Maternal/OB: Ch. 9

The nurse notes cracks, blisters, and redness around the nipples of a patient who is lactating. Which instruction would the nurse give to this patient? 1. "Avoid breast-feeding your child for a few days." 2. "Apply alcohol-based ointments on the nipples." 3. "Apply a small amount of breast milk to the nipples." 4. "Apply a cold-water compress to the breast."

"Apply a small amount of breast milk to the nipples." (This prevents nipple dryness and heals it). --The presence of cracks, blisters, and redness around the nipples is indicative of nipple trauma. --A WARM compress provides pain relief, not a cold compress. P. 238

Put the following types of lochia in the order in which they occur during the postpartum period. 1. Lochia serosa 2. Lochia alba 3. Lochia rubra

3, 1, 2 -Lochia rubra (lasts for about 3 days). -Lochia serosa (lasts from about the third through 10th day after birth). -Lochia alba (lasts from the 10th through the 21st day after birth). P. 211

REVIEW Questions: NCLEX Ch. 9 What postpartum assessment does the acronym REEDA help a nurse remember how to complete thoroughly? 1. A perineum or an incision (C-section). 2. Breasts for a lactating mom. 3. Risk of a blood clot. 4. Breasts for a lactating patient.

A perineum or an incision (C-section). --REEDA helps a nurse to remember to assess for Redness, Edema, Ecchymosis, Discharge, and Approximation. P. 212

A patient with AB- blood group gave birth to a newborn with B+ blood group. A the postpartum office visit 4 days following the delivery, the health care provider administers intramuscular immune globulin Rho(D), advises the patient to continue taking iron supplements, and to perform Kegel exercises. Which intervention may cause complications in the patient? 1. Advising the patient to perform Kegel exercises 4 days after delivery. 2. Administering Rho(D) immune globulin (RhoGAM) intramuscularly. 3. Administering Rho(D) immune globulin (RhoGAM) 4 days after delivery. 4. Advising the patient to continue iron supplements after childbirth.

Administering Rho(D) immune globulin (RhoGAM) 4 days after delivery. --To prevent sensitization to any Rh-positive erythrocytes, the patient should be administered Rho(D) immune globulin (RhoGAM) within 72 hours (3 days) following delivery. P. 218

Which condition is associated with intermittent uterine contractions 24 hours after delivery in a multiparous postpartum patient? 1. Afterpains 2. Early involution of the uterus 3. Absence of lochia 4. Hemorrhoids

Afterpains. --Postpartum patients may have afterpain within 48 hours following delivery. --> The discomfort is similar to muscle cramps, but multiparous patients are likely to have an overly distended uterus which leads to frequent afterpains. P. 210

The perineum of a postpartum patient is red and tender with mild edema and superficial bruises. Which nursing intervention would help to relieve these symptoms? 1. Applying an ice pack within 12 hours. 2. Administering pramoxine (Epifoam). 3. Providing cool sitz bath for 20 minutes. 4. Administering benzocaine (Dermoplast).

Applying an ice pack within 12 hours. --This reduces edema and bruising and it numbs the perineal area. **Pramoxine (Epifoam): Has analgesic effects and may cause pain relief. **Benzocaine (Dermoplast): Provides relief from pain, but does not reduce bruising. P. 213

While examining a newborn, the nurse finds that the infant has tracheoesophageal fistula. Which complication is the infant at risk for developing? 1. Aspiration 2. Hypothermia 3. Jaundice 4. Gastric upset

Aspiration. --The infant is unable to swallow milk properly, resulting in the infant being at risk of aspiration. **Reduction in glucose levels may cause hypothermia. **Jaundice is caused by alteration in bilirubin levels. **Excess feeding of formula milk may cause gastric upset. P. 240

The nurse is caring for a postpartum patient who received epidural anesthesia during labor. Which intervention should the nurse perform to reduce the patient's risk of falling? 1. Instruct another nurse to sit beside the patient. 2. Suggest that the patient take 250 mL of water daily. 3. Assist the patient with ambulation and toileting. 4. Instruct the patient to use pneumatic compression devices.

Assist the patient with ambulation and toileting. --Assist when sitting by the bedside, walking, or using the toilet. P. 216

Following an episiotomy, the nurse finds that the patient has severe rectal and pelvic pain. Which medications would the nurse expect the primary health care provider to prescribe for the patient? 1. Aspirin (Acuprin) 2. Benzocaine (Americaine) 3. Docusate calcium (Surfak) 4. Methylergonovine (Methergine)

Benzocaine (Americaine). --Topical medication helps reduce the inflammation and numb the perineum. **Aspirin wouldn't be prescribed, because it interferes with blood clotting. P. 213

Two days following cesarean delivery, the nurse notes that the patient has an absence of lochia and that her white blood cell count is 11,000/mm3. The patient may have developed which complication? 1. Infection 2. Blood clots 3. Hypovolemia 4. Pulmonary embolism

Blood clots. --WBC count less than 12000/mm3 indicates the patient does not have an infection. --Lack of blood is not a normal finding and would indicate the possibility of a blood clot. P. 216

NCLEX Review Questions: Nursing the newborn promotes uterine involution because it: 1. Uses maternal fat stores accumulated during pregnancy. 2. Stimulates additional secretion of colostrum. 3. Causes the pituitary to secrete oxytocin to contract the uterus. 4. Promotes maternal formation of antibodies.

Causes the pituitary to secrete oxytocin to contract the uterus. --Breastfeeding mothers may have more afterpains due to infant suckling causes the posterior pituitary to release oxytocin, which in turn contracts the uterus. Ref: Postpartum changes in the mother.

Which type of milk aids in eliminating meconium? 1. Foremilk 2. Colostrum 3. Mature 4. Transitional

Colostrum. --It is rich in immunoglobulins and has a laxative effect that aids in the elimination of meconium. **Foremilk: Rich in water and helps quench the newborn's thirst. **Mature milk: Rich in nutrients and helps satiate the newborn's hunger. P. 232

Which laboratory results would the nurse expect in a newborn whose rate of respiration is 28 breaths per minute and body temperature is 96.0°F.? 1. Increased blood platelet count 2. Decreased blood glucose levels 3. Decreased blood bilirubin levels 4. Increased white blood cell count

Decreased blood glucose levels (Hypoglycemia). --These symptoms indicate respiratory distress and hypothermia. --> Newborns with respiratory distress requires more glucose for breathing and to generate heat. **The newborn would have increased bilirubin levels, as there is increased oxygen availability, the excess erythrocytes are broken down into bilirubin. --> Respiratory distress will not have increased bilirubin levels, therefore there would be decreased blood bilirubin levels. P. 225, 227

The nurse receives information in report that a postpartum patient is reestablishing a normal fluid balance. Which assessment finding would the nurse anticipate? 1. Diaphoresis 2. Tachycardia 3. Pedal edema 4. Low grade fever

Diaphoresis. --During reestablishment of normal fluid balance the patient's body rids itself of excess fluid through diuresis and diaphoresis. P. 216

Which finding in a newborn would the nurse associate with impaired gastrointestinal function? 1. Passing meconium 4 days after birth 2. Passing meconium 4 hours after birth. 3. Passing meconium in the mother's womb. 4. Passing meconium immediately after birth.

Passing meconium 4 days after birth. --Most newborns pass meconium within 12 hours after the birth. P. 225-226

Which complication would the nurse assess for in a patient who is 24 hours postpartum and complaining of dizziness and lightheadedness while sitting or standing? 1. A boggy uterus 2. Pulmonary embolism 3. Orthostatic hypotension 4. Pregnancy-induced hypertension

Orthostatic hypotension. --Due to the resistance to the blood flow in the pelvic vessels drops, the patient's blood pressure falls. **A soft and boggy uterus causes severe bleeding and increases the risk of hemorrhage. **Dyspnea (difficulty breathing) and tachypnea (rapid breathing) are signs of pulmonary embolism. **Edema in the lower extremities and above the waist indicates pregnancy-induced hypertension. P. 216

The nurse is teaching a postpartum patient about breast-feeding. The patient asks the nurse, "What's the best way to switch my baby to the other breast while feeding?" Which response by the nurse is best? 1. "Pull the breast away from the baby's mouth after 5 minutes." 2. "Remove the breast from the baby when audible swallowing occurs." 3. "Break the suction by inserting one of your fingers into the corner of the baby's mouth." 4. "Wake the baby, and then quickly remove the breast from the baby's mouth."

