Postpartum Ch 17 OB

What assessment finding does the nurse expect to find in a postpartum patient 12 hours after childbirth? 1 The fundus is approximately at the level of the umbilicus. 2 The palpation of the uterus is not possible abdominally. 3 The uterus is about the same size as it was at 20 weeks' gestation. 4 The fundus is located midway between the umbilicus and the symphysis pubis.

1 The fundus can rise to approximately 1 cm above the umbilicus within 12 hours after childbirth. By the sixth postpartum day the fundus is normally located halfway between the umbilicus and the symphysis pubis. At the end of the third stage of labor, the uterus is in the midline, approximately 2 cm below the level of the umbilicus with the fundus resting on the sacral promontory. The uterus is about the same size as it was at 20 weeks' gestation at 24 hours post-birth, not 12 hours after birth.

The primary health care provider suggests Kegel exercises to a postpartum patient. A week later, the patient complains of incontinence from the exercises. What does the nurse conclude from the patient's condition? 1 The patient has stopped breastfeeding the infant. 2 The patient has not been performing the exercises at all. 3 The patient has not performed the exercises correctly. 4 The patient is experiencing a side effect of the exercises.

3 If the patient does not perform the Kegel exercises as ordered, the patient may develop urinary incontinence. This condition can occur if the patient inadvertently bears down on her pelvic floor muscles and thrusts her perineum outward. Breastfeeding helps contract the uterus; however, discontinuing breastfeeding does not cause incontinence if the patient performs the Kegel exercises as directed. If the patient does not perform the exercises at all, the muscle tone that is lost during birth will not be regained, but it will not cause incontinence. There are no side effects of the exercises if the patient performs them correctly.

Which of the following increase afterbirth pains in a postpartum woman

breast feeding

What landmark is used when determining and documenting uterine involution

umbilicus

On the second day postdelivery, the patient reports feeling dizzy when she stands up. What is the probable reason for the patient's dizziness? 1 Orthostatic hypotension 2 Subinvoluted uterus 3 Decreased estrogen levels 4 Decreased progesterone levels

1 Orthostatic hypotension may develop in the first 48 hours after childbirth due to splanchnic engorgement. A patient with orthostatic hypotension may experience dizziness and faintness after standing up. Subinvolution of the uterus may not directly cause dizziness. Decreased estrogen and progesterone levels cause diuresis of excess fluid accumulated during pregnancy.

The nurse is caring for a postpartum patient who is prescribed a rubella vaccine. Which information will the nurse provide for the patient prior to administering the vaccine? 1 The patient's immune status should be retested in 6 to 8 weeks. 2 The patient should get the vaccine when she is no longer breastfeeding. 3 The patient should not get pregnant for 3 months after the vaccination. 4 The patient should expect the second dose to be administered at a follow-up appointment.

1 Women receiving the rubella vaccine should be tested for immune status at 6 to 8 weeks to verify immunity. The patient should be vaccinated prior to discharge from the hospital. The patient is advised not to get pregnant for at least 4 weeks after vaccination. The rubella vaccine is not administered as a series of vaccines.

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? 1 Talks and coos to her son 2 Seldom makes eye contact with her son 3 Cuddles her son close to her 4 Tells visitors how well her son is feeding

2 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 is a normal infant-parent interaction. Cuddling is a normal infant-parent interaction. Sharing her son's success at feeding is a normal infant-parent interaction.

The nurse is preparing to assess the fundus of a postpartum patient. What nursing action is needed before assessment? 1 Have the patient turn on her side. 2 Position the patient to lie flat on her back with her legs extended. 3 Ask the patient to urinate and empty her bladder. 4 Massage the fundus gently before determining its level.

3 Before assessing the patient's fundus, the nurse should ask the patient to empty her bladder for an accurate assessment. Then the nurse asks the woman to lie flat on her back with her knees flexed, not on her side. Massaging the fundus is an appropriate intervention if the fundus is boggy and soft. The fundus should be massaged gently until firm.

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 whom? 1 The father of the infant 2 Her mother (the infant's grandmother) 3 Her eldest daughter (the infant's sister) 4 The nurse

4 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 elder sibling may stay with the patient and her baby but is not part of the couplet.

Which physiologic change causes a postpartum increase in circulating blood volume? 1 Promotion of vasodilation 2 Reduction in plasma volume 3 Reduction of kidney function 4 Mobilization of extravascular fluid

4 Three physiologic changes occur postpartum to protect the patient by increasing circulating blood volume during puerperium. Mobilization of extravascular fluid to intravascular space increases the circulating blood volume postpartum. The placenta, which has the capability to release vasodilation-stimulating hormones, acts as an endocrine organ during pregnancy. In postpartum patients the stimulus for vasodilation is removed. Reduction in plasma volume results because of diuresis during immediate puerperium. This does not account for the increase in circulating blood volume. Postpartum hormonal changes result in reduced kidney function, which includes decreased water reabsorption, resulting in diuresis. Hence, this does not cause an increase in circulating blood volume.

After teaching postpartum pt danger signs to report, which statement indicates need for more teaching If I have chest pain or trouble breathing I'll call 911 I'll call the doctor if I have trouble urinating My vaginal dc should be bright red for the 1st week mood swings in the 1st 2 weeks postpartum are not unusual

My vaginal dc should be bright red for the 1st week

Which of the following is not used to help the patient experiencing pain from an episiotomy

duramorph used: tucks dermoplast sitz bath

Which of the following would not slow the involution process in the postpartum patient?

gravida2/para0 slows involution: large gestational baby triplets polyhydraminos

Which of the following actions is not used to prevent DVT?

increase caloric intake is used to prevent DVT: sequential compression devices increase fluid intake encourage ambulation

What are the components of cultural assessment that will help the nurse plan effective interventions for a postpartum patient? Select all that apply. 1 The primary language 2 The dietary preferences 3 The folk medicine practices 4 The patient's pharmacologic knowledge 5 The ability to read and write English

1,2,3,5 Knowing the primary language of a patient helps the nurse understand how and why the patient uses particular words. Dietary preferences in the postpartum period are different among different cultures, and so the nurse needs to consider those while planning the patient's diet. The nurse needs to assess if the patient uses folk medicine because there can be significant interactions with medications. The nurse assesses the patient's ability to read and write English to ensure that care instructions are understood. The nursing care does not depend on the patient's knowledge of pharmacology. The nurse still needs to ensure that the patient has understood all the instructions related to the care.

