Chapter 16 Nursing Management During the Postpartum Period

Bonding

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

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.

peri-bottle

Proximity

physical and psychological experience of the parents being close to their infant

1. A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 60 beats per minute. Which of these actions should the nurse take? A) Document the finding, as it is a normal finding at this time. B) Contact the physician, as it indicates early DIC. C) Contact the physician, as it is a first sign of postpartum eclampsia. D) Obtain an order for a CBC, as it suggests postpartum anemia.

A) Document the finding, as it is a normal finding at this time.

4. Which statement would alert the nurse to the potential for impaired bonding between mother and newborn? A) "You have your daddy's eyes." B) "He looks like a frog to me." C) "Where did you get all that hair?" D) "He seems to sleep a lot."

B) "He looks like a frog to me."

22. After teaching a postpartum woman about breast-feeding, the nurse determines that the teaching was successful when the woman states which of the following? A) "I should notice a decrease in abdominal cramping during breast-feeding." B) "I should wash my hands before starting to breast-feed." C) "The baby can be awake or sleepy when I start to feed him." D) "The baby's mouth will open up once I put him to my breast."

B) "I should wash my hands before starting to breast-feed."

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, breast-feed, increase exercise. C. Start a high-protein, low carbohydrate diet and restrict fluids. D. Eat no snacks or carbohydrates after dinner.

B. Avoid empty-calorie foods, breast-feed, increase exercise.

_____________ hypotension can occur when the woman changes rapidly from a lying or sitting position to a standing one

Orthostatic

___________ is considered the fifth vital sign

Pain

What are the causes of postpartum stresses?

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

Postpartum Blues

Transient emotional disturbances

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

fundus

When palpating the breasts, any evidence of any nodules, masses, or areas of warmth, may indicate a plugged duct that may progress to _____________ if not treated properly.

mastitis

3. A postpartum client has a fourth-degree perineal laceration. The nurse would expect which of the following medications to be ordered? A) Ferrous sulfate (Feosol) B) Methylergonovine (Methergine) C) Docusate (Colace) D) Bromocriptine (Parlodel)

C) Docusate (Colace)

14. A nurse is reviewing the medical record of a postpartum client. The nurse identifies that the woman is at risk for a postpartum infection based on which of the following? (Select all that apply.) A) History of diabetes B) Labor of 12 hours C) Rupture of membranes for 16 hours D) Hemoglobin level 10 mg/dL E) Placenta requiring manual extraction

A) History of diabetes D) Hemoglobin level 10 mg/dL E) Placenta requiring manual extraction

2. To decrease the pain associated with an episiotomy immediately after birth, which action by the nurse would be most appropriate? A) Offer warm blankets. B) Encourage the woman to void. C) Apply an ice pack to the site. D) Offer a warm sitz bath.

C) Apply an ice pack to the site.

Women who experience ______________ births will have less lochia discharge than those having a vaginal birth

Cesarean

The nurse observes a 2 inch (5cm) 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 hr b) document the lochia as scant c) ask when the peripad was changed d) massage the client's fundus

b) document the lochia as scant Rationale: Scant would describe a 1-2 inch 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.

16. The nurse is assessing a postpartum client's lochia and finds that there is about a 4-inch stain on the perineal pad. The nurse documents this finding as which of the following? A) Scant B) Light C) Moderate D) Large

B) Light

25. After reviewing information about postpartum blues, a group of students demonstrate understanding when they state which of the following about this condition? A) "Postpartum blues is a long-term emotional disturbance." B) "Sleep usually helps to resolve the blues." C) "The mother loses contact with reality." D) "Extended psychotherapy is needed for treatment."

B) "Sleep usually helps to resolve the blues."

23. A postpartum woman who is bottle-feeding her newborn asks the nurse, "About how much should my newborn drink at each feeding?" The nurse responds by saying that to feel satisfied, the newborn needs which amount at each feeding? A) 1 to 2 ounces B) 2 to 4 ounces C) 4 to 6 ounces D) 6 to 8 ounces

B) 2 to 4 ounces

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

- 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 newborn's response to parental stimulation - Pointing out positive physical features of the newborn

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

- 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

What are the postpartum physiologic danger signs?

- Fever more than 38/100.4 after the first 24 hrs 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 experienced with dorsiflexion on 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

11. When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure? A) Early parent-infant contact following birth B) Expert medical care for the labor and birth C) Good nutrition and prenatal care during pregnancy D) Grandparent involvement in infant care after birth

A) Early parent-infant contact following birth

13. The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which of the following would be a priority? A) Placing the call light within her reach B) Teaching her how the sitz bath works C) Telling her to use the sitz bath for 30 minutes D) Cleaning the perineum with the peri-bottle

A) Placing the call light within her reach

20. A postpartum woman who is breast-feeding tells the nurse that she is experiencing nipple pain. Which of the following would be least appropriate for the nurse to suggest? A) Use of a mild analgesic about 1 hour before breast-feeding B) Application of expressed breast milk to the nipples C) Application of glycerin-based gel to the nipples D) Reinstruction about proper latching-on technique

A) Use of a mild analgesic about 1 hour before breast-feeding

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

A. Holding the infant close to the body

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

A. Identify complications that require interventions

7. The nurse administers RhoGAM to an Rh-negative client after delivery of an Rh-positive newborn based on the understanding that this drug will prevent her from: A) Becoming Rh positive B) Developing Rh sensitivity C) Developing AB antigens in her blood D) Becoming pregnant with an Rh-positive fetus

B) Developing Rh sensitivity

5. After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention? A) Presence of lochia serosa B) Frequent scant voidings C) Fundus firm, below umbilicus D) Milk filling in both breasts

B) Frequent scant voidings

24. A nurse is observing a postpartum woman and her partner interact with the their newborn. The nurse determines that the parents are developing parental attachment with their newborn when they demonstrate which of the following? (Select all that apply.) A) Frequently ask for the newborn to be taken from the room B) Identify common features between themselves and the newborn C) Refer to the newborn as having a monkey-face D) Make direct eye contact with the newborn E) Refrain from checking out the newborn's features

B) Identify common features between themselves and the newborn D) Make direct eye contact with the newborn

18. A nurse is observing a postpartum client interacting with her newborn and notes that the mother is engaging with the newborn in the en face position. Which of the following would the nurse be observing? A) Mother placing the newborn next to bare breast. B) Mother making eye-to-eye contact with the newborn C) Mother gently stroking the newborn's face D) Mother holding the newborn upright at the shoulder

B) Mother making eye-to-eye contact with the newborn

10. A nurse is working as part of a committee to establish policies to promote bonding and attachment. Which practice would be least effective in achieving this goal? A) Allowing unlimited visiting hours on maternity units B) Offering round-the-clock nursery care for all infants C) Promoting rooming-in D) Encouraging infant contact immediately after birth

B) Offering round-the-clock nursery care for all infants

19. After teaching a group of students about risk factors associated with postpartum hemorrhage, the instructor determines that the teaching was successful when the students identify which of the following as a risk factor? (Select all that apply.) A) Prolonged labor B) Placenta previa C) Null parity D) Hydramnios E) Labor augmentation

B) Placenta previa D) Hydramnios E) Labor augmentation

21. A nurse is developing a teaching plan for a postpartum woman who is breast-feeding about sexuality and contraception. Which of the following would the nurse most likely include? (Select all that apply.) A) Resumption of sexual intercourse about two weeks after delivery B) Possible experience of fluctuations in sexual interest C) Use of a water-based lubricant to ease vaginal discomfort D) Use of combined hormonal contraceptives for the first three weeks E) Possibility of increased breast sensitivity during sexual activity

B) Possible experience of fluctuations in sexual interest C) Use of a water-based lubricant to ease vaginal discomfort E) Possibility of increased breast sensitivity during sexual activity

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

B. Wearing a tight-fitting supportive bra 24 hours daily

6. A primipara client who is bottle feeding her baby begins to experience breast engorgement on her third postpartum day. Which instruction would be most appropriate to aid in relieving her discomfort? A) "Express some milk from your breasts every so often to relieve the distention." B) "Remove your bra to relieve the pressure on your sensitive nipples and breasts." C) "Apply ice packs to your breasts to reduce the amount of milk being produced." D) "Take several warm showers daily to stimulate the milk let-down reflex."

C) "Apply ice packs to your breasts to reduce the amount of milk being produced."

9. After teaching parents about their newborn, the nurse determines that the teaching was successful when they identify the development of a close emotional attraction to a newborn by parents during the first 30 to 60 minutes after birth as which of the following? A) Reciprocity B) Engrossment C) Bonding D) Attachment

C) Bonding

12. A postpartum woman is having difficulty voiding for the first time after giving birth. Which of the following would be least effective in helping to stimulate voiding? A) Pouring warm water over her perineal area B) Having her hear the sound of water running nearby C) Placing her hand in a basin of cool water D) Standing her in the shower with the warm water on

C) Placing her hand in a basin of cool water

15. A nurse is completing a postpartum assessment. Which finding would alert the nurse to a potential problem? A) Lochia rubra with a fleshy odor B) Respiratory rate of 16 breaths per minute C) Temperature of 101° F D) Pain rating of 2 on a scale from 0 to 10

C) Temperature of 101° F

17. When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which of the following? A) Superficial structures above the muscle B) Through the perineal muscles C) Through the anal sphincter muscle D) Through the anterior rectal wall

C) Through the anal sphincter muscle

8. Which of the following factors in a client's history would alert the nurse to an increased risk for postpartum hemorrhage? A) Multiparity, age of mother, operative delivery B) Size of placenta, small baby, operative delivery C) Uterine atony, placenta previa, operative procedures D) Prematurity, infection, length of labor

C) Uterine atony, placenta previa, operative procedures

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

C. Calories and protein

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

C. Periodic crying and insomnia

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

C. Planning a daily "special time" for the older sibling

______________________ refers to the enduring nature of the attachment relationship

Commitment

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

D. Educating himself or herself about diverse cultural practices

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

D. Effective education of both parents before discharge

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

D. Swollen, tender, hot area on breast

Process of attachment

Development of strong affectionate ties between an infant and a significant other.

