, the nurse should keep in mind that: The cradle position is usually preferred by mothers who had a cesarean birth. Women with perineal pain and swelling prefer the modified cradle position. Whatever the position used, the infant is "belly to belly" with the mother. While supporting the head, the mother should push gently on the occiput.

Whatever the position used, the infant is "belly to belly" with the mother. The infant inevitably faces the mother, belly to belly. The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head, because doing so might cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

Under which circumstance would a nurse not perform a vaginal examination on a patient in labor? 1. An admission to the hospital at the start of labor 2. When accelerations of the fetal heart rate (FHR) are noted 3. On maternal perception of perineal pressure or the urge to bear down 4. When membranes rupture

When accelerations of the fetal heart rate (FHR) are noted An accelerated FHR is a positive sign not requiring vaginal examination; variable decelerations, however, merit a vaginal examination. Vaginal examination should be performed when the woman is admitted to the hospital or birthing center at the start of labor. When the woman perceives perineal pressure or the urge to bear down is another appropriate time to perform a vaginal examination, as is after rupture of membranes (ROM). The nurse must be aware that there is an increased risk of prolapsed cord immediately after ROM.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: "Don't worry about it. You'll do fine." "It's normal to be anxious about labor. Let's discuss what makes you afraid." "Labor is scary to think about, but the actual experience isn't." "You may have an epidural. You won't feel anything."

"It's normal to be anxious about labor. Let's discuss what makes you afraid." This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool. The statement in A negates the woman's fears and is not therapeutic. The statement in C also negates the woman's fears and offers a false sense of security. The statement in D is not true. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural.

While caring for the newborn, the nurse must be alert for any signs of cold stress. This would include which symptom? Decreased activity level Increased respiratory rate Hyperglycemia Shivering

Increased respiratory rate In an infant who is cold, the respiratory rate rises in response to the increased need for oxygen. Signs of cold stress include increased activity level and crying (increased basal metabolic rate [BMR] and heat production). A cold infant is at risk for hypoglycemia as the glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production.

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: Narcotics. Barbiturates. Methamphetamines. Tranquilizers.

Methamphetamines. The use of illicit drugs such as cocaine or methamphetamines might cause increased variability. Maternal ingestion of narcotics and tranquilizer use may be the causes of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these drugs are known to cross the placental barrier.

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: "True labor contractions will subside when I walk around." "True labor contractions will cause discomfort over the top of my uterus." "True labor contractions will continue and get stronger even if I relax and take a shower." "True labor contractions will remain irregular but become stronger."

"True labor contractions will continue and get stronger even if I relax and take a shower." True labor contractions occur regularly, become stronger, last longer, and occur closer together. They may become intense during walking and continue despite comfort measures. Typically, true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen. During false labor, contractions tend to be irregular and felt in the abdomen above the navel. Typically the contractions stop with walking or a change of position.

With regard to breathing techniques during labor, maternity nurses should be aware that: 1. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. 2.By the time labor has begun, it is too late for instruction in breathing and relaxation. 3.Controlled breathing techniques are most difficult near the end of the second stage of labor. 4.The patterned-paced breathing technique can help prevent hyperventilation.

1. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. First-stage techniques promote relaxation of abdominal muscles, thereby increasing the size of the abdominal cavity. Instruction in simple breathing and relaxation techniques early in labor is possible and effective. Controlled breathing techniques are most difficult in the transition phase at the end of the first stage of labor, when the cervix is dilated 8 to 10 cm. Patterned-paced breathing can sometimes lead to hyperventilation.

With regard to spinal and epidural (block) anesthesia, nurses should know that: 1.This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. 2.A high incidence of postbirth headache is seen with spinal blocks. 3.Epidural blocks allow the woman to move freely. 4.Spinal and epidural blocks are never used together.

2. A high incidence of postbirth headache is seen with spinal blocks. The headaches may be prevented or mitigated to some degree by a number of methods. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache. Spinal blocks may be used for vaginal births, but the woman must be assisted through labor. Epidural blocks limit the woman's ability to move freely. Combined use of spinal and epidural blocks is becoming increasingly popular.

