OB Review questions Ch 15, 16, and 22

23. Why are after pains usually stronger during breastfeeding? What can be done to reduce this discomfort?

Afterpains are usually stronger during breastfeeding because oxytocin released by the sucking reflex strengthens uterine contractions. Mild analgesics can be used to reduce this discomfort.

20. Lochia ___ occurs from postpartum days 10 to 14.

Alba

16. Given below, in random order, are the steps for management of uterine inversion. Choose the correct sequence. 1. Administer oxytocin. 2. Manually push back the uterus into proper position. 3. Administration of general anesthetic 4. Administration of antibiotics

Answer: 3, 2, 1, 4

6. Which of the following would the nurse assess as indicating positive bonding between the parents and their newborn? a. Holding the infant close to the body b. Having visitors hold the infant c. Buying expensive infant clothes d. Requesting that the nurses care for the infant

Answer: a Desiring to be in close proximity to another human being is all part of the bonding process. Bonding cannot take place with separation of individuals. Closeness is needed by the two people bonding, and not having others hold the infant. Buying or wearing expensive clothes has no emotional effect on a bonding relationship. Requesting that nurses provide care separates the parent from the infant and suggests that the parents lack the desire for closeness with their infant.

Chapter 15 End of Chapter Questions 1. Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement? a. An increase in blood and lymph supply to the breasts b. An increase in estrogen and progesterone levels c. Colostrum production increases dramatically d. Fluid retention in the breasts due to the intravenous fluids given during labor

Answer: a Engorgement refers to the swelling of the breast tissue as a result of an increase in blood and lymph supply to produce milk for the newborn. Estrogen and progesterone levels decrease, which allows prolactin to stimulate the glands to secrete milk. Their levels are restored when the first menses returns several weeks or months later, depending on the lactation status of the mother. Colostrum is a lemon-colored fluid secreted by both breasts immediately at birth, and within 4 to 5 days postpartum it gradually changes to transitional milk and finally mature milk by 2 weeks. Colostrum production reduces within days after childbirth as transitional and mature milk, thereby not contributing to breast engorgement.

8. The major purpose of the first postpartum homecare visit is to: a. Identify complications that require interventions b. Obtain a blood specimen for PKU testing c. Complete the official birth certificate d. Support the new parents in their parenting roles

Answer: a Home visits are usually made within the first week of discharge to assess the mother and newborn. This visit is made primarily to provide the nurse with the opportunity to recognize common biomedical and psychosocial problems or complications. Although not the primary reason, this visit also offers an opportunity to provide support and guidance to the parents in making the adjustment to the change in their lives. The home visit is not the time to complete PKU testing or complete the birth certificate.

2. A postpartum woman reports hearing voices and says, "The voices are telling me to do bad things to my baby." The clinic nurse interprets these findings as suggesting postpartum: a. Psychosis b. Anxiety disorder c. Depression d. Blues

Answer: a Postpartum psychosis can cause a woman to hallucinate and harm themselves or their families

32. A client is Rh negative and has given birth to her newborn. What should the nurse do next? a. Determine the newborn's blood type and rhesus. b. Determine if this is the clients first baby. c. Administer Rh immunoglobulins intramuscularly. d. Ask if the client received Rh immunoglobulins during the pregnancy.

Answer: a The nurse first needs to determine the rhesus of the newborn to know if the client needs Rh immunoglobulins. Mothers who are Rh negative and have given birth to an infant who was Rh positive should receive an injection of Rh immunoglobulin within 24 hours after birth; this prevents a sensitization reaction to Rh positive blood cells received during the birthing process. Women should receive the injection regardless of how many children they have had in the past.

33. Upon assessment, the nurse notes a postpartum client has increased vaginal bleeding. The client had a forceps birth which resulted in lacerations 4 hours ago. What should the nurse do next? a. Assess for uterine contractions b. Change the clients peripad c. Obtain the clients vital signs d. Have the client void

Answer: a The nurse needs to identify whether the bleeding is from lacerations or uterine atony. This can be done by looking for a well-contracted uterus with bright-red vaginal bleeding. Lacerations commonly occur during forseps birth. In subinvolution of the uterus, there is inadequate contractions, resulting in bleeding. A boggy uterus with vaginal bleeding is seen an uterine atony. Once the nurse knows the cause of the bleeding, the condition can be treated.

30. A nurse is caring for a postpartum client diagnosed with von Willebrand disease. What should be the nurses priority for the client?? a. Check the lochia b. Assess the temperature c. Monitor the pain level d. Assess the fundal height

Answer: a The nurse should assess the client for prolong bleeding time period von Willebrand disease is a congenital bleeding disorder, inherited as an autosomal dominant trait, that is characterized by a prolong bleeding time, a deficiency of von Willebrand factor, and impairment of platelet adhesion. A fever of 100.4 degrees Fahrenheit (30.0 degrees Celsius) after the first 24 hours following birth and pain indicate infection. A client with postpartum fundal height that is higher than expected may have sub involution of the uterus.

38. A client in her 7th week of postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicated of postpartum depression? Select all that apply. a. An ability to concentrate b. Loss of confidence c. Manifestation of mania d. Decreased interest in life e. Bizarre behavior

Answer: a, b, d The nurse should monitor the client for symptoms such as inability to concentrate, loss of confidence, and decreased interest in life to verify the presence of postpartum depression. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis.

10. A prolapse of the uterine fundus to or through the cervix, so that the uterus is turned inside out after birth, is called uterine___.

Inversion

15. Involves three retrogressive process, which include contraction of muscle fibers, catabolism, and regeneration of uterine epithelium

Involution

22. The uterus returns to its normal size through a process called ___.

Involution

20. ___ exercises help to strengthen the pelvic floor muscles.

Kegel

4. Which of the following would the nurse expect to include in the plan of care for a woman with mastitis who is receiving antibiotic therapy? a. Stop breast-feeding and apply lanolin b. Administer analgesics and bind both breasts c. Apply warm or cold compresses and administer analgesics d. Remove the nursing bra and expose the breast to fresh air

Answer: c Apply warm or cold compresses and administer analgesics

2. If retrogressive changes Do Not Occur as a result of retained placental fragments or infection, ___ results.

Subinvolution

2. ___ refers to the incomplete involution of the uterus, or its failure to return to its normal size and condition after birth.

Subinvolution

13. Lacerations or hematoma.

Surgical repair

21. What are the symptoms of postpartum psychosis?

Symptoms of postpartum psychosis surface within three weeks of giving birth. The main symptoms include sleep disturbances, fatigue, depression, and hypomania. The mother will be tearful, confused, and preoccupied with feelings of guilt and worthlessness. The symptoms may escalate to delirium, hallucinations, anger toward herself and her infant, bizarre behavior, manifestation of mania, and thoughts of hurting herself and the infant. The mother frequently loses touch with reality and experiences a severe regressive breakdown, associated with a high risk of suicide or infanticide.

23. How often should a client breastfeed her infant during the postpartum period?

The client is encouraged to offer frequent feedings, at least every two to three hours, using manual expression just before feeding to soften the breast so the newborn can latch on more effectively. The client should be told to allow the newborn to feed on the breast until it softens before switching to the other side.

Lucy, a 25-year-old G2P2, gave birth 2 days ago and is expected to be discharged today. She had severe postpartum depression 2 years ago with her first child. Lucy has not been out of bed for the past 24 hours, is not eating, and provides no care for herself or her newborn. Lucy states she already has a boy at home and not having a girl this time is disappointing. b. Which interventions might be appropriate at this time?

• Assess woman's emotional status & discuss concerns and feelings • Notify doctor if client's behavior does not improve

Tammy, a 32-year-old G9P9, had a spontaneous vaginal birth 2 hours ago. Tammy has been having a baby each year for the past 9 years. Her lochia has been heavy, with some clots. She hasn't been up to void since she had epidural anesthesia and has decreased sensation to her legs b. What assessments are needed before planning interventions?

• Boggy uterus- client needs to void o If uterus does not firm up after → evaluate further (lacerations or retained placenta)

c. What nursing measures will the nurse use to prevent postpartum infection complication?

• Handwashing & changing dressing with sterile gloves & gauze • Encourage personal hygiene- change peri-pads & use peri-bottle • Educate woman on S/S of infection

Lucy, a 25-year-old G2P2, gave birth 2 days ago and is expected to be discharged today. She had severe postpartum depression 2 years ago with her first child. Lucy has not been out of bed for the past 24 hours, is not eating, and provides no care for herself or her newborn. Lucy states she already has a boy at home and not having a girl this time is disappointing. c. What education does the family need prior to discharge?

