OB/maternal: exam 3- postpartum practice questions

A woman is receiving patient-controlled analgesia (PCA) post-cesarean section. Which of the following must be included in the patient teaching?

The client should report any feelings of nausea or itching to the nurse.

A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, "I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest." Which of the following actions should the nurse take at this time?

Encourage the woman exclusively to breastfeed her baby.

A maternity nurse knows that obstetric clients are most at high risk for cardiovascular compromise during the one hour immediately following a delivery because of which of the following?

Excess blood volume from pregnancy is circulating in the woman's periphery.

A client, G1 P1, who had an epidural has just delivered a daughter, Apgar 9/9, over a mediolateral episiotomy. The physician used low forceps. While recovering, the client states, "I'm a failure. I couldn't stand the pain and couldn't even push my baby out by myself!" Which of the following is the best response for the nurse to make?

"To have things work out differently than you had planned is disappointing."

The nurse is caring for a client, post-op 1 day from an emergency cesarean section with her husband in attendance. The baby's Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate?

"With all of your preparations, it must have been disappointing for you to have had a cesarean."

A breastfeeding client, 7 weeks postpartum, complains to an obstetrician's triage nurse that when she and her husband had intercourse for the first time after the delivery, "I couldn't stand it. It was so painful. The doctor must have done something terrible to my vagina." Which of the following responses by the nurse is appropriate?

"Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort."

The nurse is caring for a Seventh Day Adventist woman who delivered a baby boy by cesarean section. Which of the following questions should be asked regarding this woman's care?

"Would you like me to order a vegetarian diet for you?"

To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks?

Change the peripad at each voiding.

The nurse is evaluating the involution of a woman who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal?

Fundus 3 cm below the umbilicus, lochia serosa

A breastfeeding client, G10 P6408, delivered 10 minutes ago. Which of the following assessments is most important for the nurse to perform at this time?

Fundus.

The day after delivery, a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong: "All I do is go to the bathroom." Which of the following is an appropriate nursing response?

Inform the client that polyuria is normal.

The nurse in the obstetric clinic received a telephone call from a bottle-feeding mother of a 3-day-old. The client states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform?

Intermittently apply ice packs to her axillae and breasts.

The surgeon has removed the surgical cesarean section dressing from a postop day 1 client. Which of the following actions by the nurse is appropriate?

Monitor the incision for drainage.

Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate?

Provide the woman with warm blankets.

A breastfeeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective?

She feeds her baby every 2 to 3 hours.

The nurse is discussing the importance of doing Kegel exercises during the postpartum period. Which of the following should be included in the teaching plan?

She should practice by stopping the urine flow midstream every time she voids.

A client, 2 days postoperative from a cesarean section, complains to the nurse that she has yet to have a bowel movement since the surgery. Which of the following responses by the nurse would be appropriate at this time?

"Fluids and exercise often help to combat constipation. Take a stroll around the unit and drink lots of fluid."

A nurse is performing a postpartum assessment on a client who delivered vaginally. Which of the following actions will the nurse perform? Select all that apply.

-Palpate the breasts. -Check vaginal discharge. -Assess the extremities. -Inspect the perineum.

During a postpartum assessment, it is noted that a G1 P1001 woman who delivered vaginally over an intact perineum has a cluster of hemorrhoids. Which of the following would be appropriate for the nurse to include in the woman's health teaching? Select all that apply.

-The client should use a sitz bath daily as a relief measure. - The client should digitally replace external hemorrhoids into her rectum. -The client should apply topical anesthetic as a relief measure.

The nurse has taught a new admission to the postpartum unit about pericare. Which of the following indicates that the client understands the procedure? Select all that apply.

-The woman washes her hands before and after the procedure. - The woman sprays her perineum from front to back.

The nurse is preparing to place a peripad on the perineum of a client who delivered her baby 10 minutes earlier. The client states, "I don't use those. I always use tampons." Which of the following actions by the nurse is appropriate at this time?

State that it is unsafe to place anything into the vagina until involution is complete.

Which of the following statements is true about breastfeeding mothers as compared to bottle-feeding mothers?

Breastfeeding mothers have decreased incidence of diabetes mellitus later in life.

A client informs the nurse that she intends to bottle feed her baby. Which of the following actions should the nurse encourage the client to perform? Select all that apply.

- Wear a supportive bra 24 hours a day. - Stand with her back toward the shower water.

During a postpartum assessment, the nurse assesses the calves of a client's legs. The nurse is checking for which of the following signs/symptoms? Select all that apply.

-Pain. -Warmth. -Redness.

Which of the following is the priority nursing action during the immediate postpartum period?

Palpate fundus

The nurse is caring for a breastfeeding mother who asks advice on foods that will provide both vitamin A and iron. Which of the following should the nurse recommend?

11⁄2 cups raw broccoli.

The nurse is caring for a postpartum client who experienced a second-degree perineal laceration at delivery 2 hours ago. Which of the following interventions should the nurse perform at this time?

Apply an ice pack to the perineum.

A client has been transferred to the post-anesthesia care unit from a cesarean delivery. The client had spinal anesthesia for the surgery. Which of the following interventions should the nurse perform at this time?

Assess the level of the anesthesia.

The nurse is assessing the laboratory report on a 2-day postpartum G1 P1001. The woman had a normal postpartum assessment this morning. Which of the following results should the nurse report to the primary healthcare provider?

Hematocrit, 26%.

The nurse informs a postpartum woman that which of the following is the reason ibuprofen (Advil) is especially effective for afterbirth pains?

Ibuprofen has an antiprostaglandin effect.

A client, G1 P0101, postpartum 1 day is assessed. The nurse notes that the client's lochia rubra is moderate and her fundus is boggy 2 cm above the umbilicus and deviated to the right. Which of the following actions should the nurse take first?

Massage the woman's fundus.

A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with which of the following drinks?

Orange juice

A nurse is assessing a 1-day-postpartum woman who had her baby by cesarean section. Which of the following should the nurse report to the surgeon?

Pad saturation every 30 minutes.

A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate?

Reassure the woman that this is normal

A client has just been transferred to the postpartum unit from labor and delivery. Which of the following tasks should the registered nurse delegate to the nursing care assistant?

Take the client's vital signs.

A client has just been transferred to the postpartum unit from labor and delivery. Which of the following nursing care goals is of highest priority?

The client will have a moderate lochial flow.

A breastfeeding woman, 11⁄2 months postdelivery, calls the nurse in the obstetrician's office and states, "I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me?" The nurse should base the response to the client on which of the following?

The same hormone stimulates orgasms and the milk ejection reflex.

A client who delivered a 3,900-gram baby vaginally over a right mediolateral episiotomy states, "How am I supposed to have a bowel movement? The stitches are right there!" Which of the following is the best response by the nurse?

"Your stitches are actually far away from your rectal area."

One nursing diagnosis that a nurse has identified for a postpartum client is: Risk for intrauterine infection r/t vaginal delivery. During the postpartum period, which of the following goals should the nurse include in the care plan in relation to this diagnosis? Select all that apply.

- The client will have a stable white blood cell (WBC) count. - The client will have a normal temperature. - The client will have normal-smelling vaginal discharge

A nurse is performing a postpartum assessment on a client who delivered by cesarean section. Which of the following actions will the nurse perform? Select all that apply.

-Auscultate the abdomen. -Palpate the fundus. -Assess the nipple integrity. -Auscultate the lung fields.

A primipara, 2 hours postpartum, requests that the nurse diaper her baby after a feeding because "I am so tired right now. I just want to have something to eat and take a nap." Based on this information, the nurse concludes that the woman is exhibiting signs of which of the following?

Normal postpartum behavior.

The nurse palpates a distended bladder on a woman who delivered vaginally 2 hours earlier. The woman refuses to go to the bathroom, "I really don't need to go." Which of the following responses by the nurse is appropriate?

"I understand but I still would like you to try to urinate."

A woman had a cesarean section yesterday. She states that she needs to cough but that she is afraid to. Which of the following is the nurse's best response?

"If you support your incision with a pillow, coughing should hurt less."

A 2-day postpartum mother, G2 P2002, states that her 2-year-old daughter at home is very excited about taking "my baby sister" home. Which of the following is an appropriate response by the nurse?

"Your daughter is likely to become very jealous of the new baby."

A client, G1 P1001, 1 hour postpartum from a spontaneous vaginal delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time?

Assist the woman to the bathroom.

The nurse is developing a plan of care for the postpartum client during the "taking hold" phase. Which of the following should the nurse include in the plan?

Assure the client that she is an excellent mother.

A postpartum nurse is caring for a client who received epidural anesthesia during her labor and delivery. The nurse should advise the woman that she may experience which of the following side effects of the medication during the postpartum period?

Backache

Which of the following nursing interventions would be appropriate for the nurse to perform to achieve this client care goal: The client will not develop postpartum thrombophlebitis?

Encourage early ambulation.

A patient, G2 P1102, who delivered her baby 8 hours ago, now has a temperature of 100.2°F. Which of the following is the appropriate nursing intervention at this time?

Encourage intake of water and other fluids.

The nurse is caring for a client who had a cesarean section under spinal anesthesia less than 2 hours ago. Which of the following nursing actions is appropriate at this time?

Have her turn and deep breathe every 2 hours.

The nurse hears the following information on a newly delivered client during shift report: 21 years old, married, G1 P1001, 8 hours post-spontaneous vaginal delivery over an intact perineum; vitals 110/70, 98.6°F, 82, 18; fundus firm at umbilicus; moderate lochia rubra; ambulated to bathroom to void 4 times; breastfeeding every 2 hours. Which of the following nursing diagnoses should the nurse include in this client's nursing care plan?

Knowledge deficit r/t lack of parenting experience

A G2 P2002 who is postpartum 6 hours from a spontaneous vaginal delivery is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia rubra, and perineal sutures are intact. Which of the following actions should the nurse take at this time?

Notify the woman's primary healthcare provider.

A nurse is counseling a woman about postpartum blues. Which of the following should be included in the discussion?

Postpartum blues last about a week or two

The nurse is developing a standard care plan for postpartum clients who have had midline episiotomies. Which of the following interventions should be included in the plan?

Teach the client to contract her buttocks before sitting.

A client who is 3 days postpartum asks the nurse, "When may my husband and I begin having sexual relations again?" The nurse should encourage the couple to wait until after which of the following has occurred?

The client has had her six-week postpartum checkup.

A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse's response?

The client's obstetric status is optimal for receiving the vaccine.

A nurse is assessing the fundus of a client during the immediate postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly?

The nurse stabilizes the base of the uterus with his or her dependent hand

A post-cesarean section, breastfeeding client whose subjective pain level is 2/5 requests her as-needed (prn) narcotic analgesics every 3 hours. She states, "I have decided to make sure that I feel as little pain from this experience as possible." Which of the following should the nurse conclude in relation to this woman's behavior?

The woman is high risk for severe constipation.

A 3-day-breastfeeding client who is not immune to rubella is to receive the rubella vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine?

The woman should not become pregnant for at least 4 weeks.

Which of the following laboratory values would the nurse expect to see in a normal postpartum woman?

White blood cell count, 16,000 cells/mm3.

A nurse is caring for a postpartum client who has stated that she is putting her newborn son up for adoption. The client asks the nurse to help her breastfeed her baby. Which of the following responses by the nurse is appropriate?

"You want to place your baby on a lap pillow and have your baby face you. Then wait for the baby to open his mouth before moving the baby toward your breast."

A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following?

Rotate the baby's positions at each feed.

A bottle-feeding woman, 11⁄2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated two pads in the past 1 hour. Which of the following responses by the nurse is appropriate?

"It is important for you to be examined by the doctor today. Let me check to see when you can come in."

A 2-day-postpartum breastfeeding woman states, "I am sick of being fat. When can I go on a diet?" Which of the following responses is appropriate?

"Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."

A 1-day postpartum woman states, "I think I have a urinary tract infection. I have to go to the bathroom all the time." Which of the following actions should the nurse take?

