OB Chapter 12
After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, which statement indicates the need for additional teaching? a) "I might lose some hair, but it will grow back." b) "I can't wait for these stretch marks to disappear after delivery." c) "My nipples won't be so dark after I give birth." d) "This line on my belly will go away over time."
"I can't wait for these stretch marks to disappear after delivery."
You are the home health nurse making an initial call on a new mother who delivered her third baby five days ago. The woman says to you "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother? a) "It sounds like you need to make an appointment with a counselor. You may have postpartum depression." b) "It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the delivery. They will most likely go away in a day or two." c) "Every baby is different with their own temperament. Maybe this one just isn't ready to sleep when you want him to." d) "Tell me, are you seeing things that aren't there, or hearing voices?"
"It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the delivery. They will most likely go away in a day or two."
A new mother is concerned because it is 24 hours after childbirth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? a) "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs." b) "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in." c) "It takes about 3 days after birth for milk to begin forming." d) "You may have developed mastitis. I'll ask the physician to examine you."
"It takes about 3 days after birth for milk to begin forming."
A postpartum client who is bottle feeding her newborn asks, "When should my period return?" Which response by the nurse would be most appropriate? a) "It varies, but you can estimate it returning in about 7 to 9 weeks." b) "It's difficult to say, but it will probably return in about 2 to 3 weeks." c) "You won't have to worry about it returning for at least 3 months." d) "You don't have to worry about that now. It'll be quite a while."
"It varies, but you can estimate it returning in about 7 to 9 weeks."
An 20-year-old primipara is getting ready to go home. She had a second-degree episiotomy with repair. She confides in the nurse that she is afraid to go to her postpartum checkup because she is afraid to have the stitches removed. Which reply by the nurse is best? a) "It doesn't hurt when the midwife takes out the stitches. You will only feel a little tugging and pulling sensation." b) "Many women have that fear after having an episiotomy. The stitches do not need to be removed because the suture will be gradually absorbed." c) "Oh, you mustn't miss your follow-up appointment. Don't worry. Your midwife will be very gentle." d) "It is very important for you to go to your checkup visit. Besides, the stitches do not have to be removed."
"Many women have that fear after having an episiotomy. The stitches do not need to be removed because the suture will be gradually absorbed."
Two days after giving birth, a client is to receive RhoGAM. The client asks the nurse why this is necessary. The most appropriate response from the nurse is: a) "RhoGAM suppresses antibody formation in a woman with Rh-positive blood who gave birth to a baby with Rh-negative blood." b) "RhoGAM suppresses antibody formation in a woman with Rh-negative blood who gave birth to a baby with Rh-positive blood." c) "RhoGAM suppresses antibody formation in a woman with Rh-positive blood who gave birth to a baby with Rh-positive blood." d) "RhoGAM suppresses antibody formation in a woman with Rh-negative blood who gave birth to a baby with Rh-negative blood."
"RhoGAM suppresses antibody formation in a woman with Rh-negative blood who gave birth to a baby with Rh-positive blood."
Which instruction should the nurse provide to a breast-feeding woman experiencing breast engorgement? a) "Take a warm shower just before feeding your infant." b) "Wear a supportive tight bra all day long." c) "Try not to touch your breasts or nipples until the swelling subsides." d) "Use ice for about 15 minutes every other hour to promote comfort."
"Take a warm shower just before feeding your infant."
A client who is breast-feeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" Which response by the nurse would be most appropriate? a) "Let me check your vaginal discharge just to make sure everything is fine." b) "Your uterus is still shrinking in size; that's why you're feeling this pain." c) "The baby's sucking releases a hormone that causes the uterus to contract." d) "Your body is responding to the events of labor, just like after a tough workout."
"The baby's sucking releases a hormone that causes the uterus to contract."
Your patient is very conscious of the weight she gained during her pregnancy. She has decided to breastfeed her baby and asks you how many calories a day extra she should be eating so that she and her baby are healthy. She states she does not want to gain any extra weight from over-eating. What would be your best response? a) "You have a nice slender body type. Just eat what you want and you will do fine." b) "You need to keep eating just like when you were pregnant. That gives you about 300 kcal extra every day." c) "You should be eating an extra 200 kcal over what you were eating while you were pregnant." d) "You are eating for two now. Besides, you are breastfeeding and you will lose your pregnancy weight very quickly."
"You should be eating an extra 200 kcal over what you were eating while you were pregnant."
After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention? a) Fundus firm, below umbilicus b) Presence of lochia serosa c) Milk filling in both breasts d) Frequent scant voidings
Frequent scant voidings
Five days after giving birth, a new mother tells her nurse that she has lost some weight but still feels as if she has a long way to go to return to her prepregnancy weight. She asks what the average weight loss at 5 days into the postpartal period is. Which of the following should the nurse mention? a) 9 lb b) 14 lb c) 24 lb d) 19 lb
19 lb
The nurse is assigned to a patient on postpartum day 1. Prior to assessing her uterus, where should the nurse anticipate she will locate the fundus? a) At level of umbilicus b) 1cm below the umbilicus c) At the symphysis pubis d) 1cm above the umbilicus
1cm below the umbilicus
A nurse is caring for a client on the second day postpartum. The client informs the nurse that she is voiding a large volume of urine frequently. Which of the following should the nurse identify as a potential cause for urinary frequency? a) Postpartum diuresis b) Urinary overflow c) Trauma to pelvic muscles d) Urinary tract infection
Postpartum diuresis
Bonding between a mother and her infant can be defined how? a) A process of developing an attachment and becoming acquainted with each other b) An ongoing process in the year after delivery c) The skin to skin contact that occurs in the delivery room d) Family growing closer together after the birth of a new baby
A process of developing an attachment and becoming acquainted with each other
A patient who delivered her infant 3 days ago and was discharged home calls her provider's office with a complaint of sweating all night. What is the cause of the increased perspiration? a) Change in pregnancy hormone b) The patient may be drinking too much fluid c) The body is trying to get rid of the extra blood made during pregnancy d) Body secreting the excess fluids from pregnancy
Body secreting the excess fluids from pregnancy
One thing a new mother does is to adapt to the new baby psychologically. The woman takes on her new role as mother by going through a series of four developmental stages. What is one of them? a) Preparing for the infant before she conceives b) Physical restoration and learning to get help in caring for the infant c) Finding a way to get the new baby to conform to existing family interrelationships d) Achieving a maternal identity
Achieving a maternal identity
The night shift LPN is checking on a woman who had a cesarean delivery with spinal Duramorph anesthesia early that morning. The nurse counts a respiratory rate of eight per minute. What should the nurse do first? a) Awaken the woman and instruct her to breathe more rapidly. b) Call the anesthesiologist from the room for orders. c) Administer naloxone (Narcan), per the preprinted orders. d) Perform bag-to-mouth rescue breathing at a rate of 12 per minute.
Administer naloxone (Narcan), per the preprinted orders.
A woman is bottle-feeding her baby. When the nurse comes into the room the woman says that her breasts are painful and engorged. Which nursing intervention is appropriate? a) Explain to the woman that she should breastfeed because she is producing so much milk b) Assist the woman in placing ice packs on her breasts c) Assist the woman into the shower and have her run cold water over her breasts d) Ask if she wants a breast pump to empty her breasts
Assist the woman in placing ice packs on her breasts
A primipara client gave birth vaginally to a healthy newborn girl 12 hours ago. The nurse palpates the client's fundus, expecting it to be: a) At the level of the umbilicus b) Two fingerbreadths below the umbilicus c) Four fingerbreadths below the umbilicus d) Two fingerbreadths above the umbilicus
At the level of the umbilicus
A woman has just delivered a baby. Her prelabor vital signs were T - 98.8 B/P-P-R 120/70, 80, 20. Which combination of findings during the early postpartum period are the most concerning? a) Shaking chills with a fever of 100.3 b) B/P-P-R 90/50, 120, 24 c) Bradycardia and excessive, soaking diaphoresