Maternal Newborn Chapter 34

Answer: 1 Explanation: 1. The amount, consistency, color, and odor of the lochia are monitored on an ongoing basis. Increased bleeding is most often related to uterine atony and responds to fundal massage, expression of any clots, and emptying the bladder.

1) The nurse assesses the postpartum client to have moderate lochia rubra with clots. Which nursing intervention would be appropriate? 1. Assess fundus and bladder status. 2. Catheterize the client. 3. Administer Methergine IM per order. 4. Contact the physician immediately.

Answer: 1 Explanation: 1. Following birth, some women feel exhausted and in need of rest. Other women are euphoric and full of psychic energy, ready to retell their experience of birth repeatedly.

10) A client who delivered 2 hours ago tells the nurse that she is exhausted and feels guilty because her friends told her how euphoric they felt after giving birth. How should the nurse respond? 1. Everyone is different, and both responses are normal. 2. Most mothers do feel euphoria; I dont know why you dont. 3. Its good for me to know that because it might indicate a problem. 4. Let me bring your baby to the nursery so that you can rest.

Answer: 3 Explanation: 3. The nurse should discuss the importance of contraception during the early postpartum period and provide information on the advantages and disadvantages of different methods, including special considerations for breastfeeding mothers. The womans body needs adequate time to heal and recover from the stress of pregnancy and childbirth.

11) The breastfeeding client asks the nurse about appropriate contraception. What is the nurses best response? 1. Breastfeeding has many effects on sexual intercourse. 2. IUDs are easy to use and easy to insert prior to sexual intercourse. 3. Its possible to get pregnant before your menstrual period returns. Lets talk about some different options for contraception. 4. Breastfeeding hampers ovulation, so no contraception is needed.

Answer: 2 Explanation: 2. Women should be encouraged to limit the number of activities to prevent excessive fatigue, increase in lochia, and negative psychologic reactions, such as feeling overwhelmed. A regular exercise program including vigorous activities such as running, weight lifting, or competitive sports can usually be initiated after the 6-week postpartum examination or when approved by the clients physician/CNM.

12) The postpartum client expresses concern about getting back to her prepregnant shape, and asks the nurse when she will be able to run again. Which statement by the client indicates that teaching was effective? 1. I can start running in 2 weeks, and can breastfeed as soon as I am done. 2. I should see how my energy level is at home, and increase my activity slowly. 3. Running is not recommended for breastfeeding women. 4. If I am getting 8 hours of sleep per day, I can start running.

Answer: 1, 2, 3, 5 Explanation: 1. Adequate rest is essential to a smooth postpartum transition. The nurse can encourage rest by organizing activities to avoid frequent interruptions for the woman. 2. Mothers should be counseled to sleep when the baby sleeps. 3. Mothers should be counseled to delegate or postpone unnecessary chores and activities and to sleep when the baby sleeps. 5. Mothers should be counseled to utilize family and friends for support.

13) The nurse is teaching a new mother about ways to manage fatigue after she returns home. Which instructions should the nurse include? Select all that apply. 1. Take frequent rest periods. 2. Nap when the newborn is sleeping. 3. Avoid overdoing housework and unnecessary chores. Do not clean when infant is sleeping. 4. Avoid having others come to the house to do housework and interfere with rest. 5. Utilize friends and family to provide help and support, such as cooking a meal.

Answer: 4 Explanation: 4. Couplet care, which is care of both the mother and her baby, is an important part of the family-centered care approach, in which the infant remains at the mothers bedside and both are cared for by the same nurse.

14) The hospital is developing a new maternity unit. What aspects should be included in the planning of the new unit to best promote family wellness? 1. Normal newborn nursery centrally located to all client rooms 2. A kitchen with a refrigerator stocked with juice and sandwiches 3. Small, cozy rooms with a client bed and rocking chair 4. A nursing care model based on providing couplet care

Answer: 2 Explanation: 2. The nurse should be aware that standardized postpartum instructions, particularly those related to intercourse and contraception might need to be individualized and amended.

15) Which statement by a nursing student preparing to care for a postpartum lesbian mother would indicate the need for further teaching? 1. I cant let the client know Ive never worked with lesbian mothers. 2. I will have to adjust some of my discharge instruction for this mother. 3. I dont need to include the partner when I provide care and instruction. 4. Discharge teaching is exactly the same for lesbian mothers as for all others.

