Lippincott postpartal care
A postpartum primiparous client is having difficulty breastfeeding her infant. The infant latches on to the breast, but the mothers nipples are extremely sore during and after each feeding. The client needs further instruction about breastfeeding when she makes which statement?
"As long as some of my nipple is in the baby's mouth, the baby will receive enough milk."
A diabetic postpartum client plans to breastfeed. The nurse determines that the clients understanding of breastfeeding instructions is sufficient when the client makes which statement?
"Breastfeeding will assist in lowering maternal blood glucose."
The nurse reviews the contraception choices of a bottle-feeding postpartum client prior to discharge. The client wants to know why she needs to wait to resume the use of oral contraceptives. What is the nurses best response?
"Combined oral contraceptives potentiate the risk for blood clots immediately after birth."
Which information should the nurse include in the teaching plan for a primiparous client who asks about weaning her neonate?
"Gradually eliminate one feeding at a time."
An adolescent primiparous client 24 hours postpartum asks the nurse how often she can hold her baby without "spoiling" him. Which response would be most appropriate?
"Hold him as much as you want to hold him."
A new father indicates he feels left out of the new family relationship since he is not able to bond the same way as the breastfeeding mother. What is the most appropriate response by the nurse?
"Holding, talking to, and playing with the infant will facilitate bonding between baby and Dad."
A client gave birth 2 days ago and has been given instructions on breast care for bottle-feeding mothers. Which statement indicates that the nurse should reinforce the instructions to the client?
"I will use a breast pump to remove any milk that may appear."
After instructing a primiparous client about episiotomy care, which client statement indicates successful teaching?
"I wipe the area from front to back using a blotting motion."
A primiparous client who is bottle-feeding her neonate at 12 hrs after birth asks the nurse, "When will my menstrual cycle return?" Which response by the nurse would be most appropriate?
"It will probably be 6 to 10 weeks before it starts again."
The triage nurse is in the pediatricians office returns a call to a mother who is breastfeeding her 4 day old infant. The mother is concerned about the yellow seedy stool that has developed since discharge home. What is the best reply by the nurse?
"Soft, seedy, unformed stools with each feeding are normal for this age infant and will continue through breastfeeding."
A primiparous client who gave birth 12 hours ago under epidural anesthesia with a midline episiotomy tells the nurse that she is experiencing a great deal of discomfort when she sits in a chair with the baby. Which instructions would be most appropriate?
"Squeeze your buttock muscles together before sitting down."
Which client statement indicates effective teaching about burping a breastfed neonate?
"When I switch to the other breast, I'll burp the baby."
The nurse is reviewing discharge instructions with a postpartum breastfeeding client who is going home. She has chosen depot medroxyprogesterone acetate (DMPA) injections as birth control. Which statement by the client identifies that she needs further instruction concerning birth control?
"You will give me my first depot injection before i leave today."
A primiparous client who is bottle-feeding her neonate asks, "when should i start giving the baby solid foods?" The nurse instructs the client to introduce solid foods no sooner than at what age?
6 months
A primiparous client who underwent a cesarean birth 30 minutes ago is to receive RhoD immune globulin. The nurse should administer the medication within which time frame after birth?
72 hours
When teaching a primiparous client about the growth and development of the neonate, the nurse should explain that most babies are able to drink from a sippy cup at what age?
8 to 10 months
A client gave birth vaginally 2 hrs ago and has third degree laceration. There is ice in place on her perineum. However, her perineum is slightly edematous, and the client is having pain rated 6 on a scale of 1 to 10. Which nursing intervention would be the most appropriate at this time?
Administer pain medication per prescription
A postpartum woman has unrelenting pain in her rectum after vaginal birth despite administration of pain medications. Which action is most indicated?
Assessing the perineum
The nurse from the nursery is bringing a newborn to a mother's room. The nurse took care of the mother yesterday and knows the mother and baby well. The nurse should implement which action to ensure the safest transition of the infant to the mother?
Complete the hospital identification procedure with mother and infant
A primiparous client who gave vaginal birth to a viable term neonate 48 hours ago has a midline episiotomy and repair of a third degree laceration. When preparing the client for discharge, which assessment would be most appropriate?
Constipation
Twelve hours after a vaginal birth with epidural anesthesia, the nurse palpates the fundus of a primiparous client and finds it to be firm, above the umbilicus, and deviated to the right. What should the nurse do next?
Encourage the client to ambulate to the bathroom and void
While the nurse is caring for a primiparous client on the first postpartum day, the client asks, "How is that woman doing who lost her baby from prematurity? We were in labor together." Which response by the nurse would be most appropriate?
Explain to the client that "Nurses are not allowed to discuss other clients on the unit."
A primiparous client who gave birth vaginally 8 hours ago desires to take a shower. The nurse anticipates remaining near the client to assess for which problem?