With regard to systemic analgesics administered during labor, nurses should be aware that: 1.Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. 2.Effects on the fetus and newborn can include decreased alertness and delayed sucking. 3.IM administration is preferred over IV administration. 4.IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

2. Effects on the fetus and newborn can include decreased alertness and delayed sucking. Effects depend on the specific drug given, the dosage, and the timing. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

Concerning the third stage of labor, nurses should be aware that: 1. The placenta eventually detaches itself from a flaccid uterus. 2. The duration of the third stage may be as short as 3 to 5 minutes. 3. It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. 4. The major risk for women during the third stage is a rapid heart rate.

2. The duration of the third stage may be as short as 3 to 5 minutes. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. The placenta cannot detach itself from a flaccid (relaxed) uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage; the risk of hemorrhage increases as the length of the third stage increases.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: 1.Either hot or cold applications may provide relief, but they should never be used together in the same treatment. 2.Acupuncture can be performed by a skilled nurse with just a little training. 3.Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited. 4.Therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

3.Hand and foot massage may be especially relaxing in advanced labor, when a woman's tolerance for touch is limited. The woman and her partner should experiment with massage before labor to see what might work best. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

In most healthy newborns, blood glucose levels stabilize at __ mg/dL during the first hours after birth: 80 to 100 Less than 40 50 to 60 60 to 70

50 to 60 In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dL during the first several hours after birth. 80 to 100 mg/dL is the normal plasma glucose level in the adult. A blood glucose level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. An infant with this level can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life the blood glucose levels should be approximately 60 to 70 mg/dL.

The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume that generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct? A common practice among Mexican women is known as las dos cosas. Muslim cultures do not encourage breastfeeding because of modesty concerns. Latino women born in the United States are more likely to breastfeed. East Indian and Arab women believe that cold foods are best for a new mother.

A common practice among Mexican women is known as las dos cosas. Las dos cosas refers to combining breastfeeding and commercial infant formula. It is based on the belief that combining the two feeding methods gives the mother and infant the benefits of breastfeeding along with the additional vitamins from formula. In the Muslim culture, breastfeeding for 24 months is customary; Muslim women may, however, choose to bottle-feed formula or expressed breast milk while in the hospital. Latino women born in the United States are less likely to breastfeed. East Indian and Arab women believe that hot foods, such as chicken and broccoli, are best for the new mother. The cultural descriptor hot has nothing to do with the temperature or spiciness of the food.

Which sign does not precede the onset of labor? 1. A return of urinary frequency as a result of increased bladder pressure 2. Persistent low backache from relaxed pelvic joints 3. Stronger and more frequent uterine (Braxton Hicks) contractions 4. A decline in energy, as the body stores up for labor

A decline in energy, as the body stores up for labor A surge of energy is a phenomenon that is common in the days preceding labor. After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Prior to the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength; bloody show may be passed.

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: Uterine contractions occurring every 8 to 10 minutes. A fetal heart rate (FHR) of 180 with absence of variability. The client needing to void. Rupture of the client's amniotic membranes.

A fetal heart rate (FHR) of 180 with absence of variability. A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring; the oxytocin should be immediately discontinued and the physician should be notified. The oxytocin should also be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The client needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. The oxytocin does not need to be discontinued when the membranes rupture, but the physician should be notified.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? 1. Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours 2. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours 3. Lull: no contractions; dilation stable; duration of 20 to 60 minutes 4. Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. No official lull phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

The nurse is observing a postpartum patient who has been bleeding excessively during the first hour, saturating multiple pads. Which interventions would the nurse anticipate that the physician would order? Select all that apply. Document findings in the health care record Decrease flow rate for intravenous fluid administration Administer oxygen via nonrebreather mask @ 10 L/minute Insert a secondary intravenous line access Type & screen for 2 units of blood

Administer oxygen via nonrebreather mask @ 10 L/minute Insert a secondary intravenous line access Administration of oxygen @ 10L/minute via nonrebreather mask would be an anticipated order, as would insertion of a secondary line access for administration of fluids, blood, and/or medications. Although documentation of findings in a health care record is required, this is part of the nursing role and does not require an order by the physician. With regard to the presence of hypovolemic shock, intravenous fluids would be increased and maintained. The flow rate would not typically be decreased unless there was another comorbidity leading to potential fluid overload. Type & Screen would not be an anticipated order because no blood would be held for use; rather a Type & Cross order would be anticipated.

