OB EXAM 1
The nurse is developing a plan of care for a postpartum client during the "taking in" phase. What should the nurse include in the plan?
Discuss the labor and birth with the mother
A breastfeeding client, G10 P6408, delivered 10 minutes ago. What assessment is the most important for the nurse to perform at this time?
Fundus
A woman is recieving patient controlled analgesia (PCA) post cesarean section. What must be included in the patient teaching?
The client should report any feelings of nausea or itching to the nurse
The nurse has provided teaching to a postop cesarean client who is being discharged on Colace (docusate sodium) 100 mg PO tid. What would indicate that the teaching was sucessful?
The woman swallows the tablets whole
The nurse is assessing the midline episiotomy on a postpartum client. What findings should the nurse expect to see?
Well-approximated edges
The nurse is caring for a seventh day adventist woman who delivered a baby boy by cesarean section. What questions should be asked regarding this woman's care?
"Would you like me to order a vegetarian diet for you?"
During a postpartum assessment, the nurse assesses the calves of a clients legs/ The nurse is checking for what S/Sx?
- pain - warmth - redness
A breastfeeding woman has been counseled on how to prevent engorgement. What action by the mother shows that the teaching was effective?
She feeds her baby every 2-3 hours
The nurse is discussing the importance of doing Kegel exercises during the postpartum period. What should be included in the teaching plan?
She should practice by stopping the urine flow midstream every time she voids.
The nurse is preparing to place a peripad on the perineum of a client who delivered her baby 10 minutes earlier. The client states "I dont use those. I always use tampons." What action by the nurse is appropriate at this time?
State that it is unsafe to place anything into the vagina until involution is complete
A client has just been transferred to the postpartum unit from labor and delivery. What task should the RN delegate to the CNA?
Take the clients VS
The nurse is developing a standard care plan for postpartum clients who have had midline episiotomies. What intervention should be included in the plan?
Teach the client to contract her buttocks before sitting
A client who is 3 days postpartum asks the nurse, "When may my husband and I begin having sexual relations again?" The nurse should encourage the couple to wait until after what has occurred?
The client has had her six week postpartum checkup
A client, G1 P1001, 1 hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urniate. What action by the nurse is appropriate at this time?
Assist the woman to the bathroom
An asian client temperature 10 hours after delivery is 100.2 degrees F but, when encouraged, she refuses to drink ice water. What nursing action is most appropriate?
Replace the ice water with hot water
A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do what?
rotate the baby's positions at each feed
A woman had a cesarean section yesterday. She states that she needs to cough but that she is afraid to. What is the nurse's best response?
"If you support your incision with a pillow, coughing should hurt less"
The nurse is developing a plan of care for the postpartum client during the "taking hold" phase. What should the nurse include in the plan?
Assure the client that she is an excellent mother
A 1-day postpartum woman states, "I think I have a urinary tract infection. I ahve to go to the bathroom all the timte." What action should the nurse take?
Assure the woman that frequent urination is normal after delivery
A bottle feeding woman, 1 1/2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated two pads in the past 1 hour. What response by the nurse is appropriate?
"It is important for you to be examined by the doctor today. Let me check to see when you can come in."
During a home visit, the nurse assesses a client 2 weeks after delivery. What s/sx should the nurse expect to see?
Lochia alba
A 2 day post partum breastfeeding woman states, "I am sick of being fat. When can I go on a diet?" What is an appropriate response?
"Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day"
A nurse is performing a postpartum assessment on a client who delivered by cesarean section. What actions will the nurse perform?
- auscultate the abdomen - palpate the fundus - assess the nipple integrity - auscultate the lung fields
A nurse is performing a postpartum assessment on a client who delivered vaginally. What actions will the nurse perform?
- palpate the breasts - check vaginal discharge - assess the extremities - inspect the perineum
A mother, G1 P1, who delivered a 2800 gram baby vaginally 30 minutes earlier, is transferred to the postpartum unit. She pushed for 45 minutes and the placenta was delivered 10 minutes later. She is receiving an intravenous with 20 units oxytocin added. The postpartum nurse questions why the oxytocin was added to the IV bag. What response by the transferring nurse is most likely?
