Practice Questions Accumulated

A woman with postpartum depression is being treated with a selective serotonin reuptake inhibitor (SSRI). What statement by the patient requires further action by the nurse?

"Adding St. John's wort has really helped my depression."

A woman has painful hemorrhoids after a vaginal birth. Her husband brings her a donut pillow to sit on. What response by the nurse is best?

"Donut pillows actually increase hemorrhoid pain."

A 36-week gestation gravid lies flat on her back. Which of the following maternal symptoms would the nurse expect to observe? a. Numbness and tingling down one of her legs b. Dizziness and nausea c. Rales d. Chloasma

...

The client, whose parity is 1, had a vaginal delivery 6 days ago and arrived home yesterday after treatment for endometritis. The home health nurse visits the client and plans teaching after seeing which most concerning item in the client's bathroom? 1) a box of tampons on the floor outside of the shower stall 2) loofa bath sponge sitting on the seat of the shower stall 3) damp towel bunched on the towel bar and near the floor 4) can of bathroom cleaner on the floor of the shower stall

1) a box of tampons on the floor outside of the shower stall the nurse should plan teaching about the use of tampons during postpartum. The tampon may irritate or dry the vagina, holds lochia in the body, and increases the risk of infection. The client should be instructed to wear a peri-pad.

Twenty-four hours post-vaginal delivery, the postpartum client tells the nurse that she is concerned because she has not had a bowel movement (BM) since before delivery. Which action should be taken by the nurse? 1. Document the data in the client's medical record 2. Notify the HCP immediately 3. Administer a laxative that was prescribed prn 4. Assess the client's abdomen and bowel sounds

1. Document the data in the client's medical record A spontaneous BM may not occur for 2 to 3 days after childbirth due to decreased muscle tone in the intestines during labor and the immediate postpartum period, possible prelabor diarrhea, and decreased food intake and dehydration during labor. Thus documentation of the lack of a BM is the only action required

The nurse informs a postpartum woman that which of the following is the reason ibuprofen (Advil) is especially effective for afterbirth pains? 1. Ibuprofen is taken every two hours. 2. Ibuprofen has an antiprostaglandin effect. 3. Ibuprofen is given via the parenteral route. 4. Ibuprofen can be administered in high doses.

2. Ibuprofen has an antiprostaglandin effect.

The nurse should warn a client who is about to receive Methergine (ergonovine) of which of the following side effects? 1. Headache. 2. Nausea. 3. Cramping. 4. Fatigue.

3. Cramping.

A postpartum woman is Rho(D)-negative and needs an injection of Rho(D) immune globulin. Which of the following doses would the perinatal nurse expect to be ordered?

300 µg

The postpartum client tells the nurse that she has pain when she breastfeeds. The nurse identifies that the infant has poor latch during breastfeeding. Which breast appearance shows that the client is experiencing symptoms associated with poor latch?

4) this graphic shows breasts that have reddened nipples, one of which is cracked. if proper latch is not obtained during breastfeeding, the newborn's sucking may cause nipple cracking, blistering and bleeding

A client informs the nurse that she intends to bottle feed her baby. Which of the following actions should the nurse encourage the client to perform? Select all that apply. 1. Increase her fluid intake for a few days. 2. Massage her breasts every 4 hours. 3. Apply heat packs to her axillae. 4. Wear a supportive bra 24 hours a day. 5. Stand with her back toward the shower water

4. Wear a supportive bra 24 hours a day. 5. Stand with her back toward the shower water

A patient is being dismissed after giving birth and having a hematoma drained in the operating room. What action by the patient best indicates to the nurse that outcomes for the diagnosis of risk for altered attachment have been met?

Administer oxygen

The perinatal nurse routinely screens pregnant women for postpartum depression. Which woman does the nurse screen as the priority?

Adolescent

A nurse is caring for a client who is 2 days postpartum, is breastfeeding, and reports nipple soreness. Which of the following measures should the nurse suggest to reduce discomfort during breastfeeding? (Select all that apply.)

Apply breast milk to the nipples before each feeding Start breastfeeding with the nipple that is less sore Change the infant's position on the nipples

A woman complains of perineal pain. The nurse assesses swelling, but sees no other abnormalities. The woman does not wish pharmacological treatment. What suggestion by the nurse is most appropriate?

Applying a covered ice pack to the perineum every 2 to 4 hours for 20 minutes

An adolescent has vaginally given birth to a healthy baby. What action by the nurse would be most important in developing a plan to help this mother bond successfully?

Ask the mother about her expectations of the baby and their relationship.

A new mother is accompanied by her mother during her hospital stay on the postpartum unit. The patient's mother has made specific various requests of the nurses, including asking for a bottle so she can feed the baby after the new mother attempts to breastfeed for the first time. How would the perinatal nurse best respond to the patient's mother in a culturally sensitive way?

Ask the patient what she knows about breastfeeding and provide information to both women to support the patient's decision.

A postpartum woman is in the perinatal clinic for a routine follow-up visit with her new infant. The patient seems agitated by the questions the nurse is asking and often looks up at the ceiling apprehensively. What action by the nurse is best?

Ask the woman if she is hearing voices.

The perinatal nurse recognizes that which common organism is responsible for postpartum infection manifesting with scant, odorless lochia?

Beta-hemolytic streptococcus

As part of a research study on deep vein thrombosis (DVT), a perinatal nurse is collecting blood samples in women at highest risk for factor V Leiden mutation. Which woman would the nurse approach as the priority?

Caucasian American

The perinatal nurse is aware that a key factor contributing to suboptimal outcomes for pregnant women and their families is which of the following?

Delayed communication between health-care provider call groups

The perinatal nurse listens as the patient describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist the patient in doing which of the following?

Developing more positive feelings about her labor and birth

A mother brings her 3-month-old baby to the clinic for a well-baby check. She appears exhausted and when the nurse questions her, the mother explains that she feels that she is the only person who can look after and care for her infant properly, so all of her time is devoted to this task. The nurse should document which of the following?

Difficulty with letting-go, as evidenced by excluding her partner from infant care

A nurse on the labor and delivery unit is caring for a patient who is having induction of labor with oxytocin administered through a secondary IV line. Uterine contractions occur every 2 min, last 90 sec, and are strong to palpation. The baseline fetal heart rate is 150/min, with uniform decelerations beginning at the peak of the contraction and a return to baseline after the contraction is over. Which of the following actions should the nurse take?

Discontinue the infusion of the IV oxytocin.

A nurse is caring for a client who is 1 hr postpartum and observes a large amount of lochia rubra and several small clots on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following actions should the nurse take?

Document the findings and continue to monitor the client.

A nurse is caring for a newborn immediately following birth. After assuring a patent airway, what is the priority nursing action?

Dry the skin.

A nurse assesses a woman's temperature 6 hours after a vaginal birth and finds it to be 100.4°F (38°C). What action by the nurse is best?

Encourage the woman to drink plenty of fluids.

A postpartum woman is about to be dismissed with her baby when she reveals to the nurse that she is homeless and has nowhere to go. What action by the nurse is most appropriate?

Enlist social work to find a shelter that will take them.

A nurse on the labor and delivery unit is caring for a client who is having a difficult, prolonged labor with severe backache. Which of the following contributing causes should the nurse identify?

Fetal position is persistent occiput posterior.

A nurse is caring for a client who is postpartum and received methylergonovine. Which of the following findings indicates that the medication was effective?

Fundus firm to palpation

A nurse is assessing a client who is 8 hr postpartum and multiparous. Which of the following findings should alert the nurse to the client's need to urinate?

Fundus three fingerbreadths above the umbilicus

A new mother is concerned that her 3-year-old child is not adapting well to the birth of a new sibling 1 month ago. What suggestion can the nurse provide to best help this mother?

Give the 3-year-old a special chore that only she does to help her mom.

A woman is 1 day post-cesarean birth. The nurse auscultates crackles in her lung bases. Which action by the nurse is best?

Have the woman use her incentive spirometer.

A patient is being dismissed after giving birth and having a hematoma drained in the operating room. What action by the patient best indicates to the nurse that outcomes for the diagnosis of risk for altered attachment have been met?

Holds and comforts the infant when fussy

A nurse is caring for a client who is postpartum who asks the nurse when her breast milk will "come in." Which of the following responses should the nurse make?

In 3 to 5 days

A nursing student is preparing to give a pregnant woman heparin for a deep vein thrombosis (DVT). The student questions the dose, as it is higher than what the student has given to other patients. What response by the perinatal nurse is most appropriate?

Inform the student that physiological changes in pregnancy require higher doses.

A nurse is assisting a postpartum woman to get up for the first time after an unmedicated vaginal birth. What action by the nurse is best?

Instruct the woman to sit on the edge of the bed prior to standing.

A perinatal nurse is conducting an initial interview and assessment on a new patient in her first trimester of an unplanned pregnancy. The nurse discovers the patient was a victim of child abuse and her husband has left her and returned several times. The nurse should assess this patient for what other issue as the priority?

Intimate partner abuse

A nurse is caring for a patient on heparin for a deep vein thrombosis (DVT) and realizes that the patient has received an overdose of the medication. When contacting the physician, what orders does the nurse anticipate?

Laboratory draw for aPTT; administer protamine sulfate.

A nurse has brought a newborn to his mother's room. What action by the nurse takes priority?

Matching the information on the mother's and baby's wristbands

Two days after an uncomplicated vaginal birth, the nurse notes that the patient's hemoglobin is 13 mg/dL and the hematocrit is 48%. What does the nurse conclude about these values?

Normal for this situation

A postpartum patient is hemorrhaging despite receiving several medications and fundal massage. What action by the nurse takes priority?

Obtain informed consent for surgery.

A nurse is caring for a patient who has excessive blood loss post-delivery from uterine atony. The perinatal nurse notifies the health-care provider while another nurse performs uterine massage. Which medication does the nurse anticipate to be given as the priority?

Oxytocin (Pitocin)

A nurse in the labor and delivery unit is caring for a client who is undergoing external fetal monitoring. The nurse observes that the fetal heart rate begins to slow after the start of a contraction and the lowest rate occurs after the peak of the contraction. Which of the following actions should the nurse take first?

Place the client in the lateral position.

A nurse is assessing a patient for a perineal hematoma. Which action by the nurse is most appropriate?

Place the patient in a side-lying position and lift the upper buttock.

A postpartum woman has a deep vein thrombosis. The patient states, "I feel anxious and have some pain in my chest." The patient's respiratory rate is 28 breaths per minute. The perinatal nurse should prepare to respond to which of the following conditions?

Pulmonary embolus

A nurse is caring for a client who is 1 day postpartum and is taking a sitz bath. To determine the client's tolerance of the procedure, which of the following assessments should the nurse perform?

Pulse rate

A nurse is caring for a client who is breastfeeding her newborn and asks the nurse about the changes she should make in her diet. Which of the following dietary changes should the nurse suggest?

Reduce her intake of iron.

A woman with a deep vein thrombosis (DVT) is receiving IV heparin therapy. Which nursing diagnosis does the nurse address as the priority?

Risk for injury

A perinatal nurse receives reports from the nurse aide on four patients who all gave birth within the last 4 hours. Which patient should the nurse assess first?

Systolic blood pressure change from 132 to 110 mm Hg

A woman had a cesarean birth after a prolonged trial of labor. When assessing the patient, the nurse notes the patient is lethargic, has a pulse of 130 beats/minute, and states: "I'm glad I have so little lochia; I'm too tired to change my pad." What action by the nurse is most appropriate?

Take a full set of vital signs and call the provider.

The perinatal nurse observes the new mother watching her baby daughter closely, touching her face, and asking many questions about infant feeding. This is best described as which stage of mothering?

Taking charge

A woman is being treated for endometritis after a cesarean birth. To prevent a possible complication, what action by the nurse is best?

Teach her to splint her abdominal incision when coughing.

A nurse on the labor and delivery unit is caring for a client following a vaginal examination by the provider which is documented as: -1. Which of the following interpretations of this finding should the nurse make?

The presenting part is 1 cm above the ischial spines.

A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. Which of the following vessels should the nurse expect to observe in the umbilical cord?

Two arteries and one vein

A nurse is caring for a client who is 5 hr postpartum following a vaginal birth of a newborn weighing 9 lb 6 oz. (4252 g). The nurse should recognize that this client is at risk for which of the following postpartum complications?

Uterine atony

The perinatal nurse demonstrates the correct technique of postpartum uterine palpation for a student nurse. The nurse explains that support for the lower uterine segment is critical, because without it there is an increased risk of which complication?

Uterine inversion

The perinatal nurse teaches the postpartum woman about warning signs regarding the development of postpartum infection. The nurse teaches that fever and which of the following symptoms need to be assessed by a health-care provider?

Uterine tenderness

The perinatal nurse is teaching the patient about breastfeeding and explains that which of the following is the most appropriate time to breastfeed?

When her infant is in a quiet alert state

The nurse has taught a newly admitted patient to the postpartum unit about pericare. Which of the following indicates that the client understands the procedure? (SELECT ALL THAT APPLY). a. The client uses her peri-bottle each time she goes to the bathroom to void/stool. b. The client applies a fresh peri-pad after each void/stool c. The client wipes from back to front after voiding. d. The client washes her hand after the procedure. e. The woman mixes warm tap water with hydrogen peroxide in the peri-bottle.

a, b, d

The nurse is assigned to care for 4 new mothers on the postpartum floor. The nurse knows that the patient who is most likely to have the most painful after-birth pains is: a. G4P3 breastfeeding mom b. G1P0 bottle-feeding mom c. G1P0 who delivered a 5lb 6oz baby d. G1P0 who delivered 5 lb. twin boys and is bottle feeding

a. G4P3 breastfeeding mom

Which of the following vital sign changes should the nurse highlight for a pregnant women's obstetrician? a. Prepregnancy blood pressure (BP) 100/60 and third trimester 140/90 b. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 20 rpm c. Prepregnancy heart rate (HR) 76 bpm and third trimester 88 bpm d. Prepregnancy temperature (T) of 98.6 F and third trimester T 99.0 F

a. Prepregnancy blood pressure (BP) 100/60 and third trimester 140/90

The client who has decided to breast feed her baby has just delivered her newborn baby girl and is in recovery. Which of the following maternal hormones will increase sharply postpartum in order for the production of milk to occur? a. Prolactin b. Estrogen c. Progesterone d. Human chorionic gonadotropin

a. Prolactin

A woman 48 hours postpartum is complaining of profuse diaphoresis at night. She has no other complaints of discomfort. Which of the following actions by the nurse is most appropriate? a. Reassure the woman this is normal. b. Take the woman's temperature. c. Advise the woman to decrease her fluid intake. d. Notify the newborn's pediatrician.

a. Reassure the woman this is normal.

An 8-week gestation patient is being seen in the clinic for her first visit. She asks the nurse when her blood sugar will be tested to make sure she is not diabetic. The nurse should tell the patient which of the following? a. The Glucose Challenge test is done between the 24th-28th week of gestation b. the Glucose Challenge test will be done at the next visit. c. The three hour Glucose Tolerance Test (OGTT) will be done at 20 weeks gestation. d. The Glucose Challenge test is performed at 36 weeks gestation.

a. The Glucose Challenge test is done between the 24th-28th week of gestation

A newly pregnant patient calls into the clinic complaining of ptyalism that is bothersome. The nurse recognizes this as ptyalism and recommends which of the following? a. Wear supportive hose b. Chew gum c. get plenty of rest d. Use acetaminophen if approved

b. Chew gum

The nurse notes the following findings in a 14-week-gestation patient. Which of the findings would be considered a positive sign of pregnancy? a. Positive pregnancy test b. Fetal heart rate via Doppler c. Positive Chadwicks sign d. Ballottment

b. Fetal heart rate via Doppler

A pregnant woman is seen for her first visit in the clinic. She states that she has a son who is 10 years old that was born at 39 weeks gestation, a daughter who is 8 years old that was born at 36 weeks gestation, a set of twin girls who are three years old born at 34 weeks gestation and a history of two miscarriages. The nurse notes the patient's GTPAL as: a. G5 2213 b. G6 1224 c. G6 1324 d. G7 2224

b. G6 1224

The nurse in the obstetric clinic received a telephone call from a bottle-feeding mother of a 4 day old baby girl. The client stated that her breasts are firm, red, and very shiny. Which of the following is the best action for the nurse to advise the client to perform? a. Apply lanolin to her breasts and nipples every 3 hours. b. Intermittently apply ice packs to the axillae and breast regions or cabbage leaves c. Manually express all milk in the breasts every 3 hours. d. Ask the primary health care provider to order a pill to stop milk production.

b. Intermittently apply ice packs to the axillae and breast regions or cabbage leaves

The nurse has received an order for an early discharge for a patient that delivered a few hours ago. The assessment that is most concerning over an early discharge is: a. Patient expresses lack of confidence with infant bathing. b. Patient's fundus is boggy. c. Patient has moderate amount rubra lochia. d. Patient has perineal redness and edema

b. Patient's fundus is boggy.

The nurse is providing care to a woman who is experiencing nausea and vomiting in her first trimester. Which of the following would be included in the education related to alleviating this symptom? a. Drink plenty of fluids with your meals. b. Eat 3 large meals plus a bedtime snack each day. c. Eat dry crackers before getting out of bed. d. Brush your teeth first thing in the morning.

c. Eat dry crackers before getting out of bed.

The nurse receives the following report on a newly delivered client: 21 years of age; married; G1P1001; Spontaneous vaginal delivery with no episiotomy or lacerations; vitals: 99.0F, 88, 16, 120/70; fundus firm at umbilicus with moderate rubra lochia; ambulated to the bathroom to void 4 times; breastfeeding every two hours. Which of the following nursing diagnoses should the nurse include in this client's care plan? a. Fluid volume deficit r/t excess blood loss b. impaired skin integrity r/t vaginal delivery c. Knowledge deficit r/t lack of parenting experience d. Impaired urinary elimination r/t excessive output

c. Knowledge deficit r/t lack of parenting experience

A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following? a. Use a nipple shield at each breastfeeding b. Clean the nipples with soap three times a day c. Rotate the baby's position at each feeding d. Bottle feed for two days and then resume breastfeeding

c. Rotate the baby's position at each feeding

The nurse is explaining the hormones of pregnancy to the nursing students and states that which of the following is responsible for maintaining the pregnancy? a. estrogen b. human chorionic gonadotropin c. progesterone d. oxytocin

c. progesterone

The new mom is tearful and wonders if this is a sign of postpartum depression? The nurse correctly answers: a. "Yes, being tearful in the hospital on postpartum day 3 is one of the signs of postpartum depression." b. No, but it is unusual for you to be so emotional so quickly." c. "I will get the doctor to order you an antidepressant." d. "No, this is normal and is known as the postpartal "baby blues".

d. "No, this is normal and is known as the postpartal "baby blues".

A 15-week gestation patient should have a fundal height that is palpable to the nurse at what anatomical location? a. At the level of the umbilicus b. At the xiphoid process c. Two centimeters above the umbilicus d. Between the umbilicus and the symphysis pubis

d. Between the umbilicus and the symphysis pubis

What is the most important assessment in the immediate postpartum period for the nurse to make? a. Maternal vital signs b. Breast feeding potential c. Bladder assessment d. Fundal assessment

d. Fundal assessment

A mother has just experienced quickening. Which of the following developmental changes would the nurse expect to occur at the same time in the woman's pregnancy? a. Fetal heart begins to beat b. Coagulations factors are synthesized in the liver c. Meconium is passed d. Lanugo covers the body

d. Lanugo covers the body

A gravid client is being seen for the first time in the clinic. She states that the first day of her LMP was February 3rd. The nurse calculates the patient's EDD as: a. January 10 b. November 1 c. August 12 d. November 10

d. November 10

A primipara that delivered two hours ago requests that the nurse take care of the baby in the nursery so that she can get a nap. Based on this information, the nurse concluded that the woman is exhibiting signs of which of the following? a. Poor bonding b. Letting Go Stage c. Postpartum Depression d. Taking-In Stage

d. Taking-In Stage

A LPN asks an RN to assist in locating the fundus of the client who is 8 hours post-vaginal delivery. Place an X at the location on the client's abdomen where the RN should direct the LPN to begin to palpate the fundus

the top one 6 to 12 hours after birth, the fundus of the uterus rises to the level of the umbilicus due to blood and clots that remain within the uterus and changes in ligament support. thus the RN should direct the LPN to locate the client's fundus at the level of the umbilicus

A nurse is caring for a client who is postpartum. The nurse should recognize which of the following statements by the client as an indication of inhibition of parental attachment?

"I wish he had more hair. I will keep a hat on his head until he grows some."

A woman with postpartum depression resists treatment, saying: "Who cares if I'm depressed? It only affects me." What response by the nurse is best?

"Infants of depressed mothers have delayed development."

A husband calls the perinatal clinic because he is worried about his wife's emotional state after giving birth 2 weeks ago. Which question by the nurse would be most helpful?

"Is your wife still able to care for herself and the baby?"

A nurse is observing a student nurse prepare a sitz bath. Which actions should be performed by the student? (Select all that apply.)

-Confirm that the patient can ambulate to the bathroom. -Help the patient remove the peri-pad from front to back. -Ensure that the patient is covered enough to prevent chilling.

The delivery nurse is reporting to the postpartum nurse about the client who just delivered her first baby, a term newborn. Which number should the delivery nurse report for the client's parity? __________ Parity (record your answer as a whole number)

1 Parity refers to the number of births after 20 weeks' gestation

The client delivered a healthy newborn 4 hours ago after being induced with oxytocin. While being assisted to the bathroom to void for the first time after delivery, the client tells the nurse that she doesn't feel a need to urinate. Which explanation should the nurse provide when the client expresses surprise after voiding 900 mL of urine? 1) a decreased sensation of bladder filling is normal after childbirth 2) the oxytocin you received in labor makes it difficult to feel voiding 3) you probably didn't empty completely. I will need to scan your bladder. 4) your bladder capacity is large; you likely wont void again for 6 to 8 hours

1) a decreased sensation of bladder filling is normal after childbirth The nurse should explain about the decreased sensation of bladder filling after childbirth. it is not uncommon for the postpartum client to have increased bladder capacity, decreased sensitivity to fluid pressure, and a decreased sensation of bladder filling.

The husband of the postpartum client diagnosed with moderate postpartum depression asks the nurse about the treatments his wife will require. The nurse's response should be based on knowing that which treatment's are included in the initial collaborative plan of care? select all that apply. 1) antidepressant medication 2) individual or group psychotherapy 3) removal of the infant from the home 4) sedative-hypnotic agents 5) electroconvulsive therapy (ECT)

1) antidepressant medication 2) individual or group psychotherapy SSRIs are first-line agents for treating moderate PPD individual or group psychotherapy is a treatment for moderate PPD

The client delivered vaginally six hours ago, and is upset about bleeding too much. She shows the nurse the peri-pad that was just removed. What should the nurse do first? 1) ask her how long she has been wearing this pad 2) notify the HCP of this increased amount of lochia 3) prepare to give oxytocin to decrease bleeding 4) document the finding; this amount is normal

1) ask her how long she has been wearing this pad while a constant trickle or oozing of lochia would indicate excessive bleeding, the nurse would need to first know how long the client had been wearing the peri-pad to evaluate whether the amount was excessive. The client should not be saturating a large peri-pad every hour. If the client had been wearing the same pad for 3 or 4 hours, it may indicate an expected amount of lochia

The RN and the student nurse are caring for a postpartum client who is 16 hours post-delivery. The RN evaluates that the student needs more education about uterine assessment when the student is observed doing which activity? 1) elevating the clients head 30 degrees before doing the assessment 2) supporting the lower uterine segment during the assessment 3) gently palpating the uterine fundus for firmness and location 4) observing the abdomen before beginning palpation

1) elevating the clients head 30 degrees before doing the assessment For the uterine assessment, the client should be positioned in a supine position so the height of the uterus is not influenced by an elevated position

The client diagnosed with preeclampsia is receiving a magnesium sulfate infusion and delivered vaginally. Despite oxytocin and fundal massage, the client is experiencing heavy bleeding. Which medication should the nurse expect to administer? 1. Carboprost tromethamine 2. Methylergonovine 3. Calcium gluconate 4. Ritodrine

1. Carboprost tromethamine Carboprost tromethamine (Hemabate) is a synthetic prostaglandin that can decrease uterine bleeding postpartum by stimulating contractions

The nurse is teaching the early postmenopausal client who is prescribed short-term systemic estrogen hormones about the benefits of this therapy. Which information should the nurse include in the teaching? (Select all that apply) 1. Therapy can reduce hot flashes and night sweats 2. Therapy can aid in the prevention of osteoporosis 3. Therapy can reduce vaginal dryness and dyspareunia 4. Therapy decreases the risk of blood clots and stroke 5. Therapy decreases memory loss and Alzheimer's disease

1. Therapy can reduce hot flashes and night sweats 2. Therapy can aid in the prevention of osteoporosis 3. Therapy can reduce vaginal dryness and dyspareunia Short-term systemic estrogen therapy can help reduce hot flashes and night sweats in postmenopausal clients The FDA approves of estrogen therapy for the prevention of osteoporosis Estrogen therapy can reduce vaginal dryness and dyspareunia in postmenopausal clients

The client with gestational diabetes asks the nurse, "Why do I have to take shots? Why can't I take a pill?" Which statement is the nurse's best response? 1. "The shots will help keep your blood glucose level down better." 2. "Pills may hurt the development of the baby in your womb." 3. "Insulin will help prevent you from having the baby too early." 4. "Pills for diabetes may delay the baby's lung development."

2. "Pills may hurt the development of the baby in your womb." Oral hypoglycemic are not used during pregnancy because they cross the placental barrier; they stimulate fetal insulin production and may be teratogenic

A client who delivered a 3,900-gram baby vaginally over a right mediolateral episiotomy states, "How am I supposed to have a bowel movement? The stitches are right there!" Which of the following is the best response by the nurse? 1. "I will call the doctor to order a stool softener for you." 2. "Your stitches are actually far away from your rectal area." 3. "If you eat high-fiber foods and drink fluids you should have no problems." 4. "If you use your topical anesthetic on your stitches you will feel much less pain."

2. "Your stitches are actually far away from your rectal area."

During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see? 1. Diaphoresis. 2. Lochia alba. 3. Cracked nipples. 4. Hypertension.

2. Lochia alba.

The client is experiencing postpartum hemorrhage and has received methylergonovine. Which intervention is the priority when administering this medication? 1. Check the client's hemoglobin (Hgb) and hematocrit (Hct) levels 2. Monitor the client's peripad count frequently 3. Assess the client's vital signs every 2 hours 4. Determine the client's fundal height

2. Monitor the client's peripad count frequently Monitoring the client's peripad count will allow the nurse to directly assess how much the client is bleeding, which will help determine if methylergonovine (Methergine) is effective

The third stage of labor has just ended for a client who has decided to bottle feed her baby. Which of the following maternal hormones will increase sharply at this time? 1. Estrogen. 2. Prolactin. 3. Human placental lactogen. 4. Human chorionic gonadotropin.

2. Prolactin.

The pregnant client experienced a deep venous thrombosis (DVT) with her previous pregnancy. Which medication should the nurse question administering to this client? (Select all that apply) 1. Unfractionated heparin 2. Warfarin 3. Enoxaparin 4. Rivaroxaban 5. Dabigatran

2. Warfarin 4. Rivaroxaban 5. Dabigatran Warfarin (Coumadin) is contraindicated in pregnancy because of teratogenic effects. It is safe to use postpartum and during lactation Rivaroxaban (Xarelto), an oral direct factor Xa inhibitor, is contraindicated in pregnancy because of the risk of fetal hemorrhage, malformations, and death Dabigatran (Pradaxa), a direct thrombin inhibitor, is contraindicated in pregnancy because of teratogenic effects

twenty-four hours after the birth of her first child, the 25 y/o single client tells the nurse that she has several different male sex partners and asks the nurse to recommend an appropriate birth control method for her. Considering her lifestyle, which method of birth control should nurse suggest? 1) an intrauterine device (IUD) 2) depot-medroxyprogesterone acetate injection 3) a female condom with nonoxynol-9 4) a diaphragm

3) a female condom with nonoxynol-9 a female condom does provide protection against some of the pathogens that cause STIs, and it would be readily available over the counter

The nurse is caring for the preterm infant in the NICU who is prescribed aminoglycosides and loop diuretics. Which adverse reaction can occur from the combination of these two types of medications? 1. Blindness 2. Intellectual delays 3. Hearing loss 4. Skin rash

3. Hearing loss Ototoxicity can be an adverse reaction to aminoglycosides. Loop diuretics increase the risk of ototoxicity. The extent of hearing loss varies and may be irreversible

The 56-year-old female client tells the nurse that she is taking a herb Angelica sinensis (dong quai). Which data indicates to the nurse this medication is effective? 1. The client has normal menstrual cycles 2. The client does not have abdominal bloating 3. The client reports fewer hot flashes 4. The client has a normal bone density test

3. The client reports fewer hot flashes Dong quai is used for menopausal symptoms and premenstrual syndrome, but because the client is 56 years old the nurse should consider the medication effective when there is a lack of menopausal symptoms

. A client has just been transferred to the postpartum unit from labor and delivery. Which of the following nursing care goals is of highest priority? 1. The client will breastfeed her baby every 2 hours. 2. The client will consume a normal diet. 3. The client will have a moderate lochial flow. 4. The client will ambulate to the bathroom every 2 hours

3. The client will have a moderate lochial flow.

After delivering the full-term infant, the breastfeeding mother asks the nurse if there is any contraceptive method that she should avoid while she is breastfeeding. Which contraceptive should the nurse advise the client to avoid? 1. A diaphragm 2. An intrauterine device (IUD) 3. The combined oral contraceptive (COC) pill 4. The progesterone-only mini pill

3. The combined oral contraceptive (COC) pill Birth control pills containing progesterone and estrogen (COC) can cause a decrease in milk volume and may affect the quality of the breast milk

A perinatal clinic nurse develops concerns about a postpartum woman and her infant at the first well-baby checkup. The nurse has assessed several risk factors for depression. Which action by the nurse is most appropriate?

Administer the Edinburgh Postnatal Depression Scale.

A patient has been transferred to an intensive care unit (ICU) after experiencing a pulmonary embolus. The patient is stable 24 hours later, but will remain in the unit for another day or two. At this time, the priority for the perinatal nurse is to provide the family with information about infant care and what other action?

Advocate for infant visitation and breast pumping in the ICU if desired by the patient.

A postpartum patient is ready for discharge from the hospital with her baby. She describes having some "sad feelings" after her last baby. The perinatal nurse explains that she should seek help in which situation?

After 2 weeks of continuous sad feelings

A woman gave birth 12 hours ago. The patient complains of severe abdominal cramping when she breastfeeds her infant. The perinatal nurse should document this condition as which of the following?

Afterpains

A woman is being taken to the operating room later in the day for incision and drainage of a large perineal hematoma. What action by the nurse is most important to meet the patient's psychosocial needs?

Allow the woman to make choices when possible.

The perinatal nurse and student nurse are conducting an assessment on a postpartal woman. The nurse demonstrates percussion of the bladder. They hear a dull, thudding sound. How should the nurse document this information?

An empty bladder

A nurse is caring for a client who is considering several methods of contraception. Which of the following methods of contraception should the nurse identify as being most reliable?

An intrauterine device (IUD)

A nurse is reviewing the health history of a client who has a new prescription for a combined oral contraceptive (COC). The nurse recognizes that which of the following client medications can interfere with the effectiveness of the COC?

Anticonvulsants

A postpartum woman presents to the perinatal clinic complaining of extreme breast tenderness and an inability to express milk on the left side when breastfeeding. What nonpharmacological comfort measure does the nurse teach this patient?

Application of either warm or cold packs

Approximately 8 hours ago, a woman gave birth after 2.5 hours of pushing. She required an episiotomy and an assisted birth (forceps). The perinatal nurse assesses a slight bulge in the perineum and the presence of ecchymosis to the right of the episiotomy. The area feels "full" and is approximately 4 cm in diameter. The patient describes this area as "tender." What intervention does the nurse anticipate for this situation?

Application of ice

A woman had a cesarean birth 2 hours ago. She now complains of being hungry and wants something to eat. What action by the nurse is best?

Assess for bowel sounds and ask if she is passing gas.

A postpartum woman is complaining of a headache that is worsening despite having taken Tylenol (acetaminophen) an hour ago. She delivered yesterday with epidural anesthesia. What action by the nurse is best?

Assess if the pain is worse when she sits upright.

A nurse is caring for a woman after a cesarean birth. Prior to ambulating her for the first time, which action by the nurse takes priority?

Assess sensation in the lower extremities.

A nurse assessing a postpartum woman 12 hours after uncomplicated vaginal birth finds her pulse to be 110 beats/minute. What action by the nurse is best?

Assess the patient for causes of tachycardia.

A woman with a history of mild heart failure has just vaginally given birth to a healthy baby. What action by the nurse is most important?

Assess the woman for signs of heart failure.

A postpartum woman who had a cesarean birth complains of warmth and pain in one of her calves. Which assessment should the nurse perform as the priority?

Bilateral calf circumference

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?

Changes in the cervix

The perinatal nurse describes the need for an assessment for deep vein thrombosis (DVT) in the postpartum patient. Which of the following is one test that can be used as a screening measure for DVT?