What factors are evaluated when considering patient selection and referral to home care for the expectant mother, fetus, or infant? Select all that apply. 1 Availability of professionals to provide the needed services within the woman's community 2 Family resources, including psychosocial, social, and economic 3 Health status of the family caring for the mother and fetus or infant 4 Client resources to pay for each home care visit 5 Health status of mother and fetus or infant 6 Cost-effectiveness

1,2,5,6 The factors evaluated when considering patient selection and referral to home care for the expectant mother, fetus, or infant include the availability of professionals to provide the needed services within the woman's community; family resources, including psychosocial, social, and economic resources; health status of the mother, fetus, or infant; and cost-effectiveness. Health status of the family caring for the mother, fetus, or infant and patient resources to pay for each home care visit are not factors evaluated when considering patient selection and referral to home care.

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. What is the nurse's initial action? 1 Place her on a bedpan to empty her bladder 2 Massage her fundus 3 Call the physician 4 Administer methylergonovine (Methergine, 0.2 mg IM, which has been ordered prn)

2 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. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methylergonovine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.

After bathing a neonate, the nurse positions the neonate on the mother's chest and dims the lights in the room. What is the most likely purpose of this intervention? 1 To encourage the mother to breastfeed 2 To encourage eye contact with the mother 3 To facilitate peaceful sleep in the neonate 4 To allow the neonate to feel the mother's touch

2 Establishing good eye contact is vital for the development of mother-child bonding. Positioning the infant on the mother's chest helps the mother to maintain the "en-face" position with the child, which facilitates eye contact. Dimming the lights of the room encourages the child to open his or her eyes, which will further foster eye contact. If the nurse were trying to encourage breastfeeding, the nurse would try a more direct intervention such as placing the infant's mouth directly on the mother's nipple. Cradling the infant helps to induce sleep in the infant. Encouraging the mother to hold the neonate close to the body helps the neonate to feel the mother's touch, but this does not necessarily foster eye contact.

Which description of postpartum restoration or healing times is accurate? 1 The cervix shortens, becomes firm, and returns to form within a month postpartum. 2 Rugae reappear within 3 to 4 weeks. 3 Most episiotomies heal within a week. 4 Hemorrhoids usually decrease in size within 2 weeks of childbirth.

2 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.

Which description of postpartum restoration or healing times is accurate? 1 The cervix shortens, becomes firm, and returns to form within a month postpartum. 2 Vaginal rugae reappear within 3 to 4 weeks. 3 Most episiotomies heal within a week. 4 Hemorrhoids usually decrease in size within 2 weeks of childbirth.

2 Vaginal 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.

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, what should the nurse do? 1 Foster an active role in the baby's care. 2 Provide time for the mother to reflect on the events of and her behavior during childbirth. 3 Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. 4 Promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

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

What is characteristic of normal postbirth uterine/vaginal discharge, called lochia? 1 Is similar to a light menstrual period for the first 6 to 12 hours 2 Is usually greater after cesarean births 3 Will usually decrease with ambulation and breastfeeding 4 Should smell like normal menstrual flow unless an infection is present

4 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 usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding.

The nurse is caring for a patient who gave birth to triplets. The nurse observes that the patient's abdomen is overdistended and abdominal muscle walls are separated. What condition in the patient is likely and should be further evaluated? 1 Subinvolution 2 Persistent lochia rubra 3 Postpartum hemostasis 4 Diastasis recti abdominis

4 Multiple fetuses may cause overdistention of the abdomen and separation of abdominal muscle walls. This condition is called diastasis recti abdominis. Subinvolution is the failure of the uterus to return to the nonpregnant state due to retained placental fragments and infection. Persistent lochia rubra early in the postpartum period is caused by retained fragments of the placenta or amniotic membranes. Postpartum hemostasis occurs due to compression of intramyometrial blood vessels as the uterine muscle contracts.

When teaching a postpartum pt w/an episiotomy about a sitz bath use, the nurse should emphasize:

squeezing her butticks together prior to sitting down

What maternal blood tests are routinely done after delivery

white blood cell count HH should be before baseline and after to compare GBS is done before

The nurse is caring for a patient after a cesarean section. The patient had read in a book about lochial discharge after delivery and is anxious because of a decreased amount of lochia. Which response by the nurse would reduce the patient's anxiety? 1 "This is normal after a cesarean." 2 "You will have normal lochia after 10 days." 3 "You have higher risk of developing infection." 4 "It indicates that you have severe dehydration."

1 After a cesarean delivery, the amount of lochia is decreased because the surgeon suctions the blood and fluids from the uterus or wipes the uterine lining before closing the incision. This patient will not have normal lochia even after 10 days, because the lining of the uterus is cleaned of all the fluid and blood. An offensive odor of the lochia indicates infection, which is not found in this patient. Production of lochia is a part of the physiologic process of involution. Decreased body fluids do not affect the production of lochia.

The nurse is teaching self-management techniques to a patient after delivery. What does the nurse include in the lesson to prevent postpartum depression? 1 "Interact with other new mothers." 2 "Spend most of your time with the baby." 3 "Avoid accepting help from family members." 4 "Try to become a perfect mother to your child."

1 After childbirth, a patient may need assistance and guidance for breastfeeding and to provide better care to her child. Inability to provide better care to her newborn may make her feel incompetent, helpless, and depressed. Therefore, to prevent depression, the nurse advises the patient to contact support groups and interact with other new mothers. It helps the patient exchange ideas and experiences. The nurse should encourage the patient to go out for walks and spend time participating in recreational activities rather than caring for the baby all the time. The nurse should suggest that the patient accept the help of family members to perform household work. It helps the patient rest for a while. The nurse should advise the patient to avoid having unrealistic expectations both for herself and for the child. Inability to achieve those expectations can make the patient feel depressed. Therefore, the nurse should not advise the patient to try to become a perfect mother.

The nurse is caring for a patient who became pregnant following a rape. The nurse finds that the patient is sad and unwilling to undergo a prenatal examination. Which intervention does the nurse perform in this situation? 1 Gently discuss the patient's current situation with her. 2 Suggest that the patient abort the child. 3 Avoid conducting prenatal examinations for a few days. 4 Inform the patient's family about the patient's condition.

