Normal postpartum

2 (carboprost is an oxytocic prostaglandin that causes uterine contractions in women who are bleeding heavily. N/V/D and fever are common adverse effects)

Carboprost was injected into the uterus of a client to treat uterine atony during a cesarean. In preparing to care for this client postpartum, the nurse should assess the client for which common adverse effects of the medication? 1. vertigo and confusion 2. Nausea and diarrhea 3. restlessness and increased vaginal bleeding 4. headache and HTN

1 (Legal process for discarding med)

The OB has ordered a postop c section clients PCA be discontinued. Which of the following actions by the nurse is appropriate? 1. discard the remaining med in the presence of another nurse 2. recommend waiting until her pain level is 0 to discontinue the med 3. discontinue the med only after the analgesia is completely absorbed 4. return the unused portion of the med to the narc cabinet

1 (neonates like to look at eyes and eye to eye contact is highly effective way to provide visual stimulation. Circles, contrast of dark and light)

Which info should the nurse include in the primiparas discharge teaching plan about measures to provide visual stimulation for the neonate? 1. maintain eye contact while talking to the baby 2. paint the babys room bright colors accented with teddy bears 3. use brightly colored animals and cartoon figures on the walls 4. move a brightly colored rattle in front of the babys eyes

2

a primipara client who gave birth vaginally 8 hrs ago desires to take a shower. The nurse anticipates remaining near the client to assess for which problem? 1. fatigue 2. fainting 3. diuresis 4. hygeine needs

4 (classic symptom is fever and foul smelling lochia. Odorless heavy bleed is assoc. with placental fragments. Abdominal distension is assoc. with parametritis as the pelvic cellulitis advances and spreads causing severe pain and distention. N/V are assoc with parametritis, resulting from an abscess and advancing pelvic cellulitis)

36 hrs after vaginal birth a multipara client is diagnosed with endometritis. When assessing the client which symptom would the nurse expect to find? 1. profuse lochia 2. abdominal distension 3. N/V 4. fever greater than 100.4

2 (carboprost tromethamine may cause HTN. More commonly N/V/D and fever. GI symptoms are so common that antiemetic and antidiarrheal meds are often given as a pretreatment or immed following)

4 days after a vaginal birth a client has excessive lochia rubra with clots. The HCP prescribes carboprost 0.25 mg IM. Which statement by the client reflects the need for more teaching about carboprost? 1. This med may cause N/V 2. This med sometimes causes hypotension that leads to dizziness 3. I will also receive med to help prevent severe diarrhea 4. I may run a fever after being treated with carboprost

2 (fundus. the clients gravidity and parity indicate that she is a grand multipara. She has been preg. 10 times, carrying 6 to term and 4 preterm. Because her uterus has been stretched so many times she is at high risk for uterine atony during the postpartum period. The nurse should monitor the postpartum contraction of her uterus carefully)

A breast feeding client G10 P6408 delivered 10 mins ago. Which of the following assessments is most important for the nurse to perform at this time? 1. pulse 2. fundus 3. bladder 4. breast

3 (When women breastfeed, their estrogen levels remain low. As a result they often complain of vaginal dryness and dyspareunia. the woman should be advised to use an OTC lubricant and if that is not helpful the Dr may prescribe an estrogen based cream)

A breastfeeding client 7 weeks postpartum complains to an OB triage nurse that when she and her husband had intercourse for the first time after the delivery "I could not 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? 1. After a delivery the vagina is very tender, It should feel better the next time you have intercourse 2. Does your baby have thrush? If so you should be assessed for a yeast infection in your vagina 3. Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort 4. Sometimes the stiches of episiotomies heal too tight. Why dont you come in to be checked?

1 (respiratory depression and narcs)

A client is receiving an epidural infusion of a narc for pain relief after a c section. The nurse would report to the anesthesiologist if which of the following were assessed? 1. RR 8 2. complaint of thirst 3. urinary output of 250 mL/hr 4. numbness of feet and ankles

2 (When a postpartum clients bladder is distended, the uterus becomes displaced and boggy. The client should be escorted to the bathroom to void. However BEFORE escorting the client to urinate the nurse should gently massage the uterus)

A client G1 P1001 postpartum day 1 is assessed. The nurse notes that the clients 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? 1. notify the HCP 2. massage the womans fundus 3. escort the woman to the bathroom to urinate 4. check the quantity of lochia on the peripad

3

A postpartum primipara client is having difficulty breast feeding her infant. The infant latches on to the breast but the others nipples are extremely sore during and after each feeding. The client needs further instruction about breast feeding when she states: 1. The baby needs to have as much of the nipple and areola in the mouth as possible to prevent sore and cracked nipples 2. I can put breast milk on the nipples to heal the sore areas 3. As long as some of my nipple is in the babys mouth the baby will receive enough milk 4. Feeding the baby for a half hour on each side will not make my breasts sore

2 (performed whether male of female child. There is no baptism rite)

A primipara client has just given birth to a healthy male infant. The client and her husband are Muslim and the husband begins chanting a song while holding the neonate. How does the nurse interpret the fathers actions? 1. thanking allah for giving him a male heir 2. singing to his son from the koran in praise of allah 3. expressing appreciation that his wife and son are healthy 4. performing a ritual similar to baptism in other religions

4

On the first postpartum day the primipara reports perineal pain of 5 on a scale of 1-10 that was unrelieved by ibuprofen 800 mg given 2 hrs ago. The nurse should further assess the client for: 1. puerperal infection 2. vaginal laceration 3. history of drug abuse 4. perineal hematoma

4 (Because of the heavy lochia the nurse should notify the HCP. Heavy lochia is not a normal finding, moderate lochia which resembles a heavy menstrual period is normal. )

A G2 P2002 who is postpartum 6 hrs from a spontaneous vag delivery is assessed. The nurse notes 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? 1. do nothing, this is a normal finding 2. massage the womans fundus 3. take the woman to the bathroom to void 4. notify the HCP

4 (If she were breastfeeding she could be encouraged to put the baby to breast and see if the bleeding subsides. Since oxytocin is released when babies suckle at the breast this is a noninvasive way to promote uterine contractions. Very unlikely she is menstruating at 1 1/2 weeks postpartum)

A bottle feeding woman ,1 and 1/2 weeks postpartum from a vag delivery, calls the OB office to state she has saturated 2 pads in the last hour. Which of the following responses by the nurse is appropriate? 1. You must be doing too much. Lie down for a few hours and call back if the bleeding has not subsided 2. You are probably getting your period back, you will bleed like that for a day or two and then it will lighten up 3. It is not unusual to bleed heavily every once in awhile after the baby is born, it should subside shortly 4. It is important for you to be examined by your doctor today. Let me check to see when you can come in

1

A breast feeding primipara asks the nurse how breast milk differs from cows milk. The nurse responds by saying that breast milk is higher in which nutrient? 1. fat 2. iron 3. sodium 4. calcium

3

A breast feeding primipara with a midline episiotomy is prescribed ibuprofen 200 mg PO. The nurse instructs the client to take the med: 1. before bed 2. midway between feedings 3. immed after a feeding 4. when providing supplemental formula

3 (rotating feeding is one way to minimize the severity of sore nipples. Nipple shields should be used sparingly. soap is bad it depletes natural lanolin, use only warm water to wash.)

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? 1. use a nipple shield at each breastfeeding 2. cleanse the nipples with soap 3x a day 3. rotate the babys positions at each feed 4. bottle feed for 2 days then resume breastfeeding

3 (the blood pressure. Methergine is an oxytoxic agent that works directly on the the myofibrils of the uterus. The smooth muscle of the vascular tree is also affected. The BP may elevate to dangerous levels. The med should be held if the BP is 130/90 or higher and the HCP notified)

A medication order reads: Methergine (ergonovine) 0.2 mg PO q 6 h x 4 doses. Which of the following assessments should be made before administering each dose of this med? 1. apical pulse 2. lochia flow 3. BP 4. episiotomy

1 (Safety is the highest priority, and a nursing error has occured. If the day nurse decides to tell the night nurse, the timing of the notification will be up to the nurse initiating the incident report. The nurse should confer with the charge nurse concerning the incident, but completion of the report is required. Waiting for several hrs to initiate the report based on changes in the client data and assessment is not an ethical or professional decision and should not be considered)

A night nurse has completed the change of shift report. As the day nurse makes rounds on a postpartum client receiving MgSO4, it is noted that the client developed significantly elevated BP during the past shift. Further assessment revals the MgSO4 is infusing well below the prescribed rate. In addition to adjusting the infusion rate and notifying the HCP, what is the most important action by the nurse? 1. complete an incident report 2. discuss the matter with the nurse the next time she works 3. Ask the charge nurse if an incident report is necessary 4. Evaluate the clients BP for 4 hrs before making a decision

1,3,4,5 (B-breasts, U-uterus, B-bladder, B bowels and recutm, L-lochia, E-episiotomy, H-hormones (emotion), E-extremeties)

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 1. palpate the breasts 2. auscultate the carotid 3. check vaginal discharge 4. assess the extremeties 5. inspect the perineum

3 (after uncomplicated birth postpartum exercises may begin on day one with exercises to strengthen the abdominal muscles. These are done in the supine position with the knees flexed, inhaling deeply while allowing the abdomen to expand and then exhaling while contracting the abdominal muscles. The others are too strenuous for the first day. )

A primipara client 20 hrs after birth asks the nurse about starting postpartum exercises. Which instruction would be most appropriate to include in the plan of care? 1. start in a sitting position then lie back, and return to a sitting position repeating 5 times. 2. assume the prone position, and then do pushups using the arms to lift the upper body 3. flex the knees when supine and then inhale deeply and exhale while contracting the abdominal muscles 4. flex the knees while supine and then bring ching to chest while exhaling and reach for the knees by lifting the head and shoulders while inhaling

4 (The most likely cause of this clients atony is overdistention of the uterus caused by the hydramnios. as a result the stretched uterine musculature contracts less vigorously. Besides hydramnios, a large infant bleeding from abruptio placentae or placenta previa, and rapid labor and birth can also contribute to atony during postpartum. Although a prolonged labor could contribute this client had a cesarean.)