"Break the suction by inserting one of your fingers into the corner of the baby's mouth." --Breaking the suction also avoids trauma to the breast. P. 233

The nurse is instructing a postpartum patient about safe sexual intercourse. Which statement made by the patient indicates the need for further teaching? 1. "I can have sexual intercourse during lactation." 2. "I can have sexual intercourse 1 week after delivery." 3. "I should use contraception while I breast-feed." 4. "I should apply a water-soluble gel to the vagina during intercourse."

"I can have sexual intercourse 1 week after delivery." --The nurse should advise to avoid sexual intercourse until the bleeding stops to decrease the risk of infection. P. 243

The nurse is caring for a patient after a vaginal delivery and finds that the patient has perineal pain and is unable to sit properly. Which instruction would the nurse provide to increase the patient's comfort level? 1. "Place a fully inflated ring on the chair before sitting." 2. "Place a pillow behind your back while sitting." 3. "Squeeze your buttocks while lowering yourself to sit." 4. "Elevate your feet while sitting."

"Squeeze your buttocks while lowering yourself to sit." --Also, place a half-inflated ring instead of fully inflated ring on the chair to prevent wobbling or an accidental fall. P. 214

A lactating patient who is infected with varicella zoster virus and receiving antiviral medications has lesions on the breast. Which instruction would the nurse provide in this situation? 1. "Apply an ice pack to your breast." 2. "Stop breast-feeding your child." 3. "Wash the breast with soap and water." 4. "Feed your child with pumped breast milk."

"Stop breast-feeding your child." --To prevent the spread of the infection to the newborn. --Antiviral medications enter the breast milk and cause adverse effects in the newborn. P. 231

The nurse is teaching a lactating patient the techniques of storing and handling of expressed milk. Which instruction would the nurse give to the patient to ensure proper storage and handling of milk? 1. "The milk can be stored in the deep freezer for up to 6 months." 2. "The milk should be stored in polystyrene bottles for freezing." 3. "The milk can be stored for 2 weeks at a temperature of 8*C." 4. "The milk should be heated in a microwave before feeding it to the infant."

"The milk can be stored in the deep freezer for up to 6 months." --The milk doesn't degrade at a temp of 4*C (normal freezer temperatures). --The milk shouldn't be stored in polystyrene bottles as they degrade the lysozyme, lactoferrin, and vitamin C in the milk. --Heating the milk in a microwave destroys the immunoglobulins and lysozyme. P. 239

The nurse is teaching breast-feeding techniques to a lactating patient who gave birth by cesarean section. Which instruction would the nurse give the patient? 1. "Use a side-lying position during the day." 2. "Avoid the cradle hold position." 3. "Use the football hold position during the day." 4. "Avoid placing the child in the chest-to-chest position."

"Use the football hold position during the day." --This position is good for patients who have had a cesarean incision, it avoids pressure on the cesarean incision and is comfortable for patients with large breasts. --Side-lying position may be preferable when they want to breast-feed at night. P. 234

Which precautions would the nurse follow while performing perineal care? Select all that apply. 1. Do not flush the toilet until the patient is upright. 2. Touch only the sides and outside of the perineal pad. 3. Pour warm water over the perineum after opening the labia. 4. Apply a perineal pad immediately after applying ointment. 5. Perform perineal care every 6 hours during puerperium.

1 & 2 -Do not flush the toilet until the patient is upright. (To avoid the perineum getting sprayed with the flushing water). -Touch only the sides and outside of the perineal pad. (To avoid infection). --The nurse should pour warm water over the perineum while keeping the labia CLOSED. (to prevent infection). --The nurse should WAIT 1 to 2 minutes to apply a perineal pad after applying the medicated ointment or spray (to avoid absorption of the ointment into the pad). --Perineal care should be performed at least every 4 hours postpartum. P. 215

Which complication would the nurse assess for in a postpartum patient who is tachycardic? Select all that apply. 1. Hyperthermia 2. Hypovolemia 3. Hypokalemia 4. Pulmonary edema 5. Hyperaldosteronism