1 If a patient becomes pregnant as a result of a rape, the patient may be unwilling to undergo prenatal examination because it may trigger memories related to the trauma. Therefore, to reduce the patient's anxiety and prevent posttraumatic stress disorder, the nurse should help the patient cope by gently discussing the situation. The nurse should not be judgmental and should not suggest that the patient abort the child, because this could make the patient feel rejected. Prenatal care is essential to assess the well-being of the fetus and to make an appropriate care plan to help prevent complications in the pregnancy. Therefore, the nurse should not postpone prenatal examination. The patient's family may feel anxious or panic due to the patient's condition. Hence, the nurse should inform the primary health care provider rather than informing the patient's family.

A patient who underwent a vaginal delivery 3 hours earlier reports having severe perineal pain. Which should be the first step taken by the nurse in this situation? 1 Apply ice packs in the perineum. 2 Administer fluids to the patient. 3 Administer blood to the patient. 4 Refer the patient for hematologic tests

1 If the patient reports severe perineal pain after vaginal delivery, the nurse should apply ice packs in the first 24 hours to reduce edema, pain, and vulvar irritation. Administering fluids and blood compensates for blood loss in the patient, but does not reduce pain. Postpartum hematologic studies are performed to assess the consequences of blood loss. This intervention does not reduce pain in the patient.

A patient who underwent a vaginal delivery 3 hours earlier reports having severe perineal pain. Which should be the first step taken by the nurse in this situation? 1 Apply ice packs in the perineum. 2 Administer fluids to the patient. 3 Administer blood to the patient. 4 Refer the patient for hematologic tests.

1 If the patient reports severe perineal pain after vaginal delivery, the nurse should apply ice packs in the first 24 hours to reduce edema, pain, and vulvar irritation. Administering fluids and blood compensates for blood loss in the patient, but does not reduce pain. Postpartum hematologic studies are performed to assess the consequences of blood loss. This intervention does not reduce pain in the patient.

Which type of medication is used to decrease excessive bleeding and uterine atony in a postpartum patient? 1 Oxytocin 2 Anesthetic 3 Antiinflammatory 4 Selective serotonin reuptake inhibitors

1 Oxytocic mediations help control excessive bleeding and uterine atony in a postpartum patient. Anesthetic mediations help relieve pain. Antiinflammatory medication helps relieve discomfort due to breast engorgement. Selective serotonin reuptake inhibitors are used for treating postpartum depression.

A patient reports to the nurse that she has bright red discharge 1 hour after delivery. The patient tells the nurse that a gush of blood comes out of her vagina upon standing upright. What should the nurse interpret from the assessment? 1 Normal finding after delivery 2 Dyspareunia 3 Infection 4 Hemorrhage

1 Postbirth uterine discharge is commonly called lochia and it accumulates in the vagina when the woman is lying down. This comes out as a gush of blood when the woman assumes an upright position. If the lochia has a strong smell, it may be an offensive odor; this patient does not report an offensive odor. During the assessment, the nurse does not find any symptoms associated with hemorrhage, such as increased heart rate and low blood pressure. Dyspareunia is associated with coital discomfort.

While examining the postpartum patient, the nurse finds that her fundus is located halfway between the umbilicus and the symphysis pubis. When would the nurse estimate about the time of the patient's delivery? 1 6 days ago 2 12 hours ago 3 24 hours ago 4 6 weeks ago

1 The fundus descends gradually from the time of childbirth and returns to its normal nonpregnant state. By the 6th day after childbirth it can be located halfway between the umbilicus and the symphysis pubis. The fundus rises to approximately 1 cm above the umbilicus within 12 hours of childbirth. Within 24 hours the fundus descends 1 to 2 cm, and the size of the uterus is same as during 20 weeks' gestation. By the 6th week, the uterus returns to its normal nonpregnant state.

The nurse is evaluating a student nurse regarding postpartum physiologic changes to the placental site. Which statement made by the student nurse indicates a need for additional teaching? 1 "Endometrial regeneration takes at least 3 weeks." 2 "Placental site regeneration takes 6 weeks after birth." 3 "The placental site gets reduced to an irregular nodular area." 4 "Upward growth of the endometrium prevents scar formation."

1 The placental site undergoes many physiologic changes after childbirth. Regeneration of the endometrium is completed by the 16th day postpartum. A minimum of 6 weeks are required for the regeneration of the placental site after childbirth. After expulsion of the placenta during labor, the vascular constriction and thrombosis reduce the placental site to an irregular nodular area. Scar formation is a characteristic feature of wound healing; it is prevented by the upward growth of the endometrium during postpartum.

The nurse is caring for a postpartum patient who asks, "Will this brown patch of skin on my face return to normal?" Which statement will correctly address the patient's concern about the melasma? 1 "Yes, the discoloration will gradually fade." 2 "The discoloration does not always completely fade." 3 "The discoloration will fade after you stop breastfeeding." 4 "Now that you are no longer pregnant it should fade quickl

1 The statement that correctly addresses the patient's concern about the melasma is, "Yes, the discoloration will gradually fade." Many skin changes that occur during pregnancy are caused by an increase in hormones. When estrogen, progesterone, and melanocyte-stimulating hormones decline after childbirth, the skin gradually reverts to the nonpregnant state. This change is particularly noticeable when melasma, the "mask of pregnancy," and linea nigra fade and disappear for many women. It is likely to fully fade over time, is not likely to be affected by breastfeeding, and will not necessarily fade quickly.

A pregnant woman who is at 32 weeks of gestation asks the nurse when she will start menstruating after delivery. What question should the nurse ask before responding to the patient's question? 1 "Will you be breastfeeding your child after delivery?" 2 "Do you plan to opt for elective caesarean delivery?" 3 "Do you plan to conceive again immediately after delivery?" 4 "What form of contraception do you plan to use following the delivery?"

1 The timing of the first menstruation after delivery is very different in lactating and nonlactating mothers. Lactating mothers do not menstruate until after 6 months after delivery. Nonlactating mothers may start menstruating within 12 weeks postdelivery. Therefore, before answering the patient's question, the nurse should ask whether the patient plans to breastfeed the baby or not. The type of delivery does not affect the timing of the postdelivery menstruation. The timing of the first menstruation after delivery will not necessarily be affected by plans to conceive again or the use of contraception.

The nursing instructor is teaching a group of student nurses about postpartum depression assessment tools. Which statement by a student nurse needs correction? 1 "The Edinburgh Postnatal Depression Scale (EPDS) is a 35-item Likert response scale." 2 "A patient who gets a score ≥12 on the EPDS requires treatment for depression." 3 "The Postpartum Depression Screening Scale (PDSS) assesses seven dimensions of depression." 4 "The PDSS assess sleeping or eating disturbances, anxiety, and emotional liability."