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

Eat a wide variety of foods with high nutrient density use foods and recipes that require little to no prep avoid high fat, fast foods and fad weight reduction diets drink plenty of fluids avoid harmful substances such as alcohol, tobacco, and drugs avoiding excessive intake of fat, salt, sugar, and caffeine eat the recommended daily servings from each food group

_____________________ is the process by which the infant's capabilities and behavioral characteristic elicit parental response.

Reciprocity

Contact

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

What does the postpartum assessment of the mother include?

Vital signs, pain level, systematic head to toe review of the body systems: breasts, uterus, bladder, bowels, lochia, episiotomy/perineum, extremities, and emotional status.

A first time mother is nervous about breast feeding. 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

a) Reassure the mother that some newborns "latch on and catch on" right away, and some newborns take more time and patience Rationale: The nurse should reassure the mother than some newborns "latch on and catch on" right away, and some newborns take more time and patience; this information will help to reduce the feelings of frustration and uncertainty about their ability to breastfeed. The nurse should also explain the breastfeeding is a learned skill for both parties. It would not be correct to say that breastfeeding is 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 and food ball holds and side lying positions, should be shown to the mother.

A nurse is to care for a client during the postpartum period. The client reports pain and discomfort in her breasts. What signs should a nurse look for to find out if the client has engorged breasts? SATA a) breasts are hard b) breasts are tender c) nipples are fissured d) nipples are cracked e) breasts are soft

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

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 client's first baby c) administer Rh immunoglobulins IM d) ask if the client received Rh immunoglobulins during the pregnancy

a) determine the newborn's blood type and rhesus Rationale: 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 is Rh positive should receive an injection of Rh immunoglobulin with 72 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.

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 pack directly to the perineal area b) apply ice pack for 40 minutes continuously c) Ensure ice pack is changed frequently d) Use ice packs for a week after birth

c) Ensure ice pack is changed frequently Rationale: 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. Ice packs should be used for the first 24 hours, not fora week after birth.

A nurse is assessing a client during the postpartum period. Which findings indicate normal postpartum adjustment? SATA a) abdominal pain b) active bowel sounds c) tender abdomen d) passing gas e) nondistended abdomen

b) active bowel sounds d) passing gas e) nondistended abdomen Rationale: Finding active bowel sounds, verification of passing gas, and a 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

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

b) every 15 minutes Rationale: Postpartum assessment is typically performed every 15 minutes for the first hour. 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.

When teaching the new mother about breastfeeding, the nurse is correct when providing what instructions? SATA 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 in uninterrupted skin to skin contact with the mother.

b) help the mother initiate breastfeeding within 30 minutes of birth c) encourage breastfeeding of the newborn infant on demand e) place baby in uninterrupted skin to skin contact with the mother Rationale: The nurse should show mothers how to initiate breastfeeding within 30 minutes of birth. To ensure bonding, place the baby in 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 than no food or drink other breast milk is given to newborns.

A client who has given birth is being discharged. 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 excercises d) use oral contraceptives for contraception

b) resume intercourse if bright red bleeding stops Rationale: 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 a condom with spermicidal gel or foam should be used instead of oral contraceptives.

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 cleanse the nipples b) encourage 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

c) offer suggestions based on observation to correct positioning or latching Rationale: 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 feeding allows nipples to air dry.

A client has been discharged from the hospital after a c-section. Which should the nurse include in the discharge teaching? a) follow up with your HCP within 3 weeks of being discharged b) Notify the HCP if your temp is greater than 99 c) you should she be seen by your HCP if you have blurred vision d) call your HCP if you saturate a peripad in less than 4 hours

c) you should she be seen by your HCP if you have blurred vision Rationale: The client needs to notify the HCP for blurred vision as this can indicate preeclampsia in the postpartum period. The client should also notify their HCP for a temp greater than 100.4 or if a peripad is saturated in less than 1 hour. The nurse should ensure that the follow up appointment is fixed for within 2 weeks for hospital discharge.

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

colostrum

During assessment of the mother during the postpartum period, what sign should alter 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

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

A postpartum client is having difficult 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 excercises

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

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

d) fourth degree Rationale: The nurse should classify the laceration as fourth degree because it continue through the anterior rectal wall. First degree laceration involves only skin and superficial structures above muscle; second degree laceration extends through perineal muscles; and third degree laceration extends through the anal sphincter muscle but not through the anterior rectal wall.

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 HCP b) assess the client's BP c) change the client's peripad d) massage the client's fundus

d) massage the client's fundus Rationale: Tachycardia and a boggy fundus in the postpartum woman indicate excessive blood loss. The nurse would massage the fundus to promote uterine involution. It is not priority to notify the health care provider, assess BP, or change the peripad at this time

Elevations in blood pressure from the woman's baseline might suggest pregnancy induced _____________________

hypertension