Chapter 17: Postpartum Adaptations and Nursing Care Foundations of Maternal-Newborn & Women's Health Nursing, 7th Edition

Which patient is more likely to have less stress adjusting to her role as a mother? a. A 26-year-old woman who is returning to work in 10 weeks b. A 35-year-old anxious mother who has had no contact with babies or children c. A 16-year-old teenager who lives with her parents and has a strained relationship with her mother d. A 25-year-old woman who knew at 16 weeks of gestation that she was pregnant with twins, who were delivered by cesarean birth

a. A 26-year-old woman who is returning to work in 10 weeks

The nurse is teaching a non-breastfeeding patient measure to suppress lactation. Which information should the nurse include in the teaching session? (Select all that apply.) a. Avoid massaging the breasts. b. Allow warm shower water to run over the breasts. c. If the breasts become engorged, pumping is recommended. d. Ice packs or cabbage leaves can be applied to the breasts to relieve discomfort. e. Wear a sports bra 24 hours a day until the breasts become soft.

a. Avoid massaging the breasts. d. Ice packs or cabbage leaves can be applied to the breasts to relieve discomfort. e. Wear a sports bra 24 hours a day until the breasts become soft.

Which clinical finding should the nurse suspect if the fundus is palpated on the right side of the abdomen above the expected level? a. Distended bladder b. Normal involution c. Been lying on her right side too long d. Stretched ligaments that are unable to support the uterus

a. Distended bladder

If the patient's white blood cell (WBC) count is 25,000/mm3 on her second postpartum day, which action should the nurse take? a. Document the finding. b. Inform the health care provider. c. Begin antibiotic therapy immediately. d. Have the laboratory draw blood for reanalysis.

a. Document the finding.

During which stage of role attainment do the parents become acquainted with their baby and combine parenting activities with cues from the infant? a. Formal b. Informal c. Personal d. Anticipatory

a. Formal

Which patient would be most likely to have severe afterbirth pains and request a narcotic analgesic? a. Gravida 5, para 5 b. Primipara who delivered a 7-lb boy c. Patient who is bottle feeding her first child d. Patient who is breastfeeding her second child

a. Gravida 5, para 5

The nurse observes a patient on her first postpartum day sitting in bed while her newborn lies awake in the bassinet. Which action is most appropriate for the nurse to take at this time? a. Hand the baby to the woman. b. Explain "taking-in" to the woman. c. Offer to hand the baby to the woman. d. No action, because this situation is perfectly acceptable.

a. Hand the baby to the woman.

Which anticipatory guidance action by the nurse makes role transition to parenthood easier? a. Helps the new parents identify resources. b. Recommends employing babysitters frequently. c. Tells the parents about the realities of parenthood. d. Offers a home phone number and tells parents to call if they have a question.

a. Helps the new parents identify resources.

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby? a. Letting-go b. Taking-in c. Taking-on d. Taking-hold

a. Letting-go

Which situation would require the administration of Rho(D) immune globulin? a. Mother Rh-negative, baby Rh-positive b. Mother Rh-negative, baby Rh-negative c. Mother Rh-positive, baby Rh-positive d. Mother Rh-positive, baby Rh-negative

a. Mother Rh-negative, baby Rh-positive

The nurse includes the addition of ice sitz baths for the postpartum patient. Which assessment finding indicates the treatment has been effective? a. No swelling or edema to the perineal area b. Patient complains that the sitz bath is too cold. c. Patient reports she took two sitz baths in 12 hours. d. Edges of the perineal laceration are well approximated.

a. No swelling or edema to the perineal area

Which vaccinations are indicated for the postpartum patient if she does not have immunity? (Select all that apply.) a. Pertussis b. Rubella c. Diphtheria, tetanus (Tdap) d. RhoGAM e. Varicella

a. Pertussis b. Rubella c. Diphtheria, tetanus (Tdap) e. Varicella

Which of the following are nursing measures that can promote parent-infant bonding and attachment? (Select all that apply.) a. Provide comfort and ample time for rest. b. Keep the baby wrapped to avoid cold stress. c. Position the infant face to face with the mother. d. Point out the characteristics of the infant in a positive way. e. Limit the amount of modeling so the mother doesn't feel insecure.

a. Provide comfort and ample time for rest. c. Position the infant face to face with the mother. d. Point out the characteristics of the infant in a positive way.

