OB Exam 4 Lippincott
Breastfeeding is generally encouraged except under certain conditions. Which conditions contraindicate breastfeeding? Select all that apply. a. for multiple births b. when the mother has active tuberculosis c. when the mother is diagnosed with breast cancer d. when the mother has lactose intolerance e. when the mother takes certain medications, such as antineoplastics
b, c, e
The nurse is teaching young parents discharge instructions. Which form of birth control should the nurse point out will be the best option for the breastfeeding mom who hopes to have more children later? a. combination hormonal birth control pill b. condoms c. estrogen-based pill d. tubal ligation
b
A client experienced prolonged labor with prolonged premature rupture of membranes. The nurse would be alert for which condition in the mother and the newborn? a. hypovolemia b. infection c. hemorrhage d. trauma
b
A client presents to the clinic with a 3-week-old infant reporting general flu-like symptoms and a painful right breast. Assessment reveals temperature 101.8°F (38.8°C) and the right breast nipple with a movable mass that is red and warm. The client is diagnosed with mastitis. Which instruction should the nurse prioritize for this client? a. Increase your fluid intake to ensure that you will continue to produce adequate milk. b. Breastfeed or otherwise empty your breasts at least every 3 hours. c. Use NSAIDs, warm showers, and warm compresses to relieve discomfort. d. Complete the full course of antibiotic prescribed, even if you begin to feel better.
d
Which intervention would be helpful to a client who is bottle feeding her infant and experiencing hard, engorged breasts? a. apply ice b. apply warm compresses c. breastfeed instead d. sitz bath
a
Two weeks after giving birth, a woman is feeling sad, hopeless, and guilty because she cannot take care of the infant and partner. The woman is tired but cannot sleep and has isolated herself from family and friends. The nurse recognizes that this client is exhibiting signs of: a. postpartum psychosis b. postpartum hemorrhage c. postpartum depression d. baby blues
c
Review of a primiparous woman's labor and birth record reveals a prolonged second stage of labor and extended time in the stirrups. Based on an interpretation of these findings, the nurse would be especially alert for which condition? a. thrombophlebitis b. uterine subinvolution c. hypertension d. retained placental fragments
a
The nurse is caring for a postpartum woman who exhibits a large amount of bleeding. Which areas would the nurse need to assess before the woman ambulates? a. Blood pressure, pulse, reports of dizziness b. Attachment, lochia color, complete blood cell count c. Height, level of orientation, support systems d. Degree of responsiveness, respiratory rate, fundus location
a
The nurse is giving an educational presentation to the local Le Leche league chapter. One woman asks about risk factors for mastitis. Which condition would the nurse most likely include in the response? a. Pierced nipple b. Frequent feeding c. Complete emptying of the breast d. Use of breast pumps
a
The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? a. Symptoms include fever, chills, malaise, and localized breast tenderness. b. The most common pathogen is group A streptococcus (GAS). c. Mastitis usually develops in both breasts of a breastfeeding client. d. A breast abscess is a common complication of mastitis.
a
The nurse palpates a postpartum woman's fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding? a. The bladder is distended. b. The uterus is filling up with blood. c. The uterine placement is normal. d. There is an infection inside the uterus.
a
A woman presents to the clinic at 1-month postpartum and reports her left breast has a painful, reddened area. On assessment, the nurse discovers a localized red and warm area. The nurse predicts the client has developed which disorder? a. Breast yeast b. Plugged milk duct c. Engorgement d. Mastitis
d
In talking to a mother who is 6 hours post-delivery, the mother reports that she has changed her perineal pad twice in the last hour. What question by the nurse would best elicit information needed to determine the mother's status? a. "Are you in any pain with your bleeding?" b. "What time did you last change your pad?" c. "When did you last void?" d. "How much blood was on the two pads?"
d
The nurse is caring for several women in the postpartum clinic setting. Which statement(s), when made by one of the clients, would alert the nurse to further assess that client for postpartum psychosis? Select all that apply. a. "When the newborn is sleeping, I can see his thoughts projected on my phone and I do not like the thoughts." b. "I believe my newborn is losing weight because I will not feed him because my milk was poisoned by the health care provider." c. "I am sad because I am not spending as much time with my toddler now that my newborn is here." d. "Sometimes I get tired of being with only the newborn, so I call my mom and sister to come visit." e. "The newborn is not really mine emotionally, since I was never pregnant and do not have children."
a, b, e
A fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition? a. uterine prolapse b. uterine atony c. uterine contraction d. uterine subinvolution
b
A nurse is making a follow up visit to a new parent and 3-month-old infant. The nurse is talking with the client about her role as a mother and caring for her infant. Which statement by the client would lead the nurse to immediately call the health care provider? a. "I feel really restless and sad, nothing seems to make me happy." b. "I am so angry with myself, I just want to give up my life right now." c. "It has been hard getting enough sleep with the infant waking up during the night." d. "I get tearful every so often and then suddenly I am all smiles."
b
Annie, a new mother, is talking with the nurse about breastfeeding. She asks, "How does lactation work?" The best answer by the nurse is: a. The newborn sucking on the breast stimulates the adrenal gland causing the release of oxytocin. This causes the synthesis and release of breast milk in the breast. b. The newborn sucking on the breast stimulates the pituitary gland causing the release of prolactin and oxytocin. Prolactin causes synthesis and release of breast milk and oxytocin causes contraction of the smooth muscle around the alveoli of the breast. c. The newborn sucking on the breast stimulates the pituitary gland causing the release of prolactin. This causes contractions of the smooth muscle around the alveoli in the breast. d. The newborn sucking on the breast stimulates the pituitary gland causing the release of prolactin. This causes the synthesis and release of breast milk in the breast.
b
The nurse is assessing a client 48 hours postpartum and notes on assessment: temperature 101.2oF (38.4oC), HR 82, RR 18, BP 125/78 mm Hg. The nurse should suspect the vital signs indicate which potential situation? a. Normal vital signs b. Infection c. Dehydration d. Shock
b
The nurse is assessing a client who is 14 hours postpartum and notes very heavy lochia flow with large clots. Which action should the nurse prioritize? a. Assess her blood pressure. b. Palpate her fundus. c. Have her turn to her left side. d. Assess her perineum.
b
The nurse is explaining the discharge instructions to a client who has developed postpartum cystitis. The client indicates she is not drinking a glass of fluid every hour because it hurts too much when she urinates. What is the best response from the nurse? a. Instruct to use a sitz bath while voiding. b. Teach that adequate hydration helps clear the infection quicker.
b
The nurse is preparing discharge instructions for a new mother who has been learning to breastfeed. Which response should the nurse prioritize when the mother questions her ability to produce enough milk for her infant? a. Drink a lot of milk. b. Drink a lot of fluids. c. Consume a minimum of 3000 calories per day. d. Take a daily multivitamin.
b
When completing the morning postpartum data collection, the nurse notices the client's perineal pad is completely saturated. Which action should be the nurse's first response? a. Have the charge nurse review the assessment. b. Ask the client when she last changed her perineal pad. c. Vigorously massage the fundus. d. Immediately call the health care provider.
b
Which situation should concern the nurse treating a postpartum client within a few days of birth? a. The client is nervous about taking the baby home. b. The client feels empty since she gave birth to the neonate. c. The client would like to watch the nurse give the baby her first bath. d. The client would like the nurse to take her baby to the nursery so she can sleep.
b
While breastfeeding, all of the following can contribute to sore nipples except: a. improper newborn latch. b. allowing the nipples to dry after each feeding. c. forceful detachment of the newborn from the breast. d. allowing the newborn to suck too long
b
A client is diagnosed with a postpartum infection. The nurse is most correct to provide which instruction? a. Change the perineal pad every 3 to 4 hours to decrease the uterine infection. b. Apply ice to the perineum to decrease pain of a perineal infection. c. Finish all antibiotics to decrease a genital tract infection. d. Drink plenty of fluids to decrease a bladder infection.
c
A mother delivers her newborn and has chosen to formula-feed her baby. She asks the nurse how to keep her breasts from making milk. How would the nurse respond to the mother's question? a. When she becomes engorged, it is recommended to not wear a bra to allow the breasts to be more comfortable. b. The doctor can give her a hormone shot to dry up her breasts. c. The mother needs to understand that she will produce some milk, but wearing a constrictive bra will help dry up the milk supply. d. The mother will produce milk after delivery but by manually expressing the milk, she can reduce the discomfort.
c
A postpartum client is recovering from the birth and emergent repair of a cervical laceration. Which sign on assessment should the nurse prioritize and report to the health care provider? a. Elevated blood pressure b. Decreased respiratory rate c. Weak and rapid pulse d. Warm and flushed skin
c
A woman comes to the clinic for her first postoperative check after a cesarean birth. When the nurse asks her about what type of birth control she plans to use, she tells the nurse that she is breastfeeding so she does not need to worry. What is the nurse's best response? a. "That gives you more time to think about which type of birth control you want to use." b. "Breastfeeding does give you many advantages." c. "Breastfeeding is not a foolproof method of birth control." d. "That will definitely be easier for you and your spouse."
c
A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? a. Suggest that she take an oral analgesic. b. Encourage her to drink large amounts of fluid. c. Obtain a clean-catch urine specimen. d. Administer amoxicillin, as prescribed.
c
Breastfeeding is contraindicated in all of the following conditions in the mother except: a. illicit drug use. b. taking antiviral medications. c. mastitis. d. untreated active tuberculosis.
c
The nurse notes uterine atony in the postpartum client. Which assessment is completed next? a. Assessment of bowel function b. Assessment of the lung fields c. Assessment of the perineal pad d. Assessment of laboratory data
c
The nursing instructor is leading a discussion exploring the various conditions that can result in postpartum hemorrhage. The instructor determines the session is successful when the students correctly choose which condition is most frequently the cause of postpartum hemorrhage? a. Perineal lacerations b. Hematoma c. Uterine atony d. Disseminated intravascular coagulation
c
Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage? a. thrombophlebitis b. moderate amount of lochia rubra c. uterine atony d. hemoglobin level of 12 g/dl (120 g/L)
c
A nurse is assigned to care for a client experiencing early postpartum hemorrhage. The nurse is required to administer the prescribed methylergonovine maleate intramuscularly to the client. Which condition would the nurse identify as necessitating the cautious administration of this drug? a. respiratory problems b. low blood pressure c. mild fever d. cardiovascular disease
d
A client with a perineal hematoma undergoes an incision and drainage. Which intervention would be most appropriate after this procedure? a. Pack the area to promote hemostasis and drainage. b. Monitor the client's fluid status. c. Administer prescribed magnesium sulfate. d. Check client's clotting study results.
a
A new mother asks the postpartum nurse if she can leave the unit for a few minutes to smoke. Which response by the nurse is most appropriate at this time? a. "I cannot stop you from smoking. However, I would caution you about exposing your newborn to secondhand smoke." b. "No, cigarette smoking will get nicotine into the breast milk and make it harmful for your baby." c. "Sure, as long as you wash your hands when you return to the unit." d. "I will put in a consult for you to visit with the smoking cessation counselor while you are gone."
a
A nurse is assessing a postpartum client. Which finding would the cause the nurse the greatest concern? a. sharp, stabbing chest pain with shortness of breath b. calf pain with dorsiflexion of the foot c. perineal pain with swelling along the episiotomy d. leg pain on ambulation with mild ankle edema
a
A woman who had a cesarean is getting ready to be discharged from the hospital. Before she leaves, she asks you to assess her breasts because she has pain on both sides. The nurse notices that both breasts are hard, warm, and tender to the touch. Her vital signs are normal. What does the nurse suspect? a. engorgement b. nipple thrush c. a plugged duct d. mastitis
a
Dietary needs change from pregnancy to lactation. What should breastfeeding mothers be advised? a. Even if a mother has adequate fat stores, calorie intake should increase. b. Thirst is not a reliable indicator of need. c. Because caffeine does not enter breast milk, its intake does not need to be restricted. d. If she does not consume enough calcium, her milk will be calcium deficient.
a
On completing fundal palpation, the nurse notes that the fundus is situated in the client's left abdomen. Which action is appropriate? a. Ask the client to empty her bladder. b. Straight-catheterize the client for half of her urine volume. c. Call the client's primary health care provider for direction. d. Straight-catheterize the client immediately.
a