A primiparous client who was diagnosed with hydramnios and breech presentation while in early labor is diagnosed with early postpartum hemorrhage 1 hr after cesarean birth. The client asks "Why am I bleeding so much?" The nurse responds based on the understanding that the most likely cause of uterine atony in this client is which factor? 1. trauma during labor and birth 2. moderate fundal massage after birth 3. lengthy and prolonged 2nd stage of labor 4. overdistension of the uterus from hydramnios

3 (feelings of guilt combined with a lack of self-care can predispose a new mother to postpartum depression, especially with a Hx of depression. Sleep is essential but sleeping through the night dos not usually occur in the first few weeks after birth. Eating as much as you want is not good as gaining weight may contribute to depression. And not asking for help is likely to cause stress that will possibly increase depression)

A teen client who is 1 week postpartum is concerned about the possiblity of postpartum depression because she has a Hx of depression. Which comment by the client would indicate that she understood the nurses teaching about the postpartum period and her risk for depression? 1. sleep should not be too much of a problem because the baby will soon start to sleep through the night 2. Since I am breastfeeding I can eat all the food I want and not feel fat. The baby will use the calories 3. If I am feeling guilty or not capable of caring for the baby and I am not sleeping or eating well I need to contact the office 4. I am going to give the baby the best care possible without asking anyone for help to show all those people who think I cannot do it.

3

During a home visit to a primipara on the 4th postpartum day she tells the nurse that she has been experiencing breast engorgement. To relieve engorgement the nurse teaches the client to sue which intervention before nursing her baby? 1. apply an ice cube to the nipple 2. rub her nipples gently with lanolin 3. express a small amount of breast milk 4. offer the neonate a small amount of formula

1,2,5 (sitz baths have a soothing effect, clients feels some relief if external hemorrhoids are reinserted, and topical anesthetics can provide relief. addition the client should be advised to eat high fiber foods, and drink fluids to prevent constipation)

During a postpartum assessment, it is noted that a G1 P1001 woman who has delivered vag over an intact perineum has a cluster of hemorrhoids. Which of the following would be appropriate for the nurse to include in the womans teaching? select all that apply 1. The client should use a sitz bath daily as a relief measure 2. The client should digitally replace external hemorrhoids into her rectum 3. The client should breastfeed frequently to stimulate oxytocin to reduce the size of the hemorrhoids 4. The client should be advised that the hemorrhoids will increase in size and quantity with subsequent pregnancies 5. The client should apply topical anesthetic as a relief measure

2,3,4 (Although clients should drink fluids is not related to nursing diagnosis. Sitz baths are not given to prevent infection, they soothe and relieve pain assoc with episiotomies and hemorrhoids. The WBC is elevated in preg, delivery and postpartum, but if it rises rapidly it is assoc with bacterial infection, the lochia usually smells musty, when a client has endometritis, the lochia smells foul. A temp over 100.4 after the first 24 hrs postpartum indicates of a puerperal infection)

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 plan of care in relation to this diagnosis? select all that apply 1. The client will drink sufficient quantities of fluids 2. The client will have a stable WBC 3. The client will have a normal temp 4. The client will have normal smelling vaginal discharge 5. The client will take 2-3 sitz baths each day

3 (The client should have more active bowel sounds by this time. Ambulation will encourage passing flatus and begin peristaltic action in the GI tract. Medicating the client should be evaluated prior to ambulating, but is probably too soon since the last dose was 3 hrs ago and pain assessment is fairly low. Pain meds should not have codeine as a component as it decreases peristaltic activity, incentive spirometry or asking the client to turn cough and deep breathe is appropriate to encourage O2 exchange in the lungs prior to ambulation and walking can be used concurrently with these interventions. yet the bowel sounds is the abnormal finding and ambulation is most important at this time)

The nurse is assessing a c section client who gave birth 12 hrs ago. Findings include a distended abdomen with faint bowel sounds x1 quadrant. fundus firm at umbilicus, lochia scant rubra, and pain rated 2 on scale of 1-10. The IV and Foley cath have been D/c, and the client received medication 3 hrs ago for pain. The client can have pain medication every 3-4 hrs. The nurse should first: 1. give the client pain medication 2. have the client use the incentive spirometry 3. ambulate the client from the bed to the hallway and back 4. encourage the client to begin caring for her baby

4 (temp above 100.4 after the first 24 hrs indicates a potential for infection. WBC's are normally elevated postpartum. hgb in normal range, pulse is normal resulting from increased cardiac output from circulation after placental delivery increasing blood volume)

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? 1. hgb 12.1 2. WBC 15000 3. pulse 60 bpm 4. temp 100.8

1 (Hgb values following birth should remain close to those during pregnancy. This value (Hgb 9) is low and requires further follow up. VS can be assessed after notifying HCP, WBC are wnl.)

The nurse is reviewing lab values on the medical record of a woman postpartum day 2. WBC 18000 Hct 40% Hgb 9 Plt 400,000 Based on this information the nurse should: 1. contact the HCP 2. obtain a prescription for IV antibiotics 3. assess the VS 4. prepare to admin pain medication

2

Which measure would the nurse expect to include in the teaching plan for a multipara client who gave birth 24 hrs ago and is receiving IV antibiotic for cystitis? 1. limiting fluid intake to 1 L daily to prevent overload 2. emptying the bladder every 2-4 hrs while awake 3. washing the perineum with povidone-iodine after voiding 4. avoiding the intake of acidic fruit juices until the treatment is DC

1

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? 1. encourage early ambulation 2. promote oral fluid intake 3. massage the legs of the client twice daily 4. provide the client with high fiber foods

4 (most likely caused by orthostatic hypotension secondary to the decreased volume of blood in the vascular system resulting from the physiologic changes occurring in the mother after birth. The nurse should first allow the client to dangle on the side of the bed for a few minutes before attempting to ambulate. By 6 hrs postpartum the effects of the anesthesia should be worn off completely. Typically the effects of epidurals wear off by 1-2 hrs postpartum and locals effects usually stop by 1 hr.)

While the nurse is preparing to assist the primipara to the bathroom to void 6 hrs 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 this is most likely caused by which factor? 1. effects of anesthetic during labor 2, hemorrhage during the birth process 3 effects of analgesics used during labor 4. decreased blood volume in the vascular system

4 (urinary retention soon after childbirth is usually caused by trauma and edema at the lower urinary tract. this commonly results in difficulty voiding. Hyperemia of the bladder mucosa also commonly occurs. The combination of hyperemia and edema predisposes to decreased sensation to void, overdistension of the bladder and incomplete emptying. )

2 hrs after the 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 distension is most likely caused by which factor? 1. prolonged first stage labor 2. UTI 3. pressure of the uterus on the bladder 4. edema in the lower urinary tract area

4 (It is likely this woman is dehydrated and the slight temp elevation can come from that.)

A patient G2 P1102 who delivered her baby 8 hrs ago now has a temp of 100.2 F. Which of the following is the appropriate nursing intervention at this time? 1. Notify the Dr. to get an order for Tylenol 2. Request an infectious disease consult from the Dr. 3. Provide the woman with cool compresses 4. Encourage intake of water and other fluids

1 (The neonate should be placed in a supine position. Placing infants on their side or prone in a crib after a feeding is no longer recommended due to the increased risk of SIDS. holding is not necessary for the digestion unless the infant has reflux)

A primiparous client who will be bottle feeding her neonate asks what is the best position for the baby after feeding ? Which position would you recommend? 1. supine position 2. on the left side 3. prone without a pillow 4. sitting on the caregivers lap for 20 mins

2 (after first 24 hours warm sitz baths 3-4 times a day for 20 mins can help increase circulation to the area. Ice packs 1st 24 hrs.)

AFter instructing the primipara about episiotomy care, which client statement indicates successful teaching? 1. I will use hot, sudsy water to clean the area 2. I wipe the area from front to back using a blotting motion 3. before bedtime I will use a cold water sitz bath 4. I can use ice packs for 3-4 days after birth

2 (recommend 8-10 glasses of fluid q d)

After the nurse counsels a primipara breast feeding client about diet and nutritional needs during the lactation period, which client statement indicates a need for additional teaching? 1. I need to increase my intake of Vit D 2. I should drink at least 5 glasses of fluid daily 3. I need to get an extra 500 cal a day 4. I need to make sure I have enough calcium in my diet

3 (The nurse would expect a slight decrease in both Hgb and Hct. Because clients lose blood during their deliveries the nurse would expect to see approx 2% drop in the Hct and 0.5 drop in Hgb. If the Hct drops below 30% notify the HCP)

On admit to the L&D unit a clients Hgb was assessed at 11 and her hct at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vag delivery? 1. Hgb 12.5, Hct 37% 2 Hgb 11, Hct 33% 3. Hgb 10.5, Hct 31% 4. Hgb 9, Hct 27%

3 (post partum blues from hormonal shifts)

The HH nurse visits a client 6 days postdelivery. The client appears sad, weeps frequently, and states "I dont know what is wrong with me, I feel terrible. I should be happy but I am not". Which of the following nursing diagnoses is appropriate for this client? 1. suicidal thoughts related to psychotic ideations 2. post trauma response related to traumatic delivery 3. ineffective coping related to hormonal shift 4. spiritual distress related to immature belief systems

4 (broccoli is very high in vitamin A and also contains iron)

The nurse is caring for a breast feeding mom who asks advice on foods that will provide both Vit A and Iron. Which of the following should the nurse recommend? 1. 1/2 cup raw celery dipped in 1 ounce cream cheese 2. 8 oz yogurt mixed with 1 med banana 3. 12 oz strawberry milk shake 4. 1 1/2 cups raw broccoli

3

12 hrs after a vaginal birth with epidural, the nurse palpates the fundus of a primipara client and finds it to be firm, above the umbilicus, and deviated to the right. What should the nurse do next? 1. document this as a normal finding in the record 2. contact the HCP for a prescription for oxytocin 3. encourage the client to ambulate to the bathroom to void 4. gently massage the fundus to expel the clots

1

4 hrs after cesarean birth of a neonate weighing 8lb, 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? 1. VBAC may be possible if the client has not had a classic uterine incision 2. A history of rapid labor is a necessary criterion for VBAC 3. A low transverse incision contraindicates the possibility for VBAC 4. VBAC is not possible because the neonate was large for gestational age

1

A 1 day old breast fed 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? 1. I should breast feed my baby as often as possible 2. I should supplement the breast feeding with formula after every feeding 3. I should discontinue breast feeding and change to fomula feeding 4. I should place my baby in direct sunlight several times a day

1 (It is up to the client about interacting and caring for the infant. The nurse should be nonjudgemental and allow the client any opportunity to see and care for the neonate)