"The medication was added immediately after the baby's birth to promote placental delivery"
A client, G1 P1, who had an epidural has just delivered a daughter, Apgar 9/9, over a mediolateral episiotomy. The physician used low forceps. While recovering, the client states, "I'm a failure. I couldn't stand the pain and couldn't even push my baby out by myself." What is the best response for the nurse to make?
"To have things work out differently than you had planned is disappointing"
The nurse is caring for a client, post-op day 1 from an emergency cearean section with her husband in attendance. The baby's Abgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. What comment by the nurse is appropriate?
"With all of your preparations, it must have been disappointing for you to have had a cesarean"
A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. What response by the nurse is appropriate?
"You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks"
A nurse is caring for a postpartum client who has stated that she is putting her newborn son up for adoption. The client asks the nurse to help her breastfeed her baby. What response by the nurse is appropriate?
"You want to place your baby on a lap pillow and have your baby face you. Then wait for the baby to open his mouth before moving the baby toward your breast"
A 2-day postpartum mother, G2 P2002, states that her 2 year old daughter at home is very excited about taking "my baby sister" home. What is an appropriate response by the nurse?
"Your daughter is likely to become very jealous of the new baby"
A client who delivered a 3900 gram baby vaginally over a right mediolateral episiotomy states, "How am I supposed to have a bowel movement? The stiches are right there!" What is the best response by the nurse?
"Your stiches are actuallly far away from your rectal area"
During a postpartum assessment, it is noted that a G1 P1001 woman who delivered vaginally over an intact perineum has a cluster of hemorrhoids. What would be appropriate for the nurse to include in the woman's health teaching?
- The client should use a sitz bath daily as a relief measure - The client should digitally replace external hemorrhoids into her rectum - The client should apply topical anesthetic as a relief measure
Once nursing dx that a nurse has identified for a postpartum client is: Risj for intrauterine infection rlt vaginal delivery. During the postpartum period, what goals should the nurse include in the care plan in relation to this dx?
- the client will have a stable white blood cell count - the client will have a normal temperature - the client will have normal smelling vaginal discharge
A client informs the nurse that she intends to bottle feed her baby. What actions should the nurse encourage the client to perform?
- wear a supportive bra 24 hours a day - stand with her back toward the shower water
A postoperative cesarean section woman is to receive morphine 4 mg q 3-4 hours subcutaneously for pain. The morphine is available on the unit in premeasured syringes 10 mg/1 mL. Each time the nurse administers the medication, how many mL of morphine will be WASTED?
0.6 mL
A client is receiving an epidural infusion of a narcotic for pain relief after a cesarean section. The nurse would report to the anesthesiologist if what was assessed?
Respiratory rate 8 rpm
After a clients placenta is birthed, the obstretician states, "please add 20 units of oxytocin to the intravenous and increase the drip rate to 250 mL/hr" The client has 750 mL in her IV and the IV tubing delivers fluid at the rate of 10 gtt/mL. To what drip rate should the nurse set the intravenous?
42 gtt/min
a medication order reads: Methergine 0.2 mg PO q 6 h x 4 doses. What assessment should be made before administering each dose of this medication?
Blood pressure
A muslim woman requests something to eat after the delivery of her baby. What meal would be most apprropriate for the nurse to give her?
Chicken and dumplings
The obstretician has ordered a post op cesarean section client's patient-controlled analgesia (PCA) be discontinued. What action by the nurse is appropriate?
Discard the remaining medication in the presence of another nurse
A client, G2 P1102, is 30 minutes postpartum from a low forceps vaginal delivery over a right mediolateral episiotomy. Her Physician has just finished repainring the incision. The clients legs are in stirrups and she is breastfeeding her baby. What action should the nurse peform?
Lower both of her legs at the same time
A patient, G2 P1102, who delivered her baby 8 hours ago, now has a temperature of 100.2 degrees F. What is an appropriate nursing intervention at this time?
Encourage intake of water and other fluids
A 3-day postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, "I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest." What action should the nurse take at this time?
Encourage the woman exclusively to breastfeed her baby
The nurse is caring for a client who had a cesarean section under spinal anesthesia less than 2 hours ago. What nursing action is appropriate at this time?
Have her turn and deep breathe every 2 hours
The nurse is assessing the laboratory report on a 2 day postpartum G1 P1001. The woman had a normal postpartum assessment this morning. What results should the nurse report to the primary healthcare provider?
Hematocrit 26%
On admission to the labor and delivery unit, a clients hemoglobin (Hgb) was assessed at 11 g/dL and her hematocrit (Hct) at 33%. What values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery?
Hgb 10.5 g/dL Hct 31%
The nurse informs a postpartum woman that ______ is the reason ibuprofen is especially effective for afterbirth pains?
Ibuprofen has an antiprostaglandin effect
The home health nurse visits a client who is 6 days postdelivery. The client appears sad, weeps frequently, and states "I dont know what is wrong with me. I feel terrible. I should be happy, but I'm not." What nursing dx is appropriate for this client?
Ineffective individual coping r/t hormonal shifts
A nurse reports that a client has moderate lochia flow. What does this mean?
Less than 6 IN stain on peripad
A client, G1 P0101, postpartum 1 day is assessed. The nurse notes that the clients lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. What actions should the nurse take first?
Massage the woman's fundus
What is a priority nursing action during the immediate postpartum period?
Palpate fundus
A nurse is assessing the fundus of a client during the immediate postpartum period. What action indicates that the nurse is performing the skill correctly?
The nurse stabilizes the base of the uterus with his or dependent hand
A breastfeeding woman, 1 1/2 months postdelivery, calls the nurse in the obstretician's office and states, "I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me?" The nurse should base the response to the client on what?
The same hormone stimulates orgasms and the milk ejection reflex
A post-cesarean section, breastfeeding client whose subjective pain level is 2/5 requests her PRN narcotic analgesics every 3 hours. She states, "I have decided to make sure that I feel as little pain from this experience as possible." What should the nurse conclude in relation to this woman's behavior?
The woman is high risk for severe constipation
A 3 day old breastfeeding client who is not immune to rubella is to receive the rubella vaccine at discharge. What must the nurse include in her discharge teaching regarding the vaccine?
The woman should not become pregnant for at least 4 weeks
what laboratory value would the nurse expect to see in a normal postpartum woman?
White blood cell count of 16,000
A breastfeeding client, 7 weeks postpartum, complains to an obstetrician's triage nurse that when she and her husband had intercourse for the first time after the delivery, "I coudnt stand it. It was so paintful. The doctor must have done something terrible to my vagina." What is an appropriate response by the nurse?
Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort
A postpartum nurse is caring for a client who received epidural anesthesia during her labor and delivery. The nurse should advise the woman that she may experience what SE of the medication during the postpartum period?
backache
what is a true statement about breastfeeding mothers as compared to bottle feeding mothers?
breastfeeding mothers have decreased incidence of diabetes mellitus later in life
To prevent infection, the nurse teaches the postpartum client to perform what task?
change the peripad at each voiding
The nurse should warn a client who is about to recieve methergine of what side effect?
cramping
the third stage of labor has just ended for a client who has decided to bottle feed her baby. What maternal hormones will increase sharply at this time?
prolactin
The nurse monitors his or her postpartum clients carefully because which physiological change occurs during the early postpartum period?
decreased blood volume
A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her baby. What response by the nurse is appropriate?
discuss the action of breastfeeding hormones
What nursing intervention would be appropriate for the nurse to perform to achieve this client care goal: The client will not develop postpartum thrombophlebitis?
encourage early ambulation
A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of what?
excess blood volume from pregnancy is circulating in the woman's periphery
The nurse is evaluating the involution of a woman who is 3 days postpartum. What finding would the nurse evaluate as normal?
fundus 3 cm below umbilicus, lochia serosa
The day after delivery, a woman whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong. "All I do is go to the bathroom." What is an appropriate response from the nurse?
inform the client that polyuria is normal
The nurse in the obstetric clinic received a telephone call from a bottle feeding mother of a 3 day old. The client states that her breasts are firm, red, and warm to the touch. What is the best action for the nurse to advise the client to perform?
intermittently apply ice packs to her axillae and breasts
The nurse hears the following information on a newly delivered client during shift report: 21 years old, married, G1 P1001, 8 hours post-spontaneous vaginal delivery over an intact perineum; vitals 110/70, 98.6F, 82, 18; fundus firm at umbilicus; moderate lochia rubra; ambulated to bathroom to void 4 times; breastfeeding every 2 hours. What nursing dx should the nurse include in this clients nursing care plan?
knowledge deficit r/t lack of parenting experience
What complementary therapy can a nurse suggest to a multiparous woman who are complaining of severe afterbirth pains?
lie prone with a small pillow cushioning her abdomen
A G2 P2002 who is postpartum 6 hours from a sponatenous vaginal delivery is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia rubra, and the perineal sutures are intact. What action should the nurse take at this time?
notify the womans primary healthcare provider
A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. What action by the nurse is appropriate?
Reassure the woman that this is normal
A nurse is counseling a woman about postpartum blues. What should be included in the discussion?
Postpartum blues last about a week or two
Immediately after delivery, a woman is shaking uncontrollably. What nursing action is most appropriate?
Provide the woman with warm blankets
The nurse palpates a distended bladder on a woman who delivered vaginally 2 hours earlier. The woman refuses to go to the bathroom, "I really don't need to go." What response by the nurse is appropriate?
"I understand but I still would lie you to try to urinate"
A client, 2 days postoperative from a cesarean section, complains to the nurse that she has yet to have a bowel movement since the surgery. What response by the nurse would be appropriate at this time?
"Fluids and exercise often help to combat constipation. Take a stroll around the unit and drink lots of fluid"
The nurse takes a newborn to a primipara for a feeding. The mother holds the baby en face, strokes his cheek, and states that this is the first newborn she has ever held. What nursing assessment is most important?
Positive bonding but teaching related to newborn care is needed
The nurse is caring for a postpartum client who experienced a second degree perineal laceration at delivery 2 hours ago. What intervention should the nurse perform at this time?
Apply an ice pack to the perineum
A client has been transferred to the post-anesthesia care unit from a cesarean delivery. The client had spinal anesthesia for the surgery. What interventions should the nurse perform at this time?
Assess the level of the anesthesia
The surgeon has removed the surgical cesarean section dressing from a postop day 1 client. What action by the nurse is appropriate?
Monitor the incision for drainage
The nurse is examining a 2 day postpartum client whose fundus is 2 cm below the umbilicus and whose bright red lochia saturates about 4 inches of a pad in one hour. What should the nurse document in the nursing record?
Normal involution, lochia rubra moderate
A primipara, 2 hours postpartum, requests that the nurse diaper her baby after a feeding because "I am so tired right now. I just want to have something to eat and take a nap." Based on this information, the nurse concludes that the woman is exhibiting signs of what?
Normal postpartum behavior
The nurse must initiate discharge teaching with the couple regarding the need for an infant car seat for the day of discharge. What response indicates that the nurse acted appropriatley? The nurse discussed the need with the couple:
On admission to the labor room
A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with what drink?
Orange juice
A nurse is assessing a 1 day post partum woman who had her bay by cesarean section. What should the nurse report to the surgeon?
Pad saturation every 30 minutes
A client has just been transferred to the postpartum unit from labor and delivery. What nursing care goal is of highest priority?
The client will have a moderate lochia flow
A 3 day postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. What rationale should should guide the nurse's response?
The clients obstetric status is optimal for receiving the vaccine
The nurse has taught a new admission to the postpartum unit about pericare. What indicates that the client understands the procedure?
- The woman washes her hands before and after the procedure - The woman sprays her perineum from front to back
The nurse is caring for a breastfeeding mother who asks advice on foods that will provide both vitamin A and iron. What should the nurse recommend?
1 1/2 cups raw broccoli
