Mamas and Goblins Final Study.

Which instruction would the nurse give to a new mother regarding umbilical cord care?

"Apply alcohol on the cord stump daily to keep it dry until it falls off."

Which statement by the patient indicates that the nurse's instructions about breast-feeing were misunderstood?

"As long as I breast-feed, I can't get pregnant."

Which statement b the postpartum patient would require the nurse to reinforce teaching about self-care after discharge?

"I can't wait to soak in my Jacuzzi tub."

Which statement by a new moter would warrant a review of the infant's cord care?

"I must place the cord under the diaper."

A postpartum nurse is rounding on a patient 3 hours after vaginal delivery. Which statement by the patient would be of concern to the nurse?

"What a disappointment; I thought I was having a girl?"

When can you remove the cerclage from an incompetent cervix?

37 weeks or to delivery

What would the nurse anticipate to be prescribed for the patient whose blood glucose measurement shows elevation?

A 3- hour glucose tolerance test

Which physical sign and symptoms might the postpartum patient experience following delivery? Select all that apply.

A normal bowl movement within 2-3 days, Increased diaphoresis most commonly at night, increased urination beginning 4- 6 hours after delivery

Which essential intervention would the nurse perform for an Rh-negative patient that gives birth to an Rh-positive baby?

Administer RhoGAM as prescribed by

Which intervention would the nurse institute for a patient who has a pulse rate of 120 bpm, a 60/80 BP, and cool and clammy skin? Select all that apply.

Administer blood as prescribed, Massage the fundus, Elevate the legs to 30 degrees, Give oxygen, if prescribed, Maintain IV fluids.

A patient with hyperglycemia had a preterm delivery. Which intervention would the nurse plan to prevent complications in the newborn?

Administer glucose solution to the newborn 1 hour after birth.

What is the priority action of the nurse with a patient who presents pulomnary embolism?

Administer oxygen via face mask

Which nursing concern for a breastfeeding mother is related to lactation issues? Select all that apply

Anxiety related to lactation expectations. Decreased caloric intake because of lactation needs. Potential for infection related to dry, cracked nipples

Which intervention will the nurse expect to be most beneficial for an infant with severe bleeding after circumcision?

Arranging for the ligation of the bleeding blood vessel

A patient reports pain in her right calf, and the LPN notes that the area is reddened and edematous. Which intervention would the nurse perform next?

Assess for a positive or negative Homan's sign.

A patient who has had a routine vaginal delivery has a urinary output of 100 mL, 150 mL, and 275 mL recorded for three voiding in 6 hours after delivery. Which nursing action would be best?

Catheterize the patient, if ordered.

Which reason would the nurse give to the mother of a newborn on why not to feed the infant cow's milk?

Causes nausea and skin rashes

Which complication will the nurse expect to find in the newborn who has asummetric gluteal folds

Congenital Hip Dysplasia

Which action by the nursing mother will support milk production and promote infant comfort? Select all that apply

Drinking 8-10 glasses of fluids daily. Avoiding spicy foods, chocolate, and onions. Continuing taking prenatal vitamins and minerals until they are gone.

Which intervention would the nurse perform when observing a new mother turning away from her infant and sighing deeply?

Encourage the mother to discuss her feelings by sitting next to her and stating. "Having a baby can be overwhelming."

The father's behavior when introduced ot his new baby is typically an intense fascination. Which term describes this behavior?

Engrossment

Which medication would the nurse anticipate administering to all newborns admitted to the nursery? Select all that apply.

Erythromycin and Vitamin K

When providing discharge instructions to the family of a newborn infant, which symptoms would the parents be instructed to report to the health care provider? Select all that apply.

Fever, Diarrhea, Vomiting

Which intervention would the nurse perform FIRST when assessing the new mother's uterus and noting it to be boggy?

Gently massage the fundus to increase contractility

hich Statement made about elimination patters in an infant is incorrect?

Green, watery stoos are normally observed for 3 weeks after birth in infants.

Which nursing intervention would best enable the nurse to assess a postpartum patient for Homan's Sign?

Have the patient lie flat and point the toes toward the ankles.

What is major complication of gestational diabetes that affects the infant?

Hypoglycemia

A new mother reports feeling weak, lightheaded, and sick to her stomach. The LPN also notes that the patient's perineal pad is soaked since she last checked it 15 minutes ago. The patient's skin is cool and clammy, her pulse 110 bpm, and blood pressure is 80/60. Which complication do these symptoms indicate?

Hypovolemic shock

Which statement indicates that a mother fully understands care of her son's penis after circumcision? Select all that apply.

I will try not to touch the penis too much because it will be painful to the baby. I should put petroleum jelly on the penis with each diaper change. Some yellow discharge may be seen on the penis after a few days.

Which intervention would the nurse perform for a postpartum patient with an anterior rectal laceration? Select all that apply.

Instructing the patient to drink a lot of fluids. Administering stool softeners to the patient. Assessing the fecal continence of the patient.

Why is the fetus dependent on the mother for glucose control?

Insulin does not cross the pacenta

The nurse would primarily monitor for symptoms of which condition in the neonate after administereing 1 mg of vitamin K intramuscularly? Select all that apply.

Kernicterus, Hyperbilirubinemia, and Hemolytic anemia

What would happen if a patient with hyperemesis gravidarum is not treated?

Maternal or fetal death

The nurse palpates the uterus of a postpartum patient for involution and observes that the uterine fundus is soft and distended. Which medication will the nurse expect the health care provider to prescribe to the patient?

Methylergonovine maleate (Methergine)

Calculating fluid intake for newborn based on weight.

Minimum fluid intake is 140-160 mL per kg/daily is recommended. EX: Baby weighs 3 kg x 140 = 420 mL/daily

Which occurrence would be prevented by folding the baby's diaper down such that the plastic side is facing outside for proper umbilical cord care?

Moistue retention in the umbilicus

Which intervention would the nurse perform to provide effective care to a newly postpartum patient who reports feeling weak and "seeing stars"? Select all that apply.

Monitor the patient's vital signs. Gently message the patient's uterus. Notify the health care provider.

Which medication will the nurse expect the health care provider to prescribe for the newborn with a white patchy coating on the oral mucous membrane that cannot be wiped off?

Nystatin (Mycostatin)

A client with a history of rheumatic heart diease is in the hospital, what measures would you anticipate to be ordered?

Oxygen administration

What various problems can occur in infants who are large for gestational age and posterm?

Placenta begins to deteriorate before delivery, placing the fetus at risk for hypoxia

Which reflex is being demonstrated when the newborn curls the toes downward?

Planter Grasp

The vital signs of a newborn are as follows: T 97.9, P 140 bpm, RR 34 with brief periods of apnea, and BP 80/40 with an increase in systolic pressure when crying. Which nursing action would be best?

Realize that these vital signs are normal for a newborn, and document the data on the flow sheet.

A recently diagnosed gestation diabetic patient asks about insulin. What is the best nurses response?

Some may need insulin, but it can be controlled with diet.

In which order would the nurse perform a disposable type of sitz bath for a postpartum patient with severe lacerations and hemorrhage?

Step1. Clamp the tubing and fill the bag with water. Step 2. Fill the bad with required amount of water. Step 3. Toliet seat is raised and the bath is placed in the bowl. Step 4. The container is placed above the toilet bowl Step5. The tube is attached into the groove at the front side of bath Step 6. The tube clamp is loosened to regulate the rate of flow and fill the bath to halfway full.

Which intervention would the nurse provide to the non-breastfeeding postpartum patient to provide relief from swollen, firm, and painful breast? Select all that apply.

Suggest that the patient take lukewarm showers. Suggest that the patient wear a good supportive bra. Apply ice bags on the patient's breasts four times daily.