A 15 year old unmarried primiparous client is being cared for in the hospitals birthing center after vaginal birth of a viable neonate. The neonate is being placed for adoption through a social service agency. Four hours postpartum, the client asks if she can feed her baby. Which of the responses would be the most appropriate? 1. I will bring the baby to you for feeding 2. I think we should ask your HCP if this is a good idea 3. It is not a good idea for you to have any contact with the baby 4. I will check with the social worker to see if the adopting parents will permit this

1 (encourage feed at least q2h, Tx also includes bed rest, increased fluid intake, local heat application, analgesics and antibiotic therapy. Continually emptying breasts decreases risk of engorgement or breast abscess. Usually the contaminating organism is safe for the baby, and the client can continue to breastfeed with the antibiotic)

A 20 year old primiparous client is seen in the urgent care 2 weeks after giving birth to a viable female neonate. The client who is breastfeeding, is diagnosed with mastitis of the right breast. The client asks the nurse "Can I continue to breastfeed?" The nurse should tell the client: 1. You can continue to breastfeed, feeding your baby more frequently 2. you can continue once your symptoms begin to decrease 3. You must dc breast feeding until antibiotic therapy is completed 4. you must stop breastfeeding because the breast is contaminated

3 (Gaining 1 oz; 30g; a day is normal for a neonate. Initial weight loss that exceeds 10% is abnormal. Adding rice cereal increases risk of aspiration and may promote obesity, doubling birth weight is typical at 5 months)

A 24 year old 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? 1. A baby normally loses 15% of weight before beginning to gain weight 2. Adding rice cereal to the bottle is a good way to increase calories if weight gain is slow 3. Gaining 30 g a day is a normal weight pattern 4. Babies typically double birth weight by 3 months

2

A 25 year old primipara who gave birth 2 hrs ago has decided to breast feed her neonate. Which instructions should the nurse address as the highest priority in the teaching plan about preventing nipple soreness? 1. keeping the plastic liners in the brassiere to keep the nipple drier 2. placing as much of the areola as possible into the babys mouth 3. smoothly pulling the nipple out of the mouth after 10 mins 4. removing any remaining milk left on the nipple with a soft wash cloth

2 (refer to HCP s/s of mastitis. Likely prescribe antibiotics. She should continue to feed from both breasts. Frequent breastfeeding is encouraged, warm compressess may help with pain. )

A breast feeding client is seen at home by the visiting nurse 10 days after a vag birth. The client has a warm, red ,painful breast, temp of 100 F, and flu like symptoms. What should the nurse do? 1. encourage the client to breast feed her infant using the unaffected breast 2. refer the woman to the HCP 3. inform the client that she needs to discontinue breast feeding 4. instruct the woman to apply warm compresses to the affected breast

4 (pumping would stimulate milk production)

A client gave birth two days ago and has been given instructions for breast care for bottle feeding mothers. Which statement indicates that the nurse should reinforce the instructions to the client? 1. I will wear a sports bra or a well fitting bra fro several days 2. When showering I will direct water onto my shoulders 3. I will use only water to clean my nipples 4. I will use a breast pump to remove any milk that may appear

4 (breast feeding consumes maternal calories and requires energy that increases the maternal basal metabolic rate and assists in lowering maternal blood glucose levels. Insulin is NOT transferred to the infant through breast milk. Breast feeding IS recommended for diabetic mothers because it does lower blood glucose levels.)

A diabetic postpartum mom plans to breast feed. The nurse determines that the clients understanting of breast feeding instructions is sufficient when she states: 1. Insulin will be transferred to the baby through breast milk 2. Breastfeeding is not recommended for diabetic mothers 3. Breast milk from diabetic mothers contains few antibodies 4. Breast feeding will assist in lowering maternal blood glucose

2

A mulitpara whose fundus is firm and midline at the umbilicus 8 hrs post vag birth tells the nurse that when she ambulated to the bathroom after sleeping for 4 hrs her dark red lochia seemed heavier. Which information would the nurse include when explaining to the client about the increased lochia on ambulation? 1. her bleeding needs to be reported to the HCP immediately 2. The increased lochia occurs from lochia pooling in the vaginal vault 3. the increase in lochia may be an early sign of postpartal hemorrhage 4. This increase in lochia usually indicates retained placental fragments

4 (slightly red tinged urine may indicate the bladder was accidentally cut during the cesarean birth. Notify the HCP)

A multigravid 30 year old has given cesarean birth to a healthy term female neonate due to an abnormal FHR tracing. At 2 hrs postpartum the nurse assesses the clients Foley and observes that the clients urine is slightly red tinged. What should the nurse do next? 1. continue to monitor the clients intake and output 2. palpate the clients fundus gently every 15 mins 3. Assess the placement of the Foley 4. Contact the HCP for further instructions

1

A primipara who gave vaginal birth to a viable term neonate 48 hrs ago has a midline episiotomy and repair of a 3rd degree laceration. When preparing the client for discharge, which assessment would be most important? 1. constipation 2 diarrhea 3. excessive bleeding 4. rectal fistulas

4 (pale and shaky could indicate hypovolemic shock primary cause is blood loss from uterine atony. Immed intervention for atony is fundal massage to help uterus contract and stop bleeding. Obtain vs etc after fundus and lochia assessed. glucose, temp, loc, infection and pain after handling the fundus)

A multigravid client gave birth vaginally 2 hrs ago. A family member notifies the nurse that the client is pale shaky. Which are the priority assessments for the nurse to make? 1. blood glucose and VS 2. temp and LOC 3. uterine infection and pain 4. fundus and lochia

4 (most likely cause retained placental fragments. The client may be scheduled for a D&C to remove remaining fragments. The other answers are associated with EARLY postpartum hemorrhage)

A multipara client visits the urgent care center after 5 days after a vaginal birth, experiencing persistent lochia rubra in a moderate to heavy amount. The client asks the nurse "Why amd I continuing to bleed like this?" The nurse should instruct the client that this type of postpartum bleeding most likely caused by which problem? 1. uterine atony 2. cervical lacerations 3. vaginal lacerations 4. retained placental fragments

4

A multipara, 28 hrs after a c section, who is breastfeeding has severe cramps. The nurse explains these are caused by: 1. flatulence accumulation after a c section 2. healing of the abdominal incision after c section 3. adverse effects of the meds administered after birth 4. release of oxytocin during the breast feeding session

3 (indicates DVT, ask the client to remain in bed, )

A multiparous client at 24 hrs postpartum is found to have a swelling and pain in her right leg.She demonstrates positive Homans sign with discomfort. The nurse should: 1. place a cold pack on the perineal area 2. place the client in Semi-Fowlers position 3. Notify the HCP immed 4. Ask the client to ambulate around the room

2

A new father feels left out of the bonding process because the mother breastfeeds. What is the most appropriate response by the nurse? 1. This is normal and these feelings will go away in a few days 2. holding, talking to and playing with the baby will facilitate bonding between baby and dad 3. bonding occurs later in the first year of life and Dad can become involved when the infant is better able to recognize him 4. Maternal infant bonding takes priority over paternal infant bonding.

4

A nurse is caring for a woman who gave birth to her baby boy 2 hrs ago. The nurse notes that the womans perineal pad contains some small clots and a moderate amount of lochia has accumulated under her buttocks. What is the first action the nurse should take at this time? 1. request prescription to admin oxytocin 2. perform an in and out cath immed 3. measure blood loss by measuring perineal pad 4. check fundus for position and consistency

1,2,3,5,6

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 1. My fertility can return as early as 21 days after the babys birth 2. I have the hospital phone number if I have any questions 3. If I have any breathing problems, chest pain, or pounding fast heart rate, I will seek medical assistance 4. My mother is coming to help for a month so I will be fine 5. I know if I get fever or chills or change in lochia to call the HCP 6. I will continue my prenatal vitamins until my postpartum checkup or longer

4

A nurse is explaining basic principles of asepsis and infection control to a client who has a respiratory tract infection following birth. The nurse determines the client understands principles of infection control to follow when the client says: 1. I must ask visitors to wear a mask 2. I must wear gloves when I handle the baby 3. I must use individual client care equipment 4. I must practice freq hand washing

4

A nurse is walking down the hall in the main corridor of a hospital when the infant security alert system sounds and a code for an infant abduction is announced. The first responsibility of the nurse when this situation occurs is to take which action? 1. move to the entrance of the hospital and check each person leaving 2. go to the OB unit to determine if they need help with the situation 3. Call the nursery to ask which baby is missing 4. Observe individuals in the area for large bags or oversized coats

1,2,4,5

A nurse working in the postpartum unit is asked to participate in the unit Client Safety Committee. The nurse wants to know what type of projects would be conducted for the unit. Select all that apply 1. prevention of infant abduction 2. safe med admin 3. adequate nourishment on unit 4. proper restraints used during procedures 5. maternal/infant ID system

1 (Initial regurgination in the neonate during the first 12-24 hrs may be caused by excessive mucus and GI irritation from foreign substances in the stomach. After the first 24 hours, regurgitation is thought to be caused by the neonates immature cardiac sphincter. It represents an overflow of stomach contents and is probably a result of feeding the neonate too much or too fast. A GI defect results in severe s/s. A small amount of regurgitation is normal, but vomiting or forceful fluid expulsion is not. Burping often during the feeding can decrease the amount of air in the stomach from swallowing. However the burping can lead the neonate to become tired or fussy. )

A pirmiparous client with a neonate who is 36 hrs old asks the nurse why does my baby spit up a small amount of formula after the feeding? The nurse explains that the regurgitation is thought to result from which factor? 1. an immature cardiac sphincter 2. a defect in the GI system 3. burping the infant too infrequently 4. moving the infant during feeding

3 (A uterine fundus off to one side and above the level of the umbilicus is commonly a result of a full bladder. Although the client had voided, the client may be experiencing urinary retention with overflow. If anesthesia had been used for birth the inability to void may be related to the lingering effect of anesthesia however, that is not the case her. HCP commonly write a one time prescription for cath, after which typically enough edema has subsided to make it easier and less painful for the client to void and completely empty her bladder. Waiting an hour to reassess could be detrimental since the clients distended bladder is interfering with uterin einvolution predisposing her to possible hemorrhage. )

A postpartum client gave birth 6 hrs ago without anesthesia and just voided 100 mL The nurse a=palpates the fundus two fingerbreadths above the umbilicus and off to the right side. What should the nurse do first? 1. admin ibuprofen 2. reassess in 1 hr 3. cath the client 4. obtain a prescription for fluid bolus

1

A postpartum multipara diagnosed with endometritis is to receive IV antibiotic therapy with ampicillin. before administering this drug the nurse must take which action? 1. ask the client drug allergies 2. assess the clients HR 3. Place the client in a side lying position 4. check the clients perineal pad

1

A primipara client 48 hrs after 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? 1. orange juice 2. herbal tea 3. milk 4. grape juice

1 (Downs is a genetic abnormality that is caused by an EXTRA chromosome)

A primiparous client who had a vaginal birth 1 hr ago voices anxiety because she has a nephew with Downs syndrome. After teaching the client about Down syndrome, which client statement indicates the need for further teaching? 1. Down syndrome is an abnormality that can result from a missing chromosome 2. Down syndrome usually results in some degree of mental retardation 3. There are several methods available to determine whether my baby has Down syndrome 4. Older mothers are more likely to have a baby with chromosomal abnormalities

2 (recommended that infants be given either breast milk or formula until at least 6 months of age because of difficulty with digestion. Giving foods early can lead to allergy. Chewing motions do not occur until 7-9 months of age)

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 which age? 1. 2 months 2. 6 months 3. 8 months 4. 10 months

1

A primiparous client with cephalopelvic disproportion 4 hrs after a cesarean, the client requests assistance in breast feeding to promote maximum maternal comfort which position would be the most appropriate for the nurse to suggest? 1. football hold 2. scissors hold 3. cross cradle hold 4. cradle hold

2 (eriksons trust vs mistrust stage. holding helps them develop trust in caregivers and is unlikely to spoil them.)

A teen primipara client 24 hrs postpartum asks the nurse how often she can hold her baby without spoiling him. which response by the nurse would be most appropriate? 1. hold him when he is fussy or crying 2. hold him as much as you want to hold him 3. try to hold him infrequently to avoid over stimulation 4. you can hold him periodically throughout the day

4 (The client needs further instruction when she says that she should begin feeding on the right breast to decrease pain. Starting the feeding on the unaffected breast can stimulate the milk ejection reflex in the right breast and thereby decrease the pain. )

AFter teaching a primipara client about treatment and self care of mastitis of the right breast the nurse determines that the client needs further instruction when she makes which statement? 1. I can apply localized heat to the infected area 2. I should increase my fluid intake to 2000 mL/day 3. I will need to take antibiotics for 7-10 days before I am cured 4. I should begin breast feeding on the right side to decrease the pain

1 (The entire feed should take 15-20 mins. The other options are correct for bottle feeding)

After instruction a primiparous client who is bottle feeding about burping which client statement indicates that the client needs further teaching? 1. I will burp him after 15 mins of feeding him formula 2. After he takes 1/2 ounces I will burp him 3. I will burp him while he is in an upright position 4. I will gently pat his back to get him to burp

3 (stored breast milk can be safely kept in the refrigerator for 5-7 days)

After the nurse teaches a primipara client planning to return to work in 6 weeks about storing breast milk, which client statement indicated the need for further teaching? 1. I can safely store my milk at room temp for 8 hrs 2. I will be sure to label the milk with the date time and amount 3. I must discard any breast milk stored for more than 3 days in the refrigerator 4. I can keep the milk in a deep freeze in clean glass bottles for up to 1 year

1 (Asians many believe in hot/cold theory of disease. and will often not drink cold fluid or eat cold food during postpartum period)

An Asian clients temp 10 hrs after delivery is 100.2 but when encouraged she refuses to drink ice water. Which of the following nursing actions is most appropriate? 1. replace the ice water with hot water 2. notify the HCP 3. reassess the temp in one-half hour 4. remind the client that drinking is very important

4 (on 11th day should be lochia alba, clear or white in color. Rubra first 2-3 days, serosa day 3-10.)

At a postpartum checkup 11 days after birth, the nurse asks the client about the color of her lochia. which color is expected? 1. dark red 2. pink 3. brown 4. white

1 (If not contraindicated for moral , cultural or religous reasons a condom with spermicide is commonly recommended for contraception after birth until the clients 6 week postpartal exam. Since the couple is asking, abstinence may not be acceptable to them)

During a home visit a breast feeding client asks the nurse what contraception method she and her partner should use until she has her 6 week checkup. Which method would be most appropriate for the nurse to suggest? 1. condom with spermicide 2. oral contraceptives 3. rhythm method 4. abstinence

4 (oxytocin=letdown reflex, prolactin = milk production)

During a home visit on the fourth postpartum day a primipara 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? 1. progesterone 2. estrogen 3. prolactin 4. oxytocin

1,2,5

During a postpartum assessment the nurse assesses the calves of a clients legs. The nurse is checking for which of the following sign/symptoms? Select all that apply 1. pain 2. warmth 3. discharge 4. ecchymosis 5. redness

1 (s/s of early postpartal hemorrhage, which is blood loss greater than 500 cc in the first 24 hrs. Rapid infusion of oxytocin, O2 therapy and fundal massage to contract the uterus are usually effective. If bleeding persists the nurse should inspect for lacerations. Place client in supine position to allow inspection of fundus. )

During the first hr postpartum assessment of a multiparous client who gave a cesarean birth to a neonate weighing 10 lbs 2 oz reveals a soft fundus with excessive lochia rubra. the nurse should include which intervention in the clients plan of care? 1. admin of IV oxytocin 2. placement of the client in a side lying position 3. rigorous fundal massage every 5 mins 4. preparation for an emergency hysterectomy

1 (common to get chill after delivery.)

Immed after delivery a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate? 1. provide the woman with warm blankets 2. put the woman in trendelenburg position 3. notify the HCP 4. Increase the IV infusion

4 (This question could be 2 or 4... according to different texts. but this one says once lochia has stopped and pain ceased about 3 weeks postpartum)

In preparation for discharge the nurse discusses the sexual issues with a multiparous client who had a routine vaginal birth with a midline episiotomy. The client asked 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? 1. In 6 weeks when the episiotomy is completely healed 2. after a postpartum check by the HCP 3. whenever the client is feeling amorous and desirable 4. when lochia flow and episiotomy pain have stopped

4 (heparin therapy is prescribed to prevent further clot formation by inhibiting further thrombus and clot formation. Heparin and anticoagulant does not make blood clots thinner. An adverse effect of heparin therapy during the puerperium is increased lochia flow, the nurse must be observant for s/s of hemorrhage such as heavy lochia flow. )

Prophylactic 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 instructions when she states which as the purpose of the drug? 1. to thin blood clots 2. to increase the lochia flow 3. to increase the perspiration for diuresis 4. to prevent further blood clot formation

3 (polyuria is normal. Blood volume reducing)

The day after delivery a woman whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse something must be wrong. "All I do is go to the bathroom" Which of the following is the appropriate nursing response? 1. cath the pt per Dr. orders 2. measure the clients next void 3. inform the client that polyuria is normal 4. check the specific gravity the next void

1,5 (are signs of postpartum infection. Bilateral engorgement is normal finding and typically responds to nursing interventions such as ice packs. Postpartum blues can cause the client to cry easily for up to 2 weeks postpartum. Soaking a peripad evey 3-4 hrs is normal lochia for a postpartum client within a week of birth.)

The nurse assesses a client who delivered vaginally 6 days ago, during a home visit. which finding should the nurse report immed. to the HCP? select all that apply 1. foul smelling lochia 2. engorged breasts bilaterally 3. client who cries easily 4. soaking 1 peripad every 3-4 hrs 5. temp of 100.8

1

The nurse assesses a swollen ecchymosed area to the right of an episiotomy on a primipara client 6 hours after vaginal birth. The nurse should next: 1. apply an ice pack to the perineal area 2. assess the clients temp 3. have the client take a warm sitz bath 4. contact the HCP for an antibiotic

1,4,6

The nurse assigns an UAP to care for a client who is 1 day postpartum. Which tasks would be appropriate to delegate to this person? select all that apply 1. changing the perineal pad and reporting the drainage 2. teaching the mother to latch the infant onto the breast 3. checking the location of the fundus prior to ambulating the client 4. reinforcing good hygiene while assisting the client with washing the perineum 5. discussing postpartum depression with the client who is found crying 6. assisting the client with ambulation shortly after birth

4

The nurse from the nursery is bring a newborn to a mothers room. The nurse took care of the mother yesterday and knows the mother and baby well. The nurse should implement which action next to ensure the safest transition of the infant to the mother? 1, assess whether the mother is able to ambulate to care for the infant 2. ask the mother if there is anything else she needs for the care of her baby 3. check the crib to determine if there are enough diapers and formula 4. Complete the hospital identification procedure with mother and infant

4

The nurse is caring for a multipara client after vaginal birth of a set of twins 2 hrs ago. The nurse should encourage the mother and partner to : 1. bottle feed the twins to prevent exhaustion and fatigue 2. plan for each parent to spend equal amounts of time with each twin 3. avoid assistance form other family members until attachment occurs 4. relate to each twin individually to enhance the attachment process

2 (milk is produced about day 3, colostrum is produced until that time)

The nurse is caring for a primipara who gave birth yesterday and has chosen to breastfeed. Which assessment finding is considered unusual for the client at this point postpartum" 1. diaphoresis 2. milk production 3. constipation 4. diuresis

1,4,5 (endometritis is an ascending infection from lower reproductive tract that contaminates the sterile uterine lining. )

The nurse is caring for a woman who gave birth vaginally 4 hrs ago. Which factors would likely contribute to the development of endometritis in this woman? select all 1. manual removal of the placenta 2. in and out cath during labor 3. epidural use 4. prolonged labor 5. placement of fetal scalp electrode

2 (increased pain with high parity, breastfeeding. contractions stronger in multigravida, and release of oxytocin when breastfeeding.)

The nurse is caring for several mom baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains? 1 G4 P1 breastfeeding 2. G3 P3 breastfeeding 3. G2P2 cesarean bottle feeding 4. G3 P3 bottle feeding

2 3 1 4

The nurse is catheterizing a client who cannot void after a normal birth 8 hrs ago. The nurse begins the catheterization process, and the client states "I forgot to tell the nurse I get hives to betadine" The nurse should take which steps in order of priority from first to last? Use all options 1. document the incident 2. clean povidone-iodine from the clients vaginal area 3. Notify the HCP 4. File an incident report

1,2,3,5 (babys feed more often than every 6-8 hrs)

The nurse is providing follow up care with clients 10 days after the birth of the NB. The nurse would anticipate what outcomes from the new mother. Select all that apply 1. the client feels tired but is able to care for herself and her new infant 2. The family has adequate support from one another and others 3. Lochia is changing from red to pink and is smaller in amount 4. the client feeds the baby every 6-8 hrs without difficulty 5. The client has positive comments about her new infant

4 (With breastfeeding DMPA can reduce initial production of breast milk, usually given to breastfeeding moms at postpartum checkup once milk established. Does last 3 months.)