An Apgar score of 10 at 1 minute after birth indicates: An infant having no difficulty adjusting to extrauterine life and needing no further testing. An infant in severe distress that needs resuscitation. A prediction of a future free of neurologic problems. An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.

An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth. A score of 10 at 1 minute of life indicates excellent transition to extrauterine life; however, the assessment needs to be repeated at 5 minutes of life. An infant in need of resuscitation has a very low Apgar score. Apgar scores do not predict neurologic outcome but are useful for describing the newborn's transition to extrauterine environment.

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae: Are benign if they disappear within 48 hours of birth. Result from increased blood volume. Should always be further investigated. Usually occur with forceps delivery.

Are benign if they disappear within 48 hours of birth. Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face. They usually occur with a breech presentation vaginal birth, although in this case they are soft-tissue injury resulting from the nuchal cord at birth. These lesions are benign if they disappear within 2 days of birth and no new lesions appear. Unless they do not dissipate in 2 days, there is no reason to alarm the family. Petechiae may also result from decreased platelet formation.

The nurse providing care for the laboring woman understands that accelerations with fetal movement: Are reassuring. Are caused by umbilical cord compression. Warrant close observation. Are caused by uteroplacental insufficiency.

Are reassuring. Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being; they do not warrant close observation. Umbilical cord compression results in variable decelerations in the FHR. Uteroplacental insufficiency would result in late decelerations in the FHR.

Which statement is not accurate regarding the effect of breastfeeding on the family or society at large? Breastfeeding requires fewer supplies and less cumbersome equipment. Breastfeeding saves families money. Breastfeeding costs employers in terms of time lost from work. Breastfeeding benefits the environment.

Breastfeeding costs employers in terms of time lost from work. Less time is lost from work by breastfeeding mothers, in part because infants are healthier than bottle-fed infants. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment, and it saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Also, breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is: An on-demand feeding schedule. Breastfeeding. Lower-calorie infant formula. Smaller, more frequent feedings.

Breastfeeding. Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also helps the woman return to her prepregnant weight sooner.All breastfed infants should be fed on demand. Use of lower-calorie formula is an inappropriate strategy that does not meet the infant's nutritional needs. Breastfeeding is the most appropriate choice for infant feeding. Smaller feedings are not necessary. Infants should continue to be fed every 2 to 3 hours in the newborn period.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: Change in position. Oxytocin administration. Regional anesthesia. Intravenous analgesic.

Change in position. Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This pressure reduces venous return to the woman's heart, as well as cardiac output, and subsequently lowers her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration, regional anesthesia, and intravenous analgesic may all reduce maternal cardiac output.

A nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should: Instill within 15 minutes of birth for maximum effectiveness. Cleanse eyes from inner to outer canthus before administration if necessary. Apply directly over the cornea. Flush eyes 10 minutes after instillation to reduce irritation.

Cleanse eyes from inner to outer canthus before administration if necessary. The newborn's eyes should be cleansed if necessary before the administration of erythromycin ointment. Instillation of the ointment can be delayed for up to 2 hours to facilitate eye-to-eye contact between the newborn and parents, an activity that fosters bonding and attachment, especially for fathers. Erythromycin ointment should be applied into the conjunctival sac to avoid accidental injury to the eye. The eyes should not be flushed after instillation.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. Gentle cleansing with warm water, not wipes, and application of petroleum jelly at each diaper change are appropriate care for an infant who has had a circumcision. If bleeding occurs, gentle pressure should be applied to the site of the bleeding with a sterile gauze square. Yellow exudate covers the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudate should not be removed.

When performing vaginal examinations on a laboring woman, the nurse should be guided by what principle? 1. Cleanse the vulva and perineum before and after the examination as needed. 2. Wear a clean glove lubricated with tap water to reduce discomfort. 3. Perform the examination every hour during the active phase of the first stage of labor. 4. Perform an examination immediately if active bleeding is present.

Cleanse the vulva and perineum before and after the examination as needed. Cleansing will reduce the possibility that secretions and microorganisms will ascend into the vagina to the cervix. Maternal comfort will also be enhanced. Sterile gloves and lubricant must be used to prevent infection. Vaginal examinations should be performed only as indicated to limit maternal discomfort and reduce the risk for transmission of infection, especially when rupture of membranes occurs. Examinations are never done by the nurse if vaginal bleeding is present, because the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure is to use: 1.Counterpressure against the sacrum. 2.Pant-blow (breaths and puffs) breathing techniques. 3.Effleurage. 4.Biofeedback.

Counterpressure against the sacrum. Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain but it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support.

With regard to the respiratory development of the newborn, nurses should be aware that: Crying increases the distribution of air in the lungs. Newborns must expel the fluid at uterine life from the respiratory system within a few minutes of birth. Newborns are instinctive mouth breathers. Seesaw respirations are no cause for concern in the first hour after birth.

Crying increases the distribution of air in the lungs. Respirations in the newborn can be stimulated by mechanical factors such as changes in intrathoracic pressure resulting from the compression of the chest during vaginal birth. With birth, the pressure on the chest is released, helping draw air into the lungs. The positive pressure created by crying helps keep the alveoli open and increases distribution of air throughout the lungs. Newborns continue to expel fluid for the first hour of life. They are natural nose breathers and may not have the mouth-breathing response to nasal blockage for 3 weeks. Seesaw respirations instead of normal abdominal respirations are not normal and should be reported.

Which description of the phases of the second stage of labor is accurate? 1. Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes 2. Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes 3. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies 4. Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes

Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors. The latent phase is the lull, or "laboring down" period, at the beginning of the second stage. It lasts 10 to 30 minutes on average. The second stage of labor has no active phase. The transition phase is the final phase in the second stage of labor; contractions are strong and painful.

The nurse is providing discharge instructions related to the baby's respiratory system. Which statement should not be included as part of discharge teaching? Prevent exposure to people with upper respiratory tract infections. Keep the infant away from secondhand smoke. Avoid loose bedding, waterbeds, and beanbag chairs. Don't let the infant sleep on his or her back.

Don't let the infant sleep on his or her back. The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome. Infants are vulnerable to respiratory infections, so infected people must be kept away. Secondhand smoke can damage lungs. Infants can suffocate in loose bedding, and furniture that can trap them.

The birth weight of a breastfed newborn was 8 lb, 4 oz. On the third day the newborn's weight is 7 lb, 12 oz. On the basis of this finding, the nurse should: Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. Notify the physician because the newborn is being poorly nourished. Refer the mother to a lactation consultant to improve her breastfeeding technique.

Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz. The infant is not undernourished, and the physician does not need to be notified. Breastfeeding is effective, and bottle feeding does not need to be initiated at this time.

In the current practice of childbirth preparation, emphasis is placed on: 1.The Dick-Read (natural) childbirth method. 2.The Lamaze (psychoprophylactic) method. 3.The Bradley (husband-coached) method. 4.Encouraging expectant parents to attend childbirth preparation in any or no specific method.

Encouraging expectant parents to attend childbirth preparation in any or no specific method. Encouraging expectant parents to attend class is most important, because preparation increases a woman's confidence and thus her ability to cope with labor and birth. The goal is to encourage new parents to attend any one of the acceptable childbirth education programs. Gaining in popularity are Birthing from Within and Hypnobirthing. The Dick-Read method is historically popular and is still in use. The Lamaze method is less focused on a method approach and more concerned with psychologic preparation for labor. Attendance at any available class should be encouraged, however. Bradley as well as other methods encourage women to choose the techniques that work best for them. Women are helped to develop their own birth philosophy and then choose from a variety of skills to help cope with the labor process.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: 1. Encouraging the woman to try various upright positions, including squatting and standing. 2. Telling the woman to start pushing as soon as her cervix is fully dilated. 3. Continuing an epidural anesthetic so that pain is reduced and the woman can relax. 4. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

Encouraging the woman to try various upright positions, including squatting and standing. Upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. An epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed-glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressures, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia.