1 Unlike the PDSS, the EPDS is not a 35-item Likert response scale; rather it has 10 statements about common symptoms of depression. A maximum score on the EPDS is 30, and a patient with a score ≥12 requires treatment for depression. The PDSS assesses seven dimensions of depression. These seven dimensions include sleeping or eating disturbances, anxiety, emotional liability, mental confusion, loss of self, guilt or shame, and suicidal thoughts.

The nurse is assessing a postpartum patient 5 days after delivery. The patient's partner tells the nurse that the patient does not eat properly, starts crying suddenly for no reason, and has difficulty sleeping. What does the nurse infer from these symptoms? 1 The patient is experiencing postpartum blues. 2 The patient is experiencing postpartum anxiety. 3 The patient is experiencing postpartum psychosis. 4 The patient is experiencing postpartum depression.

1 Loss of appetite, insomnia, and crying suddenly for no reason indicate that the patient is experiencing postpartum blues. These symptoms diminish in few days or a week. The symptoms of anxiety are abdominal pain, restlessness, muscle tension, and irritability. The patient with postpartum psychosis has suicidal intention and hallucinations. If the patient experiences the symptoms of postpartum blues for more than 2 weeks, it indicates that the patient has postpartum depression.

The nurse observes that a breastfeeding patient is experiencing postpartum fatigue (PPF). Which intervention may help reduce fatigue in this patient? 1 Encourage relatives and friends to bring meals and help with housework. 2 Ask the patient to postpone hospital discharge for a few days. 3 Encourage the patient to avoid ambulation and increase rest. 4 Ask the patient to assume the side-lying position for breastfeeding.

1 The nurse should suggest fewer visitors in the hospital so that the patient gets enough rest, but should encourage visitors to help the new mother with housework and meals when she returns home. Postponing hospital discharge will not ensure that the patient will get enough rest. The nurse does not encourage the patient to avoid ambulation, because it may increase the risk for venous thromboembolism. The side-lying position for breastfeeding may promote rest and reduce PPF, but it is not recommended because of the risk of sudden infant death syndrome in newborns.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize that the patient understands this properly if she does what? Select all that apply. 1 Uses soap and warm water to wash the vulva and perineum 2 Washes from symphysis pubis back to the episiotomy 3 Changes her perineal pad every 2 to 3 hours 4 Uses the peribottle to rinse upward into her vagina 5 Wiping from back to front

1,2,3 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 patient should be instructed to change her perineal pad every 2 to 3 hours. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina, because debris will be forced upward into the uterus through the still-open cervix. Wiping from back to front is incorrect; it should always be done from front to back.

The nurse is caring for a mother and her newborn baby. The nurse is assessing to see if the parent(s) are exhibiting attachment behavior. Which behaviors are the nurse looking for in the parent(s)? Select all that apply. 1 When parents are holding the infant, what kind of body contact is seen? 2 How comfortable do the parents appear in terms of caring for the infant? 3 When the infant is awake, what kinds of stimulation do the parents provide? 4 When the infant is brought to the parents, do they keep watching the movie on television? 5 What type of affection do they demonstrate to the newborn, such as smiling, stroking, kissing, or rocking? 6 Do the parents speak about the infant in terms of identification—who the infant resembles, and what appears special about their infant over other infants?

1,2,3,5,6 When assessing attachment behaviors in the parent(s), the nurse should look for the following behaviors: When parents are holding the infant, what kind of body contact is seen? How comfortable do the parents appear in terms of caring for the infant? When the infant is awake, what kinds of stimulation do the parents provide? What type of affection do they demonstrate to the newborn, such as smiling, stroking, kissing, or rocking? Do the parents speak about the infant in terms of identification—who the infant resembles, and what appears special about their infant over other infants? Parents continuing to watch the movie on television when the infant is brought to them is not part of the assessment for attachment behaviors.

What are some interventions utilized to promote parent-infant attachment? Select all that apply. 1 Provide rooming-in while in the hospital. 2 Assist the parent(s) to participate in infant care. 3 Encourage theparent(s) to hold the infant close to the body. 4 Encourage the parent(s) to keep the newborn in his or her crib most of the time. 5 Explain to the parent(s) that the newborn will stay in the nursery so the parent(s) can get some rest. 6 Provide an opportunity for parent(s) to see, hold, and examine the newborn immediately after birth.

1,2,3,6 Some interventions utilized to promote parent-infant attachment include: providing rooming-in while in hospital; assisting parent(s) in participating in infant care; encouraging parent(s) to hold the infant close to the body; and providing an opportunity for parent(s) to see, hold, and examine the newborn immediately after birth. Encouraging the parent(s) to keep the newborn in his or her crib most of the time and telling the parent(s) that the newborn will stay in the nursery to allow them to get some rest are not interventions to promote attachment between parent and infant.

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 well adaptive behavior regarding parent-infant attachment? Select all that apply. 1 Talks and coos to her son 2 Seldom makes eye contact with her son 3 Cuddles her son close to her 4 Tells visitors how well her son is feeding 5 Keeps son in the nursery most of the time

1,3,4, Talking and cooing to her son, cuddling with her son, and sharing in her son's feeding success are normal infant-parent interactions. The mother is encouraged to rest but keeping the infant in the nursery most of the time is not considered positive adaptation. The woman should be encouraged to hold her infant in the en face position and make eye contact with him.

Which hormone levels decrease postpartum? Select all that apply. 1 Estrogen 2 Prolactin 3 Oxytocin 4 Progesterone

1,4, The rapid decrease in various hormonal levels is responsible for triggering various postpartum physiologic changes in patients. Rapid decreases in cortisol levels, estrogen levels, and progesterone levels result in diuresis. This helps in expulsion of extracellular fluid, which is increased during pregnancy. Prolactin levels increase with the decrease in estrogen levels, thereby promoting lactation. Oxytocin levels are increased during the immediate postpartum period.

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, what is the most serious consequence likely to occur from bladder distention? 1 Urinary tract infection 2 Excessive uterine bleeding 3 A ruptured bladder 4 Bladder wall atony

2 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 is caring for a postpartum patient. One day after delivery, the nurse assesses the lochia of the patient and finds that it is red in color and has a foul-smelling odor. What does the nurse conclude from this assessment? 1 The patient is healing well. 2 Presence of an infection 3 Evidence of clinical dehydration 4 Potential internal hemorrhage

2 Lochia is vaginal discharge that can be observed after childbirth; it contains blood and mucus. Usually, lochia appears to be dark red during the first 3 days after delivery and has fleshy odor. The presence of foul odor indicates that the patient has an infection. Foul-smelling lochia does not indicate that the patient is healing well. The presence of a moderate amount of lochia would indicate that the patient is healing well. An increase in body temperature would indicate that the patient is dehydrated. Excessive bleeding would indicate internal hemorrhage.

A patient who was very excited to deliver the baby has suddenly become quiet and uninterested after childbirth. What could be the reason if the postpartum patient lacks energy and enthusiasm? 1 The parent finds the child to be very cuddly. 2 The parent is disappointed with the child's sex. 3 The newborn does not seek attention from others. 4 The newborn starts crying loudly upon feeling hungry.

2 Many parents know the infant's sex before birth through ultrasonography. Sometimes, the parents do not learn the sex until after birth and may be disappointed if the sex of the baby does not match their expectations. The parents develop attachment and feel excited if the child cuddles. If the newborn does not seek attention from others, then it indicates that the newborn has good attachment with the parents. This would not cause the parents to feel disappointed. A healthy child cries only upon being hungry or wet. This does not hinder the parents' enthusiasm.

The nurse is caring for a postpartum patient with fourth-degree perineal lacerations who has been prescribed opioid analgesics. After 2 days, the nurse informs the primary health care provider that the patient has constipation. Which medication does the nurse expect to be included in the patient's treatment regimen? 1 Enemas 2 Laxatives 3 Prostaglandins 4 Rectal suppositories

2 Opioid analgesics decrease intestinal motility, which results in constipation. To decrease constipation, the primary health care provider includes laxatives in the patient's treatment regimen. Enemas and rectal suppositories should not be administered to the patient with fourth-degree perineal lacerations, because they are very uncomfortable and may cause hemorrhage or damage to the suture line. Prostaglandins may suppress the immune system and can also predispose the patient to the various infections.

The nurse is providing care for a postpartum Asian patient. Which practice is in accordance with the cultural beliefs of this patient? 1 The nurse applies cold packs to the perineum. 2 The nurse keeps the room temperature warmer. 3 The nurse instructs the patient to bathe with cold water. 4 The nurse encourages the patient to be out of bed often.

2 People from many Asian cultures believe that birth depletes the patient's body of heat because there is a loss of inner energy and blood. Therefore, the patient consumes "hot" foods and beverages like chicken, eggs, and soup. The patient may ask the nurse to keep the room temperature warmer than usual. The nurse should not apply cold packs to the perineum, because it contradicts the theory of heat loss. An Asian patient may avoid showering or bathing for several days or weeks to help prevent the loss of heat from her body. The patient spends most of the time in bed so that cold air does not enter her body.

Based on the postpartum patient's description, the nurse concludes that the patient has lochia alba. What description by the patient led the nurse to this conclusion? 1 Pink-colored discharge 2 Yellow-colored discharge 3 Brown-colored discharge 4 Bright red-colored discharge

2 Postpartum uterine discharge is common after childbirth. Postpartum uterine discharge that is yellow, along with mucus, is called lochia alba. The postbirth uterine discharge that is fading to pale pink or brown color, along with tissue debris, is called lochia serosa. Lochia rubra is the name for uterine discharge that is bright red, containing small clots

Which characteristic feature would the nurse observe in the patient who may be experiencing "baby blues"? 1 The patient is scared to hold the baby. 2 The patient cries for no apparent reason. 3 The patient is happy about having a baby girl. 4 The patient feels protective towards the baby.

2 Some patients may experience postpartum blues or "baby blues" after labor. During this period, the patient may be emotionally vulnerable and may cry without any apparent reason. Being scared while holding the baby is normal for every new parent; it does not indicate that the patient is experiencing baby blues. A patient with postpartum blues usually may express unusual happiness and sorrow. Being protective towards the baby does not indicate that the patient is experiencing postpartum blues.

The nurse hands over a baby—who is crying due to hunger—to the mother. The nurse watches the mother lay the baby on the side of the bed and continue reading her book. Which nursing intervention is most important for the mother? 1 Lactation counseling 2 Promotion of child-parent attachment 3 Preparation of the family to integrate the baby in the family 4 Manipulation of the environment to foster parent-child bonding

2 The mother ignores the baby's cries and continues reading her book, which could inhibit the development of the mother-child relationship. Therefore, the nurse should teach the mother about strategies to improve parent-child attachment. The nurse should give lactation counseling to mothers who have difficulty breastfeeding, but that would be secondary to building mother-child bonding. The nurse should teach about strategies for successful integration of a new member into the family to those couples who have difficulty giving routine care to the baby. If the mother is facing difficulty in bonding with the baby due to the surroundings, the nurse should modify the environment so as to facilitate parent-child bonding.

After reviewing the laboratory reports of a pregnant patient with a history of depression, the nurse concludes that the patient is at risk of postpartum depression. Which laboratory finding supports the nurse's assumptions? 1 Increase in estrogen levels 2 Decrease in thyroxine levels 3 Increase in progesterone levels 4 Decrease in thromboplastin levels

2 Thyroid disorders increase the risk of postpartum depression in the patient. Therefore, a decrease in the thyroxine levels indicates that the patient has hypothyroidism and an increased risk of postpartum depression. A decrease in estrogen and progesterone levels results in hypogonadism and increases the risk of postpartum depression. Thromboplastin helps in blood clotting, but does not play a role in postpartum depression.

The nurse is assessing a postpartum patient who has received epidural narcotics for postoperative pain after a cesarean section three hours prior. The assessment findings include respiratory rate of 14, O2 saturation of 94%, temperature of 100.0° F, P 98, and blood pressure of 116/64 mm Hg. What should be the nurse's next action? 1 Administer oxygen. 2 Elevate the head of the bed. 3 Administer naloxone hydrochloride. 4 Continue to monitor the patient hourly

2 When a patient receives epidural narcotics for postoperative pain relief, respirations should be assessed frequently because narcotics depress the respiratory center. If a woman receiving epidural narcotics has a respiratory rate of 12 to 14 breaths per minute or less or the pulse oximeter shows a persistent oxygen saturation less than 95%, the anesthesia provider should be notified immediately by the charge nurse or another nurse while the primary care nurse elevates the head of the bed. Elevating the head of the bed will allow for greater lung expansion. After elevating the head of the bed, the nurse should instruct the patient to breathe deeply. Oxygen will be administered and a pulse oximeter will be applied after the head of the bed is raised, followed by naloxone hydrochloride administration if needed and continuous monitoring.