Answer: 2 Explanation: 2. In a mother-baby unit, the newborns crib is placed near the mothers bed, where she can see her baby easily; this is conducive to an on-demand feeding schedule for both breastfeeding and formula-feeding infants.

16) A new grandmother comments that when her children were born, they stayed in the nursery. The grandmother asks the nurse why her daughters baby stays mostly in the room instead of the nursery. How should the nurse respond? 1. Babies like to be with their mothers more than they like to be in the nursery. 2. Contact between parents and babies increases attachment. 3. Budget cuts have decreased the number of nurses in the nursery. 4. Why do you ask? Do you have concerns about your daughters parenting?

Answer: 1, 2, 4 Explanation: 1. Mother-baby care is an important part of the family-centered care approach. 2. The nurse should encourage skin-to-skin contact between mother (or father) and baby to promote breastfeeding and bonding. 4. The mother-baby unit is conducive to an on-demand feeding schedule for both breastfeeding and formula-feeding infants.

17) What maternity unit policies promote postpartal family wellness and shared parenting? Select all that apply. 1. Mother-baby care or couplet care on the postpartum unit 2. Skin-to-skin contact between the mother and baby and the father and baby 3. Newborn kept in the nursery to allow mother to rest between feedings 4. On-demand feeding schedule for both breastfed and bottle-fed infants 5. Limited visiting hours for the father so that the mother can sleep as needed

Answer: 1, 2, 5 Explanation: 1. Currently, the couple is advised to abstain from intercourse until the episiotomy is healed and the lochia has stopped. 2. Because postpartum women often experience vaginal dryness due to hormonal changes, the use of a water-based lubrication, such as K-Y jelly or Astroglide, may initially be necessary during intercourse. 5. Maternal fatigue is often a significant factor limiting the resumption of sexual intercourse. While interest and desire vary, most couples resume sexual activity within 3 months.

18) What information should the nurse include when teaching the postpartal client and partner about resumption of sexual activity? Select all that apply. 1. Couples should be encouraged to abstain from intercourse until the episiotomy is healed and the lochial flow has stopped. 2. Postpartum women often experience vaginal dryness, and should be encouraged to use some kind of lubrication initially during intercourse. 3. Breastfeeding the newborn after intercourse can reduce the chance of milk spouting from the nipples. 4. Maternal changes in libido are usually indicative of psychological depression. 5. Maternal fatigue is often a significant factor limiting the resumption of sexual intercourse.

Answer: 3 Explanation: 3. Using a special intravenous (IV) pump system, the woman presses a button to self-administer small doses of the medication as needed. For safety, the pump is preset with a time lockout so that the pump cannot deliver another dose until a specified time has elapsed. Women using PCA feel less anxious and have a greater sense of control with less dependence on the nursing staff.

19) What is the advantage of a client using a patient-controlled analgesia (PCA) following a cesarean birth? 1. The client receives a bolus of the analgesia when pressing the button. 2. The client experiences pain relief within 30 minutes. 3. The client feels a greater sense of control, and is less dependent on the nursing staff. 4. The client can deliver as many doses of the medication as needed.

Answer: 3 Explanation: 3. This is an open-ended question about an important physiologic issue. A discussion that includes both partners can facilitate an open dialog between them and can provide an opportunity for questions and answers.

2) The nurse is providing education to the new family. Which question by the nurse is best? 1. Do you know how to give the baby a bath? 2. You have diapers and supplies at home, right? 3. How have your breastfeedings been going? 4. How much formal education do you have?

Answer: 2 Explanation: 2. The use of sequential compression devices (SCDs) and early ambulation are essential to the prevention of deep vein thrombosis, especially if the client had a cesarean birth.

20) The client having her second child is scheduled for a cesarean birth because the baby is in a breech presentation. The client states, Im wondering what will be different this time compared with my first birth, which was vaginal. What response is best? 1. Well take good care of you and your baby. Youll be home before you know it. 2. Youll be wearing a sequential compression device until you start walking. 3. You will have a lot of pain, but there are medications that we give when it gets really bad. 4. You wont be able to nurse until the baby is 12 hours old, because of your epidural.

Answer: 2, 3, 4 Explanation: 2. Immobility increases the risk of abdominal distention and discomfort. Leg exercises serve to prevent or minimize abdominal distention in a surgical client who received a general anesthetic. 3. Abdominal tightening serves to prevent or minimize abdominal distention in a surgical client who received a general anesthetic. 4. Early ambulation prevents abdominal distention that can occur with excess accumulation of gas in the intestines.