A new father calls the nurse's station stating that his wife, who delivered last week, is happy one minute and crying the next. He states, "She was never like this before the baby was born." How should the nurse best respond? a. Reassure him that this behavior is normal. b. Advise him to get immediate psychological help for her. c. Tell him to ignore the mood swings because they will go away. d. Instruct him in the signs, symptoms, and duration of postpartum blues.

a. Reassure him that this behavior is normal.

The nurse is planning comfort measures to implement for a patient after a vaginal birth. Which measures should the nurse plan to include in the patient's care plan? (Select all that apply.) a. Sitz baths four times a day b. Use of only warm water with the sitz baths c. Topical anesthetic spray after perineal care d. Ice pack to the perineum for the first 24 hours e. Relax the perineal and buttock areas when sitting

a. Sitz baths four times a day c. Topical anesthetic spray after perineal care d. Ice pack to the perineum for the first 24 hours

The postpartum nurse is reviewing dietary practices for an Asian patient. Which of the following should the nurse expect to observe as a dietary practice for this culture? a. Special foods brought from home. b. Preference for fresh fruits. c. Preference for "cold" foods. d. Request for ice water instead of hot water.

a. Special foods brought from home.

The postpartum nurse has completed discharge teaching for a patient being discharged after an uncomplicated vaginal birth. Which statement by the patient indicates that further teaching is necessary? a. "I may not have a bowel movement until the 2nd postpartum day." b. "If I breastfeed and supplement with formula, I won't need any birth control." c. "I know my normal pattern of bowel elimination won't return until about 8 to 10 days." d. "If I am not breastfeeding, I should use birth control when I resume sexual relations with my husband."

b. "If I breastfeed and supplement with formula, I won't need any birth control."

The nurse has completed a postpartum assessment on a patient who delivered 1 hour ago. Which amount of lochia consists of a moderate amount? a. Saturated peripad b. 10 to 15 cm (4- to 6-inch) stain on the peripad c. 2.5 to 10 cm (1- to 4-inch) stain on the peripad d. Less than a 1-inch stain on the peripad

b. 10 to 15 cm (4- to 6-inch) stain on the peripad

The nurse is conducting discharge teaching for a patient going home after a cesarean birth. Which signs and symptoms should the patient be taught to report? (Select all that apply.) a. Mild incisional pain b. Feeling of pelvic fullness c. Lochia changing from red to pink in color d. Frequency, urgency, or burning on urination e. Redness or edema of the abdominal incision

b. Feeling of pelvic fullness d. Frequency, urgency, or burning on urination e. Redness or edema of the abdominal incision

Which description best explains the term reciprocal attachment behavior? a. Behavior during the sensitive period when the infant is in the quiet alert stage b. Positive feedback that the infant exhibits toward parents during the attachment process c. Unidirectional behavior exhibited by the infant, initiated and enhanced by eye contact d. Behavior by the infant during the sensitive period to elicit feelings of "falling in love" from the parents

b. Positive feedback that the infant exhibits toward parents during the attachment process

Which fundal assessment finding at 12 hours after birth requires further assessment? a. The fundus is palpable at the level of the umbilicus. b. The fundus is palpable two fingerbreadths above the umbilicus. c. The fundus is palpable one fingerbreadth below the umbilicus. d. The fundus is palpable two fingerbreadths below the umbilicus.

b. The fundus is palpable two fingerbreadths above the umbilicus.

An example of binding in during the postpartum period is a a. new mother telling her friends all about her labor and birth experience. b. father looking at his newborn and stating that he "looks like I did when I was a baby." c. mother reporting increasing anxiety during the postpartum period because she feels like she is without support. d. mother wanting some time alone so that she can catch up on needed sleep.

b. father looking at his newborn and stating that he "looks like I did when I was a baby."

A postpartum patient asks, "Will these stretch marks ever go away?" Which is the nurse's best response? a. "No, never." b. "Yes, eventually." c. "They will fade to silvery lines but won't disappear completely." d. "They will continue to fade and should be gone by your 6-week checkup."

c. "They will fade to silvery lines but won't disappear completely."

The nurse is developing a plan of care for the patient's fourth stage of labor. One nursing intervention is to promote bonding. Specifically, which nursing action will facilitate the bonding process? a. Encourage the patient to call the baby by his or her first name. b. Stimulate the grasp reflex by placing the patient's finger in the infant's palm. c. Ask the patient if she wants her baby placed on her chest immediately after birth. d. Assess for familial characteristics and remark on the resemblance to the patient or the father.

c. Ask the patient if she wants her baby placed on her chest immediately after birth.

The nurse is providing care to a patient 2 hours after a cesarean birth. In the hand-off report, the preceding nurse indicated that the patient's lochia was scant rubra. On initial assessment, the oncoming nurse notes the patient's peripad is saturated with lochia rubra immediately after breastfeeding her infant. What is the nurse's priority action with this finding? a. Weigh the peripad. b. Replace the peripad. c. Contact the health care provider. d. Document the finding in the patient's chart.

c. Contact the health care provider.

The nurse is caring for a postpartum patient who delivered by the vaginal route 12 hours ago. Which assessment finding should the nurse report to the health care provider? a. Pulse rate of 50 b. Temperature of 38°C (100.4°F) c. Firm fundus, but excessive lochia d. Lightheaded when moving from a lying to standing position

c. Firm fundus, but excessive lochia

Which of the following behaviors would be applicable to a nursing diagnosis of Risk for Impaired Parenting? a. En face behavior is observed between father and infant. b. Mother relates that she feels exhilarated postbirth. c. Mother states that she feels excessive fatigue as a result of the childbirth experience. d. Father displays finger tipping behavior toward infant.

c. Mother states that she feels excessive fatigue as a result of the childbirth experience.

When assessing the A of the acronym REEDA, the nurse should evaluate the a. skin color. b. degree of edema. c. edges of the episiotomy. d. episiotomy for discharge.

c. edges of the episiotomy.

A postpartum patient calls the clinic and reports to the nurse feelings of fatigue, tearfulness, and anxiety. What is the nurse's most appropriate response at this time? a. "When did these symptoms begin?" b. "Sounds like normal postpartum depression." c. "Are you having trouble getting enough sleep?" d. "Are you able to get out of bed and provide care for your baby?"

d. "Are you able to get out of bed and provide care for your baby?"

Which should the nurse do to provide support to a patient who must return to full-time employment 6 weeks after a vaginal birth? a. Discuss child care arrangements with her. b. Allow her to solve the problem on her own. c. Reassure her that she'll get used to leaving her baby. d. Allow her to express her positive and negative feelings freely.

d. Allow her to express her positive and negative feelings freely.

The nurse is providing care to a patient who delivered a 3525-g infant 14 hours ago. The nurse palpates the fundus of the uterus as firm and at the umbilicus. What is the nurse's priority action related to this finding? a. Inform the health care provider. b. Encourage the patient to urinate. c. Massage the uterus to expel clots. d. Document the finding in the patient's chart.

d. Document the finding in the patient's chart.

To assess fundal contraction 6 hours after cesarean birth, which technique should the nurse utilize? a. Assess lochial flow rather than palpating the fundus. b. Palpate forcefully through the abdominal dressing. c. Place hands on both sides of the abdomen and press downward. d. Gently palpate, applying the same technique used for vaginal deliveries.

d. Gently palpate, applying the same technique used for vaginal deliveries.

To facilitate adequate urinary elimination during the postpartum period, the nurse should incorporate which intervention into the plan of care? a. Have the patient drink carbonated beverages to promote urinary excretion. b. Tell the patient that because of postpartum diuresis there is less risk to develop dehydration. c. Limit fluid intake to prevent polyuria. d. Teach the patient to perform pelvic floor exercises to combat potential stress incontinence.

d. Teach the patient to perform pelvic floor exercises to combat potential stress incontinence.

Which assessment finding 24 hours after vaginal birth would indicate a need for further intervention? a. Pain level 5 on scale of 0 to 10 b. Saturated pad over a 2-hour period c. Urinary output of 500 mL in one voiding d. Uterine fundus 2 cm above the umbilicus

d. Uterine fundus 2 cm above the umbilicus

A pregnant patient asks when the dark line on her abdomen (linea nigra) will go away. The nurse knows the pigmentation will fade after birth due to a. increased estrogen. b. increased progesterone. c. decreased human placental lactogen. d. decreased melanocyte-stimulating hormone.

d. decreased melanocyte-stimulating hormone.

The postpartum patient who continually repeats the story of her labor, birth, and recovery experiences is performing which of the following tasks? a. Making the birth experience "real" b. Accepting her response to labor and birth c. Providing others with her knowledge of events d. Taking hold of the events leading to her labor and birth

a. Making the birth experience "real"

A family is concerned about how their 2-year-old son is going to react to the new baby. Which intervention would help facilitate sibling attachment? a. Have the mother and father spend individual time with their son to allay potential anxiety over the new baby coming in and displacing his position in the family as the only child. b. Make sure that their son is supervised at all times when the baby is brought home from the hospital and is in his presence. c. Include the son in helping to take care of the baby and reinforce the label of "big brother" as a special role. d. Observe the son's reaction to the baby and let him decide when he wants to be introduced to his new sibling.

c. Include the son in helping to take care of the baby and reinforce the label of "big brother" as a special role.

The postpartum nurse is observing a patient holding the baby she delivered less than 24 hours ago. The partner is watching his wife and asking questions about newborn care. The 4-year-old big brother is punching his mother on the back. What should the nurse do next? a. Report the incident to the social services department. b. Advise the parents that the older son needs to be reprimanded. c. No action; this is a normal family adjusting to family change. d. Report to oncoming staff that the mother is probably not a good disciplinarian.

c. No action; this is a normal family adjusting to family change.

Which action should the nurse take in order to provide support and encouragement to the new postpartum patient? a. Recount how she solved her own problems. b. Correct the new mother at every opportunity. c. Praise the mother's early attempts at infant care. d. Explain to the new mother that everything will be fine.

c. Praise the mother's early attempts at infant care.

To promote bonding and attachment immediately after birth, which action should the nurse take? a. Assist the mother in feeding her baby. b. Allow the mother quiet time with her infant. c. Teach the mother about the concepts of bonding and attachment. d. Assist the mother in assuming an en face position with her newborn.

d. Assist the mother in assuming an en face position with her newborn.

Postpartal overdistention of the bladder and urinary retention can lead to which complication? a. Fever and increased blood pressure b. Postpartum hemorrhage and eclampsia c. Urinary tract infection and uterine rupture d. Postpartum hemorrhage and urinary tract infection

d. Postpartum hemorrhage and urinary tract infection

Which measure is optimal in order to prevent abdominal distention following a cesarean birth? a. Rectal suppositories b. Carbonated beverages c. Early and frequent ambulation d. Tightening and relaxing abdominal muscles

c. Early and frequent ambulation

Which maternal event is abnormal in the early postpartal period? a. Diuresis and diaphoresis b. Flatulence and constipation c. Extreme hunger and thirst d. Lochial color changes from rubra to alba

d. Lochial color changes from rubra to alba