Following a vaginal delivery, the patient tells the nurse that she intends to breastfeed her infant but she is very concerned about returning to her prepregnancy weight. On the basis of this interaction, the nurse would advise the patient that: Select all that apply. She should join Weight Watchers as soon as possible to ensure adequate weight loss. Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period. Weight loss diets are not recommended for women who breastfeed. If breastfeeding, she should regulate her fluid consumption in response to her thirst level. If she decreases her calorie intake by 100-200 calories a day she will lose weight more quickly.

Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period. Weight loss diets are not recommended for women who breastfeed. If breastfeeding, she should regulate her fluid consumption in response to her thirst level. Weight loss diet plans are not recommended for women who are breastfeeding because they can lead to depletion of reserves and nutrient stores and decreased milk production. Breastfeeding mothers need to increase their caloric intake by 400-500 calories/day to ensure adequate nutritional stores and milk production. Breastfeeding women lose weight faster postpartum than women who bottle feed their infants. Regulating fluid consumption in response to her thirst level will ensure that a breastfeeding woman has adequate hydration without overhydration.

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious likely consequence of bladder distention is: Urinary tract infection. Excessive uterine bleeding. A ruptured bladder. Bladder wall atony.

Excessive uterine bleeding. Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black. She asks the nurse whether something is wrong. The nurse should respond to this mother's concern by: Telling the mother not to worry because all breastfed babies have this type of stool. Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns. Asking the mother what she ate for her last meal. Suggesting to the mother that she ask her pediatrician to explain normal newborn stooling patterns to her.

Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns. The majority of healthy term infants pass meconium during the first 12 to 24 hours after birth. Meconium is composed of amniotic fluid, intestinal secretions, shed mucosal cells, and possibly blood, resulting in the dark green to black color. At this early age this type of stool is typical of both bottle- and breastfed newborns. The mother's nutritional intake is not responsible for the appearance of a meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns.

Excessive blood loss after childbirth can have several causes; however, the most common is: Vaginal or vulvar hematomas. Unrepaired lacerations of the vagina or cervix. Failure of the uterine muscle to contract firmly. Retained placental fragments.

Failure of the uterine muscle to contract firmly. Although vaginal or vulvar hematomas, unrepaired lacerations, and retained placental fragments are possible causes of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention.

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor? Fetal position Uterine contractions Blood pressure Umbilical cord blood flow

Fetal position Maternal position may affect fetal circulation; however, fetal position is unlikely to disturb umbilical blood flow. Uterine contractions during labor tend to decrease circulation and subsequent perfusion. Most healthy fetuses are well able to compensate for this stress and exposure to increased pressure while moving passively through the birth canal during labor. Maternal blood pressure is likely to have a significant effect on fetal circulation. Compression of the cord and reduction of umbilical blood flow do affect fetal circulation.

The most common cause of decreased variability in the FHR that lasts 30 minutes or less is: Altered cerebral blood flow. Fetal hypoxemia. Umbilical cord compression. Fetal sleep cycles.

Fetal sleep cycles. A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes. Altered fetal cerebral blood flow results in early decelerations in the FHR, and umbilical cord compression in variable decelerations. Fetal hypoxemia is evidenced by tachycardia initially and then bradycardia. A persistent decrease or loss of FHR variability may be seen.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: Kidney function returns to normal a few days after birth. Diastasis recti abdominis is a common condition that alters the voiding reflex. Fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. With adequate emptying of the bladder, bladder tone is usually restored 2 to 3 weeks after childbirth.

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

Which of the following would not be included in a labor nurse's plan of care for an expectant mother? 1. The onset of progressive, regular contractions 2. The bloody, or pink, show 3. The spontaneous rupture of membranes 4. Formulation of the woman's plan of care for labor

Formulation of the woman's plan of care for labor Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment.

Which of the following findings would raise concern for the nurse who is monitoring a postpartum patient who had a spontaneous vaginal delivery (SVD) of a 10-lb baby boy? Lochia rubra with minimal clots expressed on fundal massage Fundus midline and firm with nonpalpable bladder Fundus midline and firm with spurts of bright red blood upon fundal massage Patient report of mild to moderate cramping and request for pain medication

Fundus midline and firm with spurts of bright red blood upon fundal massage Even though the fundus is firm and midline, the fact that spurts of blood are evident on fundal massage may indicate that a tear is present. Further investigation is required as this is considered nonlochial bleeding. Lochia rubra with minimal clots expressed on fundal massage would be considered a normal finding, given that the patient had an SVD of a large infant. Fundus midline and firm with nonpalpable bladder would be considered a normal finding. A report of mild to moderate cramping with a request for pain medication would be considered a normal finding in the postpartum period; the cramping is due to uterine contractions as the uterus returns to its normal prepregnancy status.

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: 1.Notify the woman's physician. 2.Tell the woman to slow the pace of her breathing. 3.Administer oxygen via a mask or nasal cannula. 4.Help her breathe into a paper bag.

Help her breathe into a paper bag. This client is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, dizziness, tingling of the fingers, and circumoral numbness. Notification of the physician is not necessary. The best approach is to have the client breathe into a paper bag held tightly around the nose and mouth to eliminate respiratory alkalosis. The woman can also breathe into her cupped hands if no paper bag is available. Slowing the pace of her breathing will not correct the problem, nor will administration of oxygen. Once the pattern of breathing is corrected, her partner can help the woman maintain her breathing rate with visual, tactile, or auditory cues.

Which of the following changes are consistent with metabolic function during the postpartum period? Select all that apply. Moderate hyperglycemia Increased BMR in the immediate postpartum period Secretion of insulinase Mildly increased T3 and T4 levels for the first several weeks postpartum Decrease in estrogen and cortisol levels

Increased BMR in the immediate postpartum period Secretion of insulinase Decrease in estrogen and cortisol levels BMR remains elevated for the first 2 weeks after birth and then returns to prepregnancy levels. Insulinase enzyme reverses the diabetogenic effects of pregnancy, leading to decreased glucose levels in the postpartum period. Decreases in hormones such as estrogen and cortisol are seen during the postpartum period.Blood sugar levels typically decrease in the postpartum period as a result of the reversal of diabetogenic effects of pregnancy. Thyroid hormones gradually decrease to prepregnant levels in the 4 weeks following delivery.

A nurse providing care to a woman in labor should be aware that cesarean birth: Is declining in frequency in the United States. Is more likely to be performed in the poor in public hospitals who do not receive the nurse counseling that wealthier clients do. Is performed primarily for the benefit of the fetus. Can be either elected or refused by women as their absolute legal right.

Is performed primarily for the benefit of the fetus. The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

Which statement is inaccurate with regard to normal labor? 1. A single fetus presents by vertex. 2. It is completed within 8 hours. 3. A regular progression of contractions, effacement, dilation, and descent occurs. 4. No complications are involved.

It is completed within 8 hours. Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within 18 hours. In normal labor, a single fetus presents by vertex. A regular progression of contractions, effacement, dilation, and descent is the trajectory that the nurse expects for a woman experiencing a normal labor, which usually occurs with no complications.

If a woman complains of back labor pain, the nurse might best suggest that she: 1. Lie on her back for a while with her knees bent. 2. Do less walking around. 3. Take some deep, cleansing breaths. 4. Lean over a birth ball with her knees on the floor.

Lean over a birth ball with her knees on the floor. The hands-and-knees position, with or without the aid of a birth ball, should help with the back pain. The supine position should be discouraged. Walking generally is encouraged. Deep cleansing breaths will assist with any labor pain; however, it is very important that this woman's position is changed so that she is not on her back.

Which action of a breastfeeding mother indicates the need for further instruction? Holds breast with four fingers along bottom and thumb at top. Leans forward to bring breast toward the baby. Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth. Puts her finger into newborn's mouth before removing breast.

Leans forward to bring breast toward the baby. To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby. The mother would need further demonstration and teaching to correct the ineffective action. The other actions described are correct.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman 1 day postpartum. An expected finding is: Little if any change. Leakage of milk at let-down. Swollen, warm and tender on palpation. A few blisters and a bruise on each areola.

Little if any change. Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action is to: Place her on a bedpan to empty her bladder Massage her fundus Call the physician Administer methylergonovine (Methergine), 0.2 mg IM, which has been ordered prn

Massage her fundus A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action is to massage the fundus until firm.The physician can be called or methylergonovine administered after the fundus massage, especially if the fundus does not become or remain firm with massage. There is no indication of a distended bladder, so having the woman urinate will not alleviate the problem.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: Begin an IV infusion of Ringer's lactate solution. Assess the woman's vital signs. Call the woman's primary health care provider. Massage the woman's fundus.

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

Which findings would lead to increased bilirubin levels in the newborn? Select all that apply. Cord clamped immediately following delivery of newborn Meconium passed after 24 hours Initiation of newborn feedings delayed following birth Hyperglycemia Twin-to-twin transfusion syndrome

Meconium passed after 24 hours Initiation of newborn feedings delayed following birth Twin-to-twin transfusion syndrome Delay in passage of meconium or in newborn feedings could lead to increased bilirubin levels because of increased enterohepatic circulation. Twin-to-twin transfusion syndrome could lead to increased bilirubin levels as a result of an increased amount of hemoglobin. An increase in bilirubin levels would be seen if cord clamping were delayed following birth. Hypoglycemia could lead to increased bilirubin levels because of alterations in hepatic function and perfusion.

A woman in active labor receives an opioid agonist analgesic. Which medication relieves severe, persistent, or recurrent pain, creates a sense of well-being, overcomes inhibitory factors, and may even relax the cervix but should be used cautiously in women with cardiac disease? Meperidine (Demerol) Promethazine (Phenergan) Butorphanol tartrate (Stadol) Nalbuphine (Nubain)

Meperidine (Demerol) Meperidine is the most commonly used opioid agonist analgesic for women in labor throughout the world. It overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, meperidine is used cautiously in women with cardiac disease. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol and Nubain are opioid agonist-antagonist analgesics.

With regard to afterbirth pains, nurses should be aware that these pains are: Caused by mild, continual contractions for the duration of the postpartum period. More common in first-time mothers. More noticeable in births in which the uterus was overdistended. Alleviated somewhat when the mother breastfeeds.

More noticeable in births in which the uterus was overdistended. A large baby or multiple babies overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

While evaluating the reflexes of a male newborn, the nurse notes that with a loud noise, the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. The nurse documents this finding as a positive: Tonic neck reflex response Glabellar (Myerson) reflex response Babinski reflex response Moro reflex response

Moro reflex response The characteristics displayed by the infant are associated with a positive Moro reflex response. The tonic neck reflex occurs when the infant extends the leg on the side to which the infant's head simultaneously turns. The glabellar reflex is elicited by tapping on the infant's head while the eyes are open; a characteristic response is blinking for the first few taps. The Babinski reflex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot; a positive response occurs when all the toes hyperextend, with dorsiflexion of the big toe.

Which statement is incorrect regarding bathing of a new baby? Newborns should be bathed every day, for the bonding as well as the cleaning. Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed. Only plain warm water should be used to preserve the skin's acid mantle. Powders are not recommended because the infant can inhale powder.

Newborns should be bathed every day, for the bonding as well as the cleaning. Newborns do not need a bath every day, even if the parents enjoy it. The diaper area and creases under the arms and neck need more attention. Tub baths may be given as soon as an infant's temperature has stabilized. Unscented mild soap is appropriate to use to wash the infant. Powder is not recommended because of the risk of inhalation. Should a parent elect to use baby powder, it should never be sprinkled directly onto the baby's skin. The parent can apply a small amount of powder to his or her own hand and then apply it to the infant.

In planning for an expected cesarean birth for a woman who has given birth by cesarean section previously and who has a fetus in the transverse presentation, the nurse includes which information? "Because this is a repeat procedure, you are at the lowest risk for complications." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." "Because this is your second cesarean birth, you will recover faster." "You will not need preoperative teaching because this is your second cesarean birth."

"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." The statement in B is most appropriate. The statements in A, C, and D are not accurate. Maternal and fetal risks are associated with every cesarean section. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

Baby-friendly hospitals mandate that infants be put to breast within the first __ after birth. 1 hour 30 minutes 2 hours 4 hours

1 hour Baby-friendly hospitals mandate that the infant be put to breast within the first hour after birth (BFHI, 2010). The ideal time to initiate breastfeeding is within the first 1 to 2 hours after delivery. In many countries this is the norm; however, the BFHI mandates 1 hour. Four hours is much too long to wait to initiate breastfeeding, whether the hospital is baby-friendly or not.