Postpartum, Transition to parenthood, Discharge Planning and teaching

The nurse is preparing to teach a class on the benefits of breastfeeding for infants. Which benefits will the nurse include in the presentation? Select all that apply. 1. Decreased incidence of SIDS 2. Fewer cases of necrotizing enterocolitis 3. Less likely to become obese adults 4. Decreased risk for developing otitis media 5. Immunity to respiratory syncytial virus

ANS 1,2,4 There is a decreased incidence of SIDS in infants who are breastfed. Breastfed infants have fewer cases of necrotizing enterocolitis. Breastfed infants have a decreased risk for developing otitis media.

The nurse is researching for evidence-based practice related to a mother's response during the postpartum period. Based on research by Rubin and Mercer, which finding will the nurse be able to easily implement to change the culture of the unit? 1. Satisfaction questionnaires 2. Alterations in terminology 3. Decrease nurse/patient ratios 4. Soliciting paternal expectations

ANS 2 Rubin and Mercer have addressed the terminology used regarding the mother during early postpartum. From "maternal phases" and "maternal touch" (Rubin), terminology was changed by Mercer to "maternal role attainment" and finally to "becoming a mother." This change can be easily implemented by the nurse and promote a change in the unit culture.

Dayton et al. (2016) performed qualitative research regarding expectant fathers' beliefs and expectations. The nurse identifies which theme as emerging from this research? 1. Men felt that the role of being a father can be learned. 2. Men described fathering as an extremely difficult task. 3. Men rely on other men to support the fathering role. 4. Men believe that the nurturing role is always the mother's

ANS 2 The referenced research did result in men describing fathering as being an extremely difficult task. Fathers felt the task included being responsible for another life and the importance of providing financial and concrete support to their children.

The lactation nurse visits the room of a patient who is postpartum and being prepared for discharge. The nurse plans to provide breastfeeding information aimed at assisting the patient to continue breastfeeding her newborn. Which observation by the nurse indicates a possible disruption to the planned teaching? 1. The patient is currently breastfeeding her baby. 2. The patient is excited about taking her baby home. 3. The patient's partner is in the patient's room. 4. The patient states she has no questions or concerns.

ANS 2 When the patient is distracted by feelings and/or activities, there is the possibility for disruption of the nurse's teaching. The right time for teaching is imperative

The nurse is concerned about the number of infants in the community who die from SIDS even with teaching about "back to sleep" being provided. On which additional preventive measures will the nurse focus? Select all that apply. 1. During pregnancy, women should not smoke, drink alcohol, or use illegal drugs. 2. Infants need to be dressed to prevent infants from overheating during sleep. 3. Mothers need to be informed that breastfeeding reduces the risk for SIDS. 4. Parents should not smoke or allow smoking around their baby. 5. Parents need to avoid products that claim to reduce the risk of SIDS.

ANS: 1, 2, 3, 4, 5

The nurse is providing teaching to a patient who is breastfeeding a newborn. The patient expresses interest in maintaining a healthy nutritional status for both her and her baby. Which information does the nurse present to meet the patient's needs? *Select all that apply: A. Increase caloric intake by 500-1,000 per day. B. Drink 2-3 liters of fluid each day. C. Abstain from the intake of alcohol. D. Eat fresh fruits and vegetables E. Avoid the intake of processed foods.

A. Increase caloric intake by 500-1,000 per day. B. Drink 2-3 liters of fluid each day. These are correct because when lactating a mother should increased her caloric intake by 500-1,000 per day, and when lactating the mother needs to increase her fluids to 2-3 liters a day. *Some fresh veggies and fruit may give baby gas, cramps, and/or loose stools. *It has not been shown harmful to the infant if the mother consumes alcohol during breastfeeding although it is not recommended. If you consume alcohol make sure it is 2-2.5 hours before feeding.

