OB - mental health and substance abuse

The nurse is teaching self-management techniques to a client after delivery. What does the nurse include in the lesson to prevent postpartum depression? 1 "Interact with other new mothers." 2 "Spend most of your time with the baby." 3 "Avoid accepting help from family members." 4 "Try to become a perfect mother to your child."

Answer: 1 After childbirth, a client may need assistance and guidance for breastfeeding and to provide better care to her child. Inability to provide better care to her newborn may make her feel incompetent, helpless, and depressed. Therefore, to prevent depression, the nurse advises the client to contact support groups and interact with other new mothers. It helps the client exchange ideas and experiences. The nurse should encourage the client to go out for walks and spend time participating in recreational activities rather than caring for the baby all the time. The nurse should suggest that the client accept the help of family members to perform household work. It helps the client rest for a while. The nurse should advise the client to avoid having unrealistic expectations both for herself and for the child. Inability to achieve those expectations can make the client feel depressed. Therefore, the nurse should not advise the client to try to become a perfect mother.

Which are significant barriers to receiving necessary treatment of substance abuse when pregnant? 1 Social stigma, labeling, and guilt 2 Financial barriers 3 Mental and physical barriers 4 Religious and spiritual barriers

Answer: 1 Significant barriers to receiving necessary treatment for substance abuse when pregnant include social stigma, labeling, and guilt.

The primary health care provider has asked a client to stop taking valproic acid (Depakote) for the treatment of bipolar disorder after a positive pregnancy test. A few weeks after stopping the medication, the client has a relapse of the symptoms related to bipolar disorder. Which treatment is best suited for the client? 1 Prescribing a high dose of desipramine (Norpramin) 2 Prescribing a low dose of lithium carbonate (Eskalith) 3 Prescribing the same dose of divalproex sodium (Depakote) 4 Prescribing herbal medication for treating bipolar disorder II

Answer: 2 A client who is on divalproex sodium (Depakote) or antipsychotic medications may have a relapse of symptoms upon discontinuing the medication. In such conditions, a low dose of lithium carbonate (Eskalith) should be prescribed to the client to prevent further worsening of the symptoms. Lithium carbonate (Eskalith) is considered the first-line medication for the treatment of psychosis during pregnancy. Desipramine (Norpramin) is an antidepressant agent and may not be helpful for the treatment of bipolar disorder II. Divalproex sodium (Depakote) is a category D drug and may cause teratogenic effects when prescribed in the same dose. Herbal medications are not clinically tested and are not safe to prescribe to client.

While assessing a pregnant client, the nurse finds that the client is sad and depressed after a family member's death. Which complication may be possible in the client and the newborn? 1 The client may have post-term delivery. 2 The client's newborn may have low birth weight. 3 The client may have may have maternal hypotension. 4 The client's newborn may have respiratory depression.

Answer: 2 If a client is depressed during pregnancy, it affects fetal growth and development. This can lead to low birth weight in the newborn. Depression may lead the client to have preterm labor rather than postterm childbirth. Depression may also lead to preeclampsia, which is characterized by an increase in blood pressure. Therefore, the client would not have maternal hypotension. Respiratory depression in the newborn is caused by maternal alcohol use, not depression.

The nurse is caring for a breastfeeding client who smokes. What advice does the nurse give the client to minimize the amount of nicotine in the milk and to improve the let-down reflex? 1 "You should stop breastfeeding the baby." 2 "You should avoid smoking for 2 hours before feeding the baby." 3 "You should use nicotine patches while feeding the baby." 4 "You should chew gum or eat candy after smoking."

Answer: 2 The nurse should advise the client to avoid smoking for 2 hours before breastfeeding the infant. This helps reduce the nicotine content in the milk and improves the let-down reflex. Breast milk enhances immunity and helps in proper growth and development of the newborn. Therefore, the nurse should not advise the client to avoid breastfeeding the infant. Using nicotine patches will not help minimize the amount of nicotine in the milk or improve the let-down reflex. The nurse can advise the client to chew gum after smoking to mask the odor and taste. However, this does not improve the let-down reflex or reduce the nicotine content of the breast milk.

A nurse is advising a pregnant client who has a substance abuse problem about a contingency management program. Which statement identifies an aspect of this type of program? 1 Pregnant woman are confined to an inpatient treatment method during their pregnancy. 2 Pregnant woman are given biofeedback modalities as stimulus responses to control their addition. 3 Pregnant woman are given motivational incentives as a primary approach to stop their drug abuse problem. 4 Pregnant woman are placed on a strict medication nutritional program during the course of their pregnancy.

Answer: 3 A contingency management program utilizes a motivational incentive approach with clients in response to their efforts to maintain abstinence. This may include small cash amounts, privileges, or prizes. Contingency management programs are not limited to inpatient settings and do not include biofeedback modalities or medication nutritional programs.

A pregnant client with anxiety has been prescribed diazepam (Valium). During the follow-up visit, the nurse finds that the primary health care provider has reduced the dose of the medication. How would this action help the client? 1 It would prevent neonatal abstinence syndrome. 2 It would prevent sudden infant death syndrome. 3 It would prevent neonatal withdrawal syndrome. 4 It would prevent neuroleptic malignant syndrome.

Answer: 3 Diazepam (Valium) belongs to the benzodiazepine class of drugs and is prescribed for the treatment of anxiety. If the client continues taking the same dose of diazepam (Valium) as before delivery, it may cause floppy infant syndrome in the newborn. However, discontinuing medication such as diazepam (Valium) suddenly during pregnancy may cause neonatal withdrawal syndrome. This condition manifests as depression of the central nervous system in the neonate. Therefore, to prevent neonatal withdrawal syndrome, the dose of the medicine should be decreased gradually. Opioids have the potential to cause neonatal abstinence syndrome. Tobacco consumption during pregnancy may lead to sudden infant death syndrome. Neuroleptic malignant syndrome is due to antipsychotic medication. Therefore, reducing the dose of diazepam (Valium) does not prevent neonatal abstinence syndrome, sudden infant death syndrome, or neuroleptic malignant syndrome.

Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance? 1 Methamphetamine is a depressant. 2 All methamphetamines are vasodilators. 3 Methamphetamine users are extremely psychologically addicted. 4 Rehabilitation is usually successful.

Answer: 3 Methamphetamine users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain. This substance is relatively inexpensive and easy to obtain. Methamphetamines are vasoconstrictors. The rate of relapse for methamphetamine users is very high.

Where do most deliveries for pregnant women who have mental health issues take place? 1 Mental health hospital setting. 2 Midwife assisted births 3 Community hospital settings 4 Psychiatric hospitals on locked units

Answer: 3 Most pregnant women who have mental health issues receive care and deliver in community settings. Although midwives are trained to provide obstetrical care, they typically do not take care of complex patients, and a woman who has a diagnosed mental health issue would be classified as a complex patient. Unless there is some specific psychiatric mental health issue that requires a client being on a locked unit, most pregnant women who have mental health issues deliver in community settings.

A client who used cocaine during pregnancy asks the nurse about feeding the infant. The infant is being treated for cocaine withdrawal symptoms. After further discussion, the nurse finds that the client is not willing to participate in the drug rehabilitation program and still uses cocaine frequently. What does the nurse instruct the client related to infant nutrition? 1 "Breastfeeding may be good for the child." 2 "Avoid using infant formulas for the child." 3 "Avoid breastfeeding the child." 4 "The child needs parenteral nutrition."

Answer: 3 The nurse instructs the parent to avoid breastfeeding the infant, because significant amounts of cocaine are found in breast milk. Breastfeeding may expose the child to further complications. The nurse encourages the parent to use infant formulas, because they are safe for the infant. Parenteral nutrition is not needed unless the infant is unable to feed orally.

What are some strategies for preventing postpartum depression? Select all that apply. 1 Take care of everyone else and cook for them. 2 Exercise on a monthly basis, at least 60 minutes a month. 3 Don't place unrealistic expectations on yourself; no mother is perfect! 4 Share knowledge about postpartum emotional problems with close family and friends. 5 Sleep as much as possible; make a promise to yourself to try to sleep when the baby sleeps. 6 At least once each day or every other day, purposely relax for 15 minutes: deep-breathing, meditating, taking a hot bath.

Answer: 3, 4 , 5, 6 Strategies for preventing postpartum depression include: take care of yourself by eating a balanced diet (not take care of everyone else and cook for them); exercise on a regular basis, at least 30 minutes a day, (not exercise on a monthly basis, at least 60 minutes a month); don't place unrealistic expectations on yourself (no mother is perfect); share knowledge about postpartum emotional problems with close family and friends; sleep as much as possible and make a promise to yourself to try to sleep when the baby sleeps; and at least once each day or every other day, purposely relax for 15 minutes by deep-breathing, meditating, or taking a hot bath.

What nursing intervention is important to implement when caring for a substance-abusing client? 1 Nurses must confront the substance-abuse client and force him or her into treatment. 2 Nurses should try to understand that substance abusers are just like any other client and should be treated the same. 3 Nurses should get a nurse who is recovering from substance abuse to care for the substance-abuse client, so the nurse will understand the client. 4 Nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary.

Answer: 4 The most important nursing intervention to implement when caring for a substance-abuse client is that nurses must understand that substance abuse is an illness and that the client deserves to be treated with patience, kindness, consistency, and firmness when necessary. The interventions that nurses must confront the substance-abuse client and force him or her into treatment; nurses should try to understand that substance abusers are just like any other client and should be treated the same; and nurses should get a nurse who is recovering from substance abuse to care for the substance-abuse client are not appropriate interventions to implement.