Homans' sign

A nurse is teaching a client who is postpartum and has a new prescription for an injection of Rho (D) immunoglobulin. Which of the following should be included in the teaching?

It prevents the formation of Rh antibodies in mothers who are Rh negative.

A patient is receiving methylergonovine (Methergine) after a vaginal birth. What assessment finding by the nurse warrants immediate intervention?

Palpitations

A woman with postpartum depression is in the perinatal clinic for follow-up. The health-care provider tells the nurse that the patient will be prescribed a tricyclic antidepressant. The nurse will instruct the patient about which medication?

Pamelor (Nortriptyline)

A patient was discharged from the hospital on warfarin sodium (Coumadin) and is now in the perinatal clinic for follow-up. Which of the following would best indicate to the nurse that goals for discharge teaching have been met?

Patient INR of 2.5

The perinatal nurse administers heparin as ordered to the postpartum woman with newly diagnosed deep vein thrombosis. The patient asks about the purpose of the medication. Which response by the nurse is best?

Prevents extension of the clot and new clot formation

A breast-feeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective? a. She pumps her breasts after each feeding. b. She feeds her baby on each side for 5 minutes. c. She feeds her baby every 2-3 hours. d. She supplements each feeding with formula.

c. She feeds her baby every 2-3 hours.

A gravida's fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in pregnancy? a. Lanugo covers the entire body b. Insulin is produced for the first time c. Surfactant is formed d. Respiratory movements begin

c. Surfactant is formed

A 3-day-breastfeeding client who is not immune to rubella is to receive the rubella vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine? a. The woman should pump and dump her breast milk for 1 week. b. surgical masks must be worn by the mother when she holds the baby. c. Antibodies transported through the breast milk will protect the baby. d. The woman should not become pregnant for at least 4 weeks.

d. The woman should not become pregnant for at least 4 weeks.

A nursing student who once lived in the southwest was overheard making disparaging comments about Hispanic immigrants, stating: "They only come here for free medical care." What response by the nursing faculty member is best?

"Research actually shows that most immigrants come to find work."

A diabetic patient is 1 day postpartum after an uncomplicated vaginal birth. She wants to know why her blood sugar levels are so much lower than usual. What explanation by the nurse is best?

"The levels of hormones that cause an anti-insulin effect are decreased."

The perinatal nurse explains to students that certain groups of women are less likely to breastfeed. Which of the following women would the nurse identify as needing extra education, support, or encouragement to breastfeed? (Select all that apply.)

-African American -Those who participate in federal nutrition programs

A postpartum woman who had a prolonged labor presents to the clinic complaining of abdominal pain, high fevers with chills, and back pain. The nurse notes the patient's heart rate is 142 beats/minute, and her abdomen is tender with hypoactive bowel sounds. The patient will be admitted, and when giving report to the hospital nurse, the clinic nurse advises that the patient will probably receive what initial treatment? (Select all that apply.)

-Antibiotics -Forced fluids -Heparin -Ibuprofen (Motrin)

A nurse is caring for a woman who just experienced a cesarean birth under epidural anesthesia. What interventions are important to include on this woman's care plan? (Select all that apply.)

-Apply compression stockings or sequential compression devices. -Encourage ankle exercises while the woman remains in bed. -Maintain bedrest until sensation returns to the woman's legs.

A nurse uses the acronym REEDA to perform a perineal assessment on a postpartum woman. What are the components of this exam? (Select all that apply.)

-Approximation of the episiotomy -Drainage or discharge -Ecchymosis -Redness

The nurse is assessing a woman in the immediate postpartum period. The patient's respiratory rate is 22 breaths/minute. The most important aspects of nursing care would be to do which of the following? (Select all that apply.)

-Assess and provide pain management. -Assess the patient's blood pressure and pulse. -Notify the provider for continued tachypnea. -Provide ongoing physical assessment.

A perinatal nurse is teaching a woman who is in a violent relationship about safety-promoting behaviors. Which of the following does the nurse include in teaching? (Select all that apply.)

-Begin hiding money and an extra set of keys. -Find and safely store important documents. -Photocopy and save utility and rent receipts. -Remove weapons or bullets from the home.

The perinatal nurse is teaching the new mother who has chosen to formula-feed her infant. Which of the following are appropriate instructions to give the parents? (Select all that apply.)

-Discard any unused formula in the bottle following use. -Periodically check the nipple for slow flow.

The postpartum nurse is aware that following childbirth there is an increased risk of maternal perineal infection related to which of the following factors? (Select all that apply.)

-Drainage of blood and lochia -Impaired tissue integrity -The anatomical proximity to the anus -Urinary retention

The perinatal nurse explains risk factors for hematoma formation to a group of nursing students. What risk factors does the nurse include in the teaching? (Select all that apply.)

-Episiotomy -Genital tract laceration -Prolonged second stage of labor

The perinatal nurse teaches the postpartum woman about the normal process of diuresis that she can expect to occur approximately 6 to 8 hours after childbirth. Which hormones are responsible for the diuresis? (Select all that apply.)

-Estrogen -Oxytocin

The nursing faculty member who is explaining uterine atony to nursing students informs them of risk factors contributing to this condition. Which factors would place a woman at higher risk of uterine atony? (Select all that apply.)

-Forceps-assisted birth -Multi-fetal gestation -Oxytocin labor induction -Use of magnesium sulfate

A woman is hospitalized emergently for postpartum psychosis. For which of the following does the nurse prepare the patient as initial treatment? (Select all that apply.)

-Lithium (Lithobid) -Chlorpromazine (Thorazine) -Diazepam (Valium)

A nurse manager in the perinatal clinic wants to begin screening male partners for risk factors for committing intimate partner abuse. What risk factors does the manager include on the new screening form? (Select all that apply.)

-Low income -Male-dominant family structure -Unemployment -Young age

The perinatal nurse describes infant feeding cues to a new mother. These feeding cues include which of the following behaviors? (Select all that apply.)

-Mouth movements -Moving the hand to the mouth -Vocalizations

A patient is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? (SELECT ALL THAT APPLY). a. Shortness of breath b. Urinary frequency c. Nasal stuffiness d. Back pain e. Nausea and vomiting

...

An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? Select all that apply. A) Amenorrhea. B) Breast tenderness. C) Quickening. D) Frequent urination. E) Uterine growth.

...

The patient who is 28 weeks gestation will receive Rhogam at this visit if which of the following conditions are present? a. Mother is B negative blood type and the Indirect Coombs is positive. b. Mother is A positive blood type and the Indirect Coombs is negative. c. Mother is A negative blood type and Father is B positive blood type. d. Mother is A negative blood type and Indirect Coombs is negative.

...

Which of the following nursing outcomes related to the nursing diagnosis, "Risk for intrauterine infection related to vaginal delivery" should be included in the plan of care? (SELECT ALL THAT APPLY). a. The client changes her peri-pad at least once a day throughout hospitalization. b. The client will use her peri-bottle after every void throughout hospitalization. c. The client will drink sufficient quantities of fluid throughout hospitalization d. The client will report that lochia is not foul-smelling throughout hospitalization. e. The client will have a normal temperature within 24 hours of delivery.

...

The nurse is preparing to administer 2 mg hydromorphone hydrochloride to the client who is 28 hours post-cesarean section. The medication available is in a concentration of 4 mg/mL. How many milliliters should the nurse administer? _________ mL (record your answer in tenths)

0.5 mL 4 mg:1 mL :: 2 mg : x mL; 4 X =2; 2 / 4 = 0.5 mL

The clinic nurse sees a patient and her infant in the clinic for their 2-week follow-up visit. The woman appears to be tired, her clothes and hair appear unwashed, and she does not make eye contact with her infant. Which question would be most appropriate for the nurse to ask?

"Tell me about the first few days at home."

A nurse is caring for a client who is beginning to breastfeed her newborn after delivery. The new mother states, "I don't want to take anything for pain because I am breastfeeding." Which of the following statements should the nurse make?

"We can time your pain medication so that you have an hour or two before the next feeding."

As a member of the health-care team, the perinatal nurse finds it helpful following a maternal emergency, such as a postpartum hemorrhage, to engage in which of the following activities? (Select all that apply.)

-A family meeting to encourage communication and understanding -Debriefing with the other staff members involved in the patient's care -Health-promoting behaviors such as adequate sleep and exercise

The perinatal nurse knows that breastfeeding is contraindicated if a mother has which of the following conditions? (Select all that apply.)

-Active herpes lesion on her nipple -Active tuberculosis

A woman is considering abandoning breastfeeding attempts because of severe afterpains. What actions by the nurse are most helpful? (Select all that apply.)

-Administer pain medication 30 minutes prior to breastfeeding. -Encourage ambulation. -Have the woman lie prone with a pillow under her stomach. -Prepare a sitz bath for the woman after she has breastfed.

The perinatal nurse teaches the student nurse that deep breathing exercises following cesarean birth are critical to the prevention of what complications? (Select all that apply.)

-Atelectasis -Pneumonia

A woman presents to the emergency department in labor and states that she is homeless and has not had prenatal care. The emergency department nurse explains to the nursing student that homeless women face many challenges to getting prenatal care, including which of the following?

-Caring for other children -Lack of insurance -Mistrust of health-care providers -Transportation difficulties

A visiting nurse is concerned that a mother has not properly bonded with her infant. The nurse should assess for what factors that could impact this process? (Select all that apply.)

-Chaotic home life -Lack of family support -Poverty -Substance abuse

A woman is hospitalized after an incision and drainage of a large breast abscess that cultured methicillin-resistant Staphylococcus aureus. What dietary choices indicate that she has understood teaching regarding nutrition and wound healing? (Select all that apply.)

-Chicken breast -Hard-boiled egg -Orange slices -Spinach

The perinatal nurse includes a pain assessment as part of the postpartum care provided to each patient. This action helps to do which of the following? (Select all that apply.)

-Decrease the recovery time -Decrease the risk of depression -Help identify complications -Improve the patient's coping ability

A nursing faculty member is explaining to a class of students that women experiencing cesarean birth have more challenges than do women who give birth vaginally. The faculty member is referring to what challenges? (Select all that apply.)

-Delayed mother-infant bonding -Increased risk of deep vein thrombosis -Pain from the surgical incision and intestinal gas -Slower initiation and pace of ambulation

The nursing faculty member explains to a class of nursing students the risk factors for developing postpartum depression (PPD). Which of the following does the faculty include? (Select all that apply.)

-Financial stress -Isolation -Low self-esteem -Unplanned pregnancy

A perinatal nurse explains to the nursing student that pregnant women have risk factors for deep vein thrombosis (DVT) as a result of their pregnancy. To which components of Virchow's triad is the nurse referring? (Select all that apply.)

-Hypercoagulability -Venous stasis

A postpartum woman has a suspected deep vein thrombosis (DVT). Which diagnostic studies does the nurse prepare the woman to possibly have? (Select all that apply.)

-Laboratory draw for D-dimer -Magnetic resonance imaging (MRI) -Venous duplex ultrasound

The client has a vaginal delivery of a full-term newborn. immediately after delivery, the nurse assesses that the client's perineum and labia are edematous, but she does not have an episiotomy or a perineal laceration. Which intervention should the nurse implement? 1) give her an ice pack to apply to the perineum 2) teach her to relax her buttocks before sitting 3) apply warm packs to the affected areas 4) provide a plastic donut cushion for sitting

1) give her an ice pack to apply to the perineum if perineal edema is present, ice packs should be applied for the first 24 hours. ice reduces edema and vulvar irritation

The nurse is caring for the client who is 28 hours postpartum. Which assessment findings should prompt the nurse to notify the HCP of possible puerperal infection? select all that apply 1) oral temp of 102.2 F 2) telangiectasis on the neck and chest 3) mild abdominal tenderness with palpation 4) lochial discharge that is foul smelling 5) white blood cells count of 16,500 cells/mm3

1) oral temp of 102.2 F 4) lochial discharge that is foul smelling a temp of 100.4 F or higher after 24 hours postpartum is associated with a puerperal infection malodorous lochia is a common sign of a puerperal infection

The student nurse reports to an experienced nurse finding a warm, red, tender area on the left calf of the client who is 48 hours post-vaginal delivery. The nurse assesses the client and explains that postpartum clients are at increased risk for thrombophlebitis due to which factors? select all that apply 1) the fibrinogen levels in the blood of postpartum clients are elevated 2) fluids normally shift from the interstitial to the intravascular space 3) postpartum hormonal shifts irritate vascular basement membranes 4) pressure is placed on the legs when elevated in stirrups during delivery 5) dilation of veins in the lower extremities occurs during pregnancy 6) compression of the common iliac vein occurs during pregnancy

1) the fibrinogen levels in the blood of postpartum clients are elevated 4) pressure is placed on the legs when elevated in stirrups during delivery 5) dilation of veins in the lower extremities occurs during pregnancy 6) compression of the common iliac vein occurs during pregnancy during pregnancy, fibrinogen levels increase, and this increase continues to be present in the postpartum period. The increased levels can contribute to clot formation elevation of the legs in stirrups during delivery leads to pooling of blood and vascular stasis dilation of the veins in the lower extremities occurs during pregnancy and increased the risk of venous stasis compression of the common iliac vein occurs during pregnancy due to an enlarging fetus and increases the risk for venous stasis

The home care nurse is visiting the mother and her 6-day-old son. The nurse observes that the infant is sleeping in a crib on his back and has a blanket draped over his body. The mother had been sleeping in a nearby room. Which statements are appropriate for the nurse to make in response to this situation? (Select all that apply) 1. "I'm glad to see that you are sleeping while your baby sleeps." 2. "Having your baby sleep on his back reduces the risk of SIDS." 3. "It is best for you to sleep in the same room as your newborn." 4. "Position your baby on his tummy and side when he is awake." 5. "When using a blanket, always tuck its sides under the mattress."

1. "I'm glad to see that you are sleeping while your baby sleeps." 2. "Having your baby sleep on his back reduces the risk of SIDS." 4. "Position your baby on his tummy and side when he is awake." This is an appropriate statement. Sleeping while the infant sleeps will help the mother get the rest she needs This is an appropriate statement. The American Academy of Pediatricians recommends the supine position for infant sleeping to decrease the risk of SIDS This is an appropriate statement. While awake, the infant should be positioned prone and side-lying to help build neck muscles and decrease the chance of deformation plagiocephaly. Deformation plagiocephaly is a malformation of the skull caused by consistently lying on the back

The nurse educates the breastfeeding client diagnosed with mastitis. The nurse evaluates that the client has an adequate understanding of how to prevent mastitis in the future when the client makes which statements? (Select all that apply) 1. "Incorrect latch of my baby can lead to mastitis." 2. "I should perform hand hygiene before I breastfeed." 3. "I should rinse my baby's mouth before I let her latch." 4. "A tight underwire bra has support that prevents mastitis." 5. "I should allow my nipples to air-dry after breastfeeding."

1. "Incorrect latch of my baby can lead to mastitis." 2. "I should perform hand hygiene before I breastfeed." 5. "I should allow my nipples to air-dry after breastfeeding." Incorrect latch can cause nipple tissue to blister, crack, and bleed. These breaks in the tissue may serve as an entry point for pathogens Hand hygiene prior to breastfeeding reduces the number of pathogens available for invasion Allowing breasts to air-dry helps to reduce skin breakdown that might be caused by a moist, wet environment

The nurse asks the 12-hour postpartum client, who is breastfeeding her baby now, why she has not yet received a dinner tray. The client states that her mother is bringing curry and that she won't be eating the hospital food tonight. Which response by the nurse is best? 1. "Please let me know if you change your mind. I can order food for you later." 2. "Because you are breastfeeding, you should avoid eating highly spiced food." 3. "I will ask the dietitian to meet with you so you can discuss your nutritional needs." 4. "You should not be eating highly spiced food 12 hours after delivery."

1. "Please let me know if you change your mind. I can order food for you later." Offering to order food later if the client changes her mind is the best response. Many clients have culturally based beliefs about food and beverages that should be consumed in the postpartum period. Unless contraindicated, nurses should support and encourage women to incorporate food preferences with cultural significance into their postpartum diet

The nurse is caring for a client who reports a decreased sexual desire. The HCP has prescribed flibanserin. Which information should the nurse discuss with the client? (Select all that apply) 1. Alcohol is contraindicated when taking flibanserin 2. This medication is only for postmenopausal women 3. This medication can be used to improve sexual performance 4. Flibanserin should be taken orally, once a day, at bedtime 5. If you miss a dose, take as soon you remember, then resume regular schedule

1. Alcohol is contraindicated when taking flibanserin 4. Flibanserin should be taken orally, once a day, at bedtime Alcohol taken with flibanserin (Addyi) can cause hypotension and syncope. The client should also avoid grapefruit juice as it can change the amount of medication that is absorbed in the body Flibanserin (Addyi) is taken orally, once a day, at bedtime. Taking flibanserin any other time increases the risk of hypotension, syncope, and accidental injury. The medication can cause drowsiness

The client who is pregnant asks the nurse, "What does category A mean if the doctor orders that medication for me?" Which statement best describes the scientific rationale for the nurse's response? 1. Category A is the safest medication a client can take when pregnant 2. Category A medications are safe as long as the client does not take them during the first trimester 3. Research has not determined if these medications are harmful to the fetus 4. This category is dangerous to the fetus, but could be prescribed in emergencies

1. Category A is the safest medication a client can take when pregnant Category A medications have a remote risk of causing fetal harm and are prescribed for clients who are pregnant

The nurse is preparing to administer erythromycin ophthalmic ointment to a newborn client. Which interventions should the nurse implement? (Select all that apply) 1. Cleanse the client's eyes before application as needed 2. Apply a thin ribbon of medication to each eye in a single dose 3. Administer from the inner canthus to the outer canthus 4. Ensure medication is given within 2 hours of birth 5. Gently rinse the eye with saline after administration

1. Cleanse the client's eyes before application as needed 2. Apply a thin ribbon of medication to each eye in a single dose 3. Administer from the inner canthus to the outer canthus The newborn's eyes should be cleaned as needed prior to application A thin ribbon of 0.5% erythromycin ointment is applied to each eye. A new ointment tube is used with each newborn to prevent the spread of infection The ointment is administered in the lower conjunctival sac beginning at the inner canthus and moving to the outer canthus

Which statement best indicates the scientific rationale for administering vitamin K to the newborn infant? 1. It promotes blood clotting in the infant 2. It prevents conjunctivitis in the infant's eyes 3. It stimulates peristalsis in the small intestines 4. It helps the digestive process in the newborn

1. It promotes blood clotting in the infant The newborn's gut is sterile and the liver cannot synthesize vitamin K (Aqua-MEPHYTON) from the food ingested until there are bacteria present in the gut

Which of the following complementary therapies can a nurse suggest to a multiparous woman who is complaining of severe afterbirth pains? 1. Lie prone with a small pillow cushioning her abdomen. 2. Contract her abdominal muscles for a count of ten. 3. Slowly ambulate in the hallways. 4. Drink ice tea with lemon or lime.

1. Lie prone with a small pillow cushioning her abdomen.

The perinatal nurse accurately defines postpartum hemorrhage to a group of nursing students by including a decrease in hematocrit levels from prebirth to postbirth by which percentage?

10%

The postpartum client is being admitted for mastitis. The nurse should prepare the client for which interventions? select all that apply? 1) walking at least four times in 24 hours 2) receiving a prescribed oral antibiotic 3) applying warm packs to the breasts 4) getting a prescribed anti-inflammatory drug 5) limited oral fluid intake to 1000 mL per day 6) emptying the milk from her breast frequently

2) receiving a prescribed oral antibiotic 3) apply warm packs to the breasts 4) getting a prescribed anti-inflammatory drug 6) emptying the milk from her breast frequently treatment for mastitis includes administration of antibiotics to treat the infection application of warm packs decrease pain and promotes milk flow and breast emptying. treatment for mastitis includes anti-inflammatory medication to treat fever and decrease breast inflammation if the breasts continue to be emptied by either breastfeeding or pumping, the duration of symptoms and the incidence of a breast abscess are decreased

when looking in the mirror at her abdomen, the postpartum client says to the nurse, "my stomach still looks like im pregnant" the nurse explains that the abdominal muscles, which separate during pregnancy, will undergo which change? 1) regain tone within the first week after birth 2) regain pregnancy tone with exercise 3) remain separated, giving the abdomen a slight bulge 4) regain tone as the weight gained during pregnancy is lost

2) regain pregnancy tone with exercise The "still pregnant" appearance is caused by relaxation of the abdominal wall muscles. With exercise, most women can regain prepregnacy abdominal muscles tone within about 6 weeks.

The female client tells the nurse that she is taking the herb Jasminum grandiflorum (jasmine) to improve her mood and decrease insomnia. Which response by the nurse is most appropriate? 1. "You should speak with your HCP about taking this herb." 2. "You should stop taking this herb immediately; it can cause miscarriages." 3. "You should take chasteberry instead to enhance infertility." 4. "No herbal supplements can increase fertility or prevent miscarriages."

2. "You should stop taking this herb immediately; it can cause miscarriages." The nurse should instruct the client to stop the herbal supplement J. grandiflorum (jasmine) immediately as it can cause miscarriage

The client experiencing infertility is receiving menotropin and human chorionic gonadotropin (HCG). Which diagnostic test indicates the medications are effective? 1. A serum HCG level 2. A serum estrogen level 3. A negative urine pregnancy test 4. A hemoglobin A1C

2. A serum estrogen level The serum estrogen level should increase three to four times the pretreatment baseline if the medications, menotropin (Pergonal), an ovarian stimulant, and HCG, are effective, and the client may be able to get pregnant

The nurse is reviewing the laboring client's fetal monitor strip. Which order by the HCP should the nurse question? 1. Initiate a saline lock or NS IV line 2. Administer butorphanol 1 mg IV push (IVP) 3. Continue oxytocin infusion via pump 4. Perform a sterile vaginal examination

2. Administer butorphanol 1 mg IV push (IVP) The client is experiencing early decelerations, which are indicative of head compression and possible imminent delivery. The nurse should question the administration of butorphanol (Stadol) because if given too close to delivery it can cause respiratory depression in the newborn

Which of the following statements is true about breastfeeding mothers as compared to bottle-feeding mothers? 1. Breastfeeding mothers usually involute completely by 3 weeks postpartum. 2. Breastfeeding mothers have decreased incidence of diabetes mellitus later in life. 3. Breastfeeding mothers show higher levels of bone density after menopause. 4. Breastfeeding mothers are prone to fewer bouts of infection immediately postpartum.

2. Breastfeeding mothers have decreased incidence of diabetes mellitus later in life.

The client, who had a forceps-assisted vaginal birth 4 hours ago, tells the nurse that she is having continuing perineal pain rated at 7 out of 10 and rectal pressure. An oral analgesic was given and ice applied to the perineum earlier. What should the nurse do now? 1. Call the HCP to report the pain 2. Closely reinspect the perineum 3. Help her out of bed to ambulate 4. Administer a stool softener

2. Closely reinspect the perineum A forceps-assisted delivery can increase the risk of hematoma development. Rectal pressure and perineal pain can indicate a hematoma in the posterior vaginal wall. The nurse should closely examine the perineum and the vaginal introitus for ecchymosis and a bulging mass

The nurse is preparing to administer medication in a labor and delivery unit. Which medication should the nurse question administering? 1. Magnesium sulfate to a client diagnosed with preeclampsia 2. Dinoprostone to a client diagnosed with asthma 3. Betamethasone to a client who is 27 weeks pregnant 4. Oxytocin to a client diagnosed with an incomplete abortion

2. Dinoprostone to a client diagnosed with asthma The synthetic prostaglandin dinoprostone (Cervidil) is used cautiously in clients who have asthma because it can initiate an asthmatic attack; therefore, the nurse should question administering this medication

A nurse manager has many at-risk mothers in the labor and birth unit. What policy can the manager adapt that would best facilitate mother-baby bonding?

Limit separation of mother and baby to exceptional circumstances only.

The nurse is evaluating a breastfeeding session. the nurse determines that the infant has appropriately latched on to the mother's breast when which observations are made? select all that apply 1) the mother reports a firm tugging feeling on her nipple 2) a smacking sound is heard each time the baby sucks 3) the infant's mouth covers only the mother's nipple 4) the baby's nose, mouth, chin, are touching the breast 5) the infant's cheek are rounded when sucking 6) the infant's swallowing can be heard after sucking

1) the mother reports a firm tugging feeling on her nipple 4) the baby's nose, mouth and chin, are touching the breast 5) the infant's cheek are rounded when sucking 6) the infant's swallowing can be heard after sucking if the latch is correct, the mother should feel only a firm tugging and not pain or pinching when the infant sucks when an infant is correctly latched to the breast, 2 to 3 cm of areola should be covered by the infant's mouth. if this occurs, it will result in the infant's nose, mouth, and chin touching breasts when the infant is latched correctly, the cheeks will be rounded rather than dimpled. when the infant is latched correctly, the swallowing will be audible

The nurse receives report for four postpartum clients. In which order should the nurse assess the clients? Prioritize the clients in order from first to last. 1. The client who had a normal, spontaneous vaginal delivery 30 minutes ago 2. The client who had a cesarean section 48 hours ago and is bottle feeding her newborn infant 3. The client who had a vaginal delivery 32 hours ago and is having difficulty breastfeeding 4. The client who delivered her newborn via scheduled C-section 8 hours ago and has a PCA pump with morphine for pain control

1, 4, 3, 2 1. The client who had a normal, spontaneous vaginal delivery 30 minutes ago 4. The client who delivered her newborn via scheduled C-section 8 hours ago and has a PCA pump with morphine for pain control 3. The client who had a vaginal delivery 32 hours ago and is having difficulty breastfeeding 2. The client who had a cesarean section 48 hours ago and is bottle feeding her newborn infant

The client with mastitis asks the nurse if she should stop breastfeeding because she has developed a breast infection. Which response by the nurse is best? 1. "Continuing to breastfeed will decrease the duration of your symptoms" 2. "Breastfeeding should only be continued if your symptoms decrease." 3. "Stop feeding for 24 hours until antibiotic therapy begins to take effect." 4. "It is best to stop breastfeeding because the infant may become infected."

1. "Continuing to breastfeed will decrease the duration of your symptoms" Continuing to breastfeed is recommended when the client has mastitis. If the breasts continue to be emptied by either breastfeeding or pumping, the duration of symptoms and the incidence of a breast abscess are decreased

The client has been taking birth control pills for 5 weeks. Which statement from the client warrants intervention by the clinic nurse? 1. "I stay nauseated and my breasts are very tender." 2. "I have not had a period since I started the pill." 3. "I make my boyfriend use a condom even though I am on the pill." 4. "I took the pills for 3 weeks then stopped for 1 week."

1. "I stay nauseated and my breasts are very tender." If signs of estrogen excess are apparent (nausea, edema, or breast discomfort), a preparation with lower estrogen content is needed. This statement therefore warrants the nurse to intervene

The primiparous client, who is bottle feeding her infant, asks the nurse when she can expect to start having her menstrual cycle again. Which response by the nurse is most accurate? 1. "Most women who bottle feed can expect their period within 6 to 10 weeks after birth." 2. "Your period should return a few days after your lochial discharge stops." 3. "Your lochia will change from pink to white; when white, your period should return." 4. "Bottle feeding delays the return of a normal menstrual cycle until 6 months postbirth."

1. "Most women who bottle feed can expect their period within 6 to 10 weeks after birth." In nonlactating women, the average time to first ovulation is 45 days, and the return of menstruation usually happens within 6 to 10 weeks postbirth

The postpartum client, who is 24-hours post-vaginal birth and breastfeeding, asks the nurse when she can begin exercising to regain her pregnancy body shape. Which response by the nurse is correct? 1. "Simple abdominal and pelvic exercises can begin right now." 2. "You will need to wait until after your 6-week postpartum checkup." 3. "Once your lochia has stopped, you can begin exercising." 4. "You should not exercise while you are breastfeeding."

1. "Simple abdominal and pelvic exercises can begin right now." On the first postpartum day, the client should be taught to start abdominal breathing and pelvic rocking. Kegel exercises, which should have been taught during pregnancy, should be continued. Simple exercises should be added daily until, by 2 to 3 weeks postpartum, the mother should be able to do sit-ups and leg raises

The nurse is caring for a pregnant client who delivered her last baby at 30 weeks gestation. The HCP has prescribed hydroxyprogesterone caproate injections. Which information should the nurse discuss with the client? (Select all that apply) 1. "This medication lowers the risk of having another preterm infant." 2. "Injections are given weekly from 16 to 37 weeks gestation." 3. "This medication can be used to stop active preterm labor." 4. "Pain, redness, and swelling can occur at the injection site." 5. "This medication is intended for use in clients with multiple gestations."

1. "This medication lowers the risk of having another preterm infant." 2. "Injections are given weekly from 16 to 37 weeks gestation." 4. "Pain, redness, and swelling can occur at the injection site." Hydroxyprogesterone caproate (Makena) is shown to reduce the risk of recurrent preterm birth in a client with a history of at least one previous preterm birth and pregnant with a single fetus Injections are administered intramuscularly every week beginning at 16 to 20 weeks gestation until 37 weeks gestation Pain, redness, and swelling can occur at the injection site

The client, who is 20 days postpartum, telephones the perinatal clinic to tell the nurse that she is having heavy, bright red bleeding since hospital discharge 18 days ago. Which instruction to the client is correct? 1. "You need to come to the clinic immediately." 2. "Limit physical activity until the bleeding stops." 3. "There is no need for concern; this is expected." 4. "Call next week if the bleeding has not stopped."

1. "You need to come to the clinic immediately." Lochia rubra that persists for longer than 2 weeks is suggestive of subinvolution of the uterus, which is the most common cause of delayed postpartum hemorrhage. The client should be seen in the clinic immediately to determine what is causing her abnormal lochial discharge

Which male client should the nurse consider at risk for complications when taking sildenafil? 1. A 56-year-old client with unstable angina 2. An 87-year-old client with glaucoma 3. A 44-year-old client with type 2 diabetes 4. A 32-year-old client with an L1 spinal cord injury (SCI)

1. A 56-year-old client with unstable angina Sildenafil (Viagra), a vasodilator and erectile dysfunction agent, should be used cautiously in clients with coronary heart disease because during sexual activity the client could have a myocardial infarction from the extra demands on the heart. Specifically, clients taking nitroglycerin or any nitrate medication should not take sildenafil (Viagra) because the vasodilation effects may cause hypotension. A client with unstable angina would be taking a nitrate medication

Which interventions should the nurse implement when the nurse anesthetist is administering spinal anesthesia to a pregnant client in labor? (Select all that apply) 1. Administer 500 to 1,000 mL of IV fluid before insertion of the spinal catheter 2. Instruct the client to lie on her side in the fetal position during insertion of the spinal catheter 3. Perform a neurovascular assessment on the client's lower extremities 4. Monitor the client's blood pressure, pulse, and respirations during spinal anesthesia 5. Assist the client with pushing when instructed by the obstetrician

1. Administer 500 to 1,000 mL of IV fluid before insertion of the spinal catheter 2. Instruct the client to lie on her side in the fetal position during insertion of the spinal catheter 3. Perform a neurovascular assessment on the client's lower extremities 4. Monitor the client's blood pressure, pulse, and respirations during spinal anesthesia 5. Assist the client with pushing when instructed by the obstetrician Spinal anesthesia has been shown to be well tolerated by a healthy fetus when a maternal IV fluid preload in excess of 500 to 1,000 mL precedes the administration of the spinal. The client can be in the side-lying or fetal position when the spinal anesthesia is being administered This neurovascular assessment should be performed prior to and after the spinal anesthesia to determine the effectiveness of the anesthesia Baseline vital signs can be obtained 30 mins to 1 hour prior to spinal anesthesia; postprocedure vital signs are monitored every 1 to 2 minutes for the first 10 minutes and then every 5 to 10 minutes throughout the delivery Spinal anesthesia will cause the pregnant client not to feel the contractions, so the nurse needs to assist the client with pushing

The labor and delivery nurse is preparing the client for a scheduled cesarean birth. Which interventions should the nurse expect to implement? (Select all that apply) 1. Administer famotidine or sodium citrate with citric acid 2. Perform an abdominal prep with an antiseptic containing chlorhexidine and alcohol 3. Give cephazolin via intravenous piggyback (IVPB) 4. Administer ondansetron intravenously 5. Perform a "time out" procedure

1. Administer famotidine or sodium citrate with citric acid 2. Perform an abdominal prep with an antiseptic containing chlorhexidine and alcohol 3. Give cephazolin via intravenous piggyback (IVPB) 5. Perform a "time out" procedure Famotidine (Pepcid) or sodium citrate with citric acid (Bicitra) is given prior to a cesarean section to reduce gastric acid An abdominal prep is performed using an antiseptic containing chlorhexidine and alcohol (Chloraprep). This antiseptic is effective against methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and many other viruses and fungi. It needs to dry for 3 minutes to be effective. In an emergency cesarean, a povidone iodine solution (Betadine) could be used since it requires no drying time A single prophylactic antibiotic such as cephazolin is recommended to reduce risk of infection A "time out" procedure is performed for client safety to verify the client's identity and procedure to be performed

The client diagnosed with neonatal abstinence syndrome (NAS) is irritable, having difficulty feeding, and sleeping poorly. Which interventions should the nurse expect to implement? (Select all that apply) 1. Administer morphine orally 2. Loosely wrap the infant during feedings 3. Give phenobarbital to control seizures 4. Collaborate with child protective services 5. Perform gavage feeding

1. Administer morphine orally 3. Give phenobarbital to control seizures 4. Collaborate with child protective services 5. Perform gavage feeding Oral morphine can be given to reduce the signs of withdrawal Phenobarbital is effective in the treatment of opioid withdrawal seizures When a newborn client tests positive for drugs, child protective services becomes involved Gavage feeding may be necessary in the client unable to coordinate sucking and swallowing with breathing. Additionally, it conserves energy in the client

The clinic nurse reviews the laboratory results illustrated from the postpartum client who is 3 days post delivery. What should the nurse do in response to these results? Hct - 35% Hgb - 11 g/dL WBCs - 20,000/mm3 1. Document the laboratory report findings 2. Assess the client for increased lochia 3. Assess the client's temperature orally 4. Notify the HCP immediately

1. Document the laboratory report findings The only action required is to document the findings; all values are within expected parameters. Nonpathological leukocytosis often occurs during labor and in the immediate postpartum period because labor produces a mild pro-inflammatory state. WBCs should return to normal by the end of the first postpartum week. Hct and Hgb will begin to decrease on postpartum day 3 or 4 from hemodilution

The nurse is caring for a client who is to receive prostaglandin E2 dinoprostone insert for cervical ripening. Which interventions should the nurse implement? (Select all that apply) 1. Ensure the client has signed informed consent for the procedure 2. Instruct the client to void prior to insertion of the medication 3. Have the client maintain a recumbent position for 2 hours after administration 4. Prepare to remove the insert in the event of an adverse reaction 5. Avoid oxytocin induction for 6 to 12 hours after gel administration

1. Ensure the client has signed informed consent for the procedure 2. Instruct the client to void prior to insertion of the medication 3. Have the client maintain a recumbent position for 2 hours after administration 4. Prepare to remove the insert in the event of an adverse reaction The nurse should ensure the client understands the procedure and obtain an informed consent The client should void prior to medication administration The client should remain supine with a lateral tilt or in the side-lying position for 2 hours after placement of the insert to maintain the proper positioning of the insert in the posterior uterine fornix Prostaglandin E2 dinoprostone insert (Cervidil) is an insert with attached polyester tape that allows for insert removal if uterine hyperstimulation occurs

The nurse is preparing the newborn for a circumcision using a Gomco clamp. Which interventions should the nurse implement? (Select all that apply) 1. Ensure vitamin K was administered at birth 2. Apply eutectic mixture of lidocaine and prilocaine 3. Give 2 ounces of glucose water for pain 4. Obtain petroleum jelly to place on the penis after procedure 5. Administer acetaminophen orally prior to procedure

1. Ensure vitamin K was administered at birth 2. Apply eutectic mixture of lidocaine and prilocaine 4. Obtain petroleum jelly to place on the penis after procedure 5. Administer acetaminophen orally prior to procedure Vitamin K is administered shortly after birth to prevent bleeding. The nurse should confirm this was administered prior to the circumcision procedure A eutectic mixture of lidocaine and prilocaine (EMLA) cream is applied to the penis prior to the procedure to anesthetize the area Petroleum jelly is applied to the penis after the procedure and after each diaper change for 7 days. Petroleum jelly is not needed for a circumcision using a PlastiBell device Acetaminophen given prior to the procedure and intermittently as needed after the procedure can control pain

The nurse is caring for the pregnant client in labor. The client has had no prenatal care and reports being dependent on opioids throughout her pregnancy. Which interventions for pain control could be provided to this client? (Select all that apply) 1. Epidural anesthesia 2. Butorphanol IV 3. Morphine IV 4. Acetaminophen po 5. 1% lidocaine locally

1. Epidural anesthesia 3. Morphine IV 4. Acetaminophen po 5. 1% lidocaine locally Epidural anesthesia is not contraindicated in the opioid-dependent client and is an acceptable form of pain management If narcotics can be safely administered, the nurse should not withhold the medication during labor. Giving opioids during acute pain does not enhance an opioid-addicted client's chemical dependence Acetaminophen administered orally can reduce pain in early labor 1% lidocaine can be administered by the HCP prior to an episiotomy or for perineal repair

Which statement best indicates the scientific rationale for administering erythromycin ophthalmic ointment to a newborn client? 1. Erythromycin prevents ophthalmia neonatorum in infants of mothers with gonorrhea 2. Erythromycin prevents otitis externa in infants of mothers with herpes simplex virus 3. Erythromycin prevents transient strabismus in infants of mothers with chlamydia 4. Erythromycin prevents blindness in infants of mothers with cytomegalovirus

1. Erythromycin prevents ophthalmia neonatorum in infants of mothers with gonorrhea Erythromycin ophthalmic ointment is prophylaxis against Neisseria gonorrhoeae, preventing ophthalmia neonatorum in infants of mothers with gonorrhea. It is required by law.

The oncoming shift nurse assesses the fundus of the postpartum client 6 hours after a vaginal birth and finds that it is firm. When the nurse then assists the client out of bed for the first time, blood begins to run down the client's leg. Which action by the nurse in response to the client's bleeding is correct? 1. Explain that extra bleeding can occur with initial standing 2. Immediately assist the client back into bed 3. Push the emergency call light in the room 4. Call the HCP to report this increased bleeding

1. Explain that extra bleeding can occur with initial standing Lochia normally pools in the vagina when the postpartum client remains in a recumbent position for any length of time. When the client then stands, gravity causes the blood to flow out. As long as the nurse knows the fundus is firm and not bleeding, a simple explanation to the client is all that is required

The client who is infertile and diagnosed with endometriosis is prescribed leuprolide. Which information should the nurse discuss with the client? (Select all that apply) 1. Explain that this medication may take 3 to 6 months to work 2. Discuss that this medication will help regulate the client's menstrual cycle 3. Instruct to take leuprolide every night to help decrease menstrual pain 4. Teach that this medication will not affect when the client can have intercourse 5. Tell the client not to drink grapefruit juice when taking this medication

1. Explain that this medication may take 3 to 6 months to work 4. Teach that this medication will not affect when the client can have intercourse The client should be aware that it may take 3 to 6 months for leuprolide therapy to achieve maximum benefits; therefore, the nurse should discuss the long-term possibility with the client Leuprolide (Lupron), a GnRH medication, does not affect when the client can have intercourse

The premature newborn client is diagnosed with a patient ductus arteriosus (PDA) and is experiencing labored breathing and an increased need for oxygen. Which medication would the nurse anticipate the HCP to order? (Select all that apply) 1. Indomethacin 2. Ibuprofen 3. Gentamicin 4. Caffeine 5. Captopril

1. Indomethacin 2. Ibuprofen 4. Caffeine Indomethacin causes the PDA to constrict, which closes the opening. This medication works well in premature infants Ibuprofen works similarly to indomethacin and is useful in closing PDAs in premature infants Early caffeine therapy decreases the medical treatment required for a PDA

The sexually active couple has decided to use a spermicide for birth control. Which information should the nurse discuss with the female partner? (Select all that apply) 1. Insert the spermicide prior to having sexual intercourse 2. Douche with vinegar and water immediately after intercourse 3. Teach to apply spermicide in the woman's vagina 4. Instruct that spermicide is effective up to three times 5. Explain this form of birth control will not prevent STIs

1. Insert the spermicide prior to having sexual intercourse 3. Teach to apply spermicide in the woman's vagina 5. Explain this form of birth control will not prevent STIs Correct use of spermicide is required for contraceptive efficacy. The spermicide must be in place prior to intercourse, and the foam is immediately active. If a suppository or tablet is used, it must be inserted 10 to 15 minutes before intercourse to allow time for it to dissolve The spermicide must be inserted into the female's vagina Condoms or abstinence are the only two ways to prevent STIs

The adolescent client is prescribed the birth control medication depot medroxyprogesterone. Which interventions should the clinic nurse implement? (Select all that apply) 1. Instruct the client to schedule an appointment every 3 months 2. Explain that infertility may occur up to 2 years after discontinuing 3. Demonstrate how to administer the medication subcutaneously in the abdomen 4. Discuss how to care for the intrauterine device (IUD) inserted in her vagina 5. Tell the client that she will not have to take a pill every day

1. Instruct the client to schedule an appointment every 3 months 2. Explain that infertility may occur up to 2 years after discontinuing 5. Tell the client that she will not have to take a pill every day Depot medroxyprogesterone (Depo-Provera) is a safe, effective contraceptive that is effective for 3 months or longer and is administered via intramuscular injection every 3 months to provide continuous protection When injections are discontinued, an average of 12 months is required for fertility to return. Some women remain infertile for as long as 2 1/2 years The advantage to this medication is that it is only taken every 3 months, which is why it is recommended for adolescents or women who may not use other methods of birth control reliably

The pregnant client diagnosed with bipolar disorder has been taking lamotrigine to control symptoms. The client asks the nurse for information about the medication and pregnancy. Which information should the nurse tell the client? (Select all that apply) 1. Lamotrigine is the preferred treatment for bipolar disorder in pregnancy 2. Medication dosage may need to be increased during pregnancy. 3. Serum lamotrigine levels should be obtained every 4 weeks in pregnancy. 4. Breastfeeding is contraindicated with lamotrigine 5. Lamotrigine causes no significant increase in birth defects

1. Lamotrigine is the preferred treatment for bipolar disorder in pregnancy 2. Medication dosage may need to be increased during pregnancy. 3. Serum lamotrigine levels should be obtained every 4 weeks in pregnancy. 5. Lamotrigine causes no significant increase in birth defects Lamotrigine is the preferred treatment for bipolar disorder in pregnancy Lamotrigine dosage may need to be increased during pregnancy to avoid recurrence of symptoms. If dose is increased in pregnancy, the medication should be tapered off in the postpartum period to prepregnancy levels Serum lamotrigine levels should be monitored every 4 weeks during pregnancy. There are no established therapeutic lamotrigine levels, so dose should be individualized to the client Lamotrigine causes no significant increase in birth defects

Which medication for the treatment of postpartum hemorrhage can be administered rectally? 1. Misoprostol 2. Carboprost 3. Oxytocin 4. Methylergonovine

1. Misoprostol Misoprostol (Cytotec) can be administered by mouth, intravaginally, or rectally

The nurse is preparing an aminoinfusion for a client who is experiencing severe variable decelerations of the FHR. Which solution should the nurse expect to administer through the intrauterine pressure catheter? (Select all that apply) 1. Normal (0.9%) saline 2. 5% Dextrose in water 3. Lactated ringer's 4. Albumin 255 solution 5. Dextrose in saline

1. Normal (0.9%) saline 3. Lactated ringer's NS is used in aminoinfusions. It can cause slight changes in fetal electrolytes, but is an acceptable fluid LR is the preferred fluid for aminoinfusions

The client, who had preeclampsia and delivered vaginally 4 hours ago, is still receiving magnesium sulfate IV. When assessing the client's deep tendon reflexes (DTRs). the nurse finds that they are 3+. What should be the nurse's plan? (Select all that apply) 1. Notify the client's HCP about the reduced DTRs 2. Prepare to increase the magnesium sulfate dose 3. Prepare to administer calcium gluconate IV 4. Assess the level of consciousness and vital signs 5. Ask the HCP about drawing a serum calcium level

1. Notify the client's HCP about the reduced DTRs 3. Prepare to administer calcium gluconate IV 4. Assess the level of consciousness and vital signs The HCP should be notified about the decreased DTRs because weakening of these may indicate magnesium sulfate toxicity Any time the client is receiving a magnesium sulfate infusion, the nurse should be prepared for the possibility of needing the antidote, calcium gluconate The nurse should assess the client's vital signs and level of consciousness, as decreased level of consciousness and respiratory effort are serious side effects of magnesium sulfate

The nurse is caring for the postpartum primiparous client who is 13 hours post-vaginal delivery. The nurse observes that the client is passive and hesitant about making decisions about her own and her newborn's care. In response to this observation, which interventions should be implemented by the nurse? (Select all that apply) 1. Question her closely about the presence of pain 2. Ask if she would like to talk about her birth experience 3. Encourage her to nap when her infant is napping 4. Encourage attendance in teaching sessions about infant care 5. Suggest that she begin to write her birth announcements

1. Question her closely about the presence of pain 2. Ask if she would like to talk about her birth experience 3. Encourage her to nap when her infant is napping Many women hesitate to ask for medication, as they believe their pain is expected. Thus the nurse should ask the client about pain and assure her that there are methods to decrease her pain During the initial postpartum "taking-in" phase, the client may have a great need to talk about her birthing experience and to ask questions for clarification as necessary. By encouraging this verbalization, the nurse helps the client to accept the experience and enables her to move to the next maternal phase Physical discomfort can be intense initially postpartum and can interfere with rest. Sleep is a major need and should be encouraged

Based on the following assessment of the newborn client, which interventions should the nurse perform? (Select all that apply) 1. Suction the mouth and nose 2. Provide oxygen via face mask 3. Administer epinephrine endotracheally 4. Initiate an IV line of normal saline 5. Assess for need to administer naloxone

1. Suction the mouth and nose 2. Provide oxygen via face mask 5. Assess for need to administer naloxone The mouth and nose should be suctioned to ensure patency of airway The infant is breathing and has a heart rate greater than 100 breaths per minute, but is experiencing slow respirations and acrocyanosis, so oxygen should be given via face mask or "blow by" An infant having a normal heart rate and color (acrocyanosis is a normal finding in a newborn), but poor respiratory effort, should be assessed for the need for naloxone. If the mother received opiates within 4 hours of delivery, naloxone may need to be administered to the infant to counteract respiratory depression

The nurse is assisting the certified registered nurse anesthetist (CRNA) in placing an epidural in a laboring client. Which findings would indicate intravascular injection of the local anesthetic? (Select all that apply) 1. Tachycardia 2. Pruritus 3. Tinnitus 4. Sedation 5. Dizziness

1. Tachycardia 3. Tinnitus 5. Dizziness Tachycardia is a symptom of intravascular infection of a local anesthetic Tinnitus is a symptom of intravascular injection of a local anesthetic Dizziness is a symptom of intravascular injection of a local anesthetic

The male client who is infertile asks the clinic nurse about methods to improve his fertility. Which interventions should the nurse teach the client? (Select all that apply) 1. Take a multivitamin daily with zinc 2. Consume alcohol and caffeine in moderation 3. Testosterone therapy may help increase your sperm count 4. Clomiphene taken daily will help increase your fertility 5. Avoid smoking and use of nicotine products

1. Take a multivitamin daily with zinc 3. Testosterone therapy may help increase your sperm count 5. Avoid smoking and use of nicotine products A multivitamin daily improves nutrition. Zinc has been reported to increase testosterone levels, sperm count, and sperm motility Administration of testosterone will improve hormonal levels, resulting in a potential for increased spermatogenesis Smoking is associated with lower sperm count and motility

The pregnant client is diagnosed with preterm labor and the HCP has prescribed nifedipine. Which interventions should the nurse implement? (Select all that apply) 1. Teach the client that flushing of the skin and headaches can occur 2. Administer the medication sublingually before meals 3. Instruct the client to rise slowly after sitting or lying down 4. Discontinue medication if FHR increases 10 bpm over baseline 5. Advise the client to avoid grapefruit or grapefruit juice

1. Teach the client that flushing of the skin and headaches can occur 3. Instruct the client to rise slowly after sitting or lying down 5. Advise the client to avoid grapefruit or grapefruit juice Flushing of the skin and headaches are common side effects of nifedipine (Procardia) Nifedipine is a vasodilator and can cause orthostatic hypotension, so the client should be taught to rise slowly after sitting or lying down or call for assistance Consuming grapefruit or grapefruit juice with nifedipine can cause an increased amount of medication to be absorbed, causing hypotension or undesirable change in heart rate

The 14-year-old client is prescribed oral contraceptive medication for menstrual irregularity. Which assessment data indicates the medication is effective? 1. The client has a period every 28 days 2. The client has a decrease in abdominal bloating 3. The client has a negative pregnancy test 4. The client reports a decrease in facial acne

1. The client has a period every 28 days Because the client is receiving the medication for menstrual irregularity it is effective when the menstrual cycle is regular, which is every 28 days

The client who is 38 weeks pregnant and diagnosed with preeclampsia is admitted to the labor and delivery area. The HCP has prescribed IV magnesium sulfate. Which data indicates the medication is effective? (Select all that apply) 1. The client has no seizure activity 2. The client's urine output is 45 mL/hour 3. The client's blood pressure is 148/90 4. The client's deep tendon reflexes are 2 to 3+ 5. The client's apical pulse is 70 bpm

1. The client has no seizure activity 4. The client's deep tendon reflexes are 2 to 3+ Magnesium sulfate is administered to prevent seizure activity, so if no activity is occurring the medication is effective Magnesium sulfate is administered to prevent seizure activity and is determined to be effective and in the therapeutic range when the client's deep tendon reflexes are normal, which is 2 to 3+ on a 0 to 4+ scale

During a postpartum assessment, it is noted that a G1 P1001 woman, who delivered vaginally over an intact perineum, has a cluster of hemorrhoids. Which of the following would be appropriate for the nurse to include in the woman's health teaching? Select all that apply. 1. The client should use a sitz bath daily as a relief measure. 2. The client should digitally replace external hemorrhoids into her rectum. 3. The client should breastfeed frequently to stimulate oxytocin to reduce the size of the hemorrhoids. 4. The client should be advised that the hemorrhoids will increase in size and quantity with subsequent pregnancies. 5. The client should apply topical anesthetic as a relief measure.

1. The client should use a sitz bath daily as a relief measure. 2. The client should digitally replace external hemorrhoids into her rectum. 5. The client should apply topical anesthetic as a relief measure.

The nurse is teaching the pregnant client diagnosed with HIV about methods to prevent transmission to the infant. Which information should the nurse discuss with the client? (Select all that apply) 1. The client will take zidovudine po regularly beginning at 12 to 14 weeks gestation 2. The client's newborn should receive oral zidovudine 8 to 12 hours after birth 3. Breastfeeding should be encouraged to provide the infant passive immunity to HIV 4. If treated in early pregnancy, the risk of transmission of HIV to the infant is 1% or less 5. All clients diagnosed with HIV must have a cesarean delivery at 38 weeks gestation

1. The client will take zidovudine po regularly beginning at 12 to 14 weeks gestation 2. The client's newborn should receive oral zidovudine 8 to 12 hours after birth 4. If treated in early pregnancy, the risk of transmission of HIV to the infant is 1% or less ZDV is given orally, as directed, around the clock The newborn should receive oral zidovudine syrup beginning 8 to 12 hours after birth until 6 weeks old The CDC states that if the client is treated beginning in early pregnancy, the risk of transmission of HIV to the infant can be reduced to 1% or less

A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse's response? 1. The client's obstetric status is optimal for receiving the vaccine. 2. The client's immune system is highly responsive during the postpartum period. 3. The client's baby will be high risk for acquiring rubella if the woman does not receive the vaccine. 4. The client's insurance company will pay for the shot if it is given during the immediate postpartum period.

1. The client's obstetric status is optimal for receiving the vaccine.

The client who is 32 weeks pregnant and in preterm labor is prescribed terbutaline. Which data warrants intervention by the nurse? 1. The client's respiratory rate is 34 2. The fetal heart rate (FHR) is 150 bpm 3. The client's apical heart rate is 104 bpm 4. The client reports no contractions

1. The client's respiratory rate is 34 Terbutaline (Brethine), a beta-adrenergic agonist, causes bronchodilation, and if the client's respiratory rate is greater than 30 or if there is a change in quality of lung sounds (wheezing, rales, or coughing), the HCP should be notified

A 3-day-breastfeeding client who is not immune to rubella is to receive the rubella vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine? 1. The woman should not become pregnant for at least 4 weeks. 2. The woman should pump and dump her breast milk for 1 week. 3. Surgical masks must be worn by the mother when she holds the baby. 4. Antibodies transported through the breast milk will protect the baby.

1. The woman should not become pregnant for at least 4 weeks.

The nurse is preparing a client for in vitro fertilization (IVF). Which statement best describes the scientific rationale for administering supplemental progesterone to this client? 1. To enhance the receptivity of the endometrium to implantation 2. To provide more hormone to the ovary for egg production 3. To help regulate the client's monthly menstrual cycle 4. To decrease galactorrhea in the client if fertilization occurs

1. To enhance the receptivity of the endometrium to implantation Progesterone enhances the receptivity of the endometrium to implantation - the function of progesterone in the bone - and is the scientific rationale for administering supplemental progesterone to a client preparing for an in vitro fertilization

To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks? 1. Apply antibiotic ointment to the perineum daily. 2. Change the peripad at each voiding. 3. Void at least every two hours. 4. Spray the perineum with povidone-iodine after toileting.

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while assessing the breastfeeding mother 24 hours postdelivery, the nurse notes that the client's breasts are hard and painful. Which intervention should be implemented by the nurse? select all that apply 1) tell her to feed a small amount from both breasts at each feeding 2) apply ice packs to the breasts at intervals between feedings 3) give supplemental formula at least once in a 24-hour period 4) administer an anti-inflammatory medication prescribed prn 5) apply warm, moist packs to the breasts between feedings 6) pump the breasts as needed to ensure complete emptying

2) apply ice packs to the breasts at intervals between feedings 4) administering anti-inflammatory medication prescribed prn 6) pump the breasts as needed to ensure complete emptying because engorgement is caused, in part, by swelling of the breast tissue surrounding the milk gland ducts, applying ice at intervals between feedings will help to decrease this swelling. administering anti-inflammatory medication will decrease breast pain and inflammation pumping the breasts may be necessary if the infant is unable to completely empty both breasts at each feeding. pumping at this time will not cause a problematic increase in breast milk production

immediately after delivery of the client's placenta, the nurse palpates the client's uterine fundus. The fundus is firm and located halfway between the umbilicus and symphysis pubis. Which action should the nurse take based on the assessment findings? 1) immediately begin to massage the uterus 2) document the findings of the fundus 3) assess the client for bladder distention 4) monitor for increased vaginal bleeding

2) document the findings of the fundus immediately after birth, the uterus should contract, and the fundus should be located one-half to two-thirds of the way between the symphysis pubis and umbilicus. Thus the only action required is to document the assessment findings.

The client, who had a vaginal delivery 18 hours ago, asks the nurse how she should take care of her perineal laceration. Which statements by the nurse are appropriate? select all that apply 1) you should change your peri pad at least twice each day 2) once home, use a warm sitz bath to sooth your perineum 3) keep your perineum warm and dry until stitches are removed 4) use your peri bottle to apply water to the perineum after each void 5) wash your perineum with mild soap at least once each 24 hours 6) check your perineum for foul odor or increased redness, heat, or pain

2) once home, use a warm sitz bath to sooth your perineum 4) use your peri bottle to apply water to the perineum after each void 5) wash your perineum with mild soap at least once each 24 hours 6) check your perineum for foul odor or increased redness, heat, or pain a warm sitz bath is used after the first 24 hours to provide comfort, increase circulation to the area, and reduce incidence of infection cleansing the perineum after each void with the peri-bottle of water provides comfort and helps reduce the chance of infection washing with mild soap and rinsing with water each 24 hours reduces the risk for infection teaching the client to each for S/S of infection is important and allows the client to be an active participant in her care

In the process of preparing the client for discharge after a c section, the nurse addresses all of the following during discharge education. Which should be the priority advice for the client? 1) how to manage her incision 2) planning for assistance at home 3) infant care procedures 4) increased need for rest

2) planning for assistance at home Because the client has had a surgical procedure, the priority consideration is for the mother to plan additional assistance at home. Without this assistance, it is difficult for the mother to get the rest she needs for healing, pain control, and appropriate infant care.

The nurse is caring for the postpartum family. the nurse determines that paternal engrossment is occurring when which observation is made of the newborn's father? 1) talks to his newborn from across the room 2) shows similarities b/w his and baby's ears 3) expresses feeling frustrated when the infant cries 4) seems to be hesitant to touch his newborn

2) shows similarities between his and baby's ears engrossment is demonstrated by the father touching the infant, making eye contact with the infant, and verbalizing awareness of features in the newborn that are similar to his and that validate his clam to that newborn

The nurse is caring for four postpartum clients. Which client should be the nurse's priority for monitoring for uterine atony? 1) the client who is 2 hours post c section birth for a breech baby 2) the client who delivered a macrocosmic baby after a 12-hour labor 3) the client who has a firm fundus after a vaginal delivery 4 hours ago 4) the client receiving oxytocin IV for past 2 hours

2) the client who delivered a macrocosmic baby after a 12-hour labor this client is the nurse's priority for monitoring for uterine atony. a macrocosmic baby stretched the client's uterus, and thus the muscle fibers of the myometrium, beyond the usual pregnancy size. After delivery the muscles are unable to contract effectively.

The nurse is discussing fertility issues. Which statement indicates the couple is knowledgeable of fertility issues? 1. "My insurance should cover the cost of the medications completely." 2. "A multifetal pregnancy can result in preterm labor and birth." 3. "There is an excellent probability we will get pregnant the first time." 4. "Most of the implanted zygotes will result in a live birth."

2. "A multifetal pregnancy can result in preterm labor and birth." Pregnancy with more than twins carries a substantially higher risk to the mother and the fetuses because of preterm labor and birth, placental insufficiency, and higher demand on maternal body systems

The nurse is teaching the client about medication and diet during lactation. Which information should the nurse include in the teaching? (Select all that apply) 1. "Avoid the flu vaccination while breastfeeding as it can expose the baby to influenza." 2. "Do not take over-the-counter (OTC) decongestants such as pseudoephedrine." 3. "Too much caffeine can cause irritability and wakefulness in the newborn." 4. "Low dose aspirin tablets can be taken as needed for mild pain relief." 5. "Oral contraceptives containing estrogen should be taken daily to prevent pregnancy."

2. "Do not take over-the-counter (OTC) decongestants such as pseudoephedrine." 3. "Too much caffeine can cause irritability and wakefulness in the newborn." OTC decongestants, such as pseudoephedrine, can decrease milk supply and should not be taken while breastfeeding Excessive caffeine intake by the client can cause irritability and wakefulness in the newborn

The nurse is providing discharge instructions for the postpartum client concerning birth control methods. Which question is most important for the nurse to ask the client? 1. "Has your doctor discussed when to resume sexual activity?" 2. "Have you decided if you will be breastfeeding your baby?" 3. "Are you concerned about how this baby will change your life." 4. "Does your partner agree with the type of birth control you will use?"

2. "Have you decided if you will be breastfeeding your baby?" This is the most important question because if the mother has decided on breastfeeding, the nurse should discourage the use of birth control pills. Birth control pills enter breast milk and reduce milk production. Breastfeeding may delay ovulation, but should not be used as a form of birth control

At a preconception visit, the nurse instructs the client on the importance of folic acid in the prevention of serious birth defects. Which statement to the nurse indicates the client needs more teaching? 1. "I will increase my intake of spinach, orange juice, and almonds." 2. "I will increase my intake of milk, yogurt, and fish." 3. "I will take my prenatal vitamin with folic acid daily." 4. "I will avoid overcooking my food to prevent vitamin loss."

2. "I will increase my intake of milk, yogurt, and fish." Milk, yogurt, and fish are not a source of dietary folic acid

The pregnant client is prescribed metoclopramide to treat hyperemesis gravidarum. Which information should the nurse discuss with the client? (Select all that apply) 1. "Chew the tablet thoroughly before swallowing." 2. "Take the medication 30 minutes prior to mealtime." 3. "Do not drink any type of alcoholic beverages." 4. "Muscle spasms are a common side effect." 5. "The medication can cause drowsiness that will make driving unsafe."

2. "Take the medication 30 minutes prior to mealtime." 3. "Do not drink any type of alcoholic beverages." 5. "The medication can cause drowsiness that will make driving unsafe." The medication should be taken on an empty stomach at least 30 minutes before eating Alcohol can increase central nervous system depressive symptoms (drowsiness, lethargy) of the medication and should be avoided Metoclopramide (Reglan) can cause drowsiness. The client should avoid driving until response to medication is known

The client who was raped is admitted to the emergency department and tells the nurse, "I will kill myself if I get pregnant from this monster." Which statement is the nurse's best response? 1. "Have you ever thought about killing yourself and do you have a plan?" 2. "There are medications that must be taken within 72 hours to prevent pregnancy." 3. "A vaginal spermicide can be prescribed that will prevent pregnancy." 4. "You may have to have an elective abortion if you do become pregnant."

2. "There are medications that must be taken within 72 hours to prevent pregnancy." There are three emergency contraception options available: (1) Yuzpe regimen, which is a combination of estrogen and progesterone pills administered within 72 hours and a second dose 12 hours later that will initiate the onset of menstrual bleeding within 21 days; (2) the administration of mifepristone (RU 486) plus misoprostol (Cytotec), which will prevent pregnancy; and (3) the insertion of a copper IUD within 5 days of unprotected intercourse, which can prevent pregnancy (99% effective)

The nurse is caring for a client diagnosed with menopause and prescribed paroxetine mesylate for hot flashes. The client tells the nurse, "I am concerned about taking hormone therapy for my symptoms." Which statement is the nurse's best response? 1. "Hormone therapy is the best way to relieve your hot flashes." 2. "This medication does not contain any hormones." 3. "Are you concerned this medication will not help your symptoms?" 4. "Taking hormones is safe if you only take them for a short time."

2. "This medication does not contain any hormones." Paroxetine mesylate (Brisdelle) is a selective serotonin reuptake inhibitor (SSRI) and does not contain any type of hormones

The male adolescent who is sexually active tells the school nurse, "I am embarrassed, but I don't know who else to tell. Last night when I used a condom with my girlfriend I got a red itchy rash down there. I don't know what it is or what to do." Which statement is the nurse's best response? 1. "You should abstain from sex until you are older." 2. "Use a condom made out of a lamb's intestines." 3. "Do you think your girlfriend gave you an STI?" 4. "Encourage your girlfriend to use a diaphragm."

2. "Use a condom made out of a lamb's intestines." The adolescent's comments should make the school nurse consider an allergic reaction to the condom, most of which are made of latex. Suggesting a type of condom made from lamb's intestines would prevent an allergic reaction

While assessing the postpartum client who is 10 hours post-vaginal delivery, the nurse notes a perineal pad that is totally saturated. To determine the significance of this finding, which question should the nurse ask the client first? 1. "How often are you having uterine cramping?" 2. "When was the last time you changed your pad?" 3. "Do you have any bladder urgency or frequency?" 4. "Did you pass clots that required a pad change?"

2. "When was the last time you changed your pad?" The amount of lochia on a perineal pad is influenced by the individual client's pad changing practices. Thus the nurse should ask about the length of time the current pad has been in place before making a judgment about whether the amount is concerning

The nurse is teaching the client, who is breastfeeding, about returning to sexual activity after vaginal delivery. Which statement should the nurse include? 1. "Orgasm may decrease the amount of breast milk you produce." 2. "You may need to use lubrication when resuming sexual intercourse." 3. "You should not have sexual intercourse until two months postpartum." 4. "Your HCP will let you know when you can resume sexual activity."

2. "You may need to use lubrication when resuming sexual intercourse." The nurse should inform the client that she may need lubrication with sexual intercourse because the low estrogen levels in the early postpartum period causes vaginal dryness

The client, who delivered a 4200-g baby 4 hours ago, continues to have bright red, heavy vaginal bleeding. The nurse assesses the client's fundus and finds it to be firm and midway between the symphysis pubis and umbilicus. What should the nurse do next? 1. Continue to monitor the client's bleeding and weigh the peri-pads 2. Call the client's HCP and request an additional visual examination 3. Prepare to give oxytocin to stimulate uterine muscle contraction 4. Document the findings as normal with no interventions needed at that time

2. Call the client's HCP and request an additional visual examination The nurse should consider the possibility of a vaginal wall or cervical laceration, which could produce heavy, bright red bleeding. The HCP should be notified and asked to perform a visual exam of the vagina to assess for possible lacerations in need of repair

The nurse observes the postpartum multiparous client rubbing her abdomen. When asked if she is having pain, the client says, "It feels like menstrual cramps." Which intervention should the nurse implement? 1. Offer a warm blanket for her to place on her abdomen 2. Encourage her to lie on her stomach until the cramps stop 3. Instruct the client to avoid ambulation while having pain 4. Check her lochia flow; pain sometimes precedes hemorrhage

2. Encourage her to lie on her stomach until the cramps stop Multiparous women frequently experience intermittent uterine contractions called afterpains. Lying in a prone position applies pressure to the uterus, stimulating continuous uterine contraction. When the uterus maintains a state of contraction, the afterpains will cease

The client in labor has an epidural catheter in place for anesthesia. Which intervention is most important for the labor and delivery nurse? 1. Assist the client with breathing exercises during contractions 2. Ensure the client's legs are correctly positioned in the stirrups 3. Have the significant other scrub for the delivery of the baby 4. Titrate the epidural medication to ensure analgesic effect

2. Ensure the client's legs are correctly positioned in the stirrups Because the legs are numb as a result of the epidural, the nurse must ensure the legs are in the stirrups correctly so that the client will not experience neurovascular compromise or any type of injury to the legs when they are in the stirrups

The client experiencing infertility is prescribed bromocriptine. The client calls the clinic nurse and reports that she thinks she may be pregnant. Which intervention should the clinic nurse implement first? 1. Schedule the client for a pelvic sonogram 2. Instruct the client to quit taking the medication 3. Tell the client to make an appointment with the HCP 4. Encourage the client to confirm with a home pregnancy test

2. Instruct the client to quit taking the medication The client must quit taking bromocriptine (Parlodel) immediately because it can cause a miscarriage of the fetus. Once the client becomes pregnant, the medication is not needed anymore

A client, G1 P0101, postpartum 1 day, is assessed. The nurse notes that the client's lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first? 1. Notify the woman's primary health care provider. 2. Massage the woman's fundus. 3. Escort the woman to the bathroom to urinate. 4. Check the quantity of lochia on the peripad.

2. Massage the woman's fundus.

The mother diagnosed with preeclampsia has received magnesium sulfate during labor and delivery. Which interventions should the nursery nurse implement for the newborn? (Select all that apply) 1. Assess the lungs for meconium aspiration 2. Prepare to administer IV calcium gluconate 3. Administer 2 ounces of glucose water 4. Assess the infant's axillary temperature 5. Stimulate the baby by tapping the feet

2. Prepare to administer IV calcium gluconate 5. Stimulate the baby by tapping the feet The antidote for magnesium sulfate toxicity is calcium gluconate; therefore, the nurse should be prepared to administer it The baby is at risk for respiratory or neurological depression; therefore, the nurse should stimulate the baby until the effects of the magnesium sulfate have dissipated

A woman is receiving patient-controlled analgesia (PCA) post-cesarean section. Which of the following must be included in the patient teaching? 1. The client should monitor how often she presses the button. 2. The client should report any feelings of nausea or itching to the nurse. 3. The family should press the button whenever they feel the woman is in pain. 4. The family should inform the nurse if the client becomes sleepy.

2. The client should report any feelings of nausea or itching to the nurse.

One nursing diagnosis that a nurse has identified for a postpartum client is: Risk for intrauterine infection r/t vaginal delivery. During the postpartum period, which of the following goals should the nurse include in the care plan in relation to this diagnosis? Select all that apply. 1. The client will drink sufficient quantities of fluid. 2. The client will have a stable white blood cell count. 3. The client will have a normal temperature. 4. The client will have normal-smelling vaginal discharge. 5. The client will take two or three sitz baths each day.

2. The client will have a stable white blood cell count. 3. The client will have a normal temperature. 4. The client will have normal-smelling vaginal discharge.

The preterm infant is receiving synthetic surfactant. Which data indicates the medication is effective? 1. The infant's heel stick capillary blood glucose level is 90 mg/dL 2. The infant's arterial blood gases (ABGs) are within normal limits 3. The positive end-expiratory pressure (PEEP) on the ventilator is turned off 4. The infant's pulse oximeter reading fluctuates between 90% and 92%

2. The infant's arterial blood gases (ABGs) are within normal limits Synthetic lung surfactant coats the alveoli and prevents collapse of the lung by reducing the surface tension of pulmonary fluids. Normal ABGs indicate the lungs are adequately oxygenating the body, which means the medication is effective

A post-cesarean section, breastfeeding client, whose subjective pain level is 2/5, requests her as needed (prn) narcotic analgesics every 3 hours. She states, "I have decided to make sure that I feel as little pain from this experience as possible." Which of the following should the nurse conclude in relation to this woman's behavior? 1. The woman needs a stronger narcotic order. 2. The woman is high risk for severe constipation. 3. The woman's breast milk volume may drop while taking the medicine. 4. The woman's newborn may become addicted to the medication.

2. The woman is high risk for severe constipation.

The postpartum client suffered a fourth-degree perineal laceration during her vaginal birth. Which interventions should the nurse add to the client's plan of care? select all that apply 1) limit ambulation to bathroom privileges only 2) decrease fluid intake to 1000 mL every 24 hours 3) instruct the client on a high-fiber diet 4) monitor the uterus for firmness ever 2 hours 5) give prn prescribed stool softeners in the a.m. and at h.s.

3) instruct the client on a high-fiber diet 5) give prn prescribed stool softeners in the am and at hs the client with a fourth-degree perineal laceration should be instructed to increase dietary fiber to help maintain bowel continence and decrease perineal trauma from constipation

The postpartum client's blood type is A negative, and her newborn infant's blood type is AB negative. The client received RhoGAM in her second trimester, after a minor car accident. The client is preparing for discharge and asks the nurse when she will receive her RhoGAM injection. The nurse correctly responds with which statement? 1) you already recieved two doses of RhoGAM and do not need an additional dose 2) i will give your last dose of RhoGAM today, before you are discharged home 3) you and your baby have negative blood types; a dose of RhoGAM is not needed 4) RhoGAM would have been already given while you were in the delivery room

3) you and your baby have negative blood types; a dose of RhoGAM is not needed Rh immune globulin is administered to women with Rh negative blood types at approx 28 weeks of gestation and again after any trauma, such as a car accident or fall. After delivery, RhoGAM is only indicated if the newborn has a positive blood type; both the client and the newborn are Rh negative

The nurse is preparing to administer topical benzocaine to a client with a fourth-degree episiotomy. Which interventions should the nurse implement? Rank in order of performance 1. Position the client on the side with top leg up and forward 2. Wash hands and don nonsterile examination gloves 3. Check the client's MAR with the identification band 4. Ask the client if she is allergic to any "-caine" drugs 5. Apply the benzocaine to the perineal area

3, 4, 2, 1, 5 3. Check the client's MAR with the identification band 4. Ask the client if she is allergic to any "-caine" drugs 2. Wash hands and don nonsterile examination gloves 1. Position the client on the side with top leg up and forward 5. Apply the benzocaine to the perineal area The nurse must first determine if this is the right client receiving the right medication The nurse should always check about allergies. With this medication, "-caine" drugs are anesthetics and, if the client is allergic to lidocaine (suturing lacerations) or Novacaine (dental procedures), the client should not receive this medication Once the nurse determines that this is the right client receiving the right medication and that the client has no allergies, then the nurse must wash his or her hands and use gloves to administer a medication to the perineal area This position allows maximum exposure to the area that should be medicated After completing all of the previous steps, the nurse can apply the medication

Two hours after delivery, the mother tells the nurse that she will be bottle feeding. She asks what she can do to prevent the terrible pain experienced when her milk came in with her last baby. Which response by the nurse is most appropriate? 1. "Once you have recovered from the birth, I will help you bind your breasts." 2. "Engorgement is familial. If you had it with your last baby, it is inevitable." 3. "I can help you put you on a supportive bra; wear one constantly for 1 to 2 weeks." 4. "Engorgement occurs right after birth; if you don't have it yet, it won't occur."

3. "I can help you put you on a supportive bra; wear one constantly for 1 to 2 weeks." Wearing a supportive, well-fitting bra within 6 hours after birth can suppress lactation. The bra should be worn continuously, except for showering, until lactation is suppressed (usually 7 to 14 days)

The nurse is teaching a pregnant client diagnosed with tuberculosis (TB) infection about treatments during pregnancy and effects on her newborn. Which statement indicates the client understands the client teaching? 1. "My baby will be born with TB, and will be given isoniazid to treat the infection." 2. "I will not be able to breastfeed or my newborn could contract TB." 3. "I should take supplemental pyridoxine during my pregnancy." 4. "I will not take any medications to treat my TB until I have delivered my baby."

3. "I should take supplemental pyridoxine during my pregnancy." Pyridoxine (vitamin B6) is recommended for pregnant clients with TB infections to ensure the fetus gets necessary vitamins

Which statement indicates to the nurse the client using a vaginal contraceptive ring understands the birth control teaching? 1. "If the ring falls out during intercourse, I should get a new ring." 2. "I should insert the ring 30 minutes before having intercourse." 3. "I will remove the ring 3 weeks after I have inserted it." 4. "I should never use the ring continuously to stop my period."

3. "I will remove the ring 3 weeks after I have inserted it." The vaginal contraceptive ring works on the same principle that oral contraceptives work. It provides 21 days of hormone suppression, followed by 7 days to allow for menses. The ring slowly releases hormones that penetrate the vaginal mucosa and are absorbed by the blood and distributed throughout the body. The contraception occurs from systemic effects, not local effects in the vagina

The client who is pregnant is prescribed ferrous sulfate. Which statement indicates to the nurse the client needs more teaching? 1. "I should increase my fluid and fiber when taking this medication." 2. "I will take a daily stool softener to prevent becoming constipated." 3. "If I notice that my stool becomes black or dark, I will call my obstetrician." 4. "I should take my iron tablet 2 hours after I eat."

3. "If i notice that my stool becomes black or dark, I will call my obstetrician." Ferrous sulfate (Feosol), an iron product, causes the stool to become black and tarry; therefore, the client would not need to notify the obstetrician

Which instructions should the nurse discuss with the client who is prescribed oral contraceptives for birth control? (Select all that apply) 1. "Never take more than one birth control pill a day." 2. "If breakthrough bleeding occurs, discontinue the pill." 3. "Take a missed pill as soon as you realize you have missed it." 4. "Antibiotics will decrease the ovulation suppression effect of the pill." 5. "Notify the HCP if you experience a severe headache."

3. "Take a missed pill as soon as you realize you have missed it." 4. "Antibiotics will decrease the ovulation suppression effect of the pill." 5. "Notify the HCP if you experience a severe headache." The client should be instructed to take any missed pill as soon as the omission is recognized; therefore, the client could and should take more than one pill in a day. To maintain ovulation suppression the client must take the medication routinely Antibiotics decrease the effectiveness of some oral contraceptives and a secondary form of birth control should be used during antibiotic therapy The client should be instructed to notify the HCP for a severe headache, which could indicate hypertension and a possible stroke

Which statement indicates to the nurse that the male client prescribed testosterone pellets for a low testosterone level understands the teaching concerning testosterone pellets? 1. "I need to take the pellets every day with food." 2. "I will need to have monthly testosterone levels drawn." 3. "The testosterone pellets will last for 3 to 6 months." 4. "I should notify the HCP if I have more spontaneous erections."

3. "The testosterone pellets will last for 3 to 6 months." Testosterone pellets (Testopel) last 3 to 6 months then dissolve

The male client experiencing infertility problems tells the clinic nurse that he is taking St. John's wort for his depression. Which statement is the nurse's best response? 1. "This herb is useful for depression. I hope it will help." 2. "Did you discuss taking this herb with your psychologist?" 3. "This herb may cause infertility problems." 4. "Is your significant other taking any herbal medication?"

3. "This herb may cause infertility problems." St. John's wort may cause effects on sperm cells, decreased sperm motility, and decreased viability; therefore, this client should not take this herb

The postpartum client is being discharged to home with a streptococcal puerperal infection. The client is taking antibiotics but asks the nurse what precautions she should take at home to prevent spreading the infection to her husband, newborn, and toddler. Which is the best response by the nurse? 1. "No precautions are necessary because you are taking antibiotics." 2. "You should always wear a mask when caring for your newborn and toddler." 3. "Wash your hands before caring for your children and after toileting and perineal care." 4. "Your husband should provide all cares for both children until your infection is gone."

3. "Wash your hands before caring for your children and after toileting and perineal care." Other than hand hygiene, no additional precautions need to be taken by the client in her home

A 2-day postpartum mother, G2 P2002, states that her 2-year-old daughter at home is very excited about taking "my baby sister" home. Which of the following is an appropriate response by the nurse? 1. "It's always nice when siblings are excited to have the babies go home." 2. "Your daughter is very advanced for her age. She must speak very well." 3. "Your daughter is likely to become very jealous of the new baby." 4. "Older sisters can be very helpful. They love to play mother."

3. "Your daughter is likely to become very jealous of the new baby."

The female client has been taking infertility medications. Which findings indicate ovarian overstimulation syndrome? 1. Abdominal bloating and vague gastrointestinal discomfort 2. Bright red vaginal bleeding with golf ball-size clots 3. A positive fluid wave and lower abdominal wave 4. Burning and an increased frequency of urinating

3. A positive fluid wave and lower abdominal wave Ovarian hyperstimulation syndrome involves marked ovarian enlargement with exudation of fluid into the woman's peritoneal and pleural cavities. This syndrome can result in ovarian cysts that may rupture, causing pain

The nurse is reviewing the laboratory data of a pregnant client in labor at term gestation. Which intervention should the nurse implement? 1. Administer Rho (D) immune globulin IM 2. Administer measles, mumps, rubella (MMR) vaccine subQ 3. Administer penicillin IVPB 4. Administer 2 units packed red blood cells (PRBCs) IV

3. Administer penicillin IVPB Penicillin (PCN) is administered in labor for clients with a positive group B streptococcus (GBS) culture. If the client is allergic to PCN, cefazolin, clindamycin, or erythromycin are other options. GBS can be transmitted to the newborn during delivery and can cause sepsis, meningitis, or pneumonia

The postpartum client who delivered via cesarean section is receiving epidural morphine. The unlicensed assistive personnel (UAP) tells the nurse the client has a pulse of 84, respirations of 10, and a blood pressure of 102/78. Which interventions should the nurse implement first? 1. Administer naloxone intramuscularly 2. Assess the client's pain using the numerical (1-10) pain scale 3. Check the client's respiratory rate and pulse oximeter reading 4. Complete a neurovascular assessment of the client's lower extremities

3. Check the client's respiratory rate and pulse oximeter reading Because the UAP provided the initial abnormal data, the nurse should first assess the client to determine and validate the client's respiratory status

The nurse is caring for the client diagnosed with preeclampsia and receiving magnesium sulfate intravenously. The laboratory reports to the nurse a critically high magnesium level of 6 mg/dL. Which intervention should the nurse implement? 1. Stop the magnesium infusion immediately 2. Notify the HCP to increase the magnesium infusion 3. Continue to monitor the client 4. Administer calcium gluconate stat

3. Continue to monitor the client The therapeutic level of magnesium sulfate for prevention of seizures in preeclampsia is 4 to 8 mg/dL. A normal magnesium level is 1.7 to 2.2 mg/dL. Although a laboratory result of 6 mg/dL is critically high in the normal client, it is a therapeutic value in this client

The nurse is assessing the laboratory report on a 2-day postpartum G1 P1001. The woman had a normal postpartum assessment this morning. Which of the following results should the nurse report to the primary health care provider? 1. White blood cells, 12,500 cells/mm3. 2. Red blood cells, 4,500,000 cells/mm3. 3. Hematocrit, 26%. 4. Hemoglobin, 11 g/dL

3. Hematocrit, 26%.

On admission to the labor and delivery unit, a client's hemoglobin (Hgb) was assessed at 11.0 g/dL, and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery? 1. Hgb 12.5 g/dL; Hct 37%. 2. Hgb 11.0 g/dL; Hct 33%. 3. Hgb 10.5 g/dL; Hct 31%. 4. Hgb 9.0 g/dL; Hct 27%.

3. Hgb 10.5 g/dL; Hct 31%.

A client, G2 P1102, is 30 minutes postpartum from a low forceps vaginal delivery over a right mediolateral episiotomy. Her physician has just finished repairing the incision. The client's legs are in the stirrups and she is breastfeeding her baby. Which of the following actions should the nurse perform? 1. Assess her feet and ankles for pitting edema. 2. Advise the client to stop feeding her baby while her blood pressure is assessed. 3. Lower both of her legs at the same time. 4. Measure the length of the episiotomy and document the findings in the chart

3. Lower both of her legs at the same time.

A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with which of the following drinks? 1. Skim milk. 2. Ginger ale. 3. Orange juice. 4. Chamomile tea

3. Orange juice.

The nurse is caring for a newborn client who received naloxone hydrochloride IM at delivery. Which assessment data indicates the medication is effective? 1. Axillary temperature of 98.3F (36.8C) 2. Heart rate regular at 120 bpm 3. Respirations irregular at 40 breaths per minute 4. Blood pressure at 70/40 mm Hg

3. Respirations irregular at 40 breaths per minute Naloxone is administered to newborn clients with depressed respirations whose mother received opiates within 4 hours of birth and is determined to be effective when the newborn client's respirations are between 30 and 60 breaths per minute. The normal newborn has an irregular breathing pattern. It is important to remember the dose of naloxone may need to be repeated if respiratory effort does not improve or if the opiate has a longer half-life than naloxone

Which statement best indicates the scientific rationale for administering corticosteroid therapy to a client who is 30 weeks pregnant? 1. Steroids are administered to decrease uterine contractions in preterm labor 2. Steroids will increase the analgesic effects of opioid narcotics 3. Steroids accelerate lung maturation, resulting in fetal surfactant development 4. Steroids will prevent the development of maternal antibodies to the fetus's blood

3. Steroids accelerate lung maturation, resulting in fetal surfactant development This is the scientific rationale for administering corticosteroids. They are administered to a client who is in preterm labor because they accelerate lung maturation, resulting in surfactant development in the fetus

The nurse is developing a standard care plan for postpartum clients who have had midline episiotomies. Which of the following interventions should be included in the plan? 1. Assist with stitch removal on third postpartum day. 2. Administer analgesics every four hours per doctor's orders. 3. Teach client to contract her buttocks before sitting. 4. Irrigate incision twice daily with antibiotic solution.

3. Teach client to contract her buttocks before sitting.

The postpartum client, who is 24-hours post-cesarean section, tells the nurse that she has much less lochial discharge after this birth than with her vaginal birth 2 years ago. The client asks if this is normal after a cesarean birth. Which statement should be the basis for the nurse's response? 1. A decrease in her lochia is not expected; further assessment is needed 2. Women usually have increased lochial discharge after cesarean births 3. Women normally have less lochial discharge after a cesarean birth 4. The lochia amount depends on whether surgery was emergent or planned

3. Women normally have less lochial discharge after a cesarean birth The client's lochial discharge is usually decreased after cesarean birth because the uterus is cleaned during surgery

The client is diagnosed with moderate postpartum depression (PPD) after vaginal delivery of a 10-lb baby. One week following the delivery, the nurse completes a home visit. Which finding is the priority? 1. Lochia has a foul-smelling odor 2. Small but tender hemorrhoids 3. Yells at her baby to stop crying 4. Client cries throughout the visit

3. Yells at her baby to stop crying It is inappropriate for the client to yell at her baby to stop crying. Verbal abuse can escalate to physical abuse. The safety of the infant should be the nurse's priority

The client, who is 12 days postpartum, telephones the clinic and tells the nurse that she is concerned that she may have an infection because her vaginal discharge has been creamy white for 2 days now. Which response by the nurse is correct? 1) you need to come to the clinic as soon as possible 2) you'll need an antibiotic; which pharmacy do you use? 3) take your temperature and let me know if it is elevated 4) a creamy, white discharge 10 days postpartum is normal

4) a creamy, white discharge 10 days postpartum is normal creamy white discharge 10-21 days postpartum is normal. her lochia changed color on her 10th postpartum day

the postpartum client delivered a full-term infant 2 days previously. The client states to the nurse, :my breasts seem to be growing, and my bra no longer fits." Which statement should be the basis for the nurse's response to the client's concern? 1) rapid enlargement of breasts usually is a symptoms of infection 2) increasing breast tissue may be a sign of postpartum fluid retention 3) thrombi may form in veins of the breast and cause increased breast size 4) breast tissue increases in the early postpartum period as milk forms

4) breast tissue increases in the early postpartum period as milk forms breast tissue increases as breast milk forms, so a bra that was adequate during pregnancy may no longer be adequate by the second or third postpartum day

Before hospitalization, an adolescent client had decided to give up her newborn for adoption. The client had an uncomplicated vaginal delivery and is still committed to her decision. Which intervention should the nurse exclude? 1) offer the client a transfer to different unit within the hospital 2) talk to the client about having possible feelings of ambivalence. 3) initiate a case management or social. work consult for the client 4) notify her family to ensure that support is available upon her discharge

4) notify her family to ensure that support is available upon her discharge the adolescent may not have disclosed the pregnancy to family. although it would be appropriate for the nurse to explore the client's support system with the client, the nurse should not contact the client's family

two hours after the client's vaginal delivery, she reports feeling "several large, warm gushes of fluid" and finds a large pool of blood on the client's bed. Which nursing action is priority? 1) encourage the client to ambulate to the bathroom to empty her bladder 2) place two hands on the uterine fundus and prepare to vigourisly massage the uterus 3) reassure the client that heavy bleeding is expected in the first few hours postpartum 4) support the lower uterine segment with one hand and assess the fundus with the other

4) support the lower uterine segment with one hand and assess the fundus with the other the nurse's first action should be support the lower uterine segment and to assess the fundus. increased bleeding will occur if soft or boggy. failing to support the lower uterine segment may result in inversion of the uterus

the caucasian postpartum client asks the nurse if the stretch marks on her abdomen will ever go away. Which response by the nurse is most accurate? 1) your stretch marks should totally disappear over the next month 2) your stretch marks will appear raised and reddened 3) your stretch marks will lighten in color with good skin hydration 4) your stretch marks will fade to pale white over the next 3 to 6 months

4) your stretch marks will fade to pale white over the next 3-6 months in caucasian women, stretch marks will fade to a pale white over 3 to 6 months

A 2-day-postpartum breastfeeding woman states, "I am sick of being fat. When can I go on a diet?" Which of the following responses is appropriate? 1. "It is fine for you to start dieting right now as long as you drink plenty of milk." 2. "Your breast milk will be low in vitamins if you start to diet while breastfeeding." 3. "You must eat at least 3,000 calories per day in order to produce enough milk for your baby." 4. "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day

4. "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day

The female client is taking clomiphene. Which statement indicates the client understands the risk of taking this medication? 1. "The medication may cause my child to have Down syndrome." 2. "There are very few risks associated with taking this medication." 3. "I should stagger the times that I take this medication." 4. "This medication may increase my chances of having twins."

4. "This medication may increase my chances of having twins." Clomiphene (Clomid), an estrogen antagonist, is an ovarian stimulant that promotes follicle maturation and ovulation. Many follicles can mature simultaneously, resulting in the increased possibility of multiple births

A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate? 1. "You must wait to begin to perform exercises until after your six-week postpartum checkup." 2. "You may begin Kegel exercises today, but do not do any other exercises until the doctor tells you that it is safe." 3. "By next week you will be able to return to the exercise schedule you had during your prepregnancy." 4. "You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks."

4. "You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks."

The nurse administers HCG intramuscularly to the female client who is infertile. Which instruction should the nurse discuss with the couple regarding this medication? (Select all that apply) 1. Explain the need to abstain from sexual intercourse for 14 days after receiving the medication 2. Instruct the male partner to wear boxer shorts while his female partner is taking HCG 3. Discuss taking the basal metabolic temperature and having sexual intercourse when it becomes elevated 2 degrees 4. Advise the couple to have intercourse on the eve of receiving medication and 3 days after receiving the medication 5. Notify the HCP if you experience swelling of the hands and legs, severe pelvic pain, or shortness of breath

4. Advise the couple to have intercourse on the eve of receiving medication and 3 days after receiving the medication 5. Notify the HCP if you experience swelling of the hands and legs, severe pelvic pain, or shortness of breath The couple should have sexual intercourse during this time because this is the probable period of ovulation Swelling of the hands and legs, severe pelvic pain, and shortness of breath can indicate ovarian hyperstimulation syndrome (OHSS) and the client should notify the HCP

The postpartum client delivered a healthy newborn 36 hours previously. The nurse finds the client crying and asks what is wrong. The client replies, "Nothing, really. I'm not in pain or anything, but I just seem to cry a lot for no reason." What should be the nurse's first intervention? 1. Call the client's support person to come and sit with her 2. Remind her that she has a healthy baby and that she shouldn't be crying 3. Contact the HCP to have the counselor come see the client 4. Ask the client to discuss her birth experience

4. Ask the client to discuss her birth experience A key feature of postpartum blues is episodic tearfulness without an identifiable reason. Interventions for postpartum blues include allowing the client to relive her birth experience

A client, G1 P1001, 1 hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time? 1. Provide the woman with a bedpan. 2. Advise the woman that the feeling is likely related to the trauma of delivery. 3. Remind the woman that she still has a catheter in place from the delivery. 4. Assist the woman to the bathroom.

4. Assist the woman to the bathroom.

The nurse is developing a plan of care for the postpartum client during the "taking hold" phase. Which of the following should the nurse include in the plan? 1. Provide the client with a nutritious meal. 2. Encourage the client to take a nap. 3. Assist the client with activities of daily living. 4. Assure the client that she is an excellent mother

4. Assure the client that she is an excellent mother

A patient, G2 P1102, who delivered her baby 8 hours ago, now has a temperature of 100.2°F. Which of the following is the appropriate nursing intervention at this time? 1. Notify the doctor to get an order for acetaminophen. 2. Request an infectious disease consult from the doctor. 3. Provide the woman with cool compresses. 4. Encourage intake of water and other fluids.

4. Encourage intake of water and other fluids.

The woman who is Rh negative and a follower of the Jehovah's Witnesses faith delivers a baby who is Rh positive. The HCP prescribed Rho (D) immune globulin for the mother. Which intervention should the nurse implement first? 1. Administer the Rho (D) immune globulin to the client within 72 hours 2. Obtain a signed permit for administering this medication 3. Confirm the infant's blood type with the laboratory 4. Explain to the client that Rho (D) immune globulin is a blood product

4. Explain to the client that Rho (D) immune globulin is a blood product The RhoGAM is derived from blood products; therefore, the nurse must explain this to the client whose faith prohibits the administration of blood or blood products

The nurse is evaluating the involution of a woman who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal? 1. Fundus 1 cm above the umbilicus, lochia rosa. 2. Fundus 2 cm above the umbilicus, lochia alba. 3. Fundus 2 cm below the umbilicus, lochia rubra. 4. Fundus 3 cm below the umbilicus, lochia serosa

4. Fundus 3 cm below the umbilicus, lochia serosa

The nurse is caring for a healthy newborn client. Which vaccination should the nurse expect to administer before the client is discharged? 1. Haemophilius influenza type b (Hib) 2. Measles, mumps, rubella (MMR) 3. Diphtheria, tetanus, acellular pertussis (DTaP) 4. Hepatitis B (Hep B)

4. Hepatitis B (Hep B) Hep B is recommended at birth

The nurse hears the following information on a newly delivered client during shift report: 21 years old, married, G1 P1001, 8 hours post-spontaneous vaginal delivery over an intact perineum; vitals 110/70, 98.6˚F, 82, 18; fundus firm at umbilicus; moderate lochia rubra; ambulated to bathroom to void 4 times; breastfeeding every 2 hours. Which of the following nursing diagnoses should the nurse include in this client's nursing care plan? 1. Fluid volume deficit r/t excess blood loss. 2. Impaired skin integrity r/t vaginal delivery. 3. Impaired urinary elimination r/t excess output. 4. Knowledge deficit r/t lack of parenting experience

4. Knowledge deficit r/t lack of parenting experience

A G2 P2002, who is postpartum 6 hours from a spontaneous vaginal delivery, is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia rubra, and perineal sutures are intact. Which of the following actions should the nurse take at this time? 1. Do nothing. This is a normal finding. 2. Massage the woman's fundus. 3. Take the woman to the bathroom to void. 4. Notify the woman's primary health care provider.

4. Notify the woman's primary health care provider.

Which medication categories are contraindicated in clients who are pregnant? (Select all that apply) 1. Pregnancy category A 2. Pregnancy category B 3. Pregnancy category C 4. Pregnancy category D 5. Pregnancy category X

4. Pregnancy category D 5. Pregnancy category X Category D medications have a proven risk of fetal harm and are not prescribed for clients who are pregnant unless the mother's life is in danger Category X medications have a definite risk of fetal abnormality or abortion

The nurse is preparing to administer medications in the antepartum unit. Which medication should the nurse question administering? 1. Terbutaline to a client preparing for an external cephalic version 2. Hydralazine to a client diagnosed with preeclampsia 3. Methotrexate to a client with an ectopic pregnancy 4. Prochlorperazine to a client diagnosed with hyperemesis gravidarum

4. Prochlorperazine to a client diagnosed with hyperemesis gravidarum Prochlorperazine (Compazine, Stemetil) is contraindicated in pregnancy. Ondansetron (Zofran) and promethazine (Phenergan) are more common medications for nausea and vomiting in pregnancy

The nurse is caring for the client who just gave birth. Which observation should lead the nurse to be concerned about the client's attachment to her male infant? 1. Asking the caregiver about how to change his diaper 2. Comparing her newborn's nose to her brother's nose 3. Calling the baby "Kelly," which was the name selected 4. Repeatedly telling her husband that she wants a girl

4. Repeatedly telling her husband that she wants a girl Attachment is demonstrated by expressing satisfaction with a baby's appearance and sex. Frequent expressions of dissatisfaction with the sex of the infant should be concerning and followed up

Which assessment data warrants immediate intervention for the client in labor who is receiving an oxytocin infusion via pump? 1. The uterus periodically becomes hard and firm 2. The client reports an urgency to void 3. The client denies the urge to push 4. The FHR does not return to baseline

4. The FHR does not return to baseline During a contraction, the FHR will decrease but should return to the baseline FHR after the contraction. If this does not occur, it indicates the infant is in distress and this warrants immediate interventions. This could also be a sign of uterine rupture resulting from overstimulation of the uterus. The oxytocin (Pitocin) infusion should be stopped immediately

Which client should the nurse recommend taking oral contraceptive pills for birth control? 1. The client who smokes two packs of cigarettes a day 2. The client who is taking an ACE inhibitor medication 3. The client who is 65" tall and weighs 100 kg 4. The client who has a family history of ovarian cancer

4. The client who has a family history of ovarian cancer Oral contraceptives decrease the risk for several disorders, including ovarian cancer, endometrial cancer, pelvic inflammatory disease, premenstrual syndrome, toxic shock, fibrocystic breast disease, ovarian cysts, and anemia. In addition to providing birth control for the client, the client gets a secondary benefit of decreasing her risk for ovarian cancer

The client is prescribed a 28-day oral contraceptive pack. Which statement best describes the scientific rationale for this birth control product? 1. This causes longer intervals between menses 2. A hormone pill daily decreases cramping during menses 3. It is not as expensive as other birth control products 4. This ensures that the client will take a pill every day

4. This ensures that the client will take a pill every day This 28-day pack contains 21 days of hormone and 7 days of placebos. The client takes a pill every day. This eliminates the need for the woman to remember which day to restart taking the pill, as she would have to with a 21-day pack, with which the woman takes a pill for 21 days and then no pill for 7 days and then restarts a new pack

The nurse is assessing the postpartum client, who is 5 hours postdelivery. Initially, the nurse is unable to palpate the client's uterine fundus. Prioritize the nurse's actions to locate the client's fundus by placing each step in the correct sequence. 1. Place the side of one hand just above the client's symphysis pubis 2. Press deeply into the abdomen 3. Place the other had at the level of the umbilicus 4. Massage the abdomen in a circular motion 5. Position the client in the supine position 6. If the fundus is not felt, move the upper hand lower on the abdomen and repeat the massage

5, 1, 3, 2, 4, 6 5. Position the client in the supine position 1. Place the side of one hand just above the client's symphysis pubis 3. Place the other had at the level of the umbilicus 2. Press deeply into the abdomen 4. Massage the abdomen in a circular motion 6. If the fundus is not felt, move the upper hand lower on the abdomen and repeat the massage

An infant was born weighing 6 lb (2.72 kg). At the end of 30 days, approximately how much should this infant weigh to demonstrate effective breastfeeding?

6 lb, 4 oz to 7 lb (2.83-3.17 kg)

A G2 TPAL 2002 patient experienced a precipitous birth 90 minutes ago. Her infant weighed 4,200 g, and a repair of a second-degree laceration was needed following the birth. The nurse assesses that the patient's uterus is boggy and deviated to the right. The patient's vaginal bleeding has increased. Which action by the nurse takes priority?

Massage the uterine fundus with continual lower-segment support.

A nurse is assessing a woman who had a postpartum hemorrhage treated with fundal massage and oxytocin (Pitocin). Which assessment finding would require the nurse to intervene immediately?

Mean arterial pressure of 58 mm Hg

A woman is 10 hours postpartum after an uncomplicated vaginal birth. She has voided four times, and each time the volume is less than 100 mL. What action by the nurse is best?

Palpate the fundus and assess the amount of lochia present.

A postpartum patient complains of severe perineal pain and a sensation of needing to defecate but cannot pass stool. What action by the nurse is best?

Palpate the perineal area.

A postpartum woman who experienced a spontaneous vaginal birth 12 hours ago describes a headache that is worsening. The patient was given two regular-strength acetaminophen (Tylenol) tablets approximately 30 minutes ago but has had no relief from the pain. The most appropriate nursing action at this time is to do which of the following?

Perform a comprehensive pain assessment.

A nurse is teaching a postpartum patient about preventing infection after discharge. What action by the patient indicates that she needs additional teaching?

Removes her peri-pad from back to front

The nursing faculty member explains to a class of nursing students the correct way to assist with perineal care (peri-care) after childbirth. Which action by a student nurse would warrant intervention by the faculty member?

Removes the peri-pad from back to front and appropriately disposes of it

The nurse is assessing a woman who delivered 12 hours earlier. Which of the following findings would the nurse expect to find at this point? a. Fundus 1 cm above the umbilicus, lochia rubra b. Fundus 2 cm below the umbilicus, lochia rubra c. Fundus 2 cm above the umbilicus, lochia rubra d. Fundus at the level of the umbilicus, lochia rubra

d. Fundus at the level of the umbilicus, lochia rubra