The nurse is reviewing the medical record for a patient who is postpartum. The nurse notices the patient is rubella-non-immune. Which information does the nurse present to the patient? *Select all that apply: A. The risk of the fetuses of any future pregnancies. B. The patient will need to be immunized before discharge. C. Breastfeeding should be avoided for 24 hours after immunization. D. Maternal immunization carries over to the neonate. E. Pregnancy should be avoided for 4 weeks.

A. The risk to the fetuses of any future pregnancies. B. The patient will need to immunized before discharge. E. Pregnancy should be avoided for 4 weeks. These are correct because fetuses exposed to rubella during the first trimester are at risk for birth defects, women cannot be immunized during pregnancy so they need to be immunized before discharge, and the first trimester of pregnancy is said to be the most dangerous time for a fetus to be exposed to rubella.

The nurse is teaching newborn care to an adolescent mother. When the nurse attempts to teach how to swaddle the newborn, the mother states, "What's the big deal about how to wrap up a baby?" The nurse needs to convey which reason as being most important for proper swaddling? 1. Improper swaddling can cause hip dysplasia. 2. Correct swaddling will increase the neonate's comfort. 3. Neonates are swaddled only until they can turn from front to back. 4. Two to three fingers need to fit between the infant's chest and the swaddle.

ANS 1 Improper swaddling can cause hip dysplasia. It is especially important to allow the hips to spread apart and bend up. In the womb, the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket. This is the most important information for the nurse to convey.

The nurse on a postpartum unit is focused on providing care that will assist the mother and father in making the transition to parenthood. For which reason does the nurse review the prenatal and labor records? 1. Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother. 2. Awareness of prenatal classes that will help identify and focus on learning needs of both parents. 3. Identification of preexisting maternal conditions that may interfere with parenting transitions. 4. Knowledge regarding questions and concerns the mother and father may have about neonate issues.

ANS 1 The nurse reviews the maternal prenatal and labor records because pregnancy and birth experiences can either enhance or impede the process of becoming a mother. The nurse is looking for factors such as complications during pregnancy, labor, and birth.

A patient in the second trimester of pregnancy is discussing breastfeeding and other options with the nurse. Which question is most important for the nurses to ask? 1. "How does your partner feel about you breastfeeding?" 2. "Do you have family members who have breastfed their babies?" 3. "What are the reasons why you are considering breastfeeding?" 4. "At what point after childbirth do you plan to return to work?"

ANS 1 The woman's partner plays a significant role in her choice to breastfeed and to continue breastfeeding. Her feelings about and success at breastfeeding are enhanced by her partner's support

The nurse in a postpartum unit evaluates new parents for risk factors that can indicate problems with bonding/attachment. Which situations does the nurse recognize as a cause for bonding/attachment problems? Select all that apply. 1. The mother experienced eclampsia in the third trimester of pregnancy. 2. The neonate is being treated for meconium aspiration syndrome. 3. The mother experienced dystocia in the second phase of labor. 4. The father of the neonate is in the military and not yet home on leave. 5. The mother's mother lives next door and is available to help with the baby.

ANS 1,2,3

The nurse uses research from Greenberg and Morris (1974) as a guideline for identifying the presence of engrossment in a new baby by the father. Which behaviors exhibit paternal-infant bonding related to engrossment? Select all that apply. 1. Seeing the baby as attractive 2. Perceiving the baby as being perfect 3. Having a desire to touch the baby 4. Indicating an increasing sense of self-esteem 5. Positively commenting about the baby's features

ANS 1,2,3,4,5

The nurse is counseling a lesbian couple who have decided to have a child. Which considerations does the nurse present with regard to which partner will become pregnant? Select all that apply. 1. Consider the age and health of each partner. 2. Evaluate each partner's career goals. 3. Decide which partner has better insurance. 4. Determine who will be on the birth certificate. 5. Identify which woman desires to be pregnant.

ANS 1,2,3,5

The nurse on a postpartum unit is acutely aware that cultural influences impact the patient's process of "becoming a mother." For which cultural influences does the nurse assess? Select all that apply. 1. What amount of time the mother spends in each phase 2. Differences in the mother's expectation related to ability to rest 3. How the mother physically recovers from labor and delivery 4. Mother's involvement in decision making for the first few months 5. Whether the mother seems interested in how to care for her baby

ANS 1,2,4,5

A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide? 1. Frozen breast milk can be defrosted in a microwave. 2. Breast milk can be kept in a deep freezer for 6 to 12 months. 3. The freezer door shelf decreases the chance of milk contamination. 4. Breast milk can only be frozen in special plastic freezer bags

ANS 2 Breast milk can be safely kept in a deep freezer for 6 to 12 months; in a freezer attached to a refrigerator, it can be safely stored for 3 to 6 months.

The parents of a newborn male are concerned about providing care for the baby's new circumcision performed with a Plastibell. Which information will the nurse include in the teaching plan for the parents? 1. Apply lubricants to the penis to keep the diaper from sticking. 2. Report if penis is red, warm, and swollen and/or there is surgical site drainage. 3. Remove the plastic ring gently on the fifth day after surgery. 4. Contact the health care provider if newborn does not void for 36 hours

ANS 2 The nurse will include information to the parents that if the entire penis is red, warm, and swollen and/or there is drainage from the surgical site (signs of infection), it should be reported immediately to the health care provider

The postpartum nurse is preparing to present infant care information to a couple who expresses concern about when to bathe their newborn. Which behaviors will the nurse present as general guidelines? Select all that apply. 1. Bathing is best after a feeding when newborn is relaxed. 2. Daily bathing with soap is not necessary for the newborn. 3. Use a mild preservative-free soap with a neutral pH. 4. Avoid the use of soap on the face of the newborn. 5. Genital and rectal areas should be cleaned at each diaper change

ANS 2,3,4,5 Daily bathing of a newborn with soap is not necessary and can contribute to skin irritation. Between baths with soap, the newborn can be cleaned with clear water. When bathing with soap, a mild preservative-free soap with a neutral pH is used to prevent skin irritation. The use of soap on the face is not recommended. The face and neck areas should be cleaned after feedings with plain water.

The postpartum nurse is planning a home visit to a mother who delivered her baby 1 week ago. Which finding indicates to the nurse a possible problem with mother-infant bonding? 1. The mother is pleased to have the nurse visit her home and baby. 2. The baby's grandmother is present and involved with mother/baby care. 3. The mother focuses the visit on her physical recovery and concerns. 4. The baby's father is on "paternity leave" and involved with the baby

ANS 3 After the first 48 hours postpartum, the mother moves into the "taking hold" phase when the mother's focus moves from self to the infant. When the mother focuses the nurse's attention on the mother's physical recovery and concerns, the nurse needs to assess for problems with mother-infant bonding

A new mother expresses severe frustration with an infant that is exhibiting symptoms of colic. Which suggestions from the nurse are aimed at infant safety? Select all that apply. 1. Hold the infant and sway from side to side or walk around with the infant. 2. Place the infant in a car seat and take him or her for a ride in the car. 3. Place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. 4. Do simple household chores, such as vacuuming or washing the dishes. 5. Place the infant (abdomen down) over the knees and gently rub or pat the back.

ANS 3,4 When a mother expresses severe frustration with a colicky baby, she needs to place the baby in a safe place and allow the baby to cry for 10 to 15 minutes. The mother can check on the baby when she has calmed down. A mother who expresses severe frustration with a colicky baby needs to find a distraction. Doing simple household chores, such as vacuuming or washing the dishes can be effective and allow the mother time to calm down.

The nurse is providing postpartum care for an adolescent mother and her family. Which factor is most important for the nurse to consider when planning teaching about neonatal care? 1. The grandparents decided they want to be involved. 2. The parents need to discuss their expectations of each other. 3. The mother is determined the father should be involved. 4. Information must be presented on an age-appropriate level

ANS 4 Learning styles and teaching strategies are different for young teens and older teens. Information needs to be provided in a manner that will engage the adolescent parent in the learning process. This is the most important factor for the nurse to consider.

As a result of the previously mentioned research study, the nurses in a postpartum facility will implement which evidence-based change? 1. Continue to assess the level of fatigue for the mother during postpartum period. 2. Assist fathers in recognizing and managing stress and depressive symptoms. 3. Encourage the father to go home and rest while the mother is hospitalized. 4. Promote strategies to decrease fatigue during both prenatal and postnatal perio

ANS 4 Nurses will provide information on strategies to decrease fatigue during the prenatal period and postnatal periods

A mother who is 2 weeks postpartum asks the nurse lactation specialist how she knows if her baby is hungry. Which hunger indicator does the nurse discuss? 1. Crying when all other physical needs are met 2. If 2 to 3 hours have passed since feeding 3. When the mother experiences a let-down sensation 4. Opening the mouth in response to tactile stimulation

ANS 4 Opening the mouth in response to tactile stimulation is the best way to determine if a baby is hungry; the rooting reflex is not solicited in a baby who is not hungry.

A new mother expresses frustration about how to know what her baby wants. The mother states, "I don't know what I expect, but then, the baby doesn't know either." Which situation does the nurse use as an example of neonate communication? 1. The baby is content to lie still on the mother's abdomen. 2. The baby is easily awakened if irritated by loud noises. 3. The baby resists eye contact if bored or disinterested. 4. The baby roots for the breast when the cheek is stroked.

ANS 4 Rooting is an initial interaction that elicits the desire/need to eat. When a neonate's cheek is stroked, the neonate turns the head toward the touch and begins to root for the breast. The mother needs to understand this is the neonate's method of communication

The nurse is collecting information from a parent whose infant has frequent diaper dermatitis. Which comment by the parent indicates a possible cause of the condition? Select all that apply. 1. "I use disposable wipes to clean the diaper area." 2. "I buy an antibiotic ointment specified for skin rashes." 3. "I leave the diaper off while the baby is sleeping." 4. "I treat any sign of a rash immediately with zinc oxide." 5. "I even get up and change the baby's diaper during the night."

ANS: 2 When an infant has diaper dermatitis, the use of antibiotic ointments, which can increase the risk of allergic skin reactions, should be avoided. This statement alerts the nurse to a possible cause of the infant's diaper dermatitis.

The nurse is collecting the urine of a postpartum patient who is passing large clots. For which reason does the nurse examine the large collected clots? A. To validate the presence of clotting. B. To determine the presence of tissue. C. To obtain an accurate description. D. To document the number of clots.

B. To determine the presence of tissue. This is correct because retained placental tissues can be the cause of the clots and interfere with uterine involution and lead to excessive bleeding.

Prior to discharge from the birthing center, the nurse informs the patient that she will be receiving vaccines for rubella, hepatitis B, pertussis and influenza. For which reason does the nurse explain the need for vaccinations? A. Discharge with a neonate is discouraged if the mother is not vaccinated. B. Vaccinating the mother will protect the neonate from a serious illness. C. The mother's immune system has been suppressed during pregnancy. D. Vaccination is more easily accomplished while the mother is under medical care.

B. Vaccinating the mother will protect the neonate from serious illness. This is correct because the mother does not want to pass these diseases to her new infant and vaccinating will help both mother and keep baby safer.

When providing care to a multiparous mother, the nurse needs to assess for the presence of ____________________ between the older children and the new baby

sibling rivalry

The nurse is providing postpartum care to a patient 24 hours after vaginal delivery. Which action does the nurse perform prior to assessing the patient's uterus? A. Place the patient on the left side. B. Assess the passage of lochia. C. Ask the patient to void. D. Administer a dose of oxytocin.

C. Ask the patient to void. This is correct because the patient must void prior to palpation of the uterus in order to accurately assess uterine placement and tone. An over distended bladder can result in uterine displacement and atony.

What actions can non-breastfeeding women do to treat breast engorgement?

Wear a supportive bra *Avoid stimulating the breast Ice packs to breast Analgesics for pain *Cold cabbage leaves in bra.

What is the first question a nurse should ask when a patient is c/o breast engorgement?

When was the last time you fed your baby?

The nurse on a postpartum unit focuses on how to assist the father in identifying his role with the neonate. Which intervention by the nurse is most helpful? 1. Encourage the couple to identify mutual expectations of the fathering role. 2. Critique the father's methods of providing physical care for the neonate. 3. Provide written materials about the physical and emotional role of a father. 4. Observe for a competitive attitude between the parents about providing baby care.

ANS 1 Mutually agreed-upon fathering expectations, shared by the couple, can decrease the level of stress within the relationship

A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with what occurrence? A. An increase in oxytocin release related to the newborn suckling. B. The presence of intense afterbirth pains related to multiparity. C. An expected response to the daily administration of oxytocin. D. The efforts of the uterus to return to a pre-pregnancy condition.

A. An increase in oxytocin release related to the newborn suckling. This is correct because during suckling of a newborn during breastfeeding the stimulation of the uterus to be contracted is increased because of a release of oxytocin.

A nurse is preforming a uterus assessment on a patient who is 20 hours postpartum. The nurse finds the fundus of the uterus to be soft and boggy. In addition, the uterus is displaced to the left and moderate bleeding is noted. If the uterus does not respond the uterine massage, which actions does the nurse implement? *Select all that apply: A. Assist the patient to the bathroom to void. B. Reassess to determine response to treatment. C. Administer oxytocin as prescribed. D. Place an emergency call the the HCP. E. Make the patient NPO for surgery.

A. Assist the patient to the bathroom to void. B. Reassess to determine response to treatment. C. Administer oxytocin as prescribed. E. Make the patient NPO for surgery. The uterus can become displaced if the bladder is full so assist your patient to void before examining uterus. After implementing the appropriate ordered medications the nurse should always reassess. The nurse should administer oxytocin and prescribed in the HCP's orders. Anticipate surgery and make the client NPO.

The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the acronym REEDA. Which specific assessments are covered by REEDA? *Select all that apply: A. Perineal coloration B. Suture line appearance C. Amount of swelling. D. Description of pain. E. Soft tissue trauma.

A. Perineal coloration. B. Suture line appearance. C. Amount of swelling. E. Soft tissue trauma. These are correct because REEDA stands for: redness, ecchymosis, edema, discharge, approximation of edges of episiotomy or laceration.

The nurse is interested in promoting coparenting because of the high likeability that at some point, both parents will be working outside the home. After reading research by Davis, Schoppe-Sullivan, Mangelsdorf, and Brown (2009), the nurse learns that which factor impacts coparenting the most? 1. Infant temperament 2. Father's interest 3. Strength of support systems 4. Mother's expectations

ANS 1 Infant temperament difficulty reported by fathers at 3.5 months was associated with a decrease in supportive coparenting behavior. Early interventions to enhance coparenting are essential for families with temperamentally difficult infants.

Loutzenhiser, McAuslan, and Sharpe (2015) performed a study regarding maternal and paternal fatigue and factors associated with fatigue across the transition to parenthood. Which evidence-based conclusion is made regarding fatigue and the transitioning parents? 1. Levels of prenatal and postnatal fatigue are associated. 2. Postnatal fatigue remains consistent for a period of 1 year. 3. Poor sleep quality in fathers is related to depressive symptoms. 4. The length of couple relationship strongly impacts parenteral fatigue

ANS 1 The evidence-based conclusion for the study indicates that high levels of prenatal fatigue were associated with higher levels of postpartum fatigue for both the mother and father

A mother who is breastfeeding expresses concern about whether her infant is getting enough milk. Which concrete indicator does the nurse provide to the mother? 1. There are at least eight wet diapers and several stools per day. 2. The mother is physically and emotionally comfortable during feedings. 3. The newborn suckles and the mother can hear and/or see swallowing. 4. The newborn spontaneously releases the grip on the breast when satiated

ANS 1 The most concrete indicator that the breastfeeding baby is receiving enough milk is at least eight wet diapers and several stools per day

The nurse is teaching new parents about the Period of PURPLE Crying Program aimed at the prevention of shaken baby syndrome. At the end of the program, the nurse evaluates the program successful if parents select which fact? Select all that apply. 1. Your baby may not stop crying no matter what you do. 2. Your baby may cry more in the late afternoon and evening. 3. A serious condition exists if crying last 5 hours a day or more. 4. Your baby will cry less each week, the least during the first 2 months. 5. A crying baby may look to be in pain, even when he or she is not.

ANS 1,2,5 Parents who understand the baby may cry more in the late afternoon and evening is an indication of a successful program. Parents who understand the baby may not stop crying no matter what they do indicates a successful program. Parents who understand the baby may look to be in pain, even when he or she is not, indicates a successful program.

The nurse is observing a new mother interact with her baby and notices the mother holding the baby close to her body. However, the nurse also notices that the mother does not hold the baby in an enface position. Which question is most appropriate for the nurse to ask? 1. "Can I help you with a nice position in which to hold your baby?" 2. "What can you tell me about your family's beliefs with new babies?" 3. "Is there some reason that I have not seen you look into your baby's eyes?" 4. "Your baby is so expressive, have you looked into his eyes yet?"

ANS 2 Asking the mother about her family's beliefs with new babies allows the mother to provide cultural information that may be influencing the mother's interactions with her baby

The nurse is aware that some parenting skills are acquired through the process of intentional learning. Which activity does the nurse associate with intentional learning? 1. The couple observes other individuals who are mothers and fathers. 2. The couple attends hospital classes addressing newborn and infant care. 3. The couple discusses with each other how they were parented. 4. The couple watches media containing parenting roles

ANS 2 The couple who attends hospital classes addressing newborn and infant care is experiencing intentional learning

The postnatal nurse is making a newborn visit to the parents who are from a different country. The nurse finds the newborn swaddled in a heavy blanket and wearing a knitted cap. The newborn has wet hair and is restless with rapid breathing. Which initial comment from the nurse is appropriate? 1. "Your baby is exhibiting some concerning symptoms." 2. "Share with me how babies are cared for in your country." 3. "I would like to explain how to dress your baby correctly." 4. "Let me explain the baby's symptoms of being overheated."

ANS 2 When the nurse asks the parents to share how babies are cared for in their country, the nurse is showing interest and respect to the parents' culture. The nurse needs to understand the motivation behind dressing the baby in the current manner

The nurse is teaching the mother of a neonate the benefits of kangaroo care. Which action is explained to the mother regarding the procedure? 1. The neonate is tucked into the front of a parent's shirt. 2. A bare-chested neonate is held against a bare-chested parent. 3. A pouch is formed from a blanket for carrying the neonate. 4. The neonate is placed in a sling and placed on a parent's side.

ANS 2 When the nurse teaches a mother the benefit of initiating kangaroo care, a bare-chested neonate is held against a bare-chested parent and both the neonate and parent are covered with a warm blanket.

Which behavior does the nurse identify as a demonstration of unidirectional bonding between a parent and infant? 1. The parents respond to the baby's cry. 2. The parents call the baby by name. 3. The baby responds to comforting measures. 4. The parents stimulate and entertain the baby

ANS 2 When the parents call the baby by name, they are demonstrating unidirectional bonding

The nurse is providing care for a new mother during a follow-up visit 6 weeks after a vaginal delivery. The mother begins to cry and reports difficulty with eating and sleeping. The nurse identifies postpartum blues and cites which reason as the most likely cause? 1. Fatigue related to a "fussy" baby 2. Frustration over physical appearance 3. Changes in hormonal levels 4. Stress related to new mother role

ANS 3 Although the other options can contribute to postpartum blues, the most likely cause is changes in hormone levels

A patient in the first stage of pregnancy is discussing the options for feeding her infant, and asks the nurse, "Which is the most important reason I should consider breastfeeding my baby?" Which is the most significant reason the nurse presents? 1. Human milk proteins are easier to digest than protein in prepared formula. 2. The amount of cholesterol in human milk is essential for the baby. 3. Human milk contains multiple antibodies, enzymes, and immune factors. 4. Vitamins and minerals are transferred to human milk from the mother

ANS 3 Human milk contains multiple antibodies, enzymes, and immune factors that help protect the infant from common infections. It also stimulates the growth of healthy bacteria in the intestinal system, which inhibits growth of bacteria that can cause diseases. The factors are not found in formula, and this is the most significant reason for the nurse to recommend breastfeeding

The nurse is collecting information from a new mother who is bottle-feeding her infant. Which comment, if made by the mother, requires the nurse to provide patient teaching? 1. "I wish that I had tried breastfeeding because formula is expensive." 2. "At least I get a break every evening when my spouse feeds the baby." 3. "Sometimes I will add a little water to the formula if I am running low." 4. "I get frustrated if the last bottle is fed to the baby late at night."

ANS 3 If the mother states a practice of diluting the baby's formula if her supply is low, the nurse needs to provide teaching. Prolonged over-dilution of formulas can cause water intoxication, as well as decrease the caloric intake by the baby.

Which information is important for the nurse to provide to mothers of infants of 3 months of age regardless of the method of infant feeding? 1. Why breastfeeding delays the need for solid foods 2. When and what order solid foods are introduced 3. When growth spurts and dietary increases are expected 4. Why the babies are most likely to prefer food over milk

ANS 3 Mothers need to be aware of probable growth spurts regardless of the method of feeding. Infants experience growth spurts at 3 to 5 days, 1 week, 6 weeks, 3 months, and 6 months and require more frequent feedings during these time periods.

The postpartum nurse-manager wants the unit to become active as a supporter of the Baby-Friendly Hospital Initiative. Which nursing actions will be initiated? Select all that apply. 1. Give pacifiers to infants on demand. 2. Help mothers initiate breastfeeding within 1 hour of birth. 3. Teach breastfeeding and promote lactation to mothers separated from infants. 4. Refer mothers to support group resources on discharge. 5. Provide infants with water until a milk supply is established

ANS: 2, 3, 4 Initiating breastfeeding early is helpful in establishing breastfeeding. The ideal time line is to initiate breastfeeding within the first hour after birth. Even if separated from their infants for a period of time, mothers are offered information about breastfeeding and maintaining lactation. If the separation is related to a medical condition, the mother can pump and supply her infant with breastmilk unless it is medically contraindicated. For continuing care, breastfeeding mothers need to be offered the support of other breastfeeding mothers

A postpartum patient states, "I am really in pain." For which sources of pain will the nurse specifically assess the patient? *Select all that apply: A. Uterine contractions. B. Perineal trauma C. Breast engorgement D. Hemorrhoids. E. General soreness

All of the choices are correct. Uterine contractions may be afterpains. Perineal trauma include episiotomy, laceration, and/or ecchymosis. Breast engorgement will cause the mother pain as well as nipple pain from improper latching. Hemorrhoids are a source of pain. General soreness is a source of pain.

A postpartum patient calls the OB office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern? A. Increased flow noticed with physical activity. B. A description of the lochia as being red in color. C. Discharge that is noted to have a fleshy color. D. Bleeding that is described as scant.

B. A description of the lochia as being red in color. This is correct because during the 4-10 days the lochia should be described as lochia serosa [pink or brown to color]. The nurse should be concerned if the patient reports lochia that is red in color, which is indicative of bleeding.

The nurse is preparing a postpartum patient for discharge. What patient teaching is most important for the nurse to provide? A. The S/S of uterine infection. B. The S/S of secondary hemorrhage. C. The S/S of postpartum depression. D. The S/S of a boggy uterus.

B. The S/S of secondary hemorrhage. This is correct because it most often occurs after the patient has been discharged and is at home. The patient needs to understand the normal progression of lochia and uterine involution and report abnormal amounts of bleeding.

The nurse is providing care to a patient who is postpartum. Using anatomy and physiology knowledge, which expectation does the nurse related to the cardiovascular system? A. Patient reporting being cold related to blood loss. B. WBC laboratory level of 30,000/mm a few hours after delivery. C. Risk for hemorrhage due to decrease in circulating clotting factors. D. A normal postpartum hemoglobin laboratory value of less than 11g/dL

B. WBC laboratory level of 30,000/mm a few hours after delivery. This is correct because it is a normal level as a result of stress after labor and birth.

What acronym is used for postpartum assessment?

BUBBLE HE Breasts Uterus Bladder Bowel Lochia Episiotomy, lacerations, perineum, hemorrhoids, incision Holman's sign Emotions, bonding with infant, fatigue, psychosocial factors.

In an attempt to improve the effectiveness of postpartum teaching, the nurse uses AWHONN acronym POST BIRTH. Which teaching points require the patient to call for 911 assistance? *Select all that apply: A. Bleeding that soaks a pad per hour. B. A bad headache with vision changes. C. Thoughts of hurting self or baby. D. Signs an incision is not healing. E. A red, swollen leg painful to touch.

C. Thoughts of hurting self or baby. The rest of the answers are important but not part of the acronym that involves calling 911. The POST part of the acronym is for calling 911, BIRTH is for contacting your doctor.

A patient who is 12 hours postpartum after a vaginal delivery continues to have difficulty in initiating urination. The nurse is aware that an integrative method used when a woman is unable to void is peppermint oil. In which manner with peppermint oil be used? A. A thin layer is applied to the urinary meatus. B. A small amount on a cotton ball is left at the bedside. C. A small amount is added to the water of a vaporizer. D. A saturated cotton ball is placed in a "hat" on the toilet.

D. A saturated cotton ball is placed in a "hat" on the toilet. This is correct because it is known that the vapors will have a relaxing effect on the urinary sphincter.

The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis? A. To prevent uterine prolapse. B. To prevent uterine movement. C. To prevent uterine hemorrhage. D. To prevent uterine inversion.

D. To prevent uterine inversion. This is correct because the nurse should support the lower uterine segment by placing one hand just above the symphysis pubis. Pregnancy stretches the ligaments that hold the uterus in place, and fundal pressure could result in uterine inversion.

If the mother's blood pressure is low and experiences orthostatic hypotension what might the nurse want to implement?

Educate the patient to rise slowly from sitting to standing, and take plenty of time when getting up. She should always have assistance until she is steady.

What actions can breastfeeding women do to treat breast engorgement?

Feed infant frequently Warm compresses/breast massage Express milk either manual or by pump Ice packs after feeding to decrease inflammation and pain. Wear a supportive bra.

S/S of engorgement

Hard, swollen, red, tender and painful breasts. Warm to the touch. Throbbing sensation. Elevated temperature. Infant may not be able to latch.

Directly after birth is a low BP in the mother consider normal or abnormal?

Normal because the mother has been through postpartum bleeding.

You are caring for a 12 hour postpartum mother and upon auscultation you hear what sounds like a murmur. What is your immediate action?

Reassure your client that this is normal, but you will report it to the health care provider. Heart murmurs may be present due to an increased blood volume.

You are caring for a 3 hour postpartum mother who is complaining of chills. As the nurse what is your best action?

Reassure your patient that this is normal and give her a warm/heated blanket.