1 & 2 -Hyperthermia -Hypovolemia --Tachycardia can be indicative of infection, resulting in hyperthermia & hypovolemia. --Hypovolemia: Causes a decrease in the levels of sodium ion concentration but not potassium ion concentration in the plasma. **Pulmonary edema occurs as a result of hypervolemia, but is not caused by hypovolemia. **Hyperaldosteronism: Does not cause postpartum bradycardia, but it can cause hypervolemia as a result of fluid retention. P. 214, 216

The nurse is examining a patient 4 days after vaginal delivery and notes fever and bright red, foul-smelling lochia. The patient tells the nurse, "I'm having severe afterpains and my perineal pad saturates within 2 hours." Which postpartum complications would the nurse be concerned about? Select all that apply. 1. Infection 2. Thrombophlebitis 3. Vulvar hematoma 4. Postpartum hemorrhage 5. Pregnancy-induced hypertension

1 & 4 -Infection -Postpartum hemorrhage --The presence of foul-smelling lochia with or without fever is indicative of infection. --If the perineal pad saturates within 2 hours, that indicates the patient has severe bleeding and is at risk for postpartum hemorrhage. **Edema, pain, and redness indicates thrombosis. **Vulvar hematoma: Associated with perineal pain and edema. **Edema above the waist indicates that the patient has pregnancy-induced hypertension. P. 244

Which interventions will be beneficial for a non-breastfeeding mother with breast engorgement? Select all that apply. 1. Placing ice packs on the patient's breast 2. Placing cabbage leaves on the patient's breast 3. Advising the patient to wear a supportive bra 4. Advising the patient to remove breast milk by pumping 5. Advising the patient to breast-feed the infant in a side-lying position.

1, 2, 3 -Placing ice packs on the patient's breast (to reduce discomfort and pain). -Placing cabbage leaves on the patient's breast (phytochemical helps with inflammation). -Advising the patient to wear a supportive bra (to help prevent discomfort). **Do not encourage breast pumping or breast feeding due to it emptying the milk ducts and enhance milk production. --> Worsening symptoms. P. 240

Which condition puts a newborn at risk for low blood glucose after birth? Select all that apply. 1. Hypoxia 2. Preterm delivery 3. Maternal diabetes 4. Congenital heart defects 5. Large size for gestational age

1, 2, 3, 5 -Hypoxia -Preterm delivery -Maternal diabetes -Large size for gestational age --Also to include: Postterm infants, small-for-gestational-age infants, infants with IUGR, and infants who are cold-stressed. P. 228

Which signs can be observed in infants with hypoglycemia? Select all that apply. 1. Sweating 2. Jitteriness 3. Kicking of legs 4. High-pitched cry 5. Dimpling of the cheeks

1, 2, 4 -Sweating -Jitteriness -High-pitched cry --Due to a result of reduced blood glucose levels. P. 229

A postpartum patient is found to have a distended uterine fundus that has not contracted and heavy vaginal bleeding. Which nursing interventions would be beneficial to the patient? Select all that apply. 1. Inserting a urinary catheter 2. Elevating the patient's legs 3. Performing uterine massage 4. Assisting the patient to void 5. Ambulating at regular intervals

1, 3, 4 -Inserting a urinary catheter. -Performing uterine massage. -Assisting the patient to void. --If the patient has a full bladder, that may reduce uterine contractions. --Uterine massage makes the fundus firm and prevents and possible hemorrhage. P. 210

While teaching bottle-feeding techniques to the parents of a newborn, the nurse instructs to avoid propping the bottle while feeding the infant. Which condition in the newborn is the nurse addressing? Select all that apply. 1. Dehydration 2. Dental caries 3. Ear infections 4. Gastric upset 5.Skin infection

2 & 3 -Dental caries (by avoiding contact of milk with the teeth). -Ear infections (due to milk accidentally entering into the infant's ears through the Eustachian tube and may cause bacterial growth). P. 241

NCLEX Review Questions: Which of the following is a nursing intervention that does not require the written order of the health care provider? SATA. 1. Administer an analgesic for pain. 2. Teach the patient how to perform perineal care. 3. Apply the topical anesthetic for perineal suture pain. 4. Turn patient q2h.

2 & 4 -Teach the patient how to perform perineal care. -Turn patient q2h. --Administration of analgesics and topical anesthetics would require physician's order for implementation. Ref: Nursing care.

Which statements would the nurse include in postpartum patient education? Select all that apply. 1. "Your uterus should return to prepregnancy size by 6 months." 2. "You may need to use a water-soluble lubricant for intercourse." 3. "Afterpains should decrease rapidly within 48 hours postpartum." 4. "By the third day, your breasts will become firm from milk production." 5. "You might see a temporary increase of blood flow during ambulation." 6. "You should call the doctor if your discharge returns to bright red after progressing to the clear."

2, 3, 4, 5, 6 -"You may need to use a water-soluble lubricant for intercourse." -"Afterpains should decrease rapidly within 48 hours postpartum." -"By the third day, your breasts will become firm from milk production." -"You might see a temporary increase of blood flow during ambulation." -"You should call the doctor if your discharge returns to bright red after progressing to the clear." --The uterus should return to its approximate prepregnancy size by 6 weeks. P. 210-212, 214-215, 242-244

While collecting data on a female newborn, the nurse finds that she has thin transparent skin covered with lanugo hair, cheesy vernix, and ears that spring back slowly when folded. The nurse also finds that the newborn's labia majora and labia minora are equal in size. Which week of gestation was this newborn at birth? 1. 28th week 2. 36th week 3. 38th week 4. 40th week

28th week. P. 226

Which findings would the nurse observe in a healthy newborn within 24 hours of birth? Select all that apply. 1. Low blood sugar. 2. Poor muscle tone. 3. Respiratory rate of 40 breaths per minute. 4. Blood pressure of 70/40 mm Hg. 5. Axillary temperature of 37* C.

3, 4, 5 -Respiratory rate of 40 breaths per minute. -Blood pressure of 70/40 mm Hg. -Axillary temperature of 37* C. --Normal respiratory rate: 30-60 breaths/min. --Normal BP: 65/30-95/60 mm Hg. --Normal axillary temperature: 36.5-37* C. P. 224, 227

To provide adequate nutrition for a lactating patient with lactose intolerance the nurse instructs the patient to consume tofu, soy milk, canned salmon, cabbage, and beans to the patient. After a few days the patient reports that the newborn is fussy and has gas. Which food would the nurse instruct the mother to eliminate from her diet? Select all that apply. 1. Tofu 2. Soy milk 3. Canned salmon 4. Cabbage 5. Beans

4 & 5 -Cabbage -Beans --Cabbage, beans, and chocolates may alter the taste of breast milk, which causes gas in the newborn and making them fussy. --Foods rich in calcium are needed, foods such as: tofu, soy milk, and canned salmon. P. 239

The nurse is caring for an infant who has hypothermia. Which other complications does the nurse expect to find in the infant? Select all that apply. 1. Hyponatremia 2. Hypertension 3. Hyperuricemia 4. Hypoglycemia 5. Respiratory distress

4 & 5 -Hypoglycemia -Respiratory distress --Due to the need to conserve heat, the infant may utilize greater amounts of glucose stored in the body to generate heat, which in turn enhances the metabolism of glucose and causes hypoglycemia. --Hypothermia will decrease the rate of respiration and may cause respiratory distress. P. 224

Which infant formulas are cow's milk-based formulations? Select all that apply. 1. Isomil 2. ProSobee 3. Nutramigen 4. Similac Advance 5. Enfamil Premium

4 & 5 -Similac Advance -Enfamil Premium --To provide proper nutrition to newborns, most infant formulas are prepared based on the composition of cow's milk. **Isomil & ProSobee: Examples of soy formulas. **Nutramigen: An example of soy or protein-hydrolysate formula. P. 240

The nurse is caring for a postpartum patient. Place the actions for performing uterine fundus massage in the correct order. 1. Administer oxytocin (Pitocin) to the patient if prescribed. 2. Place one hand on the uterus and push the fundus. 3. Press downward slightly above the symphysis pubis. 4. Help the patient to lie in the supine position with flexed knee. 5. Locate and massage the uterine fundus in a circular motion.

4, 3, 5, 2, 1 -Help the patient to lie in the supine position with flexed knee. (This enables the nurse to observe the lochia). -Press downward slightly above the symphysis pubis. (To anchor the lower uterus). -Locate and massage the uterine fundus in a circular motion. (Until the fundus is firm). -Place one hand on the uterus and push the fundus. (To expel the blood and its clots). -Administer oxytocin (Pitocin) to the patient if prescribed. (This helps maintain uterine contractions). P. 210

The Rh-negative mother should receive a dose of RhoGAM within ____ hours after giving birth to an Rh-positive infant?

72 hours.

NCLEX Review Questions: The best way to maintain the newborn's temperature immediately after birth is to: 1. Dry the newborn thoroughly, including the hair. 2. Give the newborn a bath using warm water. 3. Feed 1 to 2 ounces of warmed formula. 4. Limit the length of time that parents hold the newborn.

Dry the newborn thoroughly, including the hair. --Newborns lose heat quickly after birth due to amniotic fluid evaporating from their bodies, which is a mechanism of heat loss. Ref: Table 9-3.

The student nurse is assisting a patient in a sitz bath under the supervision of a registered nurse. The student washes hands, places the sitz bath on the toilet seat, and has the patient sit in a water flow for 20 minutes. The student nurse then helps the patient pat the perineum dry from back to front and applies a clean perineal pad. Which action of the student nurse demonstrates a need for further teaching? 1. Applying a perineal pad 2. Placing the sitz bath on the toilet seat 3. Drying the perineum from back to front. 4. Maintaining the water flow for 20 minutes.

Drying the perineum from back to front. --A sitz bath is a warm-water bath used for a healing perineum. --The nurse should dry the perineum from front-to-back direction to prevent fecal and vaginal contamination. P. 213, 215

The nurse is caring for a patient after the fourth stage of labor and is concerned that the patient may have pregnancy-induced hypertension. Which findings enabled the nurse to reach this conclusion? 1. Increased pulse rate 2. Edema above the waist 3. Increased body temperature 4. Presence of an uncontracted uterus

Edema above the waist. **Increased pulse rate: Indicates the patient has an infection or a risk of hypovolemia. **If the uterus is uncontracted, the blood flow from the placental insertion site increases which may result in severe bleeding. P. 216

NCLEX Review Questions: Which assessments are expected 24 hours after birth? 1. Scant amount of lochia alba on the perineal pad. 2. Fundus firm and in the midline of the abdomen. 3. Breasts distended and hard with flat nipples. 4. Bradycardia.

Fundus firm and in the midline of the abdomen. --After 24 hours, the fundus begins to descend about 1 cm (one finger's width) each day. Ref: Nursing care.

A decrease in which laboratory result in a newborn would cause the nurse to instruct the parents to dry the neonate quickly after bathing, place the crib away from windows and cold walls and to cover the newborn with warm blankets? 1. Glucose 2. Bilirubin 3. Fibrinogen 4. Uric acid

Glucose. --Newborns use glucose to generate heat. --> Reduced blood glucose levels may impair thermoregulation and cause hypothermia. P. 224-225

A patient who is 36 hours postpartum has a body temperature of 38° C (100.4° F). Which laboratory result would the nurse expect related to this? 1. Decreased blood platelet levels 2. Increased red blood cell levels 3. Decreased prostaglandin levels 4. Increased white blood cell levels

Increased white blood cell levels. --If the temperature persists beyond 24 hours, it indicates that the patient has an infection. --During infection, the WBC count may rise as high as 12,000-24,000/mm3. **Decreased blood platelet levels in lab reports during severe bleeding. **Decrease in RBC is due to postpartum blood loss. P. 216

Which intervention would be beneficial for the postpartum patient who is receiving epidural narcotics and has a low respiratory rate? 1. Oral aspirin (Anacin) 2. Supine positioning 3. Intravenous naloxone (Narcan) 4. Oral fluid bolus

Intravenous naloxone (Narcan). --An opioid antagonist and it helps reverse the effects of epidural narcotics. P. 220

A lactating patient reports a tingling sensation in the breasts along with abdominal cramping. Which condition would the nurse document related to these findings? 1. Quickening 2. Rooting reflex 3. Let-down reflex 4. Breast engorgement

Let-down reflex. --The symptoms are caused as a result of the secretion of oxytocin from the posterior pituitary gland. **Oxytocin: Causes uterine contraction and nipple stimulation. **Quickening: The moment fetal movements are first felt by the mother. **Breast engorgement: Have swollen, firm, and painful breasts. P. 232

The nurse is palpating the fundus of a patient 3 days after delivery and finds it to be soft and boggy. Which action should the nurse take first? 1. Encourage the patient to take adequate fluids. 2. Administer oxytocin (Pitocin) to the patient. 3. Gently push the patient's fundus downward. 4. Massage the patient's fundus to make it firm.

