OB Test 2 Practice Questions
What are nursing interventions for a baby doing phototherapy?
-turn them q 2 hrs -diaper & goggles -monitor for dehydration
When does pathologic jaundice begin to appear?
-within 24 hours of life -usually rt increased production of bili
The nurse is planning the care of a 1-day-old infant. Which of the following nursing interventions would protect the newborn from heat loss by convection? 1. Placing the newborn away from air currents 2. Pre-warming the examination table 3. Drying the newborn thoroughly 4. Removing wet linens from the isolette
1. Placing the newborn away from air currents reduces heat loss by convection.
Frequency of voiding varies from ___________________ during the __________________ days of life
2 to 6 times per day during the first & second days of life
The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement indicates that teaching was effective? "My baby: 1. "Will be able to focus on my face when she is about a month old." 2. "May startle a little if a loud noise happens near her." 3. "Can taste sour things, like my breast milk will be." 4. "Won't have a sense of smell until she is older."
2. Stimulation of the startle reflex is common with exposure to an occasional loud noise. Newborns might be habituated to repetitive loud noises, resulting in no response.
What are some things a nurse can do to keep babies warm?
=?
Pediatric nurse is being pulled to the nursery for the day. Which 3 neonates are the best pt care assignment for the pediatric nurse? SATA A. A 4-hour old with a bluish appearance to the hands and feet. B. A recent admission with APGAR score of 8 and 10. C. A 2-day old who has not passed a meconium stool. D. A 1-day old with a cleft palate and cleft lip. E. An 18-hour, postterm, breast-fed neonate with jaundice. F. A 1-day old with caput succedaneum.
A (acrocyanosis is normal at 4 hrs old), B (APGAR 8 & 10 are good), & F (caput succedum is normal at 1 day old)
A graduate nurse is explaining how to assess newborn jaundice and the effects of phototherapy. Which statements are correct? SATA A. "Phototherapy treatment can increase the risk of dehydration." B. "It is best to observe for jaundice in the conjunctival sac or oral mucosa." C. "The neonate will be irritable from the elevated bilirubin in the system." D. "I will monitor the unconjugated bilirubin carefully as it is the dangerous one." E. "I will carefully record the neonate's intake as limiting fluids is helpful."
A, B, D
Medications used to manage postpartum hemorrhage (PPH) include (Select all that apply): a. Pitocin. b. Methergine. c.Terbutaline. d. Hemabate. e. Magnesium sulfate.
A, B, D Pitocin, Methergine, and Hemabate are all used to manage PPH. Terbutaline and magnesium sulfate are tocolytics; relaxation of the uterus causes or worsens PPH.
A nurse is reviewing contraindications for circumcision with a newly hired nursing. Which of the following conditions are contraindications? (SATA) A. Hypospadias B. Hydrocele C. Family history of hemophilia D. Hyperbilirubinemia E. Epispadias
A, C, E
1. A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath three times daily, and a stool softener. Which information regarding the clients condition is most closely correlated with these orders? a. Woman is a gravida 2, para 2. b.Woman had a vacuum-assisted birth. c.Woman received epidural anesthesia. d.Woman has an episiotomy.
ANS: D These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids. A multiparous classification is not an indication for these orders. A vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate these interventions. The use of an epidural anesthesia has no correlation with these orders.
Of these 4 babies born at full-term and healthy, which has the best chance of not getting sick? A. Baby Will who is fed infant formula by bottle exclusively B. Baby Baylee who is breastfed and is never given other liquids C. Baby Hannah who is breastfed and is given sips of herbal tea D. Baby Evie who is breastfed with formula supplementation
B (A: formula is not a bad thing, but that baby doesn't have the BEST chance of not getting sick)(C: BF & given sips of herbal tea - they don't need anything other than milk)(D: nothing wrong w being BF w formula supplementation; while formula has extra vitamins that breast milk does not have, there is a chance of this baby getting sick more than a baby who is exclusively BF bc of bottles and such that can transfer infections)
When would be appropriate to complete baby Charlie's first physical exam? A. At one hour of age, as soon as immediate car is completed B. At 4 hours of age with an axillary temp of 98.8 C. At 36 hours of age upon discharge D. At 4 weeks old
B Bonding is the most important thing! Also the latest you want to feed a baby is 1 hour old. So the ideal time is at 4 hours of age
When assessing a neonate 1 hr after birth, RN notes acrocyanosis of both feets & hands, measures an axillary temp of 95.5, an apical pulse of 110 bpm, & a RR of 64. Which assessment would be the most concerning for the nurse? A. bradypnea B. tachypnea C. hypothermia D. acrocyanosis
C RR is abnormal but its probs caused by the hypothermia so the low temp is most concerning
How often should formula fed babies have stools vs how often should breastfed babies have stools a day?
FORMULA FED: should have one stool a day at a newborn, but may have as few as one stool every other day after the first few weeks of life BREASTFED: should have at least 3 stools a day as a newborn (1-3 a day) for the first few weeks
What are formula fed stools like vs what are breastfed stools like?
FORMULA FED: stools are more formed than BF stools, pasty, pink, puddy BREASTFED: stools are looser & resemble mustard mixed w cottage cheese; the odor is less offensive than stools of infants who are formula fed
As temp goes down, what happens to glucose & respiratory rate?
RR goes up & blood sugar goes down
What were the 3 big things to remember with temperature?
TEMP, RR, & GLUCOSE
Early postpartum hemorrhage is defined as a blood loss greater than: a. 500 mL in the first 24 hours after vaginal delivery. b. 750 mL in the first 24 hours after vaginal delivery. c. 1000 mL in the first 48 hours after cesarean delivery. d. 1500 mL in the first 48 hours after cesarean delivery.
a. 500 mL in the first 24 hours after vaginal delivery.
A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: a. Uterine atony. b. Lacerations of the genital tract. c. Perineal hematoma. d. Infection of the uterus.
b. Lacerations of the genital tract.
coombs' test: direct is done on ___________?
baby
When should an infant void for the first time?
within 24 hours of life (90% of infants void within 30 hrs of life) (if the infant has not voided within 48 hours of life it may indicate renal impairment)
How much wt is it okay for a baby to lose over the first 3 to 5 days of life? & when does the baby need to regain what they lost?
-5 to 10% -regain what they lost within 10 to 14 days (depending on feeding method [BF or bottle])
Who is at risk for hypoglycemia?
-SGA or LGA -infants of mothers w diabetes -late preterm (34 0/7 through 36 6/7)
When does physiologic jaundice begin to appear? & what usually causes physiologic jaundice?
-after 24 hours of life -usually rt delayed elimination of bili with or without increased production
The parents of a newborn are receiving discharge teaching. The nurse explains that the infant should have several wet diapers per day. Which statement by the parents indicates that further education is necessary? 1. "Our baby was born with kidneys that are too small." 2. "A baby's kidneys don't concentrate urine well for several months." 3. "Feeding our baby frequently will help the kidneys function." 4. "Kidney function in an infant is very different from in an adult."
1. Size of the kidneys is rarely an issue.
How many grams are in 6lb 4 oz?
2835 grams
After day 4, how many wet diapers should a baby have in 24 hours?
6-8 wet diapers in 24 hours after day 4
Based on periods of reactivity, what should the nurse encourage the mother of a term neonate to do approximately 90 minutes after birth? A. Feed the neonate. B. Allow the neonate to sleep. C. Get to know the neonate. D. Change the neonate's diaper.
B (90 minutes after birth the baby is in the period of decreased responsiveness (the 2nd period) so the baby will probs be sleeping → allow neonate to sleep)A: incorrect bc you should feed the baby by 1 hour of age
At a 7-day checkup Charlie weighs 3250g. At birth he weighed 3325g. What is the appropriate response when his mother questions his weight loss? A. Ignore the mother as this is normal B. Suggest more frequent feedings and supplement with formula as the weight loss is a danger sign C. Say this is normal but inquire about how breastfeeding is going and offer encouragement D. Say this is normal
C Charlie lost 2.2% of his weight, this is normal
The nurse completed discharge teaching with new parents who are bottle-feeding their newborn. Which statement by the parents indicates successful teaching? A. "Our baby will require feedings through the night for the first week after birth." B. "The baby should burp during and after each feeding with projectile vomiting." C. "Our baby should have at least one soft, formed stool per day." D. "We should weigh our baby daily to make sure he is gaining weight."
C (formula fed babies usually have about 1 more formed than a BF baby stool a day - goal is to have one stool a day in the beginning)
What is the difference between caput succedaneum & cephalhematoma?
Ceph takes longer than caput to go away but they both resolve on their own! Ceph takes about 2-8 weeks vs caput will go away within about a week.Caput can cross suture lines but ceph cannot.
In assessing a newborn infant, the nurse knows that postmature infants may exhibit: A. Heavy vernix, little lanugo B. Large size for gestational age C. Increased subcutaneous fat, absent creases on feet D. Small size for gestational age
D
The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by: a. Subinvolution of the placental site. b. Defective vascularity of the decidua. c. Cervical lacerations. d. Coagulation disorders.
a. Subinvolution of the placental site. Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained placental fragments. Late PPH is not typically a result of defective vascularity of the decidua, cervical lacerations, or coagulation disorders.
A woman delivered a 9-lb, 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment, she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? a. Call for help. b.Assess the fundus for firmness. c.Take her blood pressure. d. Check the perineum for lacerations.
b. Assess the fundus for firmness.
The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: a. Call the woman's primary health care provider. b. Administer the standing order for an oxytocic. c. Palpate the uterus and massage it if it is boggy. d. Assess maternal blood pressure and pulse for signs of hypovolemic shock.
c. Palpate the uterus and massage it if it is boggy. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Though calling the health care provider, administering an oxytocic, and assessing maternal BP are appropriate interventions, the primary intervention should be to assess the uterus. Uterine atony is the leading cause of postpartum hemorrhage (PPH).
Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth? a. Postpartum depression b.Postpartum psychosis c. Postpartum bipolar disorder d. Postpartum blues
d. Postpartum blues
What education would you give to the parents with a caput or cephal?
gentle handling of the head (like lay the head down gently)
What are some early feeding signs?
hand to mouth, sucking, touching face & they move that way, etc...
hyperthermia vs infection temperatures
hyperthermia = >99.5 infection = 100.4
The home care nurse is examining a 3-day-old infant. The skin on the child's sternum is yellow when blanched with a finger. The parents ask the nurse why jaundice occurs. The best response from the nurse is: 1. "The liver of an infant is not fully mature, and doesn't conjugate the bilirubin for excretion." 2. "The infant received too many red blood cells after delivery because the cord was not clamped immediately." 3. "The yellow color of your baby's skin indicates that you are breastfeeding too often." 4. "This is an abnormal finding related to your baby's bowels' not excreting bilirubin as they should."
1. Physiologic jaundice is a common occurrence, and peaks on day 3 or 4.
The mother of a 2-day-old male has been informed that her child has sepsis. The mother is distraught, and says, "I should have known that something was wrong. Why didn't I see that he was so sick?" The best reply is: 1. "Newborns have immature immune function at birth, and illness is very hard to detect." 2. "Your mothering skills will improve with time. You should take the newborn class." 3. "Your baby didn't get enough active acquired immunity from you during the pregnancy." 4. "The immunity your baby gets in utero doesn't start to function until he is 4-8 weeks of age."
1. The immune system of a newborn lacks response to pyrogens and presents a limited inflammatory response, thus the signs and symptoms of infection are often subtle and nonspecific in the newborn.
G8 P4 client just delivered baby Charlie at 0623. What is the nurse's initial action? 1. Clamp and cut the cord 2. Apply erythromycin ointment to both eyes 3. Dry and place a cap on his head 4. Obtain hand and foot prints
3
When should you feed the baby for the first time?
30 minutes to 60 minutes after birth - AT LEAST by the 60 minute mark
When the mother of a new baby asks the nurse to feed her baby, the most appropriate response is to say: A. "I'll feed him today. Maybe tomorrow you can try it." B. "It's not difficult at all. He is just like a normal baby, only smaller." C. "You can learn to feed him as well as I can; I wasn't good when I first fed a premature infant either." D. "It's frightening sometimes to feed an infant this small, but I'll stay with you to help."
?
The nurse is assisting a breastfeeding client when she asks how she will know if her baby is getting any milk. Which statements are the priority? SATA A. "An audible sound will be heard as your baby is swallowing breast milk." B. "Appears content after feeding and sleeps 4 hours between feedings." C. "Burps loudly once or twice between breasts and when finished." D. "Finishing the feeding in 5 minutes on each breast." E. "Urinates 6-8 times/day and has 1-3 bowel movements after day 4."
A & E (B: BF pt should BF their baby q2-3 hrs so this is wrong bc the baby is not going to sleep for 4 hrs between feedings) (C: well you should burp them between breasts & when finished but there is no guarantee that the baby WILL burp so its wrong) (D: have to feed for longer than 5 mins to make sure mom gets that hind milk in)
12. Parents who have not already done so need to make time for newborn follow-up of the discharge. According to the American Academy of Pediatrics (AAP), when should a breastfeeding infant first need to be seen for a follow-up examination? a. 2 weeks of age b. 7 to 10 days after childbirth c. 4 to 5 days after hospital discharge d. 48 to 72 hours after hospital discharge
ANS: D Breastfeeding infants are routinely seen by the pediatric health care provider clinic within 3 to 5 days after birth or 48 to 72 hours after hospital discharge and again at 2 weeks of age. Formula-feeding infants may be seen for the first time at 2 weeks of age.
The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is: A. Tell the mother she must pay attention to her infant B. Show the mother how the infant initiates interaction and attends to her C. Demonstrate for the mother different positions for holding her infant while feeding D. Arrange for the mother to watch a video on parent-infant interaction
B A. Incorrect: A statement of this kind may be perceived as derogatory and is not appropriate. B. Correct: Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment. C. Incorrect: Educating the young mother in infant care is important, but pointing out the responsiveness of her baby is a better tool for facilitating mother-infant attachment. D. Incorrect: Videos are an educational tool that can demonstrate parent-infant attachment, but encouraging the mother to recognize the infant's responsiveness is more appropriate.
A pt has just delivered a healthy 7 lbs baby boy. The physician instructs the nurse to suction the baby. The procedure the nurse uses is to: A. Suction the nose first B. Suction the mouth first C. Suction neither the nose nor mouth until the physician gives further instructions D. Turn the baby on his side so mucus will drain out before suctioning
B MOUTH BEFORE NOSE! need to suction what is in their mouth first so they don't aspirate, then do each nostril
After receiving a change of shift report in the normal newborn nursery, the nurse should see which neonate first? A. 3-hour old with increased respiratory secretions B. 6-hour old with blood glucose of 25 C. 12-hour old with temperature of 97.4 D. 24-hour old with no urine output for the past 12 hours
B: 6 hr old w blood glucose of 25 = abnormal (normal is 40-60)
A nurse is performing a neurologic assessment on a 1-day-old neonate in the nursery. Which findings would indicate possible asphyxia in utero? SATA A. The neonate grasps the nurse's finger when put in the palm of the neonate's hand. B. The neonate does stepping movements when held upright with the sole of the foot touching a surface. C. The neonate displays weak, ineffective sucking. D. The neonate does not respond when the nurse claps her hands. (what reflex is this? = moro) E. The neonate turns toward the nurse's finger when touching the cheek. F. The neonate's toes do not curl downward when the soles of the feet are touched.