The nurse is reviewing the discharge instructions with a postpartum breast feeding client who is going home. She has chosen depot medroxyprogesterone acetate as birth control. Which statement by the client identifies that she needs further instruction concerning birth control? 1. I will wait for my 6 week checkup to get my first DMPA injection 2. DMPA injections last for 90 days 3. My milk supply should be well established before receiving a birth control injection 4. You will give me my first DMPA injection before I leave today

2,3,4,5

The nurse is serving on the Quality Improvement Committee for the maternity unit. Quality improvement projects for this unit impacting safety and quality of care include which projects? 1. use of recycling bins on the unit 2. infant identification system 3. sibling and family visitation policies 4. postpartum discharge instructions 5. rooming in guidlines

4

The triage nurse in the pediatricians office returns a call to a mother who is breast feeding her 4 day old baby. The mother is concerned about the yellow seedy stool that has developed since discharge home. What is the best reply by the nurse? 1. This type of stool indicates the infant may have diarrhea and should be seen in the office 2. The stool will transition into a soft brown formed stool within a few days and is appropriate for breastfeeding 3. The stool results from the gassy food eaten by the mother, refrain from eating these foods while breastfeeding 4. soft seedy unformed stools with each feeding are normal findings for this age infant and will continue thru breast feeding

4 (A small constant trickle of blood and a firm fundus are usually indicative of vaginal tear or cervical laceration. If the client had retained placental tissue the uterus would fail to contract and be boggy. Also vaginal bleeding would be evident. Uterine inversion occurs when the uterus is displaced outside of the vagina and is obvious on inspection. Bladder distension may result in uterine atony or boggy because it would prevent the uterus from fully contracting. and it would be displaced from midline)

Three hours postpartum a primipara fundus is firm and midline. on perineal inspection, the nurse observes a small, constant trickle of blood. which condition should the nurse assess further? 1. retained placental tissue 2. uterine inversion 3. bladder distension 4. perineal lacerations

1 (continue monitoring VS during the first 24 hours it is normal to have a slight temp elevation. A temp of 100.4 that persists after the first 24 hrs may indicate infection. Bradycardia during the first week postpartum is normal because of decreased blood volume, diuresis and diaphoresis. )

When caring for a multiparous client 4 hrs after vaginal birth of a term neonate the nurse notes that the mothers temp is 99.8 F the pulse is 66 and the RR are 18 breaths. Her fundus is firm, midline, and at the level of the umbilicus. The nurse should: 1. continue to monitor the clients VS 2. assess the clients lochia for large clots 3. notify the HCP about the findings 4. offer the mother an icepack for her forehead

2 (prophylaxis for opthalmia neonatorum or neonatal blindness caused by gonorrhea in the mom. Also effective in the prevention of infection and conjunctivitis from chlamydia trachomatis. The med result in redness of the neonates eyes but this will disappear.)

When instilling erythromycin ointment into the eyes of a neonate 1 hr old the nurse would explain to the parents that the medication is used to prevent which problem? 1. chorioretinitis from cytomegalovirus 2. blindness secondary to gonorrhea 3, cataracts from beta-hemolytic streptococcus 4. strabisms resulting from neonatal maturation

3 (The nurse should encourage the client to maintain Fowlers which promotes comfort and facilitates drainage. No need to Dc breast feeding although she may be quite fatigued from condtion.)

Which intervention would be most important for the nurse to encourage in a primipara client diagnosed with endometritis who is receiving IV antibiotic therapy? 1. ambulate to the bathroom freq 2. DC breastfeeding temporarily 3. maintain bed rest in fowlers position 4. restrict visitors to prevent contamination

3

Which principle forms the basis for the teaching plan about avoiding nonprescription medication for a primipara client who is breastfeeding? 1. breast milk quality and richness are decreased 2. The mothers motivation to breast feed is diminished 3. medications may be excreted in breast milk 4. medication interfere with the mothers let down reflex

3 (all other recommendations are good. Instead the client should lie in the Sims position as much as possible to aid venous return to the rectal area and to reduce discomfort.)

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? 1. I should ask my HCP about using a stool softener 2. Analgesic sprays and witch hazel pads can relieve the pain 3. I should lie on my back as much as possible to relieve the pain 4. I should drink lots of water and eat foods that have alot of roughage

4

While the nurse is caring for a primparous 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 of the following responses by the nurse would be most appropriate? 1. ignore the clients question and continue with the morning care 2.tell the client Im not sure how the other woman is doing today 3. tell the client I need to ask the womans permission before discussing her well being 4. explain to the client that nurses are not allowed to discuss other clients on the unit

3

A Dr 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? 1. skim milk 2. ginger ale 3. OJ 4. chamomile tea

2 (oxytocin stimulates sexual orgasms and is also the hormone that stimulates the milk ejection reflex)

A breastfeeding mom 1 1/2 months postdelivery calls the nurse in the OB 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? 1. the woman is exhibiting pathological galactorrhea 2. the same hormone that stimulates orgasms and the milk ejection reflex 3. The woman should have a serum galactosemia assessment done 4. the baby is stimulating the woman to produce too much milk

2 (A right mediolateral episiotomy is angled away from the perineum and rectum Unless its a 3rd or 4th degree laceration they should be assured that the stitches are a distance away from the rectal area)

A client delivered a 3900 gram baby vaginally over a right mediolateral episiotomy states "How am I supposed to have a BM? The stitches are right there!" Which of the following is the best respose by the nurse? 1. I will call the Dr. for a stool softner for you 2. Your stitches are actually far away from the rectal area 3. If you eat high fiber foods and drink fluids you should have no problem 4. If you use your topical anesthetic on your stitches you will feel much less pain

2 (pain at 6.. pain med. Ice for the first 24 hrs and heat after 24 hrs is usual intervention for trauma. Sitz baths start at the end of ice therapy. sprays also can be used, but since the pain is a 6 use pain med first)

A client gave birth vaginally 2 hrs ago and has a 3rd degree laceration on her perineum. However her perineum is slightly edematous, and the client is having pain rated 6 on a 1-10 scale. which nursing intervention would be most appropriate at this time? 1. begin sitz baths 2. admin pain med per prescription 3. replace ice packs to the perineum 4. Initiate prescription anesthetic sprays to the perineum

1 (should assess level every 15 mins while in the post-anesthesia unit)

A client has been transferred to the post-anesthesia care unit from a c section. The client had spinal anesthesia for the surgery. Which of the following interventions should the nurse perform at this time? 1. assess the level of the anesthesia 2. encourage the client to urinate in a bedpan 3. provide the client with the diet of her choice 4. check the incision for sign of infection

1 (The client is encouraged to wait until involution is complete and the HCP confirms. )

A client who is 3 days postpartum asks the nurse "When may my husband and I begin to have sexual relations again?" The nurse should encourage the couple to wait until after which of the following has occurred? 1. the client has had her 6 week postpartum checkup 2. the episiotomy has healed and the lochia has stopped 3. the lochia has turned to pink and the vagina is no longer tender 4. the client has had her first postpartum menstrual period

2 (once the placenta is birthed the reservoir for the mothers large blood volume is gone. Monitor VS closely because of drop in volume increase risk CV compromise. bradycardia is a result of increased peripheral blood volume. )

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? 1. weight of the uterine body is significantly reduced 2. Excess blood volume from pregnancy is circulating in the womans periphery 3. cervix is fully dilated and lochia flows freely 4. maternal BP drops precipitously once the babys head emerges

2 (It is likely the medication was added during the 3rd stage of labor to promote placental delivery)

A mother G1 P1 who delivered a 2800 gram baby vaginally 30 mins earlier is transferred to the postpartum unit. She pushed for 45 minutes and the placenta was delivered 10 mins later. She is receiving an IV 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? 1. The medication was added 10 mins ago to prevent excess bleeding during her transfer 2. The medication was added immediately after the babys birth to promote placental delivery 3. The medication was added after the placenta was delivered because of its rapid separation 4. The medication was added while she was pushing to speed up the babys birth

4 (role of oxytocin, stimulates the uterus to contract in the postpartum period to reduce blood loss at the placental site. oxytocin is the same hormone that regulates the milk ejection reflex, therefore during breastfeeding the oxytocin stimulates the uterus to contract.)

A multigravid postpartum woman reports severe abdominal cramping whenever she nurses her baby. Which of the following responses by the nurse is appropriate? 1. suggest that the woman bottle feed for a few days 2. instruct the patient how to massage her fundus 3. instruct the patient to feed using an alternate position 4. discuss the action of breast feeding hormones

4 (although this is not traditional muslim dish, the foods are allowable)

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? 1. ham sandwich 2. bacon and eggs 3. spaghetti with sausage 4. chicken and dumplings

2 (common side effect of narcs is constipation. postop narcs are considered safe for breastfeeding. )

A post c section breastfeeding client whose subjective pain level is 2/5 requests her as needed prn narcotic analgesics every 3 hrs. 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 womans behavior? 1. the woman needs a stronger narc order 2. the woman is high risk for sever constipation 3. the womans breast milk volume may drop while taking the med 4. the womans NB may become addicted to the medication

1 (many clients who have received epidurals during labor complain of backache during the postpartum period

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? 1. backache 2. light headedness 3. hypertension 4. footdrop

2 (educating the client about caring for herself and infant are the two highest priority goals. Bonding is significant but is only one aspect of the needs of this client and the bonding process would have been implemented immed postpartum rather than waiting 2 hrs. Planning the discharge takes place after the initial education has taken place for mother and infant and the nurse is aware of needs for referrals. Safety is taught continuously by the nurse and should include maternal as well as NB safety)

A primigravid client gave birth vaginally 2 hrs ago with no complications. As the nurse plans for care for this postpartum client, which postpartum goal would have the highest priority? 1. by discharge the family will bond with the neonate 2. the nurse will demonstrate self care and infant care by the end of the shift 3. The nurse will state instructions for discharge during the first postpartum day 4. by the end of the shift the nurse will describe a safe home environment

3

A primipara, 2 hrs 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 info, the nurse concludes that the woman is exhibiting signs of which of the following? 1. social deprivation 2. child neglect 3. normal postpartum behavior 4. postpartum depression

2,4 (use warm tap water with nothing added, from front to back after each toileting and whenever changing peripads.)

The nurse has taught a new admit about pericare. Which of the following indicates that the client understands the procedure? select all that apply 1. The woman performs the procedure 2 x a day 2. The woman washes her hands before and after the procedure 3. The woman sits in warm tap water for 10 mins 3x a day 4. The woman sprays her perineum from front to back 5. The woman mixes warm tap water with hydrogen peroxide

1 (Use ice packs and cold. Dont stimulate breasts. Milk suppressants have serious side effects.)

The nurse in an OB clinic received a call from a bottle feeding mother of a 3 day old. The client states 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 1. intermittently apply ice packs to her axillae and breasts 2, apply lanolin to her breasts and nipples every 3 hrs 3. express milk from the breasts every 3 hrs 4. ask the HCP for a milk suppressant

2 (Prostaglandins are produced as part of the inflammatory response. Ibuprofen reduces pain and acts as antiinflammatory)

The nurse informs a postpartum woman that which of the following is the reason Ibuprofen (Advil) is especially effective for afterbirth pains? 1. Ibuprofen is taken every 2 hrs 2. Ibuprofen has an antiprostaglandin effect 3. Ibuprofen is given via the parenteral route 4. Ibuprofen can be administered in high doses

3 (Hct is well below normal, the hematocrit of a postpartum woman is likely to be below the norm of 35-45% but a hematocrit of 30% or lower is considered abnormal and should be reported. The other values are wnl for postpartum)

The nurse is assessing the lab report on a 2 day pospartum G1 P1001 The woman had a normal postpartum assessment this morning Which of the following results should the nurse report to the HCP? 1. WBC 12500 2. RBC 4,500,000 3. Hct 26% 4. Hgb 11

2 (The best tool to use is REEDA R-redness, E-edema, E-ecchymosis, D-drainage. If there is any of this it should be reported documented and monitored)

The nurse is assessing the midline episiotomy on a postpartum client. Which of the following findings should the nurse expect to see? 1. moderate serosanguinous drainage 2. well-approximated edges 3. ecchymotic area distal to the episiotomy 4. an area of redness adjacent to the incision

3 (the woman should cough and deep breathe every 2 hrs. Spinal anesthesia is administered direct to the spine, as a result spinal fluid is able to escape through the puncture wound. When there is a drop in the amt of spinal fluid, clients often develop severe headaches. It is recommended that clients who had spinals be elevated only slightly during the early post op period. )

The nurse is caring for a client who had a c section under spinal anesthesia less than 2 hrs ago. Which of the following nursing actions is appropriate at this time? 1. elevate the HOB to 60 degrees 2. report absence of bowel sounds to the HCP 3. have her turn and deep breathe every 2 hrs 4. assess for patellar hyperreflexia bilaterally

1 (ICE PACK. Sitz baths are appropriate beginning the 2nd postpartum day, usually 2-3 times a day. A 2nd degree laceration affects the skin, vaginal mucosa and underlying muscles. it does not affect the rectum or rectal sphincter. Because of the injury the area often swells causing pain, ice packs help to reduce the inflammatory response and numb the area )

The nurse is caring for a postpartum client who experienced a second degree perineal laceration at delivery 2 hrs ago. Which of the following interventions should the nurse perform at this time? 1. apply an ice pack to the perineum 2. advise the woman to use a sitz bath at every voiding 3. advise the woman to sit on a pillow 4. teach the woman to insert nothing into her rectum

1 (Seventh day adventist usually follow a vegetarian diet)

The nurse is caring for a seventh day adventist woman who delivered her baby boy by c section. Which of the following questions should be asked regarding this womans care? 1. Would you like me to order a vegetarian diet for you? 2. Is there anything special you will need for your Sabbath on Sunday? 3. Would you like to telephone your clergy to set up a date for baptism? 4. Will a rabbi be performing the circumcision on your baby?

2 (during the taking in phase clients need to internalize their labor experiences. Discussing the labor process is appropriate for this postpartum phase. At this time clients may need care given, help with bed bath, rest, eat.)

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? 1. teach baby care skills such as diapering 2. discuss labor and birth with the mother 3. discuss contraceptive choices with the mother 4. teach breastfeeding skills such as pumping

3 (When clients contract the buttocks before sitting they usually feel less pain than when they sit directly on the suture line. Teach not to favor one buttock. Mediolateral incisions, that are cut at approx a 45 degree angle from the perineum tend to be more painful than midline incisions.)

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? 1. assist with stitch removal on the 3rd postpartum day 2. administer analgesics every 4 hrs per dr orders 3. teach the client to contract her buttocks before sitting 4. irrigate the incision twice daily with antibiotic solution

2 (can be performed in any location and position. )

The nurse is discussing the importance of doing Kegel exercise during the postpartum period. Which of the following should be included in the teaching plan? 1. repeatedly contract and relax her rectal and thigh muscles 2. practice by stopping the urine flow mid stream every time she voids 3. get on her hands and knees whenever performing the exercise 4. be advised that her kegel exercises should be performed during all BM's

4 (acetaminophen and hydrocodone would be the drug of choice in this situation because of the high pain level. Although Ibuprofen would typically be a good choice because it inhibits the prostaglandin synthesis assoc with a multiparous client breastfeeding, the pain level is too high for this drug to have acceptable effect.)

The nurse is evaluating the client who gave birth vaginally 2 hrs ago and is experiencing postpartum pain rated 8 on a scale of 1-10. The client is a multigravida breastfeeding mother who would like medication to decrease the pain in her uterus. Which of the medications listed on the prescriptions sheet would be the most appropriate for this client? 1. aspirin 1000 mg PO q 4-6 PRN 2. ibuprofen 800 mg PO q 6-8 PRN 3. ducosate 100 mg PO bid 4. acetaminophen and hydrocodone 10 mg 1 tab PO q 4-6 PRN

2 (Mothers often do not feel bladder pressure after delivery. )

The nurse palpates a distended bladder on a woman who delivered vaginally 2 hrs earlier. the woman refuses to go to the bathroom. "I really dont need to go". Which of the following responses by the nurse is appropriate? 1. okay I must be palpating your uterus 2. I understand but I still would like you to try and urinate 3. you still must be numb from the anesthesia 4. that is a problem I will havee to cath you

3 (cramping is the expected outcome.)

The nurse should warn a client who is about to receive Methergine (ergonovine)of which of the following side effects? 1. headache 2. nausea 3. cramping 4. fatigue

2

The surgeon has removed the surgical c section dressing from a postop day 1 client. Which of the following actions by the nurse is appropriate? 1. irrigate the incision twice daily 2. monitor the incision for drainage 3. apply steristrips to the incision line 4. palpate the incision and assess for pain

2 (prolactin will elevate sharply in the clients bloodstream. progesterone and estrogen decrease with delivery of placenta. prolactin is no longer inhibited. How the woman feeds does not matter in this question)

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? 1. estrogen 2 prolactin 3. HPL 4. HCG

1 (after birth pains can be worse for multiparas. The nurse should suggest prn meds, ibuprofen especially, and try therapies such as lying on a small pillow and placing a hot water bottle on abdomen)

Which of the following complementary therapies can a nurse suggest to a multiparous client who is complaining of severe afterbirth pains? 1. Lie prone with a small pillow cushioning her abdomen 2. contract her abdominal muscles for a count of 10 3. slowly ambulate in the hall 4. drink ice tea with lemon or lime

1 (fundal assessment is the priority nursing action. hemorrhage is one of the primary causes of morbidity and mortality in postpartum women. It is essential that the nurses repeatedly assess a clients postpartum uterine contraction. When the uterus is well contracted it is unlikely that a woman will bleed heavily after delivery)

Which of the following is the priority nursing action during the immediate postpartum period? 1. palpate fundus 2. check the pain level 3. perform pericare 4. assess breasts

2 (The nurse would expect to see an elevated WBC count. The Hct, Hgb and RBC is often low in postpartum. )

Which of the following lab values would the nurse expect to see in a normal postpartum woman? 1. hct 31% 2. WBC 16000 3. RBC 5 million cells/mm 4. Hgb 15

3 (the nurse should forewarn the mother of the likelihood of a 2 year olds jealousy. It is normal but there is a potential for injury inadvertently.)

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? 1. its always nice when siblings are excited to have the babies go home 2. Your daughter is very advanced for her age, she must speak very well 3. Your daughter is likely to become very jealous of the new baby 4, Older sisters can be very helpful, they love to play mother

1 (the lactating breast produces milk in response to being stimulated. When a feed is skipped, milk is still produced for the baby. When the baby is not fed, breast congestion aka engorgement results. not only is it uncomfortable but it gives the body the message to stop producing milk resulting in insufficient supply)

A 3 day postpartum woman is being assessed. Her breasts are firm and warm to touch. When asked when she last fed the baby her reply is "I fed him last evening. I let the nurses feed him in the nurserey last night. I needed the rest." Which of the following actions should the nurse take at this time? 1. encourage the woman to exclusively breast feed the baby 2. have the woman massage her breasts hourly 3. obtain an order to culture her breast milk 4. take the temp and HR of the mother

2 (best way to prevent engorgement. )

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? 1. she pumps her breast after each feeding 2. she feeds her baby every 2-3 hrs 3. she feeds her baby 10 mins on each side 4. she supplements each feeding with formula

4 (fluids, fiber and exercise help.)

A client 2 days postop from a c section, complains to the nurse that she has yet to have a BM since the surgery. Which of the following responses by the nurse would be appropriate at this time? 1. that is very concerning, I will request that the HCP order an enema for you 2. Two days is not that bad. Some patients go 4 days or longer without a movement 3. You have been taking antibiotics through your IV. that is probably why you are constipated 4. Fluids and exercise often help to combat constipation. Take a stroll around the unit and drink lots of fluid.

4 (slow progression, no weight lifting or high impact or stressful aerobics until after 6 week check)

A client 2 days postpartum from a spont vag delivery asks the nurse about postpartum exercises. Which of the following responses by the nurse is appropriate? 1. you must wait to begin to perform exercises until after your six-week checkup 2. you may begin Kegel exercises today, but do not do any other exercises until the Dr. tells you it is safe 3. By next week you will be able to return to the exercise schedule you had during your prepregnancy 4. You can do some Kegel exercises today and then slowly increase your toning exercises over the next few weeks

3 (very important that legs moved together to avoid risk of back and abdominal injury)

A client G 2 P1102 is 30 mins postpartum from a low forceps vaginal delivery over a right mediolateral episiotomy. The HCP has just finished repairing the incision. The clients legs are in stirrups and she is breastfeeding her baby. which of the following actions should the nurse perform? 1. assess her feet for pitting edema 2. advise the client to stop feeding her baby while her BP is assessed 3. Lower both of her legs at the same time 4. Measure the length of the episiotomy and document the findings in the chart

4 (shows understanding)

A client G1 P1, who had an epidural has just delivered a daughter, Apgar 9/9, over a mediolateral episiotomy. The HCP used low forceps. While recovering the client states "I am a failure, I couldn't stand the pain and couldnt even push my baby out by myself" Which of the following is the best response for the nurse to make? 1. You'll feel better later after you have had a chance to rest and eat 2. Dont say that. There are many women who would be ecstatic to have that baby 3. I am sure that you will have another baby, I bet that will be a natural delivery 4. To have things work out differently than you had planned is disappointing.

4 (encourage ambulation, had a local.)

A client G1 P1001 , 1 hr postpartum from a spontaneous vag delivery with local anesthesia, states that she needs to urinate. Which of the following actions by the nurse is appropriate at this time? 1. provide the woman a bedpan 2. advise the woman that the feeling is likely from the trauma of delivery 3. remind the woman that she still has a cath in place from the delivery 4. assist the woman to the bathroom

4 (primigravid)

A nurse hears the following information on a newly delivered client. 21 years old, married, G1 P1001, 8 hrs post spontaneous vag delivery over intact perineum. Vitals: 110/70, 98.6. 82, 18 fundus firm at umbilicus, moderate lochia rubra, ambulated to bathroom to void 4 times, breastfeeding every 2 hrs. Which of the following nursing diagnosis should the nurse include in this clients nursing care plan? 1. fluid volume deficit r/t excess blood loss 2. impaired skin integrity r/t vaginal delivery 3. imparied urinary elimination r/t excess output 4. knowledge deficit r/t lack of parenting experience

4 (this blood loss is excessive especially for postop c-section. Placenta in c section is manually scraped, common for postop to have scanty lochia flow. )

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? 1. fundus at the umbilicus 2. nodular breasts 3. pulse rate 60 4. pad saturation every 30 mins

2 (stabalize. measuring tape used during preg... fingerwidth for postpartum)

A nurse is assessing the fundus of a woman immed postpartum period. Which of the following actions indicates that the nurse is performing the skill correctly? 1. the nurse measures the fundal height using a paper centimerter tape 2. The nurse stabalizes the base of the uterus with her dependant hand 3. the nurse palpates the fundus with the tips of her fingers 4. the nurse precedes the assessment with a sterile vag exam

2 (The nurse should accurately respond to the clients request. )

A nurse is caring for a postpartum client who state that she is putting her NB up for adoption. The clients asks the nurse to help her breastfeed her baby. which of the following responses by the nurse is appropriate? 1. are you sure you want to try breastfeeding? You wont be able to do it once you give your baby away 2. 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 3. If you stimulate your breasts to produce milk by having the baby breastfeed you may become engorged when your baby leaves you 4. You should be forewarned that breastfeeding is such an intimate experience that if you start feeding your baby that way you wont want to give him up

2 (The blues usually resolve within 2 weeks of delivery. Meds are not usually given, many women experience it. Blues is a normal phenomenon related to fatigue, shifts in hormone, and responsibility of becoming a mother. Postpartum depression and psychosis are pathological conditions that only some women will experience)

A nurse is counseling a woman about postpartum blues. Which of the following should be included in the discussion? 1. the father may become sad and weepy 2. Postpartum blues last about a week or two 3. medications are available to relieve the symptoms 4. Very few women experience postpartum blues

1,2,3,5 (Some are reticent to palpate the fundus because of the pain it causes, but if the fundus does not contract effectively the client is at high risk for hemorrhage)

A nurse is performing a postpartum assessment on a client who delivered by C section. Which of the following would the nurse perform? select all that apply 1. auscultate the abdomen 2. palpate the fundus 3. assess the nipple integrity 4. assess the central venous pressure 5. auscultate the lung fields

4 (Clients with abd incisions experience significant postop pain. And because the abdominal muscles have been incised, the pain is increased when the clients breathe in and cough. Bracing the abdominal muscles with a pillow or blanket helps to reduce the discomfort)

A woman had a c section yesterday. She states that she needs to cough but that she is afraid to. Which of the following interventions should the nurse perform at this time? 1. I know it hurts, but it is very important for you to cough 2. let me check your lung fields to see if coughing is really necessary 3. if you take a few deep breaths in that should be as good as coughing 4. if you support your incision with a pillow, coughing should hurt less.

2 (clients often experience nausea and or itching when pca narcs are administered.)

A woman is receiving PCA post c section. Which of the following must be included in the patient teaching? 1. The client should monitor how often she presses the button 2. the client should report any feelings of nausea or itching to the nurse 3. The family should press the button whenever they feel the woman is in pain 4. the family should inform the nurse if the client becomes sleepy

2 (this comment conveys sensitivity and understanding to the client. Clients who have birth plans can be disappointed and may express regret and or anger over changes. )

The nurse is caring for a woman post op 1 day from an emergency cesarean, with her husband in attendance. The babys Apgar score 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? 1. sometimes babys just dont deliver the way we expect them to. 2. With all of your preparations, it must have been disappointing for you to have had a cesarean 3. I know you had to have surgery, but you are very lucky that your baby was born healthy 4. At least your husband was able to be with you when the baby was born

4 (the fundus is usually 3 cm below the umbilicus on day 3 and the lochia is usually serosa by day 3. The lochia does not turn to alba until around day 10.)

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? 1. fundus 1 cm above the umbilicus, lochia rosa 2. fundus 2 cm above the umbilicus, lochia alba 3. fundus 2 cm below the umbilicus, lochia rubra 4. fundus 3 cm below the umbilicus, lochia serosa

3 (Lochia rubra is bright red, serosa is pinkish to brownish, and alba is whitish. The nurse would expect the fundus to descend below the umbilicus approx 1 cm per postpartum day. In other words, day 1 the fundus is usually felt 1 cm below the umbilicus. 2 days at 2 cm below and so on)

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 hr. What should the nurse document in the nursing record? 1. abnormal involution, lochia rubra heavy 2. abnormal involution, lochia serosa scant 3. normal involution, lochia rubra moderate 4. normal involution, lochia serosa heavy

4

The nurse is preparing to place a peripad on the perineum of a client who delivered her baby 10 mins earlier. The client states I dont use those I always use a tampon. Which of the following actions by the nurse is appropriate at this time? 1. remove the peripad and insert a tampon 2. advise the client that for the first two days she will be bleeding too heavily for a tampon 3. remind the client that the tampon will hurt until the soreness from the delivery resolves 4. State that it is unsafe to place anything in the vagina until involution is complete

2

To prevent infection the nurse teaches the postpartum client to perform which of the following tasks? 1. apply antibiotic ointment to the perneum daily 2. change the peripad at each void 3. void at least every 2 hrs 4. spray the perineum with povidone-iodine after toileting

2 (evidence shows breastfeeding moms have less likelihood of developing diabetes type 2 later in life.)

Which of the following statements is true about breastfeeding mothers as compared to bottle feeding moms? 1. breastfeeding moms usually involute completely by 3 weeks postpartum 2. breastfeeding moms have decreased incidence of diabetes mellitus later in life 3. breastfeeding moms show higher levels of bone density after menopause 4. breastfeeding mothers are prone to fewer bouts of infection immed postpartum

1

a 3 day postpartum 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? 1. the woman should not become preg. for at least 4 weeks 2. the woman should pump and dump her breastmilk for 1 week 3. surgical masks must be worn by the mom when she holds her baby 4. antibodies transported through the breast milk will protect the baby

2

When teaching a primiparous client about the growth and development of the neonate the nurse should explain that most babies are able to drink independently from a sippy cup at what age? 1. 5-7 months 2. 8-10 months 3. 12-14 months 4. 15-16 months

4

Which client statement indicates effective teaching about burping a breastfed infant? 1. breastfed babies who are burped freq will take more on each breast 2. If I supplement the baby with formula, I will rarely have to burp the baby 3. I will breast feed my baby every 3 hrs so I will not have to burp the baby 4. When I switch to the other breast I will burp the baby

4 (condition is called distasis recti, a separation of the longitudinal muscles of the abdomen that is usually palpable on the 3rd postpartum day. An exercise involving raising the head and shoulders about 8 inches with the client lying on her back with knees bent and hands crossed over the abdomen is preferred. This helps to pull the abdominal muscles together , and the client gradually works up to performing this exercise 50 times per day. However until the diastasis has closed the client should avoid exercises that rotate the trunk, twist the hips or bend the trunk to one side. good posture and adequate diet assist in returning to prepreg state more quickly but do not resolve the separation of the abdominal muscles)

While assessing the fundus of multiparous client 36 hours after birth of a term neonate, the nurse notes a separation of the abdominal muscles. The nurse should tell the client: 1. that she will have a surgical repair at 6 weeks postpartum 2. to remain on bed rest until resolutions occurs 3. that the separation will resolve on its own with the right posture and diet 4. to perform exercises involving head and shoulder raising in a lying position

4

While assisting a primipara with her first breastfeeding, which action should the nurse instruct the mother to do to stimulate the neonate to open the mouth and grasp the nipple? 1. pull down gently on the neonates chin and insert the nipple 2. squeeze both of the neonates cheeks simultaneously 3. place the nipple into the neonates mouth on top of the tongue 4. brush the neonates lips lightly with the nipple

2 (major complication of DVT is pulmonary embolus. S/s which can occur suddenly and require immed Tx include; dyspnea, severe chest pain, apprehension, cough, maybe with hemoptysis, tachycardia, fever, hypotension, diaphoresis, pallor, SOB, and fiction rub. pain in the calf is common. Also some of these signs could indicate possible hemorrhage secondary to heparin therapy. bradycardia the first 7 days postpartum is normal)

While caring for the client who is receiving treatment with bed rest and IV heparin therapy for a DVT the nurse should contact the clients HCP immed if the client exhibited which symptom? 1. pain in her calf 2. dyspnea 3 HTN 4. bradycardia

2 (assess source of pain.)

A postpartum woman has unrelenting pain in her rectum after vaginal birth despite administration of pain medications. Which action is most indicated? 1. administering additional pain med 2. assessing the perineum 3. reassuring the client that pain is normal after vaginal birth 4. preparing a warm sitz bath for the client

3

A client has just been transferred to the postpartum unit from L&D. which of the following tasks should the RN delegate to the NA? 1. assess the fundal height 2. teach the client how to massage the fundus 3. take the clients VS 4. document the quantity of lochia in the chart

1

A primapara client diagnosed with cystitis at 48 hrs postpartum who is receiving IV ampicillin asks the nurse "Can I still continue to breastfeed my baby?" The nurse should tell the client: 1. you can continue to breast feed as long as you want 2. Alternate your breast feding with formula feeding to help you rest 3. you will need to DC breastfeeding until the antibiotic therapy is stopped 4. you will need to modify your technique by manually pumping your breasts

2 (expect lochia alba. The normal progression: day 1-3 = lochia rubra. Day 3-10 = lochia serosa. Day 10-stop = lochia alba. Should not revert backward to rubra etc)

During a home visit the nurse assesses a client 2 weeks after delivery. Which of the following s/s should the nurse expect to see? 1. diaphoresis 2. lochia alba 3. cracked nipples 4. HTN

3 (probably postpartum depression. Should be seen by HCP. Usually Tx with psychotherapy, social support groups, antidepressants. Contributing factors include; hormonal fluctuations, history of depression, environmental factors ie; job loss; An estimated 50-70% of women experience some degree of postpartum blues, but these feelings of sadness disappear within 1-2 weeks of birth. However the client is voicing more than just sadness. )

During a home visit to a primipara client who gave birth vaginally 14 days ago, the client says "I have been crying a lot in the past few days, I just feel so awful". "I am a rotten mother. I just do not have any energy, plus my husband just got laid off from his job" The nurse obseves that the clients appearance is disheveled. What would be the nurses best response? 1. These feelings commonly indicate symptoms of postpartum blues and are normal. They will go away in a few days 2. I think you are probably overreacting to the labor and birth process. You are doing the best you can as a mother. 3. It is not unusual for some mothers to feel depressed after the birth of a baby. I think I should contact your HCP 4. This may be symptom of a serious mental illness. I think you should probably go to the hospital

1 (do not crush break or chew. take with juice)

The nurse has provided teaching to a post op c section client who is being discharged on Colace (ducusate sodium) 100 mg PO tid. which of the following would indicate the teaching is successful? 1. The woman swallows the tablets whole 2. The woman takes the tablets between meals 3. The woman calls the HCP if she develops a headache 4. The woman understands her urine may turn orange

3 (blood volume does drop precipitously during the early postpartum period. estrogen levels decrease. urinary output increases. BP should remain stable)

The nurse monitors the postpartum clients carefully because which of the following physiological changes occur during the early postpartum period? 1. decreased urinary output 2. increased blood pressure 3. decreased blood volume 4. increased estrogen level

1 (discharge teaching should be initiated at the time of admission. Will likely repeat instruction before discharge)

The nurse must initiate the discharge teaching with the couple regarding the need for an infant car seat for the day of discharge. Which of the following response indicates that the nurse acted appropriately? The nurse discussed the need with the couple: 1. on admission to the labor room 2. in the client room after delivery 3. when the client put the baby to breast the first time 4. The day before the client and baby are to leave the hospital

3 1 4 2 (Admission assess ASAP, Draw blood right after NB assess, 0600 IV, and IV as close to change of shift as possible)

The nurse on a mother baby unit who is working on the night shift is revising the planning worksheet for the remaining two hrs of the shift. The nurse has tasks and prescriptions to complete prior to the change of shift at 0700. Using the work plan below, how should the nurse organize the tasks from first to last so that everything is completed by 0700? use all options 1. draw blood for the prescribed lab tests. (CBCs) on threes postpartum clients with report on medical records by shift changes 2. Start IV of D5 1/2 NS at keep vein open rate on postpartum client just prior to change of shift 3. complete admission assessment of NB turned over to nurse at 0500 4. Draw NB bilirubin level at 0600

2

The nurse takes a NB 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? 1. positive bonding and client needs a little teaching 2. positive bonding but teaching related to NB care is needed 3. Poor bonding and referral to a child abuse agency is essential 4. poor bonding but there is potetial for positive mothering

3 (most important... bleeding)

A client has just been transferred to the postpartum unit from labor and delivery. Which of the following nursing care goals is of the highest priority? 1 The client will breastfeed her baby every 2 hrs 2. The client will consume a normal diet 3. The client will have moderate lochia flow 4. The client will ambulate to the bathroom every 2 hrs

4 (Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day." Many mothers who consume approximately the same number of calories while breastfeeding as they did when they were pregnant do lose weight while breastfeeding Mothers should be advised to eat a well-balanced diet and drink sufficient quantities of fluids while breastfeeding. There is no absolute number of calories that the mother should consume, but if she does go on a restrictive diet, it is likely that her milk supply may dwindle. Babies do take in about 600 calories a day)

A 3 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? 1. It is fine for you to start dieting right now as long as you drink plenty of milk 2. Your breast milk will be low in vitamins if you start to diet while breastfeeding 3. you must eat at least 3000 calories a day in order to produce enough milk for your baby 4. many mothers lose weight when they breastfeed because the baby consumes 600 calories a day

1

A 3 day postpartum woman questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurses response? 1. the clients obstetric status is optimal for receiving the vaccine 2. The clients immune system is highly responsive during the postpartum period 3. the clients baby will be high risk for acquiring rubella if the woman does not receive the vaccine 4. The clients insurance company will pay for the shot if it is given during the immediate postpartum period

1 (a urine tox screen will be collected to document that the infant has been exposed. This documentation will be the basis for legal action for the protection of the infant. If the infant tests positive the legal system will be activated. Hospital security would not become involved unless mom is using drug on premises. The mother and infant have the same privileges as do any hospitalized clients unless the babys safety is jeopardized. )

A client has admitted to use of cocaine prior to beginning labor. After the infant is born, the nurse should anticipate the need to include which actions in the infants plan of care? 1. urine toxicology screening 2. notifying hospital security 3. limiting contact with visitors 4. contacting law enforcement

4,5 (wear a supportive bra for 24 hrs a day for a week or so. Dont get warm water or heat breasts, do not massage)

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 1. increase her fluid intake for a few days 2. massage her breasts every 4 hrs 3. apply heat packs to her axillae 4. wear a supportive bra 24 hrs a day 5. stand with her back to the shower water

3 ( At any point the lochia should be dark in color and not bright red. The volume should not be great enough to trickle from the vagina. Since the fundus is firm it and bladder not distended may be bleeding from lacerations and requires the HCP to assess. The hct and hgb will only give background info not determine the cause)

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 VS remain at their baseline. Based on this information, the nurse would implement which action? 1. increase the IV rate 2. recheck the admission hct and hgb levels 3. report the findings to the HCP 4. document the findings as normal

2

A newly post partum primpara client asks the nurse can my baby see? which statement about neonatal vision should the nurse include in the explanation? 1. neonates primarily focus on moving objects 2. They can see objects up to 12 inches away 3. usually they see clearly by about 2 days after birth 4. Neonates primarily distinguish light from dark

2,3,4

A nurse is caring for a client who is 3 days postpartum and breastfeeding her baby girl. The following assessment is made by the nurse: episiotomy area; red and edematous, breasts; firm and tender on palpation; fundus; firm 2 finger breadths below the umbilicus. What nursing actions are indicated? select all that apply 1 suggest the client apply cool compresses to breasts 2. encourage the client to sit on a supportive device 3. ask the client how often the baby feeds 4. suggest the client take cool sitz baths twice a day 5. obtain specimen from culture and sensitivity from episiotomy site

2

A primipara 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? 1. ask for some pain medication before you sit down 2. squeeze your buttock muscles together before sitting down. 3. keep a relaxed posture before sitting down with your full weight 4. ask the HCP for some analgesic spray or cream

4

A primipara client who is beginning to breast feed her neonate asks the nurse Is it important for my baby to get colostrum? When instructing the client the nurse would explain that colostrum provides the neonate with : 1. more fat than breast milk 2. vitamin K which the neonate lacks 3. delayed meconium passage 4. passive immunity from maternal antibodies

2 (bottle feeding in 6-10 weeks it should return after a rise in the production of follicle stimulating hormone by the pituitary gland. Nonlactating mothers rarely ovulate before 4-6 weeks postpartum. When breast feeding the flow may not return for 3-4 months or 12-16 weeks, or for some women the entire period of lactation because ovulation may be supressed.)

A primipara who is bottle feeding asks the nurse when her menstrual cycle will return, Which response by the nurse would be most appropriate? 1. in 3-4 weeks 2. 6-10 weeks 3. 12-14 weeks 4. 16-18 weeks

3 (diaphoresis is normal during the postpartum period. Because the blood volume is returning to normal the client loses fluids via both the kidney and through insensible loss.)

A woman 24 hours postpartum complains of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate? 1. take the womans temp 2. advise the woman to decrease fluid intake 3. reassure the woman this normal 4. notify the womans pediatrician

1 (Immed after the delivery of the placenta the nurse would expect to palpate the fundus halfway between the umbilicus and the symphysis pubis. Within 2 hrs the fundus should be palpated at the level of the umbilicus. the fundus remains at this level or may rise slightly above the umbilicus for approx. 12 hrs. After the first 12 hrs the fundus should decrease one fingerbreadth, per day in size; 1 cm; by the 9th-10th day the uterus is no longer palpable)

At which location would the nurse expect to palpate the fundus of a primiparous client immediately after birth of the neonate? 1. halfway between the umbilicus and the symphysis pubis 2. at the level of the umbilicus 3. just below the level of the umbilicus 4. above the level of the umbilicus

1 (By 4-6 weeks the fundus should be deep in the pelvis and the size of unpreg utererus. Subinvolution caused by infection or retained placenttal fragments is a problem associated with a uterus that is larger than expected at this time.)

The nurse is assessing a client at her postpartum checkup 6 weeks after a vag birth. The mother is bottle feeding her baby. Which client finding indicates a problem at this time? 1. firm fundus at the symphysis 2. white thick vaginal discharge 3. striae that are silver in color 4. soft breasts without milk

2

While the nurse is assessing the fundus of a 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? 1. as long as you do not get pregnant again the marks will disappear completely 2. they usually fade to a silvery white color over a period of time 3. you will need to use a specially prescribed cream to help them disappear 4. if you lose the weight you gained during pregnancy the marks will fade to a pale pink