A nurse is teaching a birthing class and asks a student nurse to demonstrate postpartum exercises for the women who will undergo vaginal deliveries. The student nurse demonstrates combined abdominal breathing and the supine pelvic tilt (pelvic rock). Which action of the student nurse needs correction? 1 Inhales deeply and rolls the pelvis 2 Lies on the abdomen with knees straight 3 Exhales slowly contracting abdominal muscles 4 Holds breath for 3 to 5 seconds after exhaling

2 While performing combined abdominal breathing and supine pelvic tilt (pelvic rock), the patient should lie on the back, not on the abdomen. Lying on the abdomen can exert pressure on the uterus and cause pain. While lying on the back, the patient should inhale deeply and roll the pelvis back by flattening the lower back on floor or bed. Then the patient should exhale slowly while contracting the abdominal muscles because this helps prevent uterus atony. The patient should not hold the breath for more than 5 seconds, because this can decrease blood oxygen levels.

While caring for a patient with postpartum depression, the nurse discerns that the patient has suicidal intentions. Which intervention followed by the nurse helps to provide safety to the patient and the newborn? 1 Encourage the patient to verbalize her feelings. 2 Help the patient's family to develop a plan for maternal supervision. 3 Assess the symptoms and signs of depression before discharging the patient. 4 Maintain frequent contact with the patient by visiting her home after discharge.

2 A patient with postpartum depression has suicidal intention and is at risk of injury. Therefore, the nurse should help the patient's family members develop a plan for maternal and infant supervision. Encouraging the patient to verbalize her feelings helps the patient develop a trusting relationship with the nurse. Maintaining frequent contact with the patient helps to determine if further interventions are necessary for the patient. Assessing the symptoms and signs of depression helps prevent postpartum depression in the patient, but does not prevent risk of injury.

Which postpartum changes are observed in the integumentary system of a postpartum woman? Select all that apply. 1 Decreased rate of hair turnover 2 Regression of palmar erythema 3 Regression of spider angiomas (nevi) 4 Disappearance of striae gravidarum on breast

2,3 Vascular abnormalities, such as palmar erythema and spider angiomas (nevi), generally regress, due to a rapid decline in estrogen after childbirth. Hyperpigmentation of the areolae also regresses after childbirth, but may not regress completely. An increased rate of hair turnover is seen during the first 3 months after childbirth. Striae gravidarum on the breasts may fade, but do not disappear completely.

What instructions would be helpful to new parents who complain of disturbed sleep? Select all that apply. 1 Increase physical activity. 2 Limit the time for visitors. 3 Use infant naptime to sleep. 4 Ask other family members to assist in daily tasks. 5 Include caffeine in the routine diet.

2,3,4 Parents of a newborn have disturbed sleep due to infant demands and environmental interruptions. The nurse should instruct the parents to limit the number of visitors because it provides some time for the parents to rest and prevent further stress and fatigue. The parents should be aware of the newborn's sleep and wake cycles because this helps the parents nap while the newborn is asleep. Seeking assistance from family for daily tasks allows the parents more time to rest. Increasing physical activity may not be helpful in promoting sleep in sleep-deprived new parents. Use of caffeine interferes with sleep; therefore, it should be avoided

A nursing student is helping to care for a patient after delivery. Upon observing the patient's behavior, the student suspects that the patient is experiencing "baby blues." Which patient characteristics or behaviors support this assumption? Select all that apply. 1 The patient is euphoric. 2 The patient has irritability. 3 The patient is fatigued. 4 The patient has difficulty breastfeeding. 5 The patient frequently cries without any reason.

2,3,5 During the postpartum period, the patient may experience irritability, fatigue, and tearfulness. During this period, the patient would feel sad rather than euphoric. It is common for patients to have difficulty breastfeeding initially as they adjust to the process, but this is not related to "baby blues."

When helping a woman cope with postpartum blues, what suggestions should the nurse offer? Select all that apply. 1 Have the father take over care of the baby because postpartum blues are exclusively a female problem. 2 Get plenty of rest. 3 Plan to get out of the house occasionally. 4 Do not ask for help because this will not foster independence. 5 Use La Leche League or community mental health centers.

2,3,5 Suggestions for coping with postpartum blues include: (1) Remember that the "blues" are normal and that both the mother and the father or partner may experience them. (2) Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not "Supermom.") (3) Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques). (4) Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk. (5) Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers' Morning Out. (6) Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics). (7) If you are breastfeeding, give yourself and your baby time to learn. (8) Seek out and use community resources such as La Leche League or community mental health centers.

Which of these components is included in a cultural assessment? Select all that apply. 1 Patient and family heritage 2 Infant care and attachment 3 Primary language spoken 4 Sibling children involvement and support 5 Ability to read and write English 6 Religious or cultural beliefs and folk medicine practices

2,3,5,6 The components included in a cultural assessment include patient and family dietary preferences, not their heritage; infant care and attachment; primary language spoken; family involvement, not sibling involvement and support; ability to read and write English; and religious or cultural beliefs and folk medicine practices.

Which are considered normal findings of vital signs after childbirth? Select all that apply. 1 The woman's respiratory rate decreases after delivery. 2 The woman should be afebrile 24 hours after childbirth. 3 Puerperal bradycardia (40 to 50 beats/minute) is not common after childbirth. 4 Blood pressure shows a transient increase of approximately 5% over the first few days after birth. 5 Pulse, along with stroke volume and cardiac output, stays elevated for the first 4 hours after birth. 6 Orthostatic hypotension can develop in the first hour after delivery because of splanchnic engorgement.

2,4 Normal findings of vital signs after childbirth include the woman's respiratory rate being slightly elevated or unchanged (not decreased) after delivery; the woman being afebrile 24 hours after childbirth; having puerperal bradycardia (40 to 50 beats/minute), which is common after childbirth; blood pressure showing a transient increase of approximately 5% over the first few days after birth; pulse, along with stroke volume and cardiac output, staying elevated for the first hour (not 4 hours) after birth; and orthostatic hypotension possibly developing in the first 48 hours (not the first hour) after delivery because of splanchnic engorgement.

With regard to afterpains, what should nurses be aware of about these pains? 1 They are caused by mild, continual contractions for the duration of the postpartum period, 2 They are more common in first-time mothers. 3 They are more noticeable in births in which the uterus was overdistended. 4 They are alleviated somewhat when the mother breastfeeds.

3 A large baby or multiple babies over distend the uterus. The cramping that causes afterpains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterpains are more common in multiparous women because first-time mothers have better uterine tone. Breastfeeding intensifies afterpain because it stimulates contractions.

The nurse is teaching a first-time mother who has delivered twins about postpartum changes. What information should the nurse include in the teaching? 1 "You will have difficulty expelling milk." 2 "You will have excess vaginal bleeding for a week." 3 "You may have painful uterine spasms while breastfeeding." 4 "You will have whitish vaginal discharge from the third day onwards."

3 A patient who delivered twins is likely to have an overdistended uterus and is therefore likely to have painful uterine spasms lasting for a period of 5 to 6 days after delivery. The patient may have severe cramping during breastfeeding, but there is no indication the patient would have trouble expelling milk. Excess vaginal bleeding should not last more than 2 hours after the delivery of the child. Whitish vaginal discharge is referred to as lochia alba, and this does not usually come until 10 to 14 days after delivery.

After discharge from the hospital, the nurse frequently visits a patient who has postpartum depression and also interacts with the patient frequently over the telephone. What is the reason behind this intervention? 1 To assess the patient's home environment 2 To prevent the patient from becoming lonely and bored 3 To determine the need for further care and treatment 4 To develop a therapeutic relationship with the patient

3 After discharging a patient with postpartum depression, the nurse should frequently contact the patient and interact with her over the telephone, or visit the patient's home. It helps the nurse evaluate the patient's feelings and perception. Frequently contacting the patient helps the nurse determine whether the patient requires further care and treatment. The nurse does not assess the patient's home environment after discharge; this should be done during the course of the therapy. To prevent loneliness and boredom, the nurse should suggest recreational activities and support groups to the patient. To develop a therapeutic relationship with the patient, the nurse should be nonjudgmental and follow therapeutic communication methods. Developing a therapeutic relationship with the patient is not the main objective of frequent home visits and follow-up care.

With regard to afterpains, nurses should be aware that these pains are what? 1 Caused by mild, continual contractions for the duration of the postpartum period 2 More common in first-time mothers 3 More noticeable in births in which the uterus was overdistended 4 Alleviated somewhat when the mother breastfeeds

3 Afterpains are more common in multiparous women because first-time mothers have better uterine tone. A large infant or multiple infants overdistend the uterus. The cramping that causes afterpains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Breastfeeding intensifies afterpain because it stimulates contractions.

The nurse is preparing to discharge a postpartum mother home. The patient says to the nurse, "I am glad I am breastfeeding and won't have to worry about getting pregnant because I will not have a period." Which statement made by the nurse provides the correct information for the patient? 1 "You will not ovulate if you exclusively breastfeed." 2 "You will not need contraception until after your first regular period." 3 "Contraception is important because you will ovulate prior to your first period." 4 "Because you are breastfeeding, you will not ovulate until after your first period."

3 Although the first few menstrual cycles for both lactating and nonlactating women are often anovulatory, ovulation may occur before the first menses. Contraceptive measures are important considerations when sexual relations are resumed for both lactating and nonlactating women. Breastfeeding mothers may ovulate and require contraception prior to their first periods. Ovulation occurs prior to a period, not after it.

The nurse is assessing a postpartum patient 1 day postdelivery. The patient reports that she has not had a bowel movement since delivery. Which nursing intervention would be most suitable in this situation? 1 Administer an enema to the patient. 2 Include fibrous foods in the patient's diet. 3 Inform the patient that this finding is normal. 4 Administer fluids and electrolytes to the patient.

3 Following a delivery, intestinal peristalsis is slow for 2 to 3 days because of decreased intestinal muscle tone. Hence, spontaneous bowel movements may not occur and the nurse should inform the patient that this finding is normal. The nurse does not need to administer an enema unless the problem persists longer than 2 to 3 days after delivery. The nurse does not need to include fibrous food in the patient's diet, because this problem should naturally resolve in a few days. The nurse does not need to administer fluids and electrolytes to the patient, because the patient does not have excess fluid loss.

The nurse is caring for a patient who underwent a cesarean section. Upon checking the medical history, the nurse finds that epidural opioid medication was administered to the patient. What complication of epidural opioid administration should the nurse look for in the patient? 1 Puerperal sepsis 2 Puerperal bradycardia 3 Respiratory depression 4 Orthostatic hypotension

3 Hypoventilation or respiratory depression may occur in the patient due to epidural opioid medication administered to relieve pain after cesarean birth. Puerperal sepsis is indicated by a persistent increase in maternal temperature for 2 days due to infection of the genital tract. Puerperal bradycardia is common during the first 2 days after birth, and is indicated by a heart rate of 40 to 50 beats/minute. Orthostatic hypotension may develop in the first 48 hours after birth due to splanchnic engorgement. Patients with orthostatic hypotension feel dizzy after standing up.

The nurse midwife is caring for a postpartum patient who delivered a baby the previous day. When the patient stands for the first time the next morning, she experiences a huge gush of blood expelled from the vagina. What should the nurse do in this situation? 1 Administer oxytocin to the patient. 2 Assess the uterine tone of the patient. 3 Inform the patient that it is a normal finding. 4 Immediately order blood for the patient.

3 The nurse should inform the patient that this sudden rush of blood is normal. Following delivery, a postpartum patient will have a red uterine discharge, called lochia rubra, which is mainly blood and uterine debris. If the patient had been sleeping all night, the lochia rubra would have accumulated in the vagina and would have been released when the patient stood up. The patient does not have a hemorrhage caused by uterine atony, so the nurse does not need to administer oxytocin or assess the patient's uterine tone. This patient does not need to have blood administered unless the bleeding continues after the initial rush of lochia rubra when the patient first stands up.

The nurse has been periodically assessing a mother's behavior in the postpartum period. Which behavior could indicate that the mother is having difficulty adjusting in the postpartum period? 1 The mother feels like playing and holding the baby all the time on the 10th day home from the hospital. 2 The mother is tired and wants to be looked after by her partner on the 1st day home from the hospital. 3 The mother is asking the nurse a lot of questions about newborn care on the 4th day home from the hospital. 4 The mother is tired and hesitant to be alone with the infant by the 7th day home from the hospital.

