Post-partum

Which practice should a nurse recommend to a client who has had a cesarean birth? Side-rolling exercises Frequent douching after she's discharged Doing sit-ups 2 weeks after birth Coughing and deep-breathing exercises

Coughing and deep-breathing exercises

A nurse is teaching a breast-feeding client how to care for her engorged breasts. Which statement by the client indicates the need for further teaching?

"If my breasts are uncomfortable, I'll limit the time I spend breast-feeding."

Phases of post-partum

Look

A postpartum primiparous client is having difficulty breastfeeding her infant. The infant latches on to the breast, but the mother's nipples are extremely sore during and after each feeding. The client needs further instruction about breastfeeding when she states: "I can put breast milk on my nipples to heal the sore areas." "Feeding the baby for a half-hour on each side will not make my breasts sore." "The baby needs to have as much of the nipple and areola in his mouth as possible to prevent sore and cracked nipples." "As long as some of my nipple is in the baby's mouth, the baby will receive enough milk."

"As long as some of my nipple is in the baby's mouth, the baby will receive enough milk."

A client gave birth 2 days ago and has been given instructions on breast care for bottle-feeding mothers. Which statement indicates that the nurse should reinforce the instructions to the client? a) "When showering, I will direct water onto my shoulders." b) "I will only use only water to clean my nipples." c) "I will use a breast pump to remove any milk that may appear." d) "I will wear a sports bra or a well-fitting bra for several days."

"I will use a breast pump to remove any milk that may appear." Explanation: The use of a breast pump to remove milk is contraindicated in bottle-feeding mothers. Nipple and breast stimulation and emptying of the breasts produce milk, rather than eliminate milk production. The bottle-feeding client is discouraged from stimulating the breasts in any way. A sports bra that is well fitting provides support and decreases stimulation. (Binders are not suggested.) Having the water in a shower land on the shoulders of the mother rather than the breasts also decreases stimulation. Only water is necessary to clean nipples when breast or bottle-feeding.

As she tries to decide on a birth-control method, a client requests information about medroxyprogesterone (Depo-Provera). Which of the following represents the nurse's best response? 1. Depo-Provera needs to be administered every 12 weeks. 2. Depo-Provera is effective for only 2 months at a time. 3. Depo-Provera can't be given to breast-feeding women. 4. Depo-Provera has a high failure rate; use a barrier form of protection also.

1. Depo-Provera needs to be administered every 12 weeks. Depo-Provera will provide effective birth control for 3 months, and it may be the birth-control method of choice for clients who are breast-feeding because studies haven't established any contraindications. There is no evidence that the drug has a high failure rate.

During an annual checkup, a client tells the nurse that she and her husband have decided to start a family. Ideally, when should the nurse plan for childbirth education to begin and end? 1. It should begin early in the third trimester and end 1 month after delivery. 2. It should begin before conception and end 3 months after delivery. 3. It should begin when the client learns she's pregnant and end after delivery. 4. It should begin at about 5 months' gestation and end at facility discharge.

2. It should begin before conception and end 3 months after delivery. RATIONALES: Ideally, childbirth education should begin before conception (or as soon after conception as possible) and continue for about 3 months after delivery. Beginning childbirth education later and ending it earlier wouldn't provide enough time for optimal preparation of the client and her partner.

A postpartum client has a temperature of 99.8° F (37.7.° C) during the first 24 hours after birth. Which nursing intervention is appropriate? Check the client's breasts for red, swollen areas. Encourage more fluid intake. Check for signs of puerperal infection. Assess lochia for foul odor.

Encourage more fluid intake

At which time should the nurse anticipate assisting a client to breastfeed her neonate? in about 2 hours, after the baby has been evaluated in about 4 hours, after the baby has had some sleep after the neonate's first period of reactivity during the neonate's first period of reactivity

during the neonate's first period of reactivity

After suction and evacuation of a complete hydatidiform mole, the 28-year-old multigravid client asks the nurse when she can become pregnant again. The nurse would advise the client not to become pregnant again for at least how long? 24 months 12 months 6 months 18 months

12 months

A client is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by: 3 full days of elevated basal body temperature and clear, thin cervical mucus. return to preovulatory basal body temperature. basal body temperature increase of 0.1° F to 0.2° F (0.06° C to 0.11° C) on the 2nd or 3rd day of the cycle. breast tenderness and mittelschmerz.

3 full days of elevated basal body temperature and clear, thin cervical mucus.

A nurse brings a new mother her neonate for the first time approximately 1 hour after the neonate's birth. After checking the identification, the nurse hands the neonate to the mother. Within a few minutes, the mother begins to undress her baby. What should the nurse do? Encourage the mother to rewrap the baby because the room is cold. Anticipate and support the behavior as a normal part of bonding. Take the baby back to the nursery and recheck the baby's temperature. Call the pediatrician and report the behavior.

Anticipate and support the behavior as a normal part of bonding.

A nurse is caring for a client during the first postpartum day. The client asks the nurse how to relieve pain from her episiotomy. What should the nurse instruct the woman to do? Apply an ice pack to her perineum. Perform perineal care after voiding or a bowel movement. Drink plenty of fluids. Take a sitz bath.

Apply an ice pack to her perineum.

Staff nurses on the postpartum floor are concerned that discharge teaching is consuming a large portion of their time. How can the nurses teach their clients in a more efficient manner? Show the clients an educational video. Organize a weekly discharge class. Conduct a class for clients who require the same discharge teaching. Assign a nursing assistant to teach a discharge class for the clients ready for discharge.

Assign a nursing assistant to teach a discharge class for the clients ready for discharge.

While caring for a the postpartum client who is receiving treatment with bed rest and intravenous heparin therapy for a deep vein thromobosis, the nurse should contact the client's health care provider (HCP) immediately if the client exhibited which symptom? Pain in her calf Hypertension Dyspnea Bradycardia

Dyspnea

In the fourth stage of labor, a full bladder increases the risk of what postpartum complication? Shock Infection Hemorrhage Disseminated intravascular coagulation (DIC)

Hemorrhage

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings contradicts the estimated gestational age of the newborn? Hypoglycemia Meconium aspiration Increased amounts of vernix Absence of lanugo

Increased amounts of vernix

Which information would the nurse include in the primiparous client's discharge teaching plan about measures to provide visual stimulation for the neonate? a) Move a brightly colored rattle in front of the baby's eyes. b) Use brightly colored animals and cartoon figures on the wall. c) Paint the baby's room in bright colors accented with teddy bears. d) Maintain eye contact while talking to the baby.

Maintain eye contact while talking to the baby. Correct Explanation: Neonates like to look at eyes, and eye-to-eye contact is a highly effective way to provide visual stimulation. The parent's eyes are circular, move from side to side, and become larger and smaller. Neonates have been observed to fix on them. In general, neonates prefer circular objects of darkness against a white background. Sharp black and white images of geometric figures are appropriate. Use of bright colors on the walls and moving a colorful rattle do not provide as much visual stimulation as eye-to-eye contact with talking. Brightly colored animals and cartoon figures are more appropriate at approximately 1 year of age.

The nurse is observing a client who gave birth yesterday. Where should the nurse expect to find the top of the client's fundus? a) One fingerbreadth above the umbilicus b) One fingerbreadth below the umbilicus c) Below the symphysis pubis d) At the level of the umbilicus

One fingerbreadth below the umbilicus

The community health nurse is providing education to a client who has given birth 74 hours earlier. The nurse teaches the client that which of the following would be a late sign or symptom of hemorrhage? Passing a quarter-sized clot Backache Peripad soaked over the course of 1 hour Foul smelling lochia

Peripad soaked over the course of 1 hour

A client is 24 hours postpartum. The nurse anticipates that the client's body is returning to homeostasis. Which assessment finding requires immediate intervention? Positive Homans' sign Elevated temperature Maternal chills Bradycardia

Positive Homens' sign

A breastfeeding client is seen at home by the visiting nurse 10 days after a vaginal birth. The client is reporting a warm, red, painful breast, a temperature of 100° F (37.7°C), and flulike symptoms. What should the nurse do?

Refer the woman to her health care provider (HCP). Explanation: The client is exhibiting signs and symptoms of a breast infection (mastitis). The nurse should instruct her to contact her HCP, who will likely prescribe a prescription for antibiotics. She should continue to breastfeed the infant from both breasts. Frequent breastfeeding is encouraged rather than discontinuing the process for anyone having a breast infection.