Assure the woman that frequent urination is normal after delivery.

A medication order reads: Methergine (ergonovine) 0.2 mg PO q 6 h × 4 doses. Which of the following assessments should be made before administering each dose of this medication?

Blood pressure.

A Muslim woman requests something to eat after the delivery of her baby. Which of the following meals would be most appropriate for the nurse to give her?

Chicken and dumplings

The nurse should warn a client who is about to receive Methergine (ergonovine) of which of the following side effects?

Cramping.

The nurse monitors his or her postpartum clients carefully because which of the following physiological changes occurs during the early postpartum period?

Decreased blood volume.

The obstetrician has ordered a postop cesarean section client's patient-controlled analgesia (PCA) be discontinued. Which of the following actions by the nurse is appropriate?

Discard the remaining medication in the presence of another nurse.

A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her baby. Which of the following responses by the nurse is appropriate?

Discuss the action of breastfeeding hormones.

The nurse is developing a plan of care for the postpartum client during the "taking in" phase. Which of the following should the nurse include in the plan?

Discuss the labor and birth with the mother.

On admission to the labor and delivery unit, a client's hemoglobin (Hgb) was assessed at 11 g/dL and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery?

Hgb 10.5 g/dL; Hct 31%

The home health nurse visits a client who is 6 days postdelivery. The client appears sad, weeps frequently, and states, "I don't know what is wrong with me. I feel terrible. I should be happy, but I'm not." Which of the following nursing diagnoses is appropriate for this client?

Ineffective individual coping related to hormonal shifts.

Which of the following complementary therapies can a nurse suggest to a multiparous woman who is complaining of severe afterbirth pains?

Lie prone with a small pillow cushioning her abdomen.

During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see?

Lochia alba

A client, G2 P1102, is 30 minutes postpartum from a low forceps vaginal delivery over a right mediolateral episiotomy. Her physician has just finished repairing the incision. The client's legs are in stirrups and she is breastfeeding her baby. Which of the following actions should the nurse perform?

Lower both of her legs at the same time.

The nurse is examining a 2-day-postpartum client whose fundus is 2 cm below the umbilicus and whose bright red lochia saturates about 4 inches of a pad in 1 hour. What should the nurse document in the nursing record?

Normal involution, lochia rubra moderate.

The nurse must initiate discharge teaching with the couple regarding the need for an infant car seat for the day of discharge. Which of the following responses indicates that the nurse acted appropriately? The nurse discussed the need with the couple:

On admission to the labor room.

The nurse takes a newborn to a primipara for a feeding. The mother holds the baby en face, strokes his cheek, and states that this is the first newborn she has ever held. Which of the following nursing assessments is most appropriate?

Positive bonding but teaching related to newborn care is needed.

The third stage of labor has just ended for a client who has decided to bottle feed her baby. Which of the following maternal hormones will increase sharply at this time?

Prolactin.

An Asian client's temperature 10 hours after delivery is 100.2°F but, when encouraged, she refuses to drink her ice water. Which of the following nursing actions is most appropriate?

Replace the ice water with hot water.

A client is receiving an epidural infusion of a narcotic for pain relief after a cesarean section. The nurse would report to the anesthesiologist if which of the following were assessed?

Respiratory rate 8 rpm.

The nurse has provided teaching to a postop cesarean client who is being discharged on Colace (docusate sodium) 100 mg PO tid. Which of the following would indicate that the teaching was successful?

The woman swallows the tablets whole.

The nurse is assessing the midline episiotomy on a postpartum client. Which of the following findings should the nurse expect to see?

Well-approximated edges.

A mother, G1 P1, who delivered a 2,800 gram baby vaginally 30 minutes earlier, is transferred to the postpartum unit. She pushed for 45 minutes and the placenta was delivered 10 minutes later. She is receiving an intravenous with 20 units oxytocin added. The postpartum nurse questions why the oxytocin was added to the IV bag. Which of the following responses by the transferring nurse is most likely?

"The medication was added immediately after the baby's birth to promote placental delivery."

A client, 2 days postpartum from a spontaneous vaginal delivery, asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate?

"You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks."