OB Ch 9

6. A woman will be discharged 48 hours after a vaginal delivery. When planning discharge teaching, the nurse would include what information about lochia? a. Lochia should disappear 2 to 4 weeks postpartum. b. It is normal for the lochia to have a slightly foul odor. c. A change in lochia from pink to bright red should be reported. d. A decrease in flow will be noticed with ambulation and activity.

ANS: C A return to bright red lochia rubra may indicate a late postpartum hemorrhage and must be reported.

20. The nurse instructed a postpartum woman about storing and freezing breast milk. What statement by the woman leads the nurse to determine that the teaching was effective? a. "I can thaw frozen breast milk in the microwave." b. "I'll put enough breast milk for one day in a container." c. "Breast milk can be stored in glass containers." d. "Breast milk can be kept in the refrigerator for up to 3 months."

ANS: C Breast milk can be safely stored in glass or clear hard plastic containers.

17. A primipara tells the nurse, "My afterpains get worse when I am breastfeeding." What is the most appropriate nursing response? a. "I'll get you some aspirin to relieve the cramping that you feel." b. "Afterpains are more intense with your first baby." c. "Breastfeeding releases a hormone that causes your uterus to contract." d. "A change of position when you're breastfeeding might help."

ANS: C Breastfeeding mothers may have more afterpains because infant suckling causes the posterior pituitary to release oxytocin, which is a hormone that contracts the uterus.

14. What will the nurse's instructions for a new mother to care for the infant's umbilical cord include? a. Keeping the area covered with a sterile dressing b. Dressing the stump with antibiotic ointment at every diaper change c. Fastening the diaper low to allow for air circulation d. Giving the newborn a daily tub bath until the cord falls off

ANS: C Diaper placement below the umbilical stump allows for drying by air circulation.

24. A woman has given birth to an unresponsive newborn that NICU staff are attempting to revive. The patient and her husband are grief stricken and request the child be baptized immediately. What is the nurse's most appropriate action? a. Contact the hospital chaplain. b. Request the couple's clergy. c. Baptize the newborn. d. Ask the physician to baptize the newborn.

ANS: C If the condition of a newborn is poor, the parents may wish to have a baptism performed. The minister or priest is notified. However this is an emergency, so the nurse may perform the baptism by pouring water on the infant's forehead while saying, "I baptize you in the name of the Father, and of the Son, and of the Holy Spirit." If there is any doubt as to whether the infant is alive, the baptism is given conditionally: "If you are capable of receiving baptism, I baptize you in the name of the Father, and of the Son, and of the Holy Spirit." The physician is attending to the patient's immediate health needs.

19. In the recovery room, the nurse checks the newly delivered woman's fundus following a cesarean section. How would the nurse proceed with this assessment? a. Palpate from the midline to the side of the body. b. Palpate from the symphysis to the umbilicus. c. Palpate from the side of the uterus to the midline. d. Massage the abdomen in a circular motion.

ANS: C The fundus is checked gently by walking the fingers from the side of the uterus to the midline.

22. Below what blood glucose level is the newborn considered hypoglycemic? a. Below 70 mg/dL b. Below 60 mg/dL c. Below 50 mg/dL d. Below 40 mg/dL

ANS: D A blood glucose level of less than 40 mg/dL is considered hypoglycemic. If the screening sample is below 40 mg/dL, a venous sample will be drawn. After the blood has been drawn, the infant should be fed to prevent a further drop.

21. What should the nurse implement for security purposes when bringing the infant from the nursery to the mother? a. Ask, "Is this your band number?" b. Confirm room number of mother. c. Ask the mother to identify herself verbally. d. Check the band number of the infant with that of the mother.

ANS: D The nurse should check the band number of the infant with that of the mother by asking the mother to verbally read the number.

1. The nurse is assessing a newborn. What sign of hypoglycemia does the nurse record? a. Increased nasal mucus b. Increased temperature c. Active muscle movements d. High-pitched cry

ANS: D There are many signs of hypoglycemia in the newborn. One is a high-pitched cry.

16. On the second postpartum day, a mother bathed her newborn for the first time. She tells the nurse, "I don't think I did it right." What postpartum psychological stage is this woman most likely in based on this comment? a. Taking in b. Taking hold c. Letting go d. Settling down

ANS: B In phase 2, taking hold, the mother begins to initiate action and becomes interested in caring for the infant. In doing so, she may become critical of her performance.

5. What type of lochia will the nurse assess initially after delivery? a. Serosa b. Rubra c. Alba d. Vaginalis

ANS: B The initial vaginal discharge after delivery is called lochia rubra. It is red and moderately heavy. Lochia rubra lasts for up to 3 days postpartum.

30. The nurse is instructing a woman at 6 months postpartum on weaning her infant from breastfeeding. What interventions will the nurse suggest? (Select all that apply.) a. Omit newborn's favorite feeding first. b. Eliminate one feeding at a time. c. Expect the need for comfort feeding. d. Formula will need to be provided to substitute for feeding. e. Pump breasts in place of eliminated feeding.

ANS: B, C, D When weaning a newborn from breastfeeding, the mother should eliminate the favorite feeding last. One feeding should be eliminated at a time, and the need for comfort feeding should be expected. In younger infants formula will need to be substituted. The mother should not be instructed to pump in place of eliminated feeding or the breasts will continue to produce milk.

27. The nurse is giving a shower to a patient who had a cesarean section 2 days previously. What interventions should be included before, during, and after the shower? (Select all that apply.) a. Leave abdominal dressing open to air. b. Position patient with back to water stream. c. Cover infusion site with rubber glove. d. Provide a shower chair. e. Confirm ambulation ability.

ANS: B, C, D, E The patient should be evaluated for ambulatory ability, and the abdominal dressing and infusion site should be covered with a waterproof cover. The patient should be provided a shower chair and positioned with her back to the water stream.

3. What statement made by a new mother indicates she needs additional information about breastfeeding? a. "I let the baby nurse 10 to 15 minutes on the first breast and then switch to the other breast." b. "The baby needs to nurse at least 5 minutes on the breast to get the hindmilk." c. "The baby has been nursing every 2 to 3 hours." d. "If the baby gets fussy between feedings, I give her a bottle of water."

ANS: D Supplemental feedings of formula or water should not be offered to a healthy newborn who is breastfeeding.

25. A woman required a cesarean section for safe delivery of her newborn. She is planning to breastfeed and verbalized concern about pain. What is the best suggestion by the nurse? a. "Consider formula feeding for the first few days." b. "Pumping breast milk would be best for now." c. "Take pain medication 30 to 40 minutes prior to nursing." d. "Use the football hold when breastfeeding."

ANS: D The best answer is to encourage use of the football hold to decrease pressure on the operative site. There is no indication for the woman to formula feed or pump. Some pain medications should not be taken when breastfeeding.

35. ____________ refers to changes that the reproductive organs, particularly the uterus, undergo after birth to return to their prepregnancy size and condition.

ANS: Involution Involution refers to changes that the reproductive organs, particularly the uterus, undergo after birth to return to their prepregnancy size and condition.

12. In what situation will the physician order RhoGAM? a. An unsensitized Rh-negative mother has an Rh-positive infant. b. An Rh-negative mother becomes sensitized. c. A sensitized infant has a rising bilirubin level. d. An unsensitized infant exhibits no outward signs.

ANS: A The Rh-negative woman should receive RhoGAM within 72 hours after the birth of an Rh-positive infant.

10. The nurse is counseling a lactating mother about diet. What would the nurse include with this information? a. Consume 500 more calories than her usual prepregnancy diet. b. Eat less meat and more fruits and vegetables. c. Drink 3 to 4 tall glasses of fluid daily. d. Eat 1000 more calories than her usual prepregnancy diet.

ANS: A To maintain nutrient stores while breastfeeding, the mother needs 500 additional calories each day over her prepregnancy diet.

11. A woman asks about resumption of her menstrual cycle after childbirth. What should the nurse respond? a. A woman will not ovulate in the absence of menstrual flow. b. Most nonlactating women resume menstruation about 2 months postpartum. c. Generally, a woman does not ovulate in the first few cycles after childbirth. d. The return of menstruation is delayed when a woman does not breastfeed.

ANS: B Menstrual periods resume in about 6 to 8 weeks if the woman is not breastfeeding.

13. After birth, the nurse quickly dries and wraps the newborn in a blanket. How does this action prevent heat loss? a. Conduction b. Radiation c. Evaporation d. Convection

ANS: C Newborns lose heat quickly after birth as fluid evaporates from their bodies.

32. The nurse explains that the three infections that are contraindications to breastfeeding are _______________, _______________, and ________________.

ANS: human immunodeficiency virus (HIV), hepatitis B, hepatitis C Mothers who are HIV positive should not breastfeed because the virus can be transmitted through breast milk, as can the viruses that cause hepatitis B and C.

31. The nurse assesses a 6-inch stain of lochia rubra on a pad that was worn for 2 hours. The nurse would document this as a(n) ________________ amount of lochia.

ANS: moderate A 6-inch stain on a pad worn for 2 hours is regarded as a moderate amount of lochia discharge.

34. The hormone responsible for milk "let-down" or ejection from the breasts is ____________.

ANS: oxytocin The milk "let-down" reflex is caused by the hormone oxytocin.

33. The hormone responsible for milk production is ____________________.

ANS: prolactin During pregnancy, the woman secretes high levels of prolactin, the hormone that causes milk production. Following delivery, increased levels of prolactin lead to lactation.

9. Which statement indicates the new mother is breastfeeding correctly? a. "I will alternate breasts when feeding the baby." b. "I keep the baby on a 4-hour feeding schedule." c. "I let the baby stay on the first breast only 5 minutes." d. "I put only the nipple in the baby's mouth when I am breastfeeding."

ANS: A Alternating breasts for feeding increases milk production, particularly hindmilk, which has a higher protein and fat content.

2. What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery? a. Well-contracted with its upper border at or just below the umbilicus b. Well-contracted with its upper border three or four fingerbreadths above the umbilicus c. Relaxed with its upper border level with the umbilicus d. Relaxed with its upper border two or three fingerbreadths below the umbilicus

ANS: A Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a grapefruit, at the level of the umbilicus.

18. A new mother has decided not to breastfeed her newborn. What information will the nurse include when planning to teach the mother about formula feeding? a. Positioning the bottle so that the nipple is full of formula during the entire feeding b. Heating the infant formula in a microwave c. Burping the infant after 4 ounces and again when the bottle is empty d. Propping a bottle for a feeding

ANS: A The nipple of the bottle should be kept full of formula to reduce the amount of air the infant swallows.

23. The nurse is caring for a woman of Middle Eastern descent on the first postpartum day. Education is provided regarding instruction on use of a sitz bath. What documentation best indicates that the woman has understood the provided instruction? a. Patient correctly performed return demonstration. b. Patient indicated understanding by nodding head with instruction. c. Patient verbalizes "I understand." d. Family member indicates patient understands procedure.

ANS: A The nurse may need an interpreter to understand and provide optimal care to the woman and her family. If possible, when discussing sensitive information the interpreter should not be a family member, who might interpret selectively. The interpreter should not be of a group that is in social or religious conflict with the patient and her family, an issue that might arise in many Middle Eastern cultures. It is also important to remember that an affirmative nod from the woman may be a sign of courtesy to the nurse rather than a sign of understanding or agreement.

8. A postpartum woman is not immune to rubella. What will the nurse expect? a. The rubella virus vaccine should be administered before discharge. b. The woman should receive the rubella virus vaccine at her 6-week postpartum checkup. c. The woman should be instructed not to get pregnant until she receives the rubella vaccine. d. No intervention is indicated at this time because the woman is not at risk for rubella.

ANS: A The woman who is not immune to rubella is immunized in the immediate postpartum period because there is no danger of her being pregnant.

15. A new mother states her preference to formula feed her newborn. What will the nurse planning discharge instructions tell her to help suppress lactation and promote comfort? a. Wear a well-fitting bra continuously for several days. b. Stand in a warm shower, letting the water spray over the breasts. c. Express small amounts of milk from the breasts several times a day. d. Massage the breasts when they ache.

ANS: A When a mother does not wish to breastfeed, a snug bra worn around the clock can help alleviate discomfort from engorgement.

29. While instructing a new mother on formula preparations, the nurse would include what types? (Select all that apply.) a. Ready-to-feed formula b. Concentrated liquid formula c. Powdered formula d. Cow's milk e. Canned evaporated milk

ANS: A, B, C Formula choices are ready-to-use, concentrated liquid formula that will be diluted according to the infant's needs and powdered formula that is mixed as needed. Cow's milk and canned evaporated milk are unsuitable because they are nutritionally inadequate and stress the kidneys.

28. What postpartum exercises should the nurse teach a patient who had a vaginal delivery yesterday? (Select all that apply.) a. Abdominal tighteners b. Head lift c. Pelvic tilt d. Kegel exercises e. Leg lifts

ANS: A, B, C, D Exercises for postpartum involution such as abdominal tighteners, head lifts, pelvic tilts, and Kegel exercises are acceptable. Leg lifts are too strenuous early in the postpartum period.

26. Which assessments would lead the nurse to determine the gestational age of the infant as preterm? (Select all that apply.) a. Thin, transparent skin b. Vernix only in the body creases c. Folded ear springs back slowly d. Breast tissue under the nipple e. Creases over entire sole

ANS: A, C The only signs of preterm are the thin skin and the slowly responding ear.

4. After delivery, the nurse's assessment reveals a soft, boggy uterus located above the level of the umbilicus. What is the most appropriate nursing intervention? a. Notify the physician. b. Massage the fundus. c. Initiate measures that encourage voiding. d. Position the patient flat.

ANS: B A poorly contracted uterus should be massaged until firm to prevent hemorrhage.

7. What instruction should the nurse teach the postpartum woman about perineal self-care? a. Perform perineal self-care at least twice a day. b. Cleanse with warm water in a squeeze bottle from front to back. c. Remove perineal pads from the rectal area toward the vagina. d. Use cool water to decrease edema of the perineum.

ANS: B Cleansing from front to back prevents contamination from the rectal area.