When caring for a client who has had a cesarean birth, which action by a nurse requires intervention? Monitoring pain status and providing necessary relief Assisting with parent-neonate bonding Removing the initial dressing for incision inspection Supporting self-esteem concerns about the birth

Removing the initial dressing for incision inspection

A mother is instructed to stimulate the rooting reflex when attempting to breast-feed her baby. Which action shows that the mother understands these instructions? a) Initiating the neonate's startle reflex to make sure the baby is aware b) Turning the neonate's head to the side, causing the neonate to extend the extremities on that side c) Giving the neonate water to check for swallowing d) Stroking the neonate's cheek

Stroking the neonate's cheek Explanation: The rooting reflex is a neonate's response to having his cheek stroked. The neonate will turn his head to the side of the stroked cheek and will open his mouth in anticipation of having a nipple placed in it. The client demonstrates understanding of teaching if she tries to elicit this reflex. The tonic neck reflex is elicited by turning the neonate's head to the side when he's lying on his back. The extremities on the same side extend and those on the other side flex. Moro's reflex is the startle reflex. Water isn't indicated for neonates

A mother with a history of varicose veins has just delivered her first baby. The nurse suspects that the mother has developed a pulmonary embolus. Which data below would lead to this nursing judgment? Select all that apply. Chest pain Chills and fever Sudden dyspnea Diaphoresis Confusion Cough

Sudden dyspnea Diaphoresis Cough Confusion Chest pain

Which factor is the most important in nursing care in the postpartum period? Supporting the mother's ability to successfully feed and care for her neonate Involving the family in the teaching Monitoring the normal progression of lochia Providing group discussions on neonatal care

Supporting the mother's ability to successfully feed and care for her neonate

Puerperium is defined as: the days spent in the hospital after birth. the 6 weeks following birth. the first hour after birth. the duration of breast-feeding.

The first hour after birth

which hormone is responsible for the let down reflex?

oxytocin

A woman who has given birth to a healthy baby is being discharged. As a part of the discharge teaching, the nurse should instruct the client to observe vaginal discharge for postpartum hemorrhage and notify the healthcare provider (HCP) about: clots the size of grapes. lochia that lasts longer than 1 week. bleeding that becomes lighter each day. saturating a pad in an hour.

saturating a pad in an hour

A primiparous client 3 days postpartum is to be discharged on heparin therapy. After teaching her about possible adverse effects of heparin therapy, the nurse determines that the client needs further instruction when she states that the adverse effects include which symptom? a) epistaxis b) slow pulse c) petechiae d) bleeding gums

slow pulse Correct Explanation: A slow pulse (bradycardia) is normal for the first 7 days postpartum as the body begins to adjust to the decrease in blood volume and return to the prepregnant state. Adverse effects of heparin therapy suggesting prolonged bleeding include hematuria, epistaxis, increased lochial flow, and bleeding gums. Typically, tachycardia, not bradycardia, would be associated with hemorrhage. Petechiae indicate bleeding under the skin or in subcutaneous tissue

Two weeks after a breastfeeding primiparous client is discharged, she calls the birthing center and says that she is afraid she is "losing my breast milk. The baby had been nursing every 4 hours, but now she is crying to be fed every 2 hours." The nurse interprets the neonate's behavior as most likely caused by which factor? a) the mother's fears about the baby's weight gain b) lack of adequate intake to meet maternal nutritional needs c) the neonate's temporary growth spurt, which requires more feedings d) preventing the neonate from sucking long enough with each feeding

the neonate's temporary growth spurt, which requires more feedings Correct Explanation: Neonates normally increase breastfeeding during periods of rapid growth (growth spurts). These can be expected at age 10 to 14 days, 5 to 6 weeks, 2.5 to 3 months, and 4.5 to 6 months. Each growth spurt is usually followed by a regular feeding pattern. Lack of adequate intake to meet maternal nutritional needs is not associated with the neonate's desire for more frequent breastfeeding sessions. However, an intake of adequate calories is necessary to produce quality breast milk. The mother's fears about weight gain and preventing the neonate from sucking long enough are not associated with the desire for more frequent breastfeeding sessions.