OB Exam 3
Which of the following would the nurse assess as indicating positive bonding between the parents and their newborn? a. Holding the infant close to the body b. Having visitors hold the infant c. Buying expensive infant clothes d. Requesting that the nurses care for the infant
a. Holding the infant close to the body Desiring to be in close proximity to another human being is all part of the bonding process. Bonding cannot take place with separation of individuals. Closeness is needed by the two people bonding, and not having others hold the infant. Buying or wearing expensive clothes has no emotional effect on a bonding relationship. Requesting that nurses provide care separates the parent from the infant and suggests that the parents lack the desire for closeness with their infant.
Which of the following suggestions would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight? a. Increase fluid intake and acid-producing foods in her diet. b. Breastfeed, avoid high-calorie foods, and increase exercise. c. Start a high-protein, low carbohydrate diet and restrict fluids. d. Do not eat snacks or carbohydrates after dinner.
b. Breastfeed, avoid high-calorie foods, and increase exercise. . Because weight loss is based on the principle of intake of calories and output of energy, instructing this woman to avoid high-calorie foods that yield no nutritive value and expending more energy through active exercise would result in weight loss for her. Acid-producing foods (plums, cranberries, and prunes) are typically recommended for women to prevent urinary tract infections to acidify the urine, not for weight-loss purposes. Increasing fluid intake (water) would be good for weight loss because it fills the stomach and reduces hunger sensations; however, this option does not identify which fluids should be increased. Increasing high-calorie juice and soda drinks would be counterproductive to weight-loss measures. Fluid restriction combined with a high-protein diet would increase the risk of gout and formation of kidney stones. Carbohydrates are needed by the body to make ATP and convert it to energy for cellular processes. Limiting snacks might be a good suggestion depending on which ones are selected. Raw fruits and vegetables are excellent high-fiber snacks that will help in an overall weight-loss program.
Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new son. This behavior is often termed: a. Attachment b. Engrossment c. Bonding d. Temperament
b. Engrossment because partner's or significant others' developing bond with the newborn—a time of intense absorption, preoccupation, and interest—is called engrossment. Responses "A," "C," and "D" are incorrect since they are terms typically describing the close relationship between the mother--infant dyad, not the father.
The nurse would expect a postpartum woman to demonstrate lochia in which sequence? a. Rubra, alba, serosa b. Rubra, serosa, alba c. Serosa, alba, rubra d. Alba, rubra, serosa
b. Rubra, serosa, alba Lochia discharge from the uterus proceeds in an orderly fashion, regardless of a surgical or vaginal birth. Its color changes from red to pink to whitish cream consistently, unless there is a complication. The correct sequence is rubra (red), then serosa (pink/brownish), and then alba (white, creamy).
After teaching a group of breastfeeding woman about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients? a. Carbohydrates and fiber b. Fats and vitamins c. Calories and protein d. Iron-rich foods and minerals
c. Calories and protein Lactating mothers need an extra 500 calories to sustain breast-feeding. An additional 20 g of protein is also needed to help build and regenerate body cells for the lactating woman. Additional intake of carbohydrates or fiber is not suggested for lactation. An increase in fats is not recommended, nor is it needed for breast-feeding. To obtain adequate amounts of vitamins during lactation, women are encouraged to choose a varied diet that includes enriched and fortified grains and cereals, fresh fruits and vegetables, and lean meats and dairy products. An increase in vitamins via supplements is not recommended. Choosing a variety of foods from the food pyramid will provide the lactating woman with adequate iron and minerals.
The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected? a. Cream-colored lochia; uterus above the umbilicus b. Bright-red lochia with clots; uterus 2 finger-breadths below umbilicus c. Light pink or brownish lochia; uterus 4-5 finger breadths below umbilicus d. Yellow, mucousy lochia; uterus at the level of the umbilicus
c. Light pink or brownish lochia; uterus 4-5 finger breadths below umbilicus . The nurse would expect light pink or brown lochia, and the uterus should be four to five fingerbreadths below the umbilicus. Cream-colored lochia wouldn't be seen for about 10 to 14 days after childbirth, thus it wouldn't be observed this early in the postpartum period. The uterus would be involuting downward into the pelvis, thus it would not be above the umbilicus by this timeframe. Bright-red lochia would be observed for up to 3 days postbirth, not 5 days later unless there was a problem. The uterus descends into the pelvis at a rate of 1 cm/day, thus the fundus should be 4 to 5 cm (fingerbreadths) below the umbilicus by now.
When assessing a postpartum woman, which of the following would lead the nurse to suspect postpartum blues? a. Panic attacks and suicidal thoughts b. Anger toward self and infant c. Periodic crying and insomnia d. Obsessive thoughts and hallucinations
c. Periodic crying and insomnia . Periodic crying and insomnia are characteristics of postpartum blues, in addition to mood changes, irritability, and increased sensitivity. Panic attacks and suicidal thoughts or anger toward self and the infant would be descriptive of postpartum psychosis, some women turn this anger toward themselves and have committed suicide or infanticide. Women experiencing postpartum blues do not lose touch with reality. Obsessive thoughts and hallucinations would be more descriptive of postpartum psychosis.
Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home? a. Punishing the older child for bedwetting behavior b. Sending the sibling to the grandparent's home c. Planning a daily "special time" for the older sibling d. Allowing the sibling to share a room with the new infant
c. Planning a daily "special time" for the older sibling
After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? a. "I will need to take medication daily to treat the anxiety and sadness." b. "I will call the OB support line only if I start to hear voices." c. "I will contact my doctor if I become dizzy and feel nauseated." d. "I may feel like laughing one minute and crying the next minute."
d. "I may feel like laughing one minute and crying the next minute." " because emotional lability is typical of postpartum blues which is usually self-limiting. Response "A" is incorrect since postpartum blues don't require any medication to treat. Response "B" is incorrect since this behavior would indicate postpartum psychosis and not merely the "blues." Response "C" would indicate a physical condition, such as infection, not a mental disorder
The nurse is explaining to a postpartum woman 48 hours after her giving childbirth, that the after-pains she is experiencing can be the result of which of the following? a. Abdominal cramping is a sign of endometriosis. b. A small infant weighing less than 8 lbs. c. Pregnancies that were too closely spaced. d. Contractions of the uterus after birth.
d. Contractions of the uterus after birth. The direct cause of afterpains is uterine contractions. Mothers experience abdominal pain secondary to contractions, especially when breast-feeding because sucking stimulates the release of oxytocin from the posterior pituitary gland, which causes uterine contractions. There is no association of afterpains with endometriosis. The small size of the newborn wouldn't stretch her uterus, thus would not be a contributing factor to her discomfort now. Pregnancies spaced too close together can contribute to frequent stretching of the uterus, but this is not the cause of afterpains.
Which of these activities would best help the postpartum nurse to provide culturally sensitive care for the childbearing family? a. Taking a transcultural course b. Caring for only families of his or her cultural origin c. Teaching Western beliefs to culturally diverse families d. Educating himself or herself about diverse cultural practices
d. Educating himself or herself about diverse cultural practices . Nurses need first to become educated about various cultural practices to incorporate them into their care delivery. By gaining an understanding of diverse cultures different from their own, nurses can become sensitive to these different practices and not violate them. Attending a transcultural course might be beneficial, but this would take several weeks to complete and the information is needed much sooner to provide culturally sensitive care for an admitted client and her family. Caring only for families of the nurse's cultural origin would not be possible or realistic in our global, culturally diverse population within the United States. Nurses need to care for every person regardless of their color, creed, or nationality with respect and competence. Teaching diverse cultural families Western beliefs would demonstrate ethnocentric behavior and would not be professional. Each culture needs to be respected and learned about with tolerance and understanding.
Which of the following would lead the nurse to suspect that a postpartum woman was developing a complication? a. Fatigue and irritability b. Perineal discomfort and pink discharge c. Pulse rate of 60 bpm d. Swollen, tender, hot area on breast
d. Swollen, tender, hot area on breast A swollen, tender area on the breast would indicate mastitis, which would need medical intervention. Fatigue and irritability are not complications of childbearing, but rather the norm during the early postpartum period secondary to infant care demands and lack of sleep on the caretaker's part. Perineal discomfort and lochia serosa are normal physiologic events after childbirth and indicate normal uterine involution. Bradycardia is a normal vital sign for several days after childbirth because of the dramatic circulatory changes that take place with the loss of the placenta at birth and the return of blood back to the central circulation.