What should you expect the plan of care for ectopic pregnancy patient?

Surgery to remove the embryo/fetus

Which behavior by a new breastfeeding mother would call for immediate corrective action?

Swiftly removing the breast from the infant's mouth

A patient who had a cesarean section due to be discharged home. Which data obtained during an assessment would be of concern to the nurse?

The abdominal incision is red and warm, and the edges are nonapproximated, with moderate exudate.

Which date on the nursing documentation would indicate a potential complication in a patient 8 hours after cesarean delivery?

The apical pulse is 25 bpm above predelivery baseline.

Which inference will the nurse conclude when the infant is passing very water and green stools after the transition stools?

The infant has GI irritation.

Which statement regarding jaundice is accurate?

The jaundice s likely related to maternal-fetal blood incompatibility

The nurse is reviewing the lab reports of a postpartum patient and the newborn and expect the health care provider to prescribe RhoGAM to the patient. Which finding enabled the nurse ot reach this conclusion?

The patient is Rh positive and the newborn is Rh negative.

Which reason explains why the patient hold her breast away from the infant's nostrils when breastfeeding the infant?

The patient is trying to promote proper respiration in the infant.

Which ESSENTIAL information would the nurse include as part of the teaching process when administering the rubella vaccine to a recently delivered mother?

The patient should avoid conceiving for a least 3 months.

Which inference would the nurse make when observing a Vietnamese mother changing her newborn's diaper and providing basic care but failing to cuddle, kiss, or talk to the infant?

This behavior is normal for a mother of this culture.

The nurse finds that the glucose level in a neonate is 45 mg/dL and advises the parents to avoid giving glucose supplements to the neonate before breastfeeding. Which reason explains why the nurse gives this advice to the parents?

To ensure that the neonate takes interest in breastfeeding.

The nurse is caring for a patient who had cesarean delivery and was administered general anesthesia. Which reason would the nurse have for suggesting that the patient walk at frequent intervals and avoid continuous bed rest?

To help promote bowl function

For which reason would the nurse advise a postpartum patient to place the newborn on the right side after feeding?

To prevent regurgitation.

While caring for a lactating patient, the nurse suggests that the patient place the infant or her shoulder after feeding. Which reason for this suggestion is best?

To promote burping in the infant.

For which reason would a lactating mother lightly brush the infant's lips with the nipple?

To promote rooting reflex

Why would the nurse place an ice pack on the patient's perineum 4 hours after delivery?

To provide pain relief

Place puts the pregnant woman at risk for Thromembolic disease

Vena cava compression

Which symptom would the nurse monitor for in the postpartum patient to ensure safe administration of oxytocin? Select all that apply.

Water intoxication, irregular heartbeat, decreased blood pressure

Which reason explains why a postpartum patient with significant bleeding would be prescribed an IV infusion of lactated Ringer's solution?

Weakness and frequent vomiting.

Which sign and symptom would indicate to the nurse that a newly postpartum patient may be in shock? Select all that apply.

Weakness, tachycardia, gray skin tone

Which actions by the other indicate that the teaching of nipple care after breast-feeding was not effective?

Wiping each nipple thoroughly with an alcohol pad after feeding

Preeclampsia tendsto occur when?

after 20 weeks gestation

Use of alcohol, tobacco, marijuana, and cocaine can cause what?

fetal growth retardation

What is the follow-up care for a patient who recently had a molar pregnancy?

she must have periodic blood studies and ultrasounds to monitor for choriocarcinoma.

BUBBLE HE

B:Breast U: Uterus B: Bladder B: Bowel L: Lochia E: Episiotomy H: Homan's Sign E: Emotional Status

When would a nurse recommend that mother give her newborn 15mL of water?

Before giving formula

Which physiologic adaptiation will the nurse expect to occur in the newly postpartum patient? Select all that apply

Brusing of the perineum, Sloughing of the urterine lining. Rapid decline of cardiac output