C, D If a baby experiences asphyxia in utero, they will have neuro problems → weak reflexes (reflexes indicate neuro status)
What PPH conditions are considered medical emergencies that require immediate treatment? a. Inversion of the uterus and hypovolemic shock b. Hypotonic uterus and coagulopathies c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura d. Uterine atony and disseminated intravascular coagulation
a. Inversion of the uterus and hypovolemic shock Inversion of the uterus and hypovolemic shock are considered medical emergencies. Although hypotonic uterus and coagulopathies, subinvolution of the uterus and idiopathic thrombocytopenic purpura, and uterine atony and disseminated intravascular coagulation are serious conditions, they are not necessarily medical emergencies that requires immediate treatment.
A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: a. Establish venous access. b. Perform fundal massage. c. Prepare the woman for surgical intervention. d. Catheterize the bladder.
b. Perform fundal massage. The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. Although establishing venous access may be a necessary intervention, the initial intervention would be fundal massage. The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus. After uterine massage the nurse may want to catheterize the client to eliminate any bladder distention that may be preventing the uterus from contracting properly.
The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective? Select all that apply. 1. "We should make sure that we keep our home air-conditioned so the baby doesn't overheat." 2. "It is important that we dry the baby off as soon as we give him a bath or shampoo his hair." 3. "When we change the baby's diaper, we should change any wet clothing or blankets, too." 4. "If the baby's body temperature gets too low, he will warm himself up without any shivering." 5. "Our baby will have a much faster rate of breathing if he is not dressed warmly enough."
2. Drying a wet baby prevents evaporation, one mechanism of heat loss. 3. Changing wet clothing or blankets immediately prevents evaporation, one mechanism of heat loss. 4. Non-shivering thermogenesis is the mechanism used by newborns to warm themselves. 5. A neonate with a low body temperature will increase oxygen consumption, which can lead to respiratory distress.
The nurse manager of the neonatal intensive care unit is preparing a handout for parents of ill newborns. Which statement should the nurse include? 1. Newborns can eliminate excess fluid as quickly as an adult. 2. The kidneys are fully functional by 30 weeks' gestation. 3. Neonates have a tendency to become dehydrated. 4. Sugar is rarely present in the urine of a newborn.
3. Neonates cannot concentrate their urine or pull water back into the vascular volume, and thus can become dehydrated easily.
The nurse is planning an educational presentation on hyperbilirubinemia for nursery nurses. Which statement is most important to include in the presentation? 1. Conjugated bilirubin is eliminated in the conjugated state. 2. Unconjugated bilirubin is neurotoxic, and cannot cross the placenta. 3. Total bilirubin is the sum of the direct and indirect levels. 4. Antibiotics decrease the incidence of hyperbilirubinemia.
3. This is true. Conjugated bilirubin is also referred to as direct, while unconjugated bilirubin is also referred to as indirect.
A telephone triage nurse gets a call from a postpartum client who is concerned about jaundice. The client's newborn is 37 hours old. What data should the nurse gather first? 1. Stool characteristics 2. Fluid intake 3. Skin color 4. Bilirubin level
3. Yellow coloration of the skin and sclera is a sign of physiologic jaundice that appears after the first 24 hours postnatally. Inspection of the skin would be the first step in assessing for jaundice.
A postpartum client calls the nursery to report that her 3-day-old newborn has passed a bright green stool. The nurse's best response is: 1. "Take your newborn to the pediatrician." 2. "There may be a possible food allergy." 3. "Your newborn has diarrhea." 4. "This is a normal occurrence."
4. By the third day of life, the newborn's stools appear brown to green in color.
How do babies warm themselves if they are not in a warm environment / If a baby starts to get cold how do they fix that?
=?
Despite placing a newborn skin-to-skin on the mother at delivery, the infant's temp is 96.4 F. Which initial actions should be implemented? (SATA) A. Placing a knit hat on the baby. B. Drying the baby well. C. Place the baby in an incubator. D. Use an overbed warmer. E. Wrap the infant in warmed blankets. F. Provide warmed intravenous fluids.
ABE A: yes, definitely want a hat bc that's the easiest way they lose heat B: yes, make sure it's dried extremely well C: no, you don't have to immediately place the baby in an incubator D: no, you don't want to take baby away from mom to place it in an over bed warmer so you should put it with warm blankets (you want to do everything you can to do things at the bedside so that the mom can stay with baby - if you have already done lots of interventions & the baby is not improving then you can take the baby to the overbed warmer) E: yes F: no
17. Rho immune globulin will be ordered postpartum if which situation occurs? a. Mother Rh, baby Rh+ b. Mother Rh, baby Rh c. Mother Rh+, baby Rh+ d. Mother Rh+, baby Rh
ANS: A An Rh mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal cells in the maternal circulation before sensitization occurs. If mother and baby are both Rh+ or Rh the blood types are alike, so no antibody formation would be anticipated. If the Rh+ blood of the mother comes in contact with the Rh blood of the infant, no antibodies would develop because the antigens are in the mothers blood, not in the infants.
2. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data? a.Rubella vaccine should be administered. b.Blood transfusion is necessary. c.Rh immune globulin is necessary within 72 hours of childbirth. d. Kleihauer-Betke test should be performed.
ANS: A This clients rubella titer indicates that she is not immune and needs to receive a vaccine. These data do not indicate that the client needs a blood transfusion. Rh immune globulin is indicated only if the client has an Rh-negative status and the infant has an Rh-positive status. A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is suspected, especially if the mother is Rh negative. However, the data provided do not indicate a need for performing this test.
13. On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurses highest priority at this time? a. Beginning an intravenous (IV) infusion of Ringers lactate solution b. Assessing the womans vital signs c. Calling the womans primary health care provider d. Massaging the womans fundus
ANS: D The nurse should first assess the uterus for atony by massaging the womans fundus. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be the nurses first action. The physician would be notified after the nurse completes the assessment of the woman.
The nurse assesses a 15-hour old infant and finds jaundice. What is the priority action the nurse needs to take? A. Continue with the normal newborn exam B. Notify the health care provider of the finding C. Provide an extra feeding for the infant D. Wait and assess the skin color when the infant is over 24 hours old
B -15 hr old infant w jaundice → pathologic → concerning → first action would be to immediately notify the HCP-after notifying the HCP, RN should continue w the exam
Which infant is at greatest risk to develop cold stress? a. Full-term infant delivered vaginally without complications b. 36-week infant with an Apgar score of 7 at 5 minutes c. 38-week female infant delivered via cesarean section because of cephalopelvic disproportion d. Term infant delivered vaginally with epidural anesthesia
B : 36 weeks = preterm infants have a harder time transitioning & apgar scores 8-10 are the best C: CPD does not always mean the baby will have fetal distressD: epidural doesn't play into this
The nurse has received a shift report on a group of newborns. The nurse should make rounds on which client first? A. Newborn who is LGA and needs a repeat blood glucose prior to the next feeding in 15 minutes B. Neonate born at 36 weeks gestation weighing 5 lb and due to breastfeed for the first time in 15 minutes C. Neonate born 24 hours ago by C/S and had a respiratory rate of 64 approximately 30 minutes ago D. Newborn who had a 97.6 temperature and was double-wrapped with a hat on 30 minutes ago to bring up the temperature
C -Bc ABCs → need to make sure the baby doesn't have any other signs of respiratory distress -Normal RR is 30-60 so this baby is abnormal bc of the time period -"What if I told you this was 30 min after birth, would that be normal or abnormal? = normal"
During a phone follow-up conversation with a woman who is 4 days postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" The nurse would recognize that the woman is experiencing: A. Taking-in B. Postpartum depression (PPD) C. Postpartum blues D. Attachment difficulty
C A. Incorrect: The taking-in phase is the period after birth when the mother focuses on her own psychologic needs. Typically, this period lasts 24 hours. B. Incorrect: PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the PP blues. C. Correct: During the PP blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day. D. Incorrect: Crying is not a maladaptive attachment response; it indicates PP blues.
Baby boy Tiger was delivered at 1012 am. After reviewing the EHR (spontaneous vaginal delivery of viable male infant. Infant umbilical cord clamped & cut per HCP. Infant placed on warm blanket on mother's chest), what is the nurse's initial action? A. Suction the nose B. Take the infant to the overhead warmer C. Begin chest compressions D. Vigorously dry the infant
D
A 1-week postpartum mother calls the unit to inquire about a tender, hard area on her left breast. What is the nurse's initial response? A. "This is a normal response at 1-week." B. "Notify the health care provider." C. "Stop breastfeeding because you probably have an infection." D. "Try massaging the area and applying heat packs before feeding, and cold packs after."
D A: plugged duct is not normal 1 week postpartum B: not the first thing the nurse should say C: incorrect because nothing in the assessment indicates infection
After giving birth to a healthy infant boy, a primiparous woman, 16, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "risk for impaired parenting related to deficient knowledge of newborn care." In planning for the woman's discharge, what should the nurse be certain to include in the plan of care? A. Tell the woman how to feed and bathe her infant B. Give the woman written information on bathing her infant C. Advise the woman that all mothers instinctively know how to care for their infants D. Provide time for the woman to bathe her infant after she views an infant bath demonstration
D A. Incorrect: Although verbalizing how to care for the infant is a form of client education, it is not the most developmentally appropriate teaching for a teenage mother. B. Incorrect: Although providing written information is useful, it is not the most developmentally appropriate teaching for a teenage mother. C. Incorrect: This statement is inappropriate; it is belittling and false. D. Correct: Having the mother demonstrate infant care is a valuable method of assessing the client's understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child.