4 According to Rubin's phase of maternal postpartum adjustment, in the first 2 days of the postpartum period the mother is focused on herself and may want to be cared for by her family members. In this early period, the mother has not fully embraced her new role and may not want to care for the infant by herself. This period does not usually last more than 2 days, however, so if the mother was hesitant to be alone after 7 days, it could be an early indication that the mother is having difficulty adjusting in the postpartum period. In the second phase of postpartum adjustment, which typically lasts from the 3rd day to several weeks, the mother focuses on the care of the baby. In this period, the mother likes playing and holding the baby as often as possible. The mother is typically eager to learn about newborn care in the second phase.

While assessing a postpartum patient, the nurse asks the patient, "Who takes care of your child at home, and are you able to get adequate rest?" Why would the nurse ask this question? 1 To address nutritional resource deficits 2 To evaluate acceptance of the newborn 3 To determine the adequacy of material resources 4 To determine the adequacy of a support system

4 After childbirth, patients may feel fatigued. They require support from their friends and family in doing household work and caring for the newborn. Therefore, to determine the adequacy of the support system, the nurse should assess whether the patient has enough help to do both household work and to care for the newborn. To address resource deficits, the nurse should assess the nutritional and financial status of the patient. To evaluate the acceptance of the newborn, the nurse should assess the bonding between the newborn and the family members. To determine the adequacy of resources the nurse should assess whether the parents are able to provide proper sleeping space and care equipment for the infant.

What is true about the postbirth uterine vaginal discharge called lochia? 1 It is similar to a light menstrual period for the first 6 to 12 hours. 2 It is usually greater after cesarean births. 3 It will usually decrease with ambulation and breastfeeding. 4 It should smell like normal menstrual flow unless an infection is present.

4 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 usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding.

Shortly after its birth, the nurse places a newborn on the bare chest of its mother, and the mother complains that she is not able to make eye contact with the baby. What would be the most suitable intervention employed by the nurse in this situation? 1 Teach the mother the kangaroo care method. 2 Tap the baby gently on the back to open its eyes. 3 Administer antibiotic ointment into the baby's eyes. 4 Teach the mother to hold the newborn in an en face position.

4 En face position involves placing a baby and the parent on the same plane about 8 inches apart to promote good eye contact, while maintaining close physical contact. The kangaroo care method encourages proper skin contact between mother and baby, but is not useful for maintaining good eye contact. The nurse should not forcibly open the baby's eyes. Mothers are encouraged to maintain eye contact when the child is active and alert. Antibiotic eye drops are not immediately put in the newborn's eyes but can wait until after the mother and infant have bonded and started the attachment process.

The nurse is assessing a postpartum patient 6 hours after delivery. The nurse finds that the patient's body temperature is 100.3° F. What should the nurse do in this situation? 1 Give a cold compress to the patient. 2 Send the patient's urine sample for culture. 3 Apply ice packs on the breasts of the patient. 4 Recheck the temperature again 24 hours after delivery.

4 It is natural for a patient's body temperature to be slightly elevated for 24 hours following delivery. In this situation, the nurse should check the patient's temperature 24 hours postdelivery to see if it has stabilized. The patient does not have a fever so does not need to be given a cold compress. The patient's urine sample needs to be cultured only if the patient is suspected to have urinary tract infection. Based on this information, the nurse cannot conclude that the patient has a urinary tract infection. Ice packs can be applied to reduce breast tenderness and discomfort after delivery, but this intervention is not used to bring down the patient's body temperatur

A Native American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of what? 1 Delayed attachment 2 Embarrassment 3 Disappointment that the baby is a girl 4 A belief that babies should not be fed colostrum

4 Native Americans often use cradle boards and avoid handling their newborn often; they believe that the infant should not be fed colostrum. A belief that babies should not be fed colostrum is a cultural belief, not a delay in attachment or an expression of embarrassment. This cultural belief does not indicate that there is disappointment regarding the sex of the baby.

The nurse is providing discharge teaching to a nonlactating patient who has breast engorgement. What should the nurse suggest that the patient do in order to reduce tissue swelling and suppress milk production? 1 "Take a warm shower twice daily." 2 "Apply hydrogel pads on the breast." 3 "Wear breast shells over your nipples." 4 "Apply fresh cabbage leaves on the breast."

4 The nurse should suggest that the patient apply cabbage leaves on her breasts between feedings because the photochemical present in cabbage leaves reduces tissue swelling and suppresses milk flow. Hydrogel pads reduce inflammation and provide comfort. They do not suppress milk flow. Taking warm showers stimulates milk flow. They do not reduce tissue swelling. Breast shells prevent irritation, but do not suppress milk production.

The nurse is assessing the fundus of a postpartum patient. The nurse notes that the fundus becomes soft and uncontracted after massage. What should be the nurse's priority intervention? 1 Begin oxytocin infusion. 2 Apply pressure to express clots. 3 Catheterize the patient to empty the bladder. 4 Continue to support the uterus and massage the fundus.

4 The priority intervention is to continue to support the uterus and massage the fundus until firm. An oxytocin infusion is initiated as prescribed after fundal massage. The nurse will not apply pressure to express clots until the fundus becomes firm. Catheterizing the patient to empty the bladder is an intervention if the fundus is above the umbilicus and/or displaced from midline.

The nurse has taught perineal care techniques to a postpartum patient to prevent infections. After the teaching session, the nurse asks the patient to repeat the measures that should be followed to prevent infection. Which statement made by the patient would indicate the need for further teaching? 1 "I should use soap and warm water to wash my perineum." 2 "I should wash from symphysis pubis back to anus." 3 "I should change the perineal pad every 2 to 3 hours." 4 "I should fill the squeeze bottle with cold water while washing."

4 The squeeze bottle should be filled with warm water. The nurse should inform the patient that the tap water should be heated to 38o C. Washing with warm water will make the patient feel comfortable and provide relief from pain. The patient should wash the perineum with mild soap and squeeze a bottle of warm water at least once daily to maintain hygiene and prevent infections. Cleansing from symphysis pubis to anal area ensures proper cleaning and prevents infection. Changing the perineal pad every 2 to 3 hours helps prevent infections.