Massage the patient's fundus to make it firm. --Massaging the fundus helps expel clots that may have accumulated in the uterus and promotes uterine contractions. --The lack of contractions may be caused by a distended bladder, the nurse would encourage the patient to void the bladder. **Administering oxytocin would help main uterine contractions. **Pushing on a soft and boggy uterus can invert the uterus and cause hemorrhage. P. 211

Which type of breast milk has a bluish color? 1. Mature 2. Colostrum 3. Foremilk 4. Transitional

Mature. --Mature milk is secreted 14 days after childbirth & has a bluish color. **Colostrum: First milk, is secreted immediately after birth & is yellow in color. **Foremilk: milk at the beginning of feeding that quenches the infant's thirst. **Transitional milk: Secreted 7-10 days after the birth. P. 222

A breastfeeding mother reports that she has cramping every time she feeds her baby and the nurse informs her that these are afterpains. Which is the best physician-ordered pharmacologic intervention? 1. Narcotic 2. Mild analgesic 3. Anesthetic 4. Tocolytic

Mild analgesic. --Provide adequate relief of afterpains for most women. --This would be taken immediately after breast-feeding to minimize sedation and side effects passing to the newborn. **Aspirin is not used postpartum because it interferes with blood clotting. **Tocolytic: Anti-contraction medications or labor suppressants. P. 210

Which test is performed to identify whether the newborn has a risk of intellectual disability? 1. Phenylketonuria (PKU) test. 2. Homocysteinuria test 3. Masimo pulse oximeter 4. Immunoreactive trypsinogen level

Phenylketonuria (PKU) test. --This test screens for the enzyme that heightens the risk of intellectual disability in the newborn. --This test identifies the presence of the enzyme needed to use the amino acid phenylalanine. --> If this enzyme is missing, then phenylalanine builds up in the child's system and causes intellectual disability over time. **Homocysteinuria: Caused as a result of altered methionine levels, a newborn with Homocysteinuria has risk for musculoskeletal abnormalities. **Masimo pulse oximeter: Used to noninvasively measure oxygen saturation of the blood. --> Altered levels may be indicative of congenital heart disease. **Immunoreactive trypsinogen level: Used to identify whether the newborn is at risk for cystic fibrosis. P. 229

The nurse is caring for a postpartum patient who is at risk for thrombophlebitis. Which treatment strategy would the nurse expect to be beneficial for the patient? 1. Vitamin C supplements 2. Pneumatic compression device 3. Intravenous oxytocin (Pitocin) 4. Methylergonovine (Methergine)

Pneumatic compression device (to enhance blood flow). --Thrombophlebitis: clots in the superficial veins. --> Which leads to venous congestion due to the accumulation of blood. **Oxytocin(Pitocin) & methylergonovine (Methergine): Help to stimulate uterine contractions. P. 216

Which medication, if taken by a lactating patient of Hispanic origin with a history of gestational diabetes, increases the risk for type 2 diabetes mellitus? 1. Iron supplements 2. Docusate sodium (Colace) 3. Progestin-only contraceptives 4. Methylergonovine (Methergine)

Progestin-only contraceptives. --Reduce the production of insulin and increases the risk of type 2 diabetes mellitus in Hispanics with gestational diabetes. P. 215

Which hormone is responsible for the production of breast milk? 1. Prolactin 2. Oxytocin 3. Endorphin 4. Progestin

Prolactin. --Produced from the posterior pituitary gland. **Oxytocin from the posterior pituitary gland: Causes the milk to be delivered from the alveoli through the duct system to the nipple. **Endorphins: A group of hormones found in the brain that reduce the sensation of pain and affect emotions. **Progestin: A hormone, such as progesterone that maintains pregnancy. P. 232

Which assessment finding in a newborn would the nurse associate with difficulty adapting to the surrounding environment? -Phase 1 (30 minutes after birth): The newborn is alert, has frequent Moro reflex, tremors, and sucking reflex. -Phase 2 (1 hour after the birth): The newborn's respiration rate is 20 breaths/min. The newborn has audible bowel sounds and decreased motor activity. -Phase 3 (5 hours after the birth): The newborn has brief change in muscle tone, oral mucus, responsive to stimuli, suck-swallow coordination. 1. Decreased motor activity in phase 2 2. Respiratory rate of 20 breaths/min in phase 2 3. Presence of oral mucus in phase 3 4. Suck-swallowing coordination in phase 3.

Respiratory rate of 20 breaths/min in phase 2. --To get sufficient oxygen the newborn should respire at a rate of 60 breaths/min in phase 2. P. 224

A postpartum patient has been prescribed Methylergonovine (Methergine). Which assessment finding would indicate to the nurse that the medication is effective? 1. Reversal of respiratory depression. 2. Relief of perineal pain 3. Relief of constipation 4. Stimulation of uterine contractions

Stimulation of uterine contractions. --If a patient has a boggy or poorly contracted uterus, the PCP prescribes methylergonovine (Methergine) to stimulate the uterine contractions and makes the uterus firm. **Naloxone (Narcan): Reverses respiratory depression. **Benzocaine (Americaine): Helps relieve perineal pain in the patient. **Docusate sodium (Colace): A stool softener. P. 212

Which condition would the nurse document in a postpartum patient who talks continuously about the labor experience? 1. Postpartum blues 2. Taking-in phase 3. Letting-go phase 4. Postpartum depression

Taking-in phase. --The patient remains passive, wants to rest, and prefers that her family members take care of the newborn. **Postpartum blues: The patient has an emotional letdown, feels sad, and does not interact with people. **Letting-go phase: The patient accepts the child and cares for the infant independently without help from family. **Postpartum depression: If the patient has symptoms of postpartum blues for more than a month, where the patient remains extremely sad and isolated. P. 221

NCLEX Review Questions: Eight hours postpartum the woman states she prefers the nurse to take care of the newborn. The woman talks in detail about her birthing experience on the phone and to anyone who enters her room. She complains of being hungry, thirsty, and sleepy and is unable to focus on the newborn care teaching offered to her. The nurse would interpret this behavior as: 1. Inability to bond with the newborn. 2. Development of postpartum psychosis. 3. Inability to assume the parenting role. 4. The normal taking-in phase of the puerperium.

The normal taking-in phase of the puerperium. --Rubin describes three phases of postpartum change that have been a framework of nursing care for 35 years, the studies show in the first phase (Taking in) the mother is passive and willing to let others do for her, conversations focus on her birth experience, she shows little interest in learning, and is focused on food, fluids and sleep. Ref: Table 9-2

Which action by the nurse is best when a Spanish-speaking patient requires postpartum discharge teaching and no one on the hospital staff speaks Spanish fluently? 1. Have a family member help interpret discharge instructions. 2. Try to relay the information using an English-to-Spanish dictionary. 3. Provide instructions in writing with illustrations. 4. Use an impartial interpreter to assist with discharge instructions.

Use an impartial interpreter to assist with discharge instructions. --Try to avoid using family members if there is sensitive information discussed. P. 209

A breastfeeding mother tells the nurse, "I include garlic in my diet, wash my nipples with soap, nurse my child for 10 minutes from each breast, and place my finger in the baby's mouth to break the suction." Which action of the patient is a reason for concern? 1. Including garlic in the diet 2. Washing the nipples with soap 3. Placing a finger in baby's mouth 4. Changing breast after 10 minutes.

Washing the nipples with soap. --The patient should maintain hygiene by washing her hands and breasts with warm water, but should avoid applying soap to the nipples as it may cause dryness and may lead to cracks and irritation. **Intake of garlic increases immunity and enhances milk production. **Feeding the infant for 10 minutes provides hind milk to the infant and helps satisfy the infant's hunger. P. 215