• Information about postpartum disorders • Resources for counseling & support groups • Encourage support

Tammy, a 32-year-old G9P9, had a spontaneous vaginal birth 2 hours ago. Tammy has been having a baby each year for the past 9 years. Her lochia has been heavy, with some clots. She hasn't been up to void since she had epidural anesthesia and has decreased sensation to her legs c. What nursing actions are needed to prevent a postpartum hemorrhage?

• Insert a catheter to promote voiding • Fundal massage

b. What assessments need to be done to detect postpartum infection complication?

• Monitor S/S of infection o Fever, foul smelling lochia, boggy uterus, tachycardia, fever o Lab tests- elevated WBC & sedimentation rate • Monitor incision site

CRITICAL THINKING EXERCISES 1. Mrs. Griffin had a 22-hour labor before a cesarean birth. Her membranes ruptured 20 hours before she came to the hospital. Her fetus showed signs of fetal distress, so internal electronic fetal monitoring was used. Her most recent test results indicate she is anemic. a. What postpartum complication is this new mother at highest risk for? Why?

• Postpartum infection o Anemia o Ruptured membrane that occurred almost 24hrs before birth o Prolonged labor before surgical intervention o Internal fetal monitor

3. Lucy, a 25-year-old G2P2, gave birth 2 days ago and is expected to be discharged today. She had severe postpartum depression 2 years ago with her first child. Lucy has not been out of bed for the past 24 hours, is not eating, and provides no care for herself or her newborn. Lucy states she already has a boy at home and not having a girl this time is disappointing. a. What factors/behaviors place Lucy at risk for an affective disorder?

• Previous diagnosis of postpartum depression • Inactivity • Lack of appetite • Lack of interest in child • Disappointment related to sex of baby

2. Tammy, a 32-year-old G9P9, had a spontaneous vaginal birth 2 hours ago. Tammy has been having a baby each year for the past 9 years. Her lochia has been heavy, with some clots. She hasn't been up to void since she had epidural anesthesia and has decreased sensation to her legs. a. What factors place Tammy at risk for postpartum hemorrhage?

• She has given birth to 9 children in the past 9 years • The epidural reduces sensation, so the woman cannot verbalize possible complication related symptoms

17. Given below, in random order, are the three stages a woman goes through immediately after she gives birth to a child. Choose the correct sequence in which they occur. a. Letting-go phase b. Taking-hold phase c. Talking-in phase

Answer: c, b, a

13. This state of the uterus allows for excessive bleeding.

Atony

Chapter 22 Workbook Questions 1. Failure of the uterus to contract and retract immediately after birth is called uterine___.

Atony

11. Is the following statement True or False? The drop in maternal blood volume after birth leads to a similar drop in hematocrit.

Answer: False Despite the decrease in blood volume, the hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma.

21. The development of strong affectional ties between an infant and significant other defines the process of ___.

Attachment

15. Sensory experiences such as touching, holding, and gazing at the newborn.

Contact

13. Breast tissue swelling secondary to vascular congestion after childbirth and preceding lactation describes

Engorgement

14. ___ or swelling of the breast tissue occurs usually 2 to 4 days after birth.

Engorgement

4. A blood clot within a blood vessel is called a___.

Thrombus

6. The top portion of the uterus, also known as the ___, is routinely assessed to determine uterine involution.

Fundus

3. ___ are the painful uterine contractions some women experience during the early postpartum period.

Afterpains

19. Why are after pains more acute in multiparous women?

Afterpains are more acute and multiparous women secondary to repeated stretching of the uterine muscles, which reduces muscle tone, allowing for alternate uterine contraction and relaxation.

22. A mother choosing to breast-feed requires an additional ___ calories per day.

500

10. A deviated fundus to the right side of the abdomen would indicate a

A full bladder

22. What are types of venous thrombosis?

A thrombosis refers to the development of a blood clot in the blood vessels. It can cause an inflammation of the blood vessel lining, which in turn can lead to a possible thromboembolism. Thrombi can involve the superficial to deep veins in the legs or pelvis: Superficial venous thrombosis usually involves saphenous system and is confined to the lower leg. The lithotomy position during birth can cause superficial thrombophlebitis in some women. Deep vein thrombosis (DVT) can involve deep veins from the foot to the calf, to the thighs, or the pelvis. In both locations, thrombi can dislodge and migrate to the lungs, causing pulmonary embolism.

9. Placenta ___ is a condition in which the chorionic villi adhere to the myometrium, causing the placenta to adhere abnormally to the uterus and not separate and deliver spontaneously.

Accreta

15. von Willebran disease.

Administration of desmopressin and plasma concentrates

16. ___ refers to the uterine contractions that occur after birth.

After pains

35. A nurse is examining a client who underwent a vaginal birth 24 hours ago. The client asks the nurse why her discharge is such a deep red color. What explanation is most accurate for the nurse to give to the client? a. "The discharge consist of mucus, tissue, debris, and blood; thus giving it the deep red color." b. "Its normal for the discharge to be a deep red since it consists of leukocytes c. "The discharge at this point in the postpartum period consists of RBC's and leukocytes." d. "This discharge is called lochia, and it consists of leukocytes and decidual tissue."

Answer: a The nurse should explain to the client that lochia rubra is a deep red mixture of mucus, tissue debris, and blood. Discharge consisting of leucocytes, decidual tissue, RBCs, and serous fluid is called lochia serous. Discharge consisting of only RBCs and leukocytes is blood. Discharge consisting of leukocytes and decidual tissue is called lochia alba.

39. A nurse is caring for a client who gave birth a week ago. The client informs the nurse that she experiences painful uterine contractions when breastfeeding the baby. The nurse would be accurate in identifying which hormone as the cause of these after pains? a. Tell the client to take an NSAID orally b. Have the client stop breastfeeding c. Instruct the client to take a warm shower d. Ask how often the client is breastfeeding

Answer: a The nurse should explaine to the client that afterpains are due to oxytocin released by the sucking reflex which strengthens uterine contractions. And NSAID such as ibuprofen will decrease the discomfort from the afterpains. The client should not discontinue breastfeeding as this could decrease her milk supply. A warm shower may help relax the client; however, the NSAID would be more appropriate at this time.

29. Two weeks after a vaginal birth, a client presents with low-grade fever. The client also reports a loss of appetite and low energy levels. The health care provider suspects an infection of the episiotomy. What sign or symptom is most indicative of an episiotomy infection? a. Foul-smelling vaginal discharge b. Sudden onset of shortness of breath c. Pain in the lower leg d. Apprehension and diaphoresis

Answer: a The nurse should monitor for foul-smelling vaginal discharge to verify the presence of an episiotomy infection. Sudden onset of shortness of breath, and apprehension and diaphoresis are signs of pulmonary embolism and do not indicate episiotomy infection. Pain in the lower leg is indicative of a thrombosis.

29. A first time mother is nervous about breastfeeding. Which intervention would the nurse perform to reduce maternal anxiety about breastfeeding? a. Reassure the mother that some newborns "latch on and catch on" right away and some newborns take more time and patience. b. Explain that breastfeeding comes naturally to all mothers. c. Tell her that breastfeeding is a mechanical procedure that involves burping once in a while and that she should try finishing it quickly. d. Ensure that the mother breastfeeds the newborn using the cradle method.

Answer: a The nurse should reassure the mother that some newborns "latch on and catch on" right away, and some newborns take time and patient; This information will help to reduce the feelings of frustration and uncertainty about their ability to breastfeed period the nurse should also explain that breastfeeding is a learned skill for both parties. It will not be correct to say that breast feeding as a mechanical procedure. In fact, the nurse should encourage the mother to cuddle and caress the newborn while feeding. The nurse should allow sufficient time to the mother and child to enjoy each other in an unhurried atmosphere. The nurse should teach the mother to burp the newborn frequently. Different positions, such as cradle, football-holds and sideline positions, should be shown to the mother.

28. A nurse is caring for a client who has had a vaginal birth. The nurse understands that pelvic relaxation can occur in any woman experiencing a vaginal birth. Which should the nurse recommend to the client to improve pelvic floor tone? a. Kegel exercises b. Urinating immediately when the urge is felt c. Abdominal crunches d. Sitz baths

Answer: a The nurse should recommend that the client practice Kegel exercises to improve pelvic floor tone, strengthen the perineal muscles, and promote healing. Sitz baths are useful in promoting local comfort in a client who had an episiotomy during the birth. Abdominal crunches would not be advised during the initial postpartum period and would not help tone the pelvic floor as much as kegel exercises.

32. A concerned client tells the nurse that her husband, who was very excited about the baby before birth, is apparently happy but seems to be afraid of caring for the baby. What suggestions should the nurse give to the client's husband to resolve the issue? a. He began by holding the baby frequently b. He speak to his friends who have children c. He read up on parental care d. The client speak to the physician on her husband's behalf

Answer: a The nurses suggest that the father care for the newborn by holding and talking to the child. Reading up on parental care and speaking to his friends or the physician will not help the father resolve his fears about caring for the child.

33. A nurse is caring for a client during the postpartum period. The client reports pain and discomfort in her breasts. What signs should the nurse look for to find out if the client has in gorged breasts? Select all that apply a. Breasts are hard. b. Breasts are tender. c. Nipples are fissured. d. Nipples are cracked. e. Breasts are soft.

Answer: a, b Engorged breasts are hard and tender, and the nurse should assess for these signs. Improper positioning of the infant on the breast, not engorged breast, results an cracked, blistered, fissured, bruised, or bleeding nipples in the breastfeeding woman.

29. The nurse is caring for a client that was administered an anesthetic block during labor. For which risk should the nurse watch in the client? Select all that apply a. Incomplete emptying of bladder b. Bladder distention c. Ambulation difficulty d. Urinary retention e. Perineal laceration

Answer: a, b, d Many women have difficulty with feeling the sensation to avoid after giving birth if they have received an anesthetic block during labor, which inhibits neural functioning of the bladder. This client will be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary retention. Ambulation difficulty and perineal lacerations are due to a episiotomy.

39. A nurse is assessing a client with postpartal hemorrhage; The client is presently on IV oxytocin. Which intervention should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply. a. Assess clients uterine tone b. Monitor clients vital signs c. Assess clients skin turgor d. Get a pad count e. Assess deep tendon reflexes

Answer: a, b, d The nurse should evaluate the efficacy of IV oxytocin therapy by assessing the uterine tone, monitoring vital signs, and getting a pad count. Assessing the skin turgor and assessing deep tendon reflexes are not interventions applicable to administration of oxytocin.

37. The nurse is caring for a client of Asian descent 1 day after she has given birth. Which foods will the client most likely refuse to eat when her meal tray is delivered? Select all that apply a. Ice cream b. Hot soup c. Raw carrots and celery d. Orange slices e. Mashed potatoes with gravy

Answer: a, c, d Many people of Latin America, African, an Asian descent believe that normal health involves a balance of heat and cold period the blood loss during birth is considered loss of warmth, leaving the woman in a cold state. Therefore, cold foods are avoided during this time period hot soup and mashed potatoes with gravy would provide warm foods that are desired.

26. The nurse observes a 2-in (5-cm) lochia stain on the perineal pad of a 1-day postpartum client. Which of the following should the nurse do Next? a. Reassess the client in 1 hour b. Document the lochia as scant c. Ask when the peripad was changed d. Massage the client's fundus

Answer: b "Scant" would describe a 1- to 2- inch (2.5- to 5-cm) lochia stain on the perineal pad, or an approximate 10 mL loss. This is a normal finding in the postpartum client. The nurse would document this and continue to assess the client as ordered.

3. Which of the following suggestions would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight? a. Increase fluid intake and acid-producing foods in her diet. b. Avoid empty-calorie foods, breastfeed, increase exercise. c. Start a high-protein, low carbohydrate diet and restrict fluids. d. Eat no snacks or carbohydrates after dinner.

Answer: b Because weight loss is based on the principle of intake of calories and output of energy, instructing this woman to avoid high-calorie foods that yield no nutritive value and expending more energy through active exercise would result in weight loss for her. Acid-producing foods (plums, cranberries, and prunes) are typically recommended for women to prevent urinary tract infections to acidify the urine, not for weight-loss purposes. Increasing fluid intake (water) would be good for weight loss because it fills the stomach and reduces hunger sensations; however, this option does not identify which fluids should be increased. Increasing high-calorie juice and soda drinks would be counterproductive to weight-loss measures. Fluid restriction combined with a high-protein diet would increase the risk of gout and formation of kidney stones. Carbohydrates are needed by the body to make ATP and convert it to energy for cellular processes. Limiting snacks might be a good suggestion depending on which ones are selected. Raw fruits and vegetables are excellent high-fiber snacks that will help in an overall weight-loss program.

24. A nurse has been assigned to the care of a client just given birth. How frequently should the nurse perform assessments during the first hour after birth? a. Every 30 minutes b. Every 15 minutes c. Every 60 minutes d. Every 45 minutes

Answer: b Postpartum assessment is typically performed every 15 minutes for the first hour period after the second hour, assessment is performed every 30 minutes. The client has to be monitored closely during the first hour after birth; Assessment frequencies of 45 or 60 minutes are too long.

9. The nurse is instructing the postpartum client who plans to bottle-feed her newborn about measures to prevent breast engorgement when she is discharged. Which of the following measures should the nurse include in the teaching plan? a. Decreasing her fluid intake for the first week at home b. Wearing a tight-fitting supportive bra 24 hours daily c. Take a diuretic to release the extra fluid in the breasts d. Manually express the milk that is accumulating

Answer: b Since wearing a supportive bra will decrease the discomfort and provide support for the heavy breasts. Engorgement will improve within 24 to 48 hours, although the milk supply may take several weeks to resolve. Responses "A" and "C" are incorrect since this is harmful advice to give a postpartum woman. Extra intake of fluids is recommended, not a reduction of them to keep her hydrated. Response "D" is incorrect since no attempt should be made to express milk from the breasts, as this will simply promote milk let down and further milk production and increase engorgement.

36. A postpartum client who was discharged home returns to the primary care facility after two weeks with reports of fever and pain in the breast. The client is diagnosed with mastitis. What education should the nurse give the client for managing and preventing mastitis? a. Discontinue breastfeeding to allow time for healing b. Perform hand washing before and after breastfeeding c. Avoid hot or cold compresses on the breast d. Discourage manual compression of breasts for expressing milk

Answer: b The nurse should educate the client to perform hand washing before and after breast feeding to prevent mastitis. Discontinuing breastfeeding to allow time for healing, avoiding hot or cold compress on the breast, and discouraging manual compression of breast by expressing milk are inappropriate interventions. The nurse should educate the client to continue breastfeeding, because it reverses milk stasis, and to manually compress the breast to express excess milk. Hot and cold compresses can be applied for comfort.

31. A client who has given birth is being discharged from the health care facility. She wants to know how safe it would be for her to have intercourse. Which instructions should the nurse provide to the client regarding intercourse after birth? a. Avoid use of water-based gel lubricants b. Resume intercourse if bright-red bleeding stops c. Avoid performing pelvic floor exercises d. Use oral contraceptives for contraception

Answer: b The nurse should inform the client that intercourse can be resumed if bright red bleeding stops. Use of water-based gel lubricants can be helpful and should not be avoided. Pelvic floor exercises may enhance sensation and should not be avoided. Barrier methods such as condoms and spermicidal gel or foam should be used instead of oral contraceptives.

31. A client complains to the nurse of pain in the lower back, hips, and joints 10 days after the birth of her baby. What instruction should the nurse give the client after birth to prevent low back pain and injury to the joints? a. Try to avoid carrying the baby for a few days. b. Maintain correct posture and positioning c. Soak in a warm bath several times a day d. Apply ice to the sore joints

Answer: b The nurse would recommend that clients maintain correct position and normal body mechanics to prevent pain in the lower back, hips, and joints. Avoiding carrying her baby and soaking several times per day are unrealistic. Application of ice is suggested to help relieve breast engorgement and non-breastfeeding clients.

8. Which of the following factors in a postpartum woman's history would lead the nurse to monitor the woman closely for an infection? a. Hemoglobin of 12 mg/dL b. Manually extracted placenta c. Labor of 10 hours length d. Multiparity of 5 pregnancies

Answer: b The uterus has been entered with foreign objects that could transfer pathogens

28. A nurse is caring for a client with idiopathic thrombocytopenia purpura (ITP). Which intervention should the nurse perform first? a. Administration of prescribed non-steroidal anti-inflammatory drugs (NSAID's) b. Administration of platelet transfusion as ordered c. Avoiding administration of oxytocic d. Continual firm massage of the uterus

Answer: b When caring for a client with ITP, the nurse should administer platelet transfusion as order to control bleeding. Glucocorticoids, intravenous immunoglobulins, and intravenous anti Rho D are also administered to the client. The nurse should not administer NSAID when caring for this client since non-steroidal anti-inflammatory drugs cause platelet dysfunction.

7. Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new son. This behavior is often termed: a. Attachment b. Engrossment c. Bonding d. Temperament

Answer: b because partner's or significant others' developing bond with the newborn—a time of intense absorption, preoccupation, and interest—is called engrossment. Responses "A," "C," and "D" are incorrect since they are terms typically describing the close relationship between the mother-infant dyad, not the father.

4. The nurse would expect a postpartum woman to demonstrate lochia in which sequence? a. Rubra, alba, serosa b. Rubra, serosa, alba c. Serosa, alba, rubra d. Alba, rubra, serosa

Answer: b Lochia discharge from the uterus proceeds in an orderly fashion, regardless of a surgical or vaginal birth. Its color changes from red to pink to whitish cream consistently, unless there is a complication. The correct sequence is rubra (red), then serosa (pink/brownish), and then alba (white, creamy).

16. Lochia refers to the discharge that occurs after birth. Given below, in random order, are the three stages of lochia. Choose the correct sequence in which they appear after birth. a. Lochia alba b. Lochia rubra c. Lochia serosa

Answer: b, c, a

37. A nurse is caring for a client who had an inter uterine fetal death with prolonged retention of the fetus. For which signs and symptoms should the nurse watch to assess for an increased risk of disseminated intravascular coagulations? select all that apply a. Hypertension b. Bleeding gums c. Tachycardia d. Acute renal failure e. Lochia less than usual

Answer: b, c, d The nurse should monitor for bleeding gums, tachycardia, an acute renal failure to assess for increased risk of disseminated intravascular coagulations in the client. The other medical manifestations of this condition include petechia, ecchymosis, and uncontrolled bleeding during birth. Hypotension an amount of lochia greater than usual our findings might suggest a coagulopathy or hypovolemic shock

27. A client who has given birth a week ago reports discomfort when defecating and ambulating. The birth involved an episiotomy. Which suggestions should the nurse provide to the client to provide local comfort? Select all that apply a. Maintain correct posture b. Use of warm sitz baths c. Use of anesthetic sprays d. Use of witch hazel pads e. Use normal body mechanics

Answer: b, c, d The nurse should tell the client to use warm sitz bath, witch Hazel pads, an anesthetic spray to provide local comfort. Use normal body mechanics and maintaining a correct position are important to prevent lower back pain and injury to the joints.

35. When teaching the new mother about breastfeeding, the nurse is correct when providing what instructions? Select all that apply a. Give newborns water and other foods to balance nutritional needs. b. Help the mother initiate breastfeeding within 30 minutes of birth. c. Encourage breastfeeding of the newborn infant on demand. d. Provide breastfeeding newborns with pacifiers. e. Place baby an uninterrupted skin to skin contact with the mother.

Answer: b, c, e The nurse should show mothers how to initiate breastfeeding within 30 minutes of birth. To ensure bonding, place the baby an uninterrupted skin-to-skin contact with the mother. Breastfeeding on demand should be encouraged. Pacifiers do not help fulfill nutritional requirements and are not a part of breastfeeding instruction. The nurse should also ensure that no food or drink other than breast milk is given to newborns.

34. A nurse is assisting a client during the postpartum period. Which findings indicate normal postpartum adjustment? Select all that apply a. Abdominal pain b. Active bowel sounds c. Tender abdomen d. Passing gas e. Non-distended abdomen

Answer: b, d, e Finding active bowel sounds, verification of passing gas, and non-distended abdomen are normal assessment results. The abdomen should be non-tender and soft. Abdominal pain is not a normal assessment finding and should be immediately looked into.

2. In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized as which of the following? a. Gaining self-confidence b. Adjusting to her new relationships c. Being passive and dependent d. Resuming control over her life

Answer: c According to Reva Rubin, the mother is very passive and is dependent on others to care for her for the first 24 to 48 hours after giving birth. Gaining self-confidence would characterize a mother in the taking-hold phase, during which the mother demonstrates mastery over her own body's functioning and feels more confident in caring for her newborn. Adjustment to relationships does not occur until the third phase, letting go, when the mother begins to separate from the symbiotic relationship she and her newborn enjoyed during pregnancy and birth. Resuming control over her life would denote the second phase of taking hold, during which the mother does resume control over her life and gains self-confidence in her newborn care.

7. Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home? a. Punishing the older child for bedwetting behavior b. Sending the sibling to the grandparents' house c. Planning a daily "special time" for the older sibling d. Allowing the sibling to share a room with the infant

Answer: c An older sibling needs to feel he or she is still loved and not upstaged by the newest family member. Allowing special time for that sibling reinforces the parent's love for him or her also. Regression behavior is common when there is stress in that sibling's life, and punishing him brings attention to negative behavior, possibly reinforcing it. The older sibling might feel he or she is being replaced and is not wanted by the parents when he or she is sent away. Including the older sibling in the care of the newborn is a better way to incorporate the newest member into the family unit. Sharing a room with the infant could lead to feelings of displacement in the sibling. In addition, frequent interruptions during the day and night will awaken the sibling and not allow a full night's sleep or undisturbed nap.

Chapter 22 End of Chapter Questions 1. A postpartum mother appears very pale and states she is bleeding heavily. The nurse should first: a. Call the client's health care provider immediately. b. Immediately set up an intravenous infusion of magnesium sulfate. c. Assess the fundus and ask her about her voiding status. d. Reassure the mother that this is a normal finding after childbirth.

Answer: c Assess first - Emptying the bladder may correct the uterus position and contractions can stop bleeding

34. The nurse is caring for a client who delivered vaginally 2 hours ago. What postpartum complication can the nurse assess within the first few hours following birth? a. Postpartal infection b. Postpartal blues c. Postpartal hemorrhage d. Postpartum depression

Answer: c Early postpartal hemorrhage can be assessed with in the first few hours following birth. Postpartal infection may be noticed as a rise in temperature after the first 24 hours following birth. Postpartal Blues and postpartum depression are emotional disorders noticed much later in the days two weeks following birth.

12. For the woman who is not breast-feeding her newborn, which measure would be most appropriate to relieve engorgement? a. Warm showers b. Nipple stimulation c. Ice to the breasts d. Manually expressing milk

Answer: c For the woman who is not breast-feeding, measures to relieve engorgement include applying ice to the breasts for 15 to 20 minutes every other hour. Warm showers promote the let-down reflex are encouraged for the woman who is breast- feeding and experiencing engorgement. Any stimulation of the breasts, such as nipple stimulation or manual milk expression, is to be avoided for the woman who is not breast-feeding.

41. Which client should the postpartum nurse assess first after receiving shift report? a. The 3-day postpartum client who has a pulse of 50 b. The 12-hour postpartum client who has a pulse of 50 c. The two-day postpartum client who has a blood pressure of 138/90 d. The 1-day postpartum client who has a respiratory rate of 20

Answer: c Involution involves three retrogressive processes. The first of these is contraction of muscle fibers, which serves to reduce those previously stretched during uterus. Next, catabolism reduces enlarged, individual myometrial cells. Finally, there is regeneration of the uterine epithelium from the lower layer of the decidua after the upper layers have been sloughed off and shed during lochia. The breasts do not return to their pre pregnancy size as the uterus does. Urinary retention inhibits uterine involution.

4. After teaching a group of breast-feeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients? a. Carbohydrates and fiber b. Fats and vitamins c. Calories and protein d. Iron-rich foods and minerals

Answer: c Lactating mothers need an extra 500 calories to sustain breast-feeding. An additional 20 g of protein is also needed to help build and regenerate body cells for the lactating woman. Additional intake of carbohydrates or fiber is not suggested for lactation. An increase in fats is not recommended, nor is it needed for breast-feeding. To obtain adequate amounts of vitamins during lactation, women are encouraged to choose a varied diet that includes enriched and fortified grains and cereals, fresh fruits and vegetables, and lean meats and dairy products. An increase in vitamins via supplements is not recommended. Choosing a variety of foods from the food pyramid will provide the lactating woman with adequate iron and minerals.

Chapter 16 End of Chapter Questions 1. When assessing a postpartum woman, which of the following would lead the nurse to suspect postpartum blues? a. Panic attacks and suicidal thoughts b. Anger toward self and infant c. Periodic crying and insomnia d. Obsessive thoughts and hallucinations

Answer: c Periodic crying and insomnia are characteristics of postpartum blues, in addition to mood changes, irritability, and increased sensitivity. Panic attacks and suicidal thoughts or anger toward self and the infant would be descriptive of postpartum psychosis, when some women turn this anger toward themselves and have committed suicide or infanticide. Women experiencing postpartum blues do not lose touch with reality. Obsessive thoughts and hallucinations would be more descriptive of postpartum psychosis.

38. The client has been discharged from the hospital after a cesarean birth. Which should the nurse include in the discharge teaching? a. "Follow up with your health care provider within 3 weeks of being discharged." b. "Notify the health care provider if your temperature is greater than 99 degrees Fahrenheit (37.2 degrees Celsius)." c. "You should be seen by your health care provider if you have blurred vision." d. "Call your health care provider if you saturate a peripad in less than four hours."

Answer: c The client needs to notify the health care provider for blurred vision as this can indicate preeclampsia in the postpartum period. The client should also notify the health care provider for a temperature greater than 100.4 degrees Fahrenheit (38 degrees Celsius) or if a peripad is saturated in less than one hour. The nurse should ensure that the follow up appointment is fixed for within two weeks after hospital discharge.

40. When assessing the uterus of a 2-day postpartum client, which finding would the nurse evaluate as normal? a. A scant amount of lochia alba b. A moderate amount of lochia alba c. A moderate amount of lochia rubra d. A scant amount of lochia serosa

Answer: c The client should have lochia rubra for 3 to 4 days postpartum. The client would then progress to lochia serous being expelled from day 3 to 10. Last the client would have lochia alba from day 10 to 14 until 3 to 6 weeks.

40. A nurse is caring for a client who has just undergone birth. What is the best method for the nurse to assess this client for postpartum hemorrhage? a. By assessing skin turgor b. By assessing blood pressure c. By frequently assessing uterine involution d. By monitoring HCG titers

Answer: c The nurse should closely assess the woman for hemorrhage after giving birth by frequently assessing uterine involution. Assessing skin turgor and blood pressure and monitoring hCG titers will not help to determine hemorrhage.

33. A client who gave birth 5 days ago complains to the nurse of profuse sweating during the night. What should the nurse recommend to the client in this regard? a. "I would suggest that you speak with your physician about this." b. "Drink plenty of cold fluids before you go to bed." c. "Be sure to change your pajamas to prevent you from chilling." d. "I'm not sure why this is occurring since this usually doesn't happen until much later in the postpartum period."

Answer: c The nurse should encourage the client to change her pajamas to prevent chilling and reassure the client that it is normal to have postpartal diaphoresis. Drinking cloud fluids at night will not prevent postpartum diaphoresis.

28. A nurse is applying ice packs to the perineal area of a client who has had a vaginal birth. Which intervention should the nurse perform to ensure that the client gets the optimum benefits of the procedure? a. Apply ice packs directly to the perineal area b. Apply ice packs for 40 minutes continuously c. Ensure ice pack is changed frequently d. Use ice packs for a week after birth

Answer: c The nurse should ensure that the ice pack is changed frequently to promote normal hygiene and to allow for periodic assessments. Ice packs are wrapped in a disposable covering or clean washcloth and then applied to the perineal area, not directly. The nurse should apply the ice pack for 20 minutes, not 40 minutes. Ice pack should be used for the first 24 hours, not for a week after birth.

26. A nurse is caring for a postpartum client who has a history of thrombosis during pregnancy and is at high risk of developing a pulmonary embolism. For which sign or symptom should the nurse monitor the client to prevent the occurrence of pulmonary embolism? a. Sudden change in mental status b. difficulty in breathing c. calf swelling d. sudden chest pain

Answer: c The nurse should monitor the client for swelling in the calf. Swelling in the calf, erythema, and pedal edema are early manifestations of deep vein thrombosis, which may lead to pulmonary embolism if not prevented at an early stage. Sudden change in the mental status, difficulty in breathing, and sudden chest pain are manifestations of pulmonary embolism, beyond the stage of prevention.

30. A client who has a breastfeeding newborn reports sore nipples. Which intervention can the nurse suggest to alleviate the client's condition? a. Recommend a moisturizing soap to clean the nipples b. Encourage the use of breast pads with plastic liners c. Offer suggestions based on observation to correct positioning or latching d. Fasten nursing bra flaps immediately after feeding

Answer: c The nurse should observe positioning and latching-on technique while breastfeeding so that she may offer suggestions based on observation to correct positioning/latching. This will help minimize trauma to the breast. The client should use only water, not soap to clean the nipples to prevent dryness. Breast pads with plastic liners should be avoided. Leaving the nursing bra flaps down after breastfeeding allows nipples to air dry.

34. A breast-feeding client informs the nurse that she is unable to maintain her milk supply. What instructions should the nurse give to the client to improve milk supply? a. Take cold baths b. Apply ice to the breast c. Empty the breast frequently d. Perform Kegel exercises

Answer: c The nurse should tell the client to frequently empty the breast to improve milk supply. Encouraging cold baths and applying ice on the breasts are recommended to relieve engorgement and non-breastfeeding clients. Kegel exercises are encouraged to promote pelvic floor tone.

5. The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected? a. Cream-colored lochia; uterus above the umbilicus b. Bright-red lochia with clots; uterus 2 fingerbreadths below umbilicus c. Light pink or brown lochia; uterus 4 to 5 fingerbreadths below umbilicus d. Yellow, mucousy lochia; uterus at the level of the umbilicus

Answer: c The nurse would expect light pink or brown lochia, and the uterus should be four to five fingerbreadths below the umbilicus. Cream-colored lochia wouldn't be seen for about 10 to 14 days after childbirth, thus it wouldn't be observed this early in the postpartum period. The uterus would be involuting downward into the pelvis, thus it would not be above the umbilicus by this timeframe. Bright-red lochia would be observed for up to 3 days postbirth, not 5 days later unless there was a problem. The uterus descends into the pelvis at a rate of 1 cm/day, thus the fundus should be 4 to 5 cm (fingerbreadths) below the umbilicus by now.

38. While caring for a client following a lengthy labor & delivery, the nurse notes that the client repeatedly reviews her labor & delivery and is very dependent on her family for care. The nurse is correct in identifying the client to be in which phase of maternal role adjustment? a. Letting-go b. Taking-hold c. Taking-in d. Acquaintance/attachment

Answer: c The taking-in phase occurs during the first 24 to 48 hours following the birth of the newborn and is characterized by the mother taking on a very passive role in caring for herself, as well as recounting her labor experience. The second maternal adjustment phase is the taking-hold phase and usually last several weeks after the birth. This phase is characterized by both dependent and independent behavior, with increasing autonomy. During the letting-go phase the mother reestablishes relationships with others and accepts her new role as a parent. Acquaintance/attachment phase is a newer term that refers to the first two to six weeks following birth when the mother is learning to care for her baby and is physically recuperating from the pregnancy and birth.

35. A nurse is caring for a postpartum client. What instructions should the nurse provide to the client as precautionary measures to prevent thromboembolic complications? a. Avoid performing any deep breathing exercises b. Try to relax with pillows under knees c. Avoid sitting in one position for long periods of time d. Refrain from elevating legs above heart level

Answer: c To help prevent the occurrence of postpartum thromboembolic complications, the nurse should instruct the client to avoid sitting or standing in one position for long periods of time. This prevents venous pooling. The nurse should instruct the client to perform post-operative deep breathing exercises to improve venous return by relieving the negative thoracic pressure on leg veins. The nurse should instruct the clients who prevent venous pooling by avoiding the use of pillows under the knees. Elevating the legs above heart level promotes venous return, and therefore the nurse should encourage it.

5. While assessing a postpartum multiparous woman, the nurse detects a boggy uterus midline 2 cm above the umbilicus. Which intervention would be the priority? a. Assessing vital signs immediately b. Measuring her next urinary output c. Massaging her fundus d. Notifying the woman's obstetrician

Answer: c Uterus is not contracting properly - massage will stimulate the uterus to contract

30. A client who delivered a baby 36 hours ago informs the nurse that she has been passing unusually large volume of urine often. How should the nurse explain this to the client? a. "Bruising and swelling of the perineum often cause excessive urination." b. "Larger that normal amounts of urine frequently occur due to swelling of tissues surrounding the urinary meatus." c. "You body usually retains extra fluids during pregnancy, so this is one way it rids itself of the excess fluids." d. "Anesthesia causes decreased bladder tone, which causes you to urinate more frequently."

Answer: c Postpartum diuresis is due to the buildup and retention of extra fluids during pregnancy. Bruising and swelling of the perineum, swelling of tissues surrounding the uterus meatus, and distended bladder tone due to anesthesia cause urinary retention.

25. During the assessment of the mother during the postpartum period, what sign should alert the nurse that the client is likely experiencing uterine atony? a. Fundus feels firm b. Foul-smelling urine c. Purulent vaginal drainage d. Boggy or relaxed uterus

Answer: d A boggy or relaxed uterus is a sign of uterine atony. This can be the result of bladder distension, which displaces the uterus upward and to the right, or retained placental fragments. Foul smelling urine and purulent discharge are signs of infections but are not related to uterine atony. The firm fundus is normal and not a sign of uterine atony.

5. Which of the following would lead the nurse to suspect that a postpartum woman was developing a complication? a. Fatigue and irritability b. Perineal discomfort and pink discharge c. Pulse rate of 60 bpm d. Swollen, tender, hot area on breast

Answer: d A swollen, tender area on the breast would indicate mastitis, which would need medical intervention. Fatigue and irritability are not complications of childbearing, but rather the norm during the early postpartum period secondary to infant care demands and lack of sleep on the caretaker's part. Perineal discomfort and lochia serosa are normal physiologic events after childbirth and indicate normal uterine involution. Bradycardia is a normal vital sign for several days after childbirth because of the dramatic circulatory changes that take place with the loss of the placenta at birth and the return of blood back to the central circulation.

10. A new mother was brought to the postpartum unit who gave birth 12 hours ago. Because this is her first child, which of the following goals by the nurse is most appropriate? a. Early discharge for the mother and newborn b. Rapid transition into her role of being a parent/caretaker c. Minimal need for expression of her feelings now d. Effective education of both parents before discharge

Answer: d Because both parents will need education about the newborn, how to care for it, and how to care for themselves. Education is essential to help both parents in their transition and adaptation to parenthood. Response "A" is an incorrect response because that should never be the goal to discharge someone early, but only when they are appropriately prepared and stable. Response "B" is incorrect because the parenthood role happens over time, not immediately after giving birth and during the hospital stay. Response "C" is incorrect due to the fact that most postpartum women do wish to express their feelings and this activity should be encouraged, not stifled.

3. When implementing the plan of care for a multigravida postpartum woman who gave birth just a few hours ago, the nurse vigilantly monitors the client for which complication? a. Deep venous thrombosis b. Postpartum psychosis c. Uterine infection d. Postpartum hemorrhage

Answer: d Can occur if the uterus does not contract to constrict blood vessels within hours

36. A postpartum client is having difficulty stopping her urine stream. Which should the nurse do next? a. Determine if the client is emptying her bladder. b. Ask the client when she last urinated. c. Perform an in and out catheter on the client. d. Educate the client on how to perform Kegel exercises.

Answer: d Client should begin Kegel exercises on the first postpartum day to increase the strength of the perineal floor muscles. Priority for this client would be to educate her on how to perform Kegel exercises as strengthening these muscles will allow her to stop her urine stream.

7. Which of the following findings would lead the nurse to suspect that a woman is developing a postpartum complication? a. Moderate lochia rubra for the first 24 hours b. Clear lung sounds upon auscultation c. Temperature of 100° F d. Chest pain experienced when ambulating

Answer: d Could be a possible pulmonary embolism

26. A client who gave birth about 12 hours ago informs the nurse that she has been voiding small amounts of urine frequently. The nurse examines the client and notes the displacement of the ureters from midline to the right. What intervention would the nurse perform next? a. Insert a 20-gauge IV b. Administer oxytocin IV c. Notify the health care provider d. Urinary catherization

Answer: d Displacement of the uterus from midline to the right and frequent voiding of small amount suggest uterine retention with overflow. Catherizatian may be necessary to empty the bladder to restore tone. An IV and oxytocin are indicated if the client experiences hemorrhage due to uterine atony from being displaced. The health care provider would be notified if no other interventions help the client.

2. Which of these activities would best help the postpartum nurse to provide culturally sensitive care for the childbearing family? a. Taking a transcultural course b. Caring for only families of his or her cultural origin c. Teaching Western beliefs to culturally diverse families d. Educating himself or herself about diverse cultural practices

Answer: d Nurses need first to become educated about various cultural practices to incorporate them into their care delivery. By gaining an understanding of diverse cultures different from their own, nurses can become sensitive to these different practices and not violate them. Attending a transcultural course might be beneficial, but this would take several weeks to complete and the information is needed much sooner to provide culturally sensitive care for an admitted client and her family. Caring only for families of the nurse's cultural origin would not be possible or realistic in our global, culturally diverse population within the United States. Nurses need to care for every person regardless of their color, creed, or nationality with respect and competence. Teaching diverse cultural families Western beliefs would demonstrate ethnocentric behavior and would not be professional. Each culture needs to be respected and learned about with tolerance and understanding.

37. Upon assessment, a nurse notes the client has a pulse of 90 beats per minute, moderate lochia, and a boggy uterus. What should the nurse do next? a. Notify the health care provider. b. Assess the client's blood pressure. c. Change the clients peripad. d. Massage the client's fundus.

Answer: d Tachycardia in a boggy fundus in the postpartum woman indicate excessive blood loss. The nurse would massage the fundus to promote urine involution. It is not priority to notify the health care provider, assess blood pressure, or change the peripad at this time.

36. A client who had a vaginal delivery 2 days ago asks the nurse when she will be able to breathe normally again. Which response by the nurse is accurate? a. "You should notice a change in your respiratory status within the next 24 hours." b. "Everyone is different, so it is hard to say when your respirations will be back to normal." c. "It usually takes about three months before all of your abdominal organs return to normal, allowing you to breath normally." d. "Within 1 to 3 weeks, your diaphragm should return to normal and your breathing will feel like it did before your pregnancy."

Answer: d The abdominal organs, including the diaphragm, typically return to pre pregnancy state within one to three weeks after birth. Discomfort such as shortness of breath and rib aches lesson, and tide value man vital capacity returned to normal values.

6. Methergine has been ordered for a postpartum woman because of excessive bleeding. The nurse should question this order if which of the following is present? a. Mild abdominal cramping b. Tender inflamed breasts c. Pulse rate of 68 beats per minute d. Blood pressure of 158/96 mm Hg

Answer: d The blood pressure is elevated Methergine can increase blood pressure more

31. The nurse is caring for a 38-year-old overweight client 24 hours post cesarean birth. The client is reporting calf tenderness. What should the nurse do first? a. Assess the client's respiration rate b. Determine the severity of the pain c. Administer an anticoagulant d. Have the client rest with the extremity elevated

Answer: d The client is probably experiencing a deep vein thrombosis (DVT). The nurse would maintain bed rest with the affected extremity elevated until the diagnosis can be confirmed. Once the diagnosis is confirmed, an anticoagulant may be ordered. It is not priority to determine the severity of the pain or a respiratory rate.

3. The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the after-pains she is experiencing can be the result of which of the following? a. Abdominal cramping is a sign of endometriosis b. A small infant weighing less than 8 lb c. Pregnancies that were too closely spaced d. Contractions of the uterus after birth

Answer: d The direct cause of afterpains is uterine contractions. Mothers experience abdominal pain secondary to contractions, especially when breast-feeding because sucking stimulates the release of oxytocin from the posterior pituitary gland, which causes uterine contractions. There is no association of afterpains with endometriosis. The small size of the newborn wouldn't stretch her uterus, thus would not be a contributing factor to her discomfort now. Pregnancies spaced too close together can contribute to frequent stretching of the uterus, but this is not the cause of afterpains.