Fainting
A breastfeeding primiparous client asks the nurse how breast milk differs from cows milk. The nurse responds by saying that breast milk is higher in which nutrient?
Fat
The nurse is assessing a client at her postpartum check up 6 weeks after a vaginal birth. The mother is bottle-feeding her baby. Which client finding indicates a problem at this time?
Firm fundus at the symphysis
A primiparous client, 20 hours after birth, asks the nurse about starting postpartum exercises. Which instruction would be most appropriate to include in the plan of care?
Flex the knees while supine, and then inhale deeply and exhale while contracting the abdominal muscles
A breastfeeding primiparous client with a midline episiotomy is prescribed ibuprofen orally. When does the nurse instruct the client to take the medication?
Immediately after a feeding
Which information would the nurse include in the primiparous clients discharge teaching plan about measures to provide visual stimulation for the neonate?
Maintain eye contact while talking to the baby
Which principle forms the basis for the teaching plan about avoiding nonprescription medication for a primiparous client who is breastfeeding?
Medications may be excreted in breast milk to the nursing neonate
Carboprost was injected into the uterus of a client to treat uterine atony during a cesarean birth. In preparing to care for this client postpartum, the nurse should assess the client for which common adverse effects of the medication?
Nausea and diarrhea
A multiparous client at 24 hrs postpartum is found to have swelling and pain in her right leg. She demonstrates a positive Homans sign with discomfort. What should the nurse do next?
Notify the clients HCP immediately
A primiparous client, 48 hours after a vaginal birth, is to be discharged with a prescription for vitamins with iron because she is anemic. To maximize absorption of the iron, the nurse instructs the client to take the medication with which liquid?
Orange juice
A 25 year old primiparous client who gave birth 2 hours ago has decided to breastfeed her neonate. Which instructions should the nurse address as the highest priority in the teaching plan about preventing nipple soreness?
Placing as much of the areola as possible into the baby's mouth
A breastfeeding primiparous client who gave birth 8 hours ago asks the nurse, "How will i know that my baby is getting enough to eat?" Which guideline should the nurse include in the teaching plan as evidence of adequate intake?
Six to eight wet diapers by the 5th day
A primiparous client 3 days postpartum is to be discharged on heparin therapy. After teaching h about possible adverse effects of heparin therapy, the nurse determines that the client needs further instruction when she states that the adverse effects include which symptoms?
Slow pulse
A multiparous client whose fundus is firm and midline at the umbilicus 8 hours after a vaginal birth tells the nurse that when she ambulated to the bathroom after sleeping for 4 hours, her dark red lochia seemed heavier. Which information would the nurse include when explaining to the client about the increased lochia on ambulation?
The increased lochia occurs from lochia pooling in the vaginal vault
A primiparous client is on a regular diet 24 hours postpartum. The clients mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds based on the understanding about which principle?
The mother can bring the daughter any foods that she desires
Two weeks after a breastfeeding primiparous client is discharged, she calls the birthing center and says that she is afraid she is "losing my breast milk. The baby had been nursing every 4 hours, but now she is crying to be fed every 2 hours." The nurse interprets the neonates behavior as most likely caused by which factor?
The neonates temporary growth spurt, which requires more feedings
A primigravid client gave birth vaginally 2 hrs ago with no complications. As the nurse plans care for this postpartum client, which postpartum goal would have the highest priority?
The nurse will demonstrate self-care and infant care by the end of the shift
A newly postpartum primiparous client asks the nurse, "Can my baby see?" Which statement about neonatal vision should the nurse include in the explanation?
They can see objects up to 12 inches away
While assessing the fundus of a multiparous client 36 hours after the birth of term neonate, the nurse notes a separation of the abdominal muscles. What should the nurse tell the client?
To perform exercises involving head and shoulder raising in a lying position
Prophylatic heparin therapy is prescribed to treat thrombophlebitis in a multiparous client who gave birth 24 hrs ago. After instructing the client about the medication, the nurse determines that the client understands the instruction when she states which effect as the purpose of the drug?
To prevent further blood clot formation
4 hrs after a cesarean birth of a neonate weighing 8 lb, 13 oz, the primiparous client asks, "If i get pregnant again, will i need to have a cesarean?" When responding to the client, the nurse should base the response to the client about vaginal birth after cesarean (VBAC) on which standard of practice?
VBAC may be possible if the client has not has a classic uterine incision
In preparation for discharge, the nurse discusses sexual issues with a multiparous client who had a routine vaginal birth with a midline episiotomy. The client asks, "Ive heard recommendations about when to resume intercourse have changed since my last baby. What are they saying now?" When should the nurse instruct the client that she can resume sexual intercourse?
When lochia flow and episiotomy pain have stopped
At a postpartum checkup 11 days after birth, the nurse asks the client about the color of her lochia. Which color is expected?
White
While the nurse is caring for a primiparous client with cephalopelvic disproportion 4 hours after a cesarean birth, the client requests assistance in breastfeeding. To promote maximum maternal comfort, which position would be most appropriate for the nurse to suggest?
football hold
A multiparous client, 28 hours after cesarean birth, who is breastfeeding has severe cramps or afterpains. The nurse explains that these are caused by which factor?
release of oxytocin during the breastfeeding session
The nurse places inflatable compression sleeves on the legs of a client undergoing a cesarean birth under regional anesthetic. When does the nurse tell the client that the sleeves will be removed?
when the client resumes ambulating
After the nurse teaches a primiparous client planning to return to work 6 weeks about storing breast milk, which client statement indicates the need for further teaching?
"I must discard any breast milk stored for more than 3 days in the refrigerator."
A 1 day old breastfed infant has a bilirubin level that is at an intermediate risk for jaundice. Which statement by the infants mother indicates an understanding of the teaching regarding jaundice?
"I should breastfeed my baby as often as possible."
After the nurse counsels a primiparous, breastfeeding client about diet and nutritional needs dung the lactation period, which client statement indicates a need for additional teaching?
"I should drink at least five glasses of fluid daily."
While assessing the episiotomy site of a primiparous client on the first postpartum day, the nurse observes a fairly large hemorrhoid at the clients rectum. After instructing the client about measures to relieve hemorrhoid discomfort, which client statement indicates the need for additional teaching?
"I should lie on my back as much as possible to relieve the pain."
After instructing a primiparous client who is bottle feeding about burping, which client statement indicates that the client needs further teaching?
"I will burp him after 15 mins of feeding him formula."
While the nurse is assessing the fundus of multiparous client who gave birth 24 hours ago, the client asks, "What can i do to get rid of these stretch marks?" Which response would be most appropriate?
"They usually fade to a silvery-white color over a period of time."
A primiparous client with a neonate who is 36 hrs old asks the nurse, "Why does my baby spit up a small amount of formula after feeding?" The nurse explains that the regurgitation is thought to result from which factor?
An immature cardiac sphincter
The nurse assesses a swollen ecchymosed area to the right of an episiotomy on a primiparous client 6 hrs after a vaginal birth. What should the nurse do next?
Apply an ice pack to the perineal area
While caring for a postpartum client who is receiving treatment with bed rest and intravenous heparin therapy for a deep vein thrombosis, the nurse should contact the clients health care provider immediately if the client exhibits which symptom?
Dyspnea
Two hours after a vaginal birth under epidural anesthesia, a client with a midline episiotomy ambulates to the bathroom to void. After voiding, the nurse assesses the clients bladder, finding it distended. The nurse interprets this finding based on the understanding that the clients bladder distention is most likely caused by which factor?
Edema in the lower urinary tract area
During a home visit on the fourth postpartum day, a primiparous client tells the nurse that she has been experiencing breast engorgement. To relieve engorgement, the nurse teaches the client to use which intervention before nursing her baby?
Express a small amount of breast milk
A multigravid client gave birth vaginally 2 hours ago. A family member notifies the nurse that the client is pale and shaky. Which are the priority assessments for the nurse to make?
Fundus and lochia
The nurse is caring for several mother baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?
G3, P3 client who is breastfeeding her infant
A 24 y/o primipara who has given birth to a healthy neonate plans to bottle-feed her neonate. What information regarding normal weight gain should the nurse include in the teaching plan?
Gaining 30 g/day is a normal weight gain pattern
At which location would the nurse expect to palpate the fundus of a primiparous client immediately after birth of a neonate?
Halfway between the umbilicus and the symphysis pubis
The nurse is caring for a primipara who gave birth yesterday and has chosen to breastfeed her neonate. Which assessment finding is considered unusual for the client at this point postpartum?
Milk production
During a home visit on the fourth postpartum day, a primiparous client tells the nurse that she is aware of a "letdown sensation" in her breasts and asks what causes it. The nurse explains that the letdown sensation is stimulated by which hormone?
Oxytocin
A primiparous client who is beginning to breastfeed her neonate asks the nurse, "It is important for my baby to get colostrum?" When instructing the client, the nurse would explain that colostrum provides the neonate with which factor?
Passive immunity from maternal antibodies
On the first postpartum day, the primiparous client reports perineal pain of 5 on a scale of 1 to 10 that was unrelieved by ibuprofen 800 mg given 2 hours ago. The nurse should further assess the client for which complication?
Perineal hematoma
Three hours postpartum, a primiparous clients fundus is firm and midline. On perineal inspection, the nurse observes a small, constant trickle of blood. Which condition should the nurse assess further?
Perineal lacerations
A breastfeeding client is seen at home by the visiting nurse 10 days after a vaginal birth. The client has a warm, red, painful breast, a temperature of 100 F and flu like symptoms. What should the nurse do?
Refer the woman to her HCP
The nurse working on the postpartum unit is in charge of a team that includes an unlicensed assistive personnel. Which tasks would the nurse question if completed by the UAP caring for a 1 day postpartum client?
Teaching the mother to latch the infant onto the breast
The nurse is caring for a multigravida woman who is 1 day postpartum following a vaginal birth. Which finding indicates a need for further assessment?
Temperature of 100.8 F
The nurse is providing follow up care to a client 10 days after birth. The nurse would anticipate what outcomes from the new mother? Select all that apply
The client feels tired but is able to care for herself & her new infant. The family has adequate support from one another and others. Lochia is changing from red to pick and is smaller in amount. The client has positive comments about her new infant.
During a home visit, a breastfeeding client asks the nurse what contraception method she and her partner should use until she has her 6 week postpartal examination. Which method would be most appropriate for the nurse to suggest?
a condom with spermicide
The nurse is assessing a client who had a cesarean birth 12 hours ago. Findings include a distended abdomen with faint bowel sounds x1 quadrant, fundus firm at umbilicus, lochia scant, rubia, and pain 2/10. The IV and foley catheter have been discontinued, and the client received medication 3 hrs ago for pain. The client can have pain meds every 3 to 4 hours. What should the nurse do first?
Ambulate the client from the bed to the hallway and back
A multigravida 30 year old woman has given cesarean birth to a healthy term neonate due to an abnormal FHR tracing. At 2 hrs postpartum, the nurse assesses the clients urinary catheter and observes that the clients urine is slightly red tinged. What should the nurse do next?
Contact the clients HCP for further instructions
While caring for a multiparous client 4 hours after vaginal birth of a term neonate, the nurse notes that the mothers temp is 99.8 F, the pulse is 66 bpm, RR are 18 per min. Her fundus is firm, midline, and at the level of the umbilicus. What should the nurse do?
Continue to monitor the clients VS
While the nurse is preparing to assist the primiparous client to the bathroom to void 6 hours after a vaginal birth under epidural anesthesia, the client says that she feels dizzy when sitting up on the side of the bed. The nurse explains that this is most likely caused by which factor?
Decreased blood volume in the vascular system
During a home visit to a breastfeeding primiparous client at 1 week postpartum, the client tells the nurse that her nipples have become sore and cracked from the feedings. Which instruction should the nurse give the client?
Position the baby with the entire areola in the babys mouth
The nurse is caring for a multiparous client after vaginal birth of a set of twins 2 hours ago. What should the nurse encourage the mother and partner to do?
Relate to each twin individually to enhance the attachment process
A client is in the first hour of her recovery after a vaginal birth. During an assessment, the lochia is moderate, is bright red, and is trickling from the vagina. The nurse locates the fundus at the umbilicus; it is firm and midline with no palpable bladder. The clients vital signs remain at their baseline. Based on this information, the nurse would implement which action?
Report the findings to the HCP
A primiparous client who will be bottle feeding her neonate asks, "What is the best position for the baby to nap after feeding?" Which position should the nurse recommend?
Supine position
In response to the nurse's question about how she is feeling, a postpartum client states that she is fine. She then begins talking to the baby, checking the diaper, and asking infant care questions. The nurse determines the client is in which postpartal phase of psychological adaptation?
Taking hold
A nurse is discussing discharge instructions with a client. Which statement indicates that the client understands the resources and information available if needed after discharge? Select all that apply.
"My fertility can return as early as 21 days after my baby's birth." "I have the hospital phone number if I have any questions." "If I have any breathing problems, chest pain, or pounding fast heart rate, I will seek medical assistance." "I know if I get fever or chills or change in lochia to call the health care provider." "I will continue my prenatal vitamins until my postpartum checkup or longer."
A nurse is caring for a client who is 3 days postpartum and breastfeeding her baby. The following assessment is made by the nurse: episiotomy area: red and edematous; breast: firm and tender on palpation; fundus: firm 2 fingerbreadths below umbilicus. What nursing actions are indicated? Select all that apply
Suggest that the client apply cool compress to breasts. Ask the client how often the baby feeds.
While assisting a primiparous client with her first breastfeeding session, the nurse should instruct the mother to perform which action in order to stimulate the neonate to open the mouth and grasp the nipple?
Brush the neonate's lips lightly with the nipple.
A postpartum client gave birth 6 hours ago without anesthesia and just voided 100 ml. The nurse palpates the fundus 2 fingerbreadths above the umbilicus and off to the right side. What should the nurse do first?
Catheterize the client.