The newborn HR is 120, has a weak cry, muscle tone is flaccid, grimaces with bulb suction, and body is pink with blue extremities. APGAR? A. 8 B. 7 C. 6 D. 5
D HR 120 → 2 Weak cry → 1 Flaccid muscle tone → 0 Grimaces → 1 Pink body with blue extremities → 1 2+1+1+1 = 5
Which woman is at greatest risk for early postpartum hemorrhage (PPH)? a. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor is being induced c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor d. A primigravida in spontaneous labor with preterm twins
b. A woman with severe who is receiving magnesium sulfate and whose labor is being induced. Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although many causes and risk factors are associated with PPH, the primiparous woman being prepared for an emergency c-section, the multiparous woman with 8-hour labor, and the primigravida in spontaneous labor do not pose risk factors or causes of early PPH.
A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that: a. The infant is protected from infection by immunoglobulins in the breast milk. b. The infant is not susceptible to the organisms that cause mastitis c. The organisms that cause mastitis are not passed to the milk. d. The organisms will be inactivated by gastric acid.
c. The organisms that cause mastitis are not passed to the milk.
If nonsurgical treatment for late postpartum hemorrhage is ineffective, which surgical procedure is appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. D&C
d. D&C
The most appropriate statement that the nurse can make to bereaved parents is: a. "You have an angel in heaven." b. "I understand how you must feel." c. "You're young and can have other children." d. "I'm sorry."
d. I'm sorry One of nurse's most important goals is to validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care. At the very least, the nurse should acknowledge the loss with a simple but sincere comment such as, "I'm sorry." The initial impulse may be to reduce one's sense of helplessness and say or do something that you think will reduce their pain. Although such a response may seem supportive at the time, it can stifle the further expression of emotion. The nurse should resist the temptation to give advice or to use clichés when offering support to the bereaved. Saying, "You're young and can have other children" is not a therapeutic response for the nurse to make.
To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features: a. Is more likely to occur in women with more than two children. b. Is rarely delusional and then is usually about someone trying to harm her (the mother). c. Although serious, is not likely to need psychiatric hospitalization. d. May include bipolar disorder (formerly called "manic depression").
d. May include bipolar disorder (formerly called "manic depression"). Manic mood swings are possible. PPD is more likely to occur in first-time mothers. Delusions may be present in 50% of women with PPD, usually about something being wrong with the infant. PPD with psychosis is a psychiatric emergency that requires hospitalization.
Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance: a. PPH is easy to recognize early; after all, the woman is bleeding. b. Traditionally it takes more than 1000 mL of blood after vaginal birth and 2500 mL after cesarean birth to define the condition as PPH. c. If anything, nurses and doctors tend to overestimate the amount of blood loss. d. Traditionally PPH has been classified as early or late with respect to birth.
d. Traditionally PPH has been classified as early or late with respect to birth. Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH. Unfortunately PPH can occur with little warning and often is recognized only after the mother has profound symptoms. Traditionally a 500-ml blood loss after a vaginal birth and a 1000-ml blood loss after a cesarean birth constitute PPH. Medical personnel tend to underestimate blood loss by as much as 50% in their subjective observations.
When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: a. Absence of cyanosis in the buccal mucosa. b. Cool, dry skin c. Diminished restlessness. d. Urinary output of at least 30 mL/hr.
d. Urinary output of at least 30 mL/hr. Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective in nature. The presence of cool, pale, clammy skin would be an indicative finding associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy, not restlessness.
A new grandfather is marveling over his 12-hour-old newborn grandson. Which statement indicates that the grandfather needs additional education? 1. "I can't believe he can already digest fats, carbohydrates, and proteins." 2. "It is amazing that his whole digestive tract moves things along at birth." 3. "Incredibly, his stomach capacity is already a cupful when he was born." 4. "He will lose some weight but then miraculously regain it by about 10 days."
3. A newborn's stomach capacity is only 20-40 ml; overfeeding of bottle-fed infants tends to cause regurgitation and abdominal discomfort, exhibited by crying.
The new father asks the nurse to describe what his baby will experience while sleeping and awake. The best response is: 1. "Babies have several sleep and alert states. Keep watching, and you'll notice them." 2. "You may have noticed that your child was in an alert awake state for an hour after his birth." 3. "Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep." 4. "Birth is hard work for babies; it takes them a week or two to recover and become more awake."
3. This statement is true. Teaching the parents how to detect the two sleep stages helps them tune in to their infant's behavioral states.
RN is assigned to care for a 2 hr old newborn in an Isolette. She checks the temp of the Isolette knowing the temp is too high if the infant: A. Pulse is decreased B. Temperature is 101 F rectally C. Temperature is 99.4 F rectally D. Respirations are decreased
=B: if the temp is high rectally-RR could stay the same or they could go up to compensate for increased temp
The nurse cares for a newborn at two hours of age. Which task is most appropriate for the nurse to delegate? A. Complete head to toe assessment B. Blood glucose assessment by heel stick C. Initial cleansing bath D. Administration of routine medications
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New parents express concern that because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurse's response should convey to the parents that: A. Attachment, or bonding, is a process that occurs over time and does not require early contact. B. The time immediately after birth is a critical period for humans. C. Early contact is essential for optimum parent-infant relationships. D. They should just be happy that the infant is healthy.
A A. Correct: This statement is accurate. B. Incorrect: The formerly accepted definition of bonding held that the period immediately after birth was a critical time for bonding to occur. Research since has indicated that parent-infant attachment occurs over time. A delay does not inhibit the process. C. Incorrect: Parent-infant attachment involves activities such as touching, holding, and gazing; it is not exclusively eye contact. D. Incorrect: This response is inappropriate because it is derogatory and belittling.
A pt is concerned because her 1 day old son, who was very alert at birth is now sleeping most of the time. The best nursing response would be...? A. "Most infants are alert at birth & then require deep sleep to recover from the birth experience." B. "Your son's behavior is slightly abnormal & bears careful observation." C. "Would you ask the pediatrician to check him to ease your mind?" D. "Your son's behavior is definitely abnormal, & we should keep him in the nursery."
A First period then deep sleep (babies sleep a lot to recover from the birthing experience)
8. A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. What goal is the nurse attempting to achieve by performing this practice? a. To improve the accuracy of blood loss estimation, which usually is a subjective assessment b. To determine which pad is best c. To demonstrate that other nurses usually underestimate blood loss d. To reveal to the nurse supervisor that one of them needs some time off
ANS: A Saturation of perineal pads is a critical indicator of excessive blood loss; anything done to help in the assessment is valuable. The nurse is noting the saturation volumes and soaking appearances. Instead of determining which pad is best, the nurse is more likely noting saturation volumes and soaking appearances to improve the accuracy of estimated blood loss. Nurses usually overestimate blood loss. Soaking perineal pads and writing down the results does not indicate the need for time off of work.
5. A primiparous woman is to be discharged from the hospital the following day with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? a. The woman is disinterested in learning about infant care. b. The woman continues to hold and cuddle her infant after she has fed her. c. The woman reads a magazine while her infant sleeps. d. The woman changes her infants diaper and then shows the nurse the contents of the diaper.
ANS: A The client should be excited, happy, and interested or involved in infant care. A woman who is sad, tearful, or disinterested in caring for her infant may be exhibiting signs of depression or postpartum blues and may require further intervention. Holding and cuddling her infant after feeding is an appropriate parent-infant interaction. Taking time for herself while the infant is sleeping is an appropriate maternal action. Showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infants elimination patterns.
3. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment, the nurse notices that both breasts are swollen, warm, and tender on palpation. Which guidance should the nurse provide to the client at this time? a. Run warm water on her breasts during a shower. b. Apply ice to the breasts for comfort. c. Express small amounts of milk from the breasts to relieve the pressure. d. Wearing a loose-fitting bra to prevent nipple irritation.
ANS: B Applying ice packs and cabbage leaves to the breasts for comfort is an appropriate intervention for treating engorgement in a mother who is bottle feeding. The ice packs should be applied for 15 minutes on and 45 minutes off to avoid rebound engorgement. A bottle-feeding mother should avoid any breast stimulation, including pumping or expressing milk. A bottle-feeding mother should continuously wear a well-fitted support bra or breast binder for at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation.
7. Under the Newborns and Mothers Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth. What is the correct interpretation of this legislation? a. 24; 72 b. 24; 96 c. 48; 96 d. 48; 120
ANS: C The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge. A client may be discharged either 24 hours after a vaginal birth or 72 hours after a cesarean birth if she is stable and her provider is in agreement. A client is unlikely to remain in the hospital for 120 hours after a cesarean birth unless complications have developed.
9. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use? a. Pouring water from a squeeze bottle over the womans perineum b. Placing oil of peppermint in a bedpan under the woman c. Asking the physician to prescribe analgesic agents d. Inserting a sterile catheter
ANS: D Invasive procedures are usually the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills). Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried first. The oil of peppermint releases vapors that may relax the necessary muscles. It, too, is easy, noninvasive, and should be tried early on. If the woman is anticipating pain from voiding, then pain medications may be helpful. Other nonmedical means should be tried first, but medications still come before the insertion of a catheter.
The nurse is providing discharge planning to a primipara patient with a 4 day old baby. What should the nurse tell the patient that warrants a call to her healthcare provider? Select all that apply. A. axillary temperature of 98.0F B. 2 consecutive green watery stools C. 7 wet diapers per day D. one stool a day while formula feeding E. forceful regurgitation after feedings F. high pitched cry
B, E, & F
A new client asks, "Why are you doing a gestational age assessment on my baby?" The nurse's best response is: A. "It was ordered by your physician." B. "This is done to accurately determine the gestational age of your newborn." C. "It helps us identify infants who are at risk for any problems." D. "The gestational age determines how long the infant will be hospitalized."
C -B: false bc it doesn't accurately
The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression. Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis? A. PPD symptoms are consistently severe B. This syndrome affects only new mothers C. PPD can easily go undetected D. Only mental health professionals should teach new parents about this condition
C A. Incorrect: PPD symptoms range from mild to severe, with women having both good day and bad days. B. Incorrect: Screening should be done for both mothers and fathers. PPD in new fathers ranges from 1% to 26%. C. Correct: PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. D. Incorrect: The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.
A nurse is completing an assessment. Which of the following data indicate the newborn is adapting to extrauterine life? (SATA) A. Expiratory grunting B. Inspiratory nasal flaring C. Apnea for 10-second periods D. Obligatory nose breathing E. Crackles and wheezing F. Bluish color to lips G. Respiratory rate of 52
C, D, G Grunting is never ok; apnea > 20 seconds is scary; nasal flaring is not normal; fine crackles are normal but wheezing is not, & coarse crackles are not common in vaginal delivery bc the fluid is being squeezed out during birth but coarse crackles are common in a C/S baby but they should not last long; bluish color to lips is central cyanosis & is not normal
A 24-year-old primipara says, "I am worried that I will not be able to breastfeed my baby because my breasts are so small." What is the best response? A. Breast milk can be enhanced by occasional formula feeding. B. The woman's motivation to breastfeed is important. C. Because her breasts are small, she will have to feed the baby more often. D. Breast size poses no influence on a woman's ability to breastfeed a baby.
D: size is not a factor, it's the makeup that's a factor (A: this is an incorrect statement)(B: motivation is important, but the pt is asking about her breast size so that's not the best response)(C: this is a false statement)
The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: a. Uterine atony. b. Uterine inversion. c. Vaginal hematoma. d. Vaginal laceration.
a. Uterine atony. Uterine atony is marked hypotonia of the uterus. It is the leading cause of postpartum hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of this client's bleeding. Furthermore, if the woman were experiencing a uterine inversion, it would be evidenced by the presence of a large, red, rounded mass protruding from the introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony. A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a firm, contracted uterine fundus.
A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son's prognosis. When the father sees his son, he says, "He looks just fine to me. I can't understand what all this is about." The most appropriate response by the nurse would be: a. "Didn't the doctor tell you about your son's problems?" b. "This must be a difficult time for you. Tell me how you're doing." c. To stand beside him quietly. d. "You'll have to face up to the fact that he is going to die sooner or later."
b. "This must be a difficult time for you. Tell me how you're doing." The grief phase can be very difficult, especially for fathers. Parents should be encouraged to share their feelings as the initial steps in the grieving process. This father is in a phase of acute distress and is "reaching out" to the nurse as a source of direction in his grieving process. Shifting the focus is not in the best interest of the parent. Nursing actions may help the parents actualize the loss of their infant through sharing and verbalization of feelings of grief. "You'll have to face up to the fact that he is going to die sooner or later" is dispassionate and inappropriate statement.
The prevalence of urinary incontinence (UI) increases as women age, with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild to moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? a. Pelvic floor support devices b. Bladder training and pelvic muscle exercises c. Surgery d. Medications
b. Bladder training and pelvic muscle exercises Pelvic muscle exercises, known as Kegel exercises, along with bladder training can significantly decrease or entirely relieve stress incontinence in many women. Pelvic floor support devices, also known as pessaries, come in a variety of shapes and sizes. Pessaries may not be effective for all women and require scrupulous cleaning to prevent infection. Anterior and posterior repairs and even a hysterectomy may be performed. If surgical repair is performed, the nurse must focus her care on preventing infection and helping the woman avoid putting stress on the surgical site. Pharmacologic therapy includes serotonin-norepinephrine uptake inhibitors or vaginal estrogen therapy. These are not the first action a nurse should recommend.
Which instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications? a. Palpate the fundus daily to ensure that it is soft. b. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding. c. Report any decrease in the amount of brownish red lochia. d. The passage of clots as large as an orange can be expected.
b. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.
The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by: a. Washing the nipples and breasts with mild soap and water once a day. b. Using proper breastfeeding techniques. c. Wearing a nipple shield for the first few days of breastfeeding. d. Wearing a supportive bra 24 hours a day.
b. Using proper breastfeeding techniques. Almost all instances of acute mastitis can be avoided by proper breastfeeding technique to prevent cracked nipples. Washing the nipples and breasts daily is no longer indicated. In fact, this can cause tissue dryness and irritation, which can lead to tissue breakdown and infection. Wearing a nipple shield does not prevent mastitis. Wearing a supportive bra 24 hours a day may contribute to mastitis, especially if an underwire bra is worn, because it may put pressure on the upper, outer area of the breast, contributing to blocked ducts and mastitis.
One of the first symptoms of puerperal infection to assess for in the postpartum woman is: a. Fatigue continuing for longer than 1 week. b. Pain with voiding. c. Profuse vaginal bleeding with ambulation. d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.
d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth. Postpartum or puerperal infection is any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the United States continues to be the presence of a fever of 38° C (100.4° F) or higher on 2 successive days of the first 10 postpartum days, starting 24 hours after birth. Fatigue would be a late finding associated with infection. Pain with voiding may indicate a urinary tract infection, but it is not typically one of the earlier symptoms of infection. Profuse lochia may be associated with endometritis, but it is not the first symptom associated with infection.