27. A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration? a. First-degree b. Second-degree c. Third-degree d. Fourth-degree

Answer: d The nurse would classify the laceration as fourth-degree because it continues through the anterior rectal wall. first-degree lacerations involve only skin and superficial structures above muscle; second-degree laceration extends through perineal muscles; and third-degree lacerations extend through the anal sphincter muscle but not through the anterior rectal wall.

32. A nurse finds that a client is bleeding excessively after a vaginal birth. Which assessment finding would indicate retained placental fragments as a cause of the bleeding? a. Soft and boggy uterus that deviates from the midline b. Firm uterus that trickles of bright red blood in perineum c. Firm uterus with a steady stream of bright red blood d. Large uterus with painless dark red blood mixed with clots

Answer: d The presence of a large uterus with painless dark red blood mixed with clots indicates retained placental fragments in the uterus. This cause of hemorrhage can be prevented by carefully inspecting the placenta for intactness. A firm uterus with a trickle of steady stream of bright-red blood in the perineum indicates bleeding from trauma. A soft and boggy uterus that deviates from the midline indicates a full bladder, interfering with uterine involution.

27. a nurse is caring for a postpartum client who has been treated for deep vein thrombosis (DVT). Which order would the nurse question? a. Wear compression stockings b. Plan long rest periods throughout the day c. Take aspirin as needed d. Take an oral contraceptive daily

Answer: d When caring for a client with DVT, the nurse should instruct the client to avoid using contraceptives, a sedentary lifestyle, and obesity increase the risk for developing DVT. The nurse should encourage the client with DVT to wear compression stockings. The nurse should instruct the client to avoid using products containing aspirin when caring for clients with bleeding, but not for clients with DVT. Prolonged rest periods should be avoided. Prolonged rest involves staying motionless; This could lead to venous stasis which needs to be avoided in cases of DVT.

8. After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? I will a. "Need to take medication daily to treat the anxiety and sadness." b. "Call the OB support line only if I start to hear voices." c. "Contact my doctor if I become dizzy and fell nauseated." d. "Feel like laughing one minute and crying the next minute."

Answer: d because emotional lability is typical of postpartum blues which is usually self-limiting. Response "A" is incorrect since postpartum blues don't require any medication to treat. Response "B" is incorrect since this behavior would indicate postpartum psychosis and not merely the "blues." Response "C" would indicate a physical condition, such as infection, not a mental disorder.

13. Development of a close emotional attachment to a newborn by the parents during the first 30 to 60 minutes after birth.

Bonding

7. Women who experience ___ births will have less lochia discharge than those having vaginal births.

Cesarean

10. Any discharge from the nipple should be described and documented if it is not ___, also called foremilk.

Colostrum

19. ___ refers to the enduring nature of the attachment relationship.

Commitment

9. ___ refers to the enduring nature of the attachment relationship.

Commitment

3. In von Willebrand disease, there is a ___ in the von Willebrand factor, which is necessary for platelet adhesion and aggregation.

Decreased

10. The profuse ___ that is common during the early postpartum periods is one of the most noticeable adaptations in the integumentary system and is a way of eliminating excess body fluid retained during pregnancy.

Diaphoresis

8. excessive blood loss that occurs within 24 hours after birth is termed ___ postpartum hemorrhage.

Early

4. Increased prolactin levels and abundant milk supply, combined with inadequate emptying of the breast, may cause breast___.

Engorgement

14. The father's developing a bond with the newborn, which is a time of intense absorption, preoccupation, and interest.

Engrossment

12. Retained placental tissue.

Evacuation and oxytocic's

19. Fathers or partners go through three stages in their role development process: ________, reality, and transition to mastery.

Expectation

20. What are the factors that facilitate uterine involution?

Factors that facilitate uterine involution are Complete expulsion of amniotic membranes and placenta at birth Complication free labor and birth process Breast feeding Ambulation

21. What are the factors the inhibit uterine involution?

Factors that inhibit involution include Prolonged labor and difficult birth Incomplete expulsion of amniotic membranes in placenta Uterine infection Over distention of the uterine muscles due to: Multiple gestation, hydramnios, or large Singleton fetus Full bladder, which displaces uterus and interferes with contractions Anesthesia, which relaxes uterine muscles Close childbirth spacing, leading to frequent and repeated distention and thus decreasing uterine tone and causing muscular relaxation

15. During the first 24 hours postpartum, heat is used to provide perineal comfort.

False

15. The postpartum period begins with the birth of the newborn.

False

23. A woman typically experiences tachycardia after delivery.

False

13. Lochia typically begins as lochia serosa.

False It begins with Lochia rubra

21. Cardiac output quickly returns to nonpregnant values after birth.

False It takes about 7-10 day

24. Danger signs postpartum.

Fever more than >100.4°F (38°C) Foul-smelling lochia or an unexpected change in color or amount Large blood clots, or bleeding that saturates a peripad in an hour Severe headaches or blurred vision: What might this be? Visual changes, such as blurred vision or spots, or headache Calf pain with dorsiflexion of the foot Swelling, redness, or discharge at the episiotomy, epidural, or abdominal sites Dysuria, burning, or incomplete emptying of the bladder Shortness of breath or difficulty breathing without exertion Depression or extreme mood swings

25. What intervention should the nurse perform to treat the clients condition of superficial venous thrombosis?

For clients with superficial venous thrombosis, the nurse should perform the following interventions: Administer NSAIDs for analgesic effect as prescribed. Provide rest and elevation of the affected leg. Apply warm compresses over the affected area to promote healing period Use anti embolism stockings, which promotes search into the extremities.

11. The vaginal discharge that occurs after the birth of the placenta

Lochia

11. Identify two questions that a nurse would ask a postpartum woman to assess for postpartum blues.

How have you been feeling recently? How has your sleep been? Have you felt low in spirits and/or able to enjoy the things you usually enjoy?

3. Elevation in blood pressure from the woman's baseline might suggest pregnancy - induced ___.

Hypertension

14. A woman who is bottle-feeding should use _____packs to alleviate the discomfort of engorgement.

Ice

18. What is idiopathic thrombocytopenic purpura?

Idiopathic Thrombocytopenic purpura (ITP) is characterized by increased platelet destruction caused by the development of autoantibodies to platelet membrane antigens. The incident of ITP in adults is approximately 66 cases per one million per year. The characteristic features of this disorder are thrombocytopenia, capillary fragility, and increased bleeding time. Clients with ITP present with easy bleeding, bleeding from mucous membranes, menorrhagia, epistaxis, bleeding gums, hematomas, and severe hemorrhage after a cesarean birth or lacerations.

9. The term that describes the return of the uterus to its prepregnant state is

Involution

8. ___ is defined as the secretion of milk by the breast.

Lactation

Postpartum hemorrhage paired with its intervention: 11. Uterine atony

Massage and oxytocic's

2. When palpating the breast, any evidence of any nodules, masses, or areas of warmth, may indicate a plugged duct that may progress to ___ if not treated promptly.

Mastitis

7. A localized inflammation of the breast is called___.

Mastitis

6. ___is an infectious condition that involves the endometrium, decidua, and adjacent myometrium of the uterus.

Metritis

20. What are baby blues?

Most postpartum women experience baby Blues. The woman exhibits mild depressive symptoms of anxiety, irritability, mood swings, cheerfulness and increased sensitivity, feelings of being overwhelmed, and fatigue after the birth of the baby The condition typically peaks on postpartum days four and five and usually resolved by postpartum day ten. Baby Blues are usually self-limiting and require no formal treatment other than reassurance and validation of the woman's experience, as well as assistance in caring for herself and the newborn.

7. For ___ women, menstruation usually resumes 7 to 9 weeks after giving birth.

Nonlactating

5. ___ hypertension can occur when the woman changes rapidly from lying or sitting position to a standing one.

Orthostatic

17. What are the causes of overdistention of the uterus?

Overdistension of the uterus can be caused by multifetal gestation, fetal macrosomia, polyhydramnios, fetal abnormalities, or placental fragments. Overdistention of the uterus is a major risk factor for uterine atony, the most common cause of early postpartum hemorrhage, which can lead to hypovolemic shock.

6. ___elicits the milk letdown reflex so that milk can be ejected from the alveoli to the nipple.

Oxytocin

4. ___ is considered the fifth vital sign.

Pain

Chapter 15 Workbook Questions 1. Within 10 days of birth, the fundus of the uterus usually cannot be palpated because it has descended in the true _____.

Pelvis

Chapter 16 Workbook Questions 1. The ___ is a plastic squeeze bottle filled with warm tap water that is sprayed over the perineal area after each voiding and before applying a new perineal pad.

Peribottle

16. What does the postpartum assessment of the mother include?

Postpartum assessment of the mother typically include vital signs, pain level, and a systemic head-to-toe review of the body systems: breast, uterus, bladder, bowels, lochia, episiotomy/perineum, extremities, an emotional status.

12. Transient emotional disturbances.

Postpartum blues

19. What are the postpartum physiologic danger signs?

Postpartum danger signs include: Fever more than 38 degrees Celsius (100.4 degrees Fahrenheit) after the first 24 hours following birth Foul smelling lochia or an unexpected change in color or amount Visual changes, such as blurred vision or spots, or headaches Calf pain experience with Dorsiflexion of the foot Swelling, redness, or discharge at the episiotomy site Dysuria, burning or incomplete emptying of the bladder Shortness of breath or difficulty breathing Depression or extreme mood swings

19. Which microorganisms are responsible for postpartum infections?

Postpartum infections are usually polymicrobial and involve Staphylococcus aureus, Escherichia coli, Klebsiella species, Gardnerella vaginalis, gonococci, coliform bacteria. Group A or B hemolytic streptococci, Chlamydia trachomatis, and the anaerobes that are common to bacterial vaginosis.

14. Development of strong affectional ties between an infant and a significant other (e.g., mother, father, sibling, caretaker)

Process of Attachment

9. ___, which is secreted from the anterior pituitary gland in increasing levels throughout pregnancy, triggers synthesis and secretion of milk after giving birth.

Prolactin

14. Bleeding disorder.

Provide blood products

11. Physical and psychological experience of the parents being close to their infant.

Proximity

12. Encompasses the time after delivery as the woman's body begins to return to the prepregnant state

Puerperium

8. ___ is the process by which the infant's capabilities and behavioral characteristics elicit parental response.

Reciprocity

23. What are the risk factors for which a nurse should assess for the development of thromboembolic complications in a postpartum client?

The major causes of thrombus formation are venous stasis, injury to the innermost layer of the blood vessel, and hypercoagulation. Venous stasis and hypercoagulations are common in the postpartum period. The risk factors for thrombosis are as follows: Prolonged bed rest Diabetes Obesity Cesarean birth Smoking Severe Anemia History of previous thrombosis Varicose veins Advanced maternal age (greater than 35 years) Multiparity Use of oral contraceptives before pregnancy

17. What nutritional recommendations can a nurse provide to a client during the postpartum period?

The new mother might ignore her own needs for health and nutrition. She should be encouraged to take good care of herself and eat a healthy diet so that nutrients lost during pregnancy can be replaced and she can return to a healthy weight. The nurse should provide nutritional recommendations, such as: Eat a wide variety of foods with high nutrient density Use foods and recipes that require little to no preparation Avoid high fat, fast foods and fad weight reduction diets Drinking plenty of fluids Avoiding harmful substances such as alcohol, tobacco, and drugs Avoiding excessive intake of fat, salt, sugar, and caffeine Eating the recommended daily servings from each food group

22. What assessments should a nurse perform on a new mother wanting to breastfeed?

The nurse should perform the following assessments in a client and tending to breastfeed her baby: Inspect the breast for size contour a symmetry, engorgement, or areas of erythema. Check the nipples for cracks, redness, fissures, or bleeding. Palpate the breast to ascertain if they are soft, feeling, or engorged, and document findings. Palpate the breast for any nodules, masses, or areas of warmth which may indicate a plugged duck that may progress to mastitis if not treated properly. Describe and document any discharge from the nipple that is not creamy yellow or bluish white.

24. What nursing intervention should the nurse perform to prevent thromboembolic complications in clients?

The nurse should perform the following nursing interventions to prevent thromboembolic tick complications in a client: Educate the client the need for early and frequent ambulation Encourage activities that cause leg muscles to contract (leg exercises and walking) to promote venous return in order to prevent venous stasis Use intermittent sequential compression devices which cause passive leg contractions until the client is ambulatory Elevate the clients legs above the heart level to promote venous return Ensure anti-embolic stockings are applied and removed every day for inspection of the legs Encourage the client to perform passive exercises on the bed Ensure that the client is involved in post-operative deep breathing exercises; this improves venous return In order to prevent venous pooling, avoid placing pillows under the knees to keeping the legs and stirrups for a long time or use the gatch on the bed Ensure the bed cradles; This helps in keeping linens and blankets off the extremities thanks caller

24. What relief measures should the nurse suggest to resolve engorgement in a client who is breastfeeding?

The nurses suggest the following measures to resolve engorgement in the client who is breastfeeding: Empty the breast frequently to minimize discomfort and resolve engorgement. Stand in a warm shower or apply warm compresses to the breast to provide some relief.

25. What relief measures should the nurse suggest for non-breastfeeding engorgement?

The nurses suggest the following relief measures for clients with non-breastfeeding engorgement: Wear is height, supportive bra 24 hours daily. Apply ice to the breast for approximately 15 to 20 minutes every other hour period Do not stimulate the breast by squeezing or manually expressing milk from the nipples. Avoid exposing the breasts to warmth.

21. What suggestions can a nurse provide to the parents to minimize sibling rivalry during the postpartum period?

The nurses suggest the following to the family to avoid sibling rivalry: Expect and tolerate some regression Discuss the new infant during relaxed family times Teach safe handling of the newborn with a doll Encourage older children to verbalize emotions about the newborn Move the sibling from the crib to a youth bed months in advance of the birth of the newborn

20. Discuss ways nurse can model behavior to facilitate parental role adaptation and attachment during the postpartum period?

The nursing model behavior to family members as follows: Holding the newborn close and speaking positively Referring to the newborn by name in front of the parents Speaking directly to the newborn in a calm voice Encouraging both parents to pick up and hold the newborn Monitoring newborns response to parental stimulation Pointing out positive physical features of the newborn

18. What are the causes of postpartum stress?

The physical stress of pregnancy and birth, the required caregiving tasks associated with newborn, meeting the needs of other family members, and fatigue can cause the postpartum period to be quite stressful for the mother.

18. Explain why breastfeeding is not a reliable form of contraception?

The timing of the first men's is anovulation after birth differs considerably and lactating and nonlactating women. And nonlactating women, ministration resumes seven to nine weeks after birth; The first cycle is anovulatory. And lactating women, the return of menses depends on the frequency and duration of breastfeeding. It usually resumes anytime from 2 to 18 months after childbirth, and the first postpartum menses is usually heavier and frequently anovulatory. However, ovulation may occur before menstruation, so breastfeeding is not a reliable method of contraception.

5. obstruction of a blood vessel by a blood clot carried by the circulation from the site of origin is called___.

Thromboembolism

16. The postpartum woman's bladder should be nonpalpable.

True

17. Pulmonary embolism is a major cause of maternal mortality.

True

18. A slight temperature elevation is normal during the first 24 hours after delivery.

True

18. The postpartum woman commonly exhibits bradycardia.

True

17. Profuse diaphoresis is common during the early postpartum period.

True It is the bodies way of removing the extra water gained during pregnancy.

5. During pregnancy, stretching of the abdominal wall muscles occurs to accommodate the enlarging___.

Uterus

12. Outline instructions you would give to a new mother on how to use her peribottle.

Wash your hands with soap and water, and dry them. Fill your peribottle with warm tap water and replace the top. Straddle the toilet and spray all the water from the peribottle over your perineal area. Pat the area dry with a clean towel and replace your peripad from front to back. Place the empty peribottle on the sink for the next time. Wash your hands with soap and water before leaving the bathroom.

22. Why do women who have had cesarean births tend to have less flow of lochial discharge?

Women who have had cesarean births tend to have less flow because the uterine debris is removed manually with delivery of the placenta.

6. Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need. a. _________ Learn how to hold and cuddle the infant. b. _________Watch a baby bath demonstration given by the nurse. c. _________ Sleep and rest without being disturbed for a few hours. d. _________ Interaction time (first 30 minutes) with the infant to facilitate bonding.

a. ___3______ Learn how to hold and cuddle the infant. b. ___4______Watch a baby bath demonstration given by the nurse. c. ___2______ Sleep and rest without being disturbed for a few hours. d. ___1______ Interaction time (first 30 minutes) with the infant to facilitate bonding.