21) The nurse is caring for a client who delivered by cesarean birth. The client received a general anesthetic. To prevent or minimize abdominal distention, which of the following would the nurse encourage? Select all that apply. 1. Increased intake of cold beverages 2. Leg exercises every 2 hours 3. Abdominal tightening 4. Ambulation 5. Using a straw when drinking fluids

Answer: 2 Explanation: 2. Women with cesarean births have special needs: increased need for rest and sleep; incisional care; self-care; and relief of pain and discomfort.

22) A multiparous client delivered her first child vaginally 2 years ago, and delivered an infant by cesarean yesterday due to breech presentation. Which statement would the nurse expect the client to make? 1. I cant believe how much more tired I was with the first baby. 2. Im having significantly more pain this time than with my last birth. 3. It is disappointing that I cant breastfeed because of the cesarean. 4. Getting in and out of bed feels more comfortable than last time.

Answer: 2, 3, 4 Explanation: 2. Immobility after delivery increases the risk of pulmonary infection. 3. Immobility after delivery increases the risk of deep vein thrombosis. 4. Immobility after delivery increases the risk of pulmonary embolism.

23) When caring for a new mother after cesarean birth, what complications would the nurse anticipate? Select all that apply. 1. Back pain 2. Pulmonary infection 3. Deep vein thrombosis 4. Pulmonary embolism 5. Perineal edema

Answer: 3 Explanation: 3. Some adolescents may not have a working knowledge of their own anatomy and physiology or the related terminology, and they may require special assistance with postpartum hygiene and care.

24) The nurse is supervising a student nurse who is working with a 14-year-old client who delivered her first child yesterday. Which statement indicates that the nursing student understands the particular needs of an adolescent client? 1. This client will need less teaching, because she will have gotten the right information in school. 2. Because of her age, this client will require less frequent fundal checks to assess for postpartal hemorrhage. 3. Because of her age, this client will probably need extra teaching about the terminology for her anatomy. 4. This client will need to have her grandmother provide day care and help raise the baby.

Answer: 3 Explanation: 3. A newborn physical examination performed at the bedside gives the parent(s) immediate feedback about the newborns health and demonstrates methods of handling an infant. This action helps the client learn about her baby as an individual and facilitates maternal-infant attachment. This is the highest priority.

25) The nurse is caring for a 15-year-old client who gave birth to her first child yesterday. What action is the best indicator that the nurse understands the parenting adolescent? 1. The clients mother is included in all discussions and demonstrations. 2. The father of the baby is encouraged to change a diaper and give a bottle. 3. The nurse explains the characteristics and cues of the baby when assessing him. 4. A discussion on contraceptive methods is the first topic of teaching.

Answer: 1 Explanation: 1. The father, if he is involved, should be included as much as possible. If classes are offered in the hospital during the postpartum stay, the adolescent mother and father should be strongly encouraged to attend and participate.

26) The nurse is planning care for three newly delivered adolescents and their babies. What should the nurse keep in mind when planning their care? 1. The babys father should be encouraged to participate when the nurse is providing instruction. 2. A class for all the adolescents would decrease teaching effectiveness. 3. The schools that the adolescents attend will provide teaching on bathing. 4. Adolescents understand the danger signals in newborns.

Answer: 4 Explanation: 4. Assessing the birth mothers preferences by respectfully asking questions and making no assumptions facilitates a more positive experience.

27) The nurse is preparing to receive a newly delivered client. The client is a young single mother who is relinquishing custody of her newborn through an open adoption. What action is most important? 1. Assign the client a room on the GYN surgical floor instead of on the postpartum floor. 2. Prepare to complete teaching in time for discharge at 24 hours post-delivery. 3. Make an effort not to bring up the topic of the baby, and discuss the mothers health instead. 4. Ask the client how much contact she would like with the baby, and whether she wants to feed it.

Answer: 2, 3, 4, 5 Explanation: 2. The mother who decides to relinquish her baby needs emotional support and validation of her loss. 3. The woman should decide whether to see and hold her baby and should have any special requests regarding the birth honored. 4. Perinatal nurses should be aware that relinquishing mothers are at risk for disenfranchised grief, in which they are unable to proceed through the grieving process and come to resolution with the loss. The nurse should acknowledge the womans loss and support her decision. 5. The amount of contact she chooses to have with her newborn should be respected.

28) The nurse is caring for a client who plans to relinquish her baby for adoption. The nurse would implement which approach to care? Select all that apply. 1. Encourage the client to see and hold her infant. 2. Encourage the client to express her emotions. 3. Respect any special requests for the birth. 4. Acknowledge the grieving process in the client. 5. Allow access to the infant, if the client requests it.

Answer: 2, 4, 5 Explanation: 2. The nurse can support the mother by encouraging her to share her feelings, by listening actively, and by being present for her. 4. The mother who decides to relinquish her baby needs emotional support and validation of her loss. The nurse should demonstrate empathy, concern, and compassion. 5. The nurse needs to acknowledge the significance of the birth mothers experience. The nurse should acknowledge the womans loss and support her decision.

29) What possible approaches should the nurse use to provide sensitive, holistic nursing care for the mother who is relinquishing her newborn? Select all that apply. 1. Allow the mother minimal control over the infant. 2. Use active listening strategies to determine the clients needs. 3. Provide only physical care in the early postpartum period. 4. Demonstrate empathy, concern, and compassion. 5. Provide nonjudgmental support and personalized care.

Answer: 1, 2, 3, 4 Explanation: 1. It is helpful for the nurse to advise parents that they may experience feelings of uncertainty as they grow into the parental role and alter their family processes to accommodate the new family member. 2. Guidance is essential in assisting the family to cope with role changes and the realities of a new baby. 3. Guidance is essential in assisting the family to cope with potential complications such as infant colic and postpartum health issues. 4. It is important for the nurse to present information about changes that may affect sexual activity and to discuss the importance of contraception during the early postpartum period.

3) The postpartum nurse provides anticipatory guidance for the new mother as well as teaching on self-care and infant care before discharge. Which topics should be included? Select all that apply. 1. Role changes brought on by the addition to the family unit 2. The realities of having a new baby, and how it affects previous lifestyle 3. Potential complications such as infant colic and postpartum issues 4. Sexuality and contraception 5. Toilet-training and preschool options

Answer: 3, 4, 5 Explanation: 3. The client should avoid overexertion. 4. The client should receive information and instruction on postpartum exercises. 5. The client should receive information on the need for adequate rest.

30) The nurse is planning discharge teaching for a postpartum woman. What information recommendations should the woman receive before being discharged? Select all that apply. 1. To abstain from sexual intercourse for 6 months 2. To avoid showers for 4 weeks 3. To avoid overexertion 4. To practice postpartum exercises 5. To obtain adequate rest

Answer: 3 Explanation: 3. Knowing how to contact their healthcare provider at all times is critical so that clients receive appropriate advice and care in case of a problem or emergency. Knowing what to watch for and when to call the healthcare provider also facilitates safety. These are the highest priorities.

31) The nurse is preparing a teaching brochure for Spanish-speaking postpartum clients. Which topics are critical for this population? 1. Baby baths and birth certificates 2. Hygiene practices 3. When and how to contact their healthcare provider 4. Pain-relief options in labor and after birth

Answer: 4 Explanation: 4. Effective parent learning requires precise timing of teaching, as well as choice of a teaching method that is effective for the family, such as DVDs and return demonstration. Content on self-care, infant care, and anticipatory guidance is important.

32) To actively involve the postpartal client during discharge teaching, the postpartum nurse applies which learning principle? 1. Reprints of magazine articles 2. Classroom lectures 3. Audiotapes 4. Interactive nurse-patient relationships

Answer: 1 Explanation: 1. A sitz bath or tub bath promotes healing and provides relief from perineal discomfort during the initial weeks following birth.

33) The nurse is performing discharge teaching for a newly delivered first-time mother and her infant on the 2nd postpartum day. Which statement by the mother indicates that teaching has been successful? 1. Taking baths will help my perineum feel less sore each day. 2. If I develop heavy bleeding, I should take my temperature. 3. My bowel movements should resume in a week. 4. I will go back to the doctor in 4 days for my RhoGAM shot.

Answer: 1 Explanation: 1. Early discharge may be advantageous if mother and baby are doing well, help is available for the mother at home, and the family and physician/CNM agree that both clients are healthy and ready for discharge.

34) The nurse is assessing clients after delivery. For which client is early discharge at 24 hours after delivery appropriate? 1. Woman and baby who have had two successful breastfeedings 2. Woman who is bottle-feeding her infant and has not voided since delivery 3. Twins delivered at 35 weeks, bottle-feeding 4. Cesarean birth performed for fetal distress

Answer: 1, 2, 4, 5 Explanation: 1. The use of sequential compression devices (SCDs) and early ambulation are essential to the prevention of deep vein thrombosis, especially if the client had a cesarean birth. 2. Ambulation should be encouraged as soon as possible to prevent pneumonia. 4. The new mother may need extra supervision and assistance when breastfeeding her baby to ensure newborn safety. 5. The obese client has needs similar to all postpartum client, but she needs special attention to prevent injury, respiratory complications, thromboembolic disease, and infection, for which she is at high risk.

35) The nurse is providing postpartum care to an obese client. As part of care for this client, the nurse should do which of the following? Select all that apply. 1. Apply sequential compression devices 2. Have the mother ambulate as early as possible 3. Encourage bottle-feeding over breastfeeding 4. Supervise breastfeeding 5. Instruct the client on signs of infection

Answer: 2 Explanation: 2. The nurse should explain the purpose and use of the sitz bath, anticipated effects, benefits, possible problems, and safety measures to prevent slipping or an injury from hot water. A call bell would be a safety measure.

4) A client is preparing to take a sitz bath for the first time. What will the nurse do? 1. Allow the client privacy during the sitz bath. 2. Place a call bell well within reach and check on the client frequently. 3. Discourage the client from taking a sitz bath. 4. Check on the client after the sitz bath.

Answer: 2 Explanation: 2. The client must avoid pregnancy for at least 1 month after receiving the rubella vaccine.

5) A postpartum client has just received a rubella vaccination. The client demonstrates understanding of the teaching associated with administration of this vaccine when she states which of the following? 1. I will need another vaccination in 3 months. 2. I must avoid getting pregnant for 1 month. 3. This will prevent me from getting chickenpox. 4. This will protect my newborn from getting the measles.

Answer: 1, 3, 4, 5 Explanation: 1. Pain can be a discomfort in the first year postpartum. 3. Urinary incontinence can be a complication in the first year postpartum. 4. Changes in mental health status can be a complication in the first year postpartum. 5. Sleep deprivation can be a complication in the first year postpartum.

6) The incidence of complications and discomforts in the first year postpartum is common and women may experience which of the following? Select all that apply. 1. Pain 2. Excess energy 3. Urinary incontinence 4. Changes in mental health status 5. Sleep deprivation

Answer: 1 Explanation: 1. A variety of drugs are used alone or in combination to provide relief of postpartum pain. An option would include nonsteroidal anti-inflammatory agents such as ibuprofen and ketorolac.

7) A variety of drugs are used either alone or in combination to provide relief of postpartum pain. Which of the following would be an option for pain relief? 1. Nonsteroidal anti-inflammatory agents 2. Proquad 3. Methergine 4. Intravenous oxytocin

Answer: 3 Explanation: 3. Applying cold packs to the breasts relieves discomfort and helps suppress lactation.

8) On the 3rd day postpartum, a client who is not breastfeeding experiences engorgement. To relieve her discomfort, the nurse should encourage the client to do which of the following? 1. Remove her bra 2. Apply heat to the breasts 3. Apply cold packs to the breasts 4. Use a breast pump to release the milk

Answer: 1, 3, 4, 5 Explanation: 1. The nurse continues to assess the womans pain level and provide relief measures as needed. 3. Within the first 12 hours postoperatively, unless medically contraindicated, the woman should be assisted to dangle her legs on the side of the bed. 4. The woman is encouraged to cough and breathe deeply and to use incentive spirometry every 2 to 4 hours while awake for the first few days following cesarean birth. 5. The nurse should encourage the use of breathing, relaxation, and distraction techniques.

9) The nurse is caring for a client who had a cesarean birth 4 hours ago. Which interventions would the nurse implement at this time? Select all that apply. 1. Administer analgesics as needed. 2. Encourage the client to ambulate to the bathroom to void. 3. Encourage leg exercises every 2 hours. 4. Encourage the client to cough and deep-breathe every 2 to 4 hours. 5. Encourage the use of breathing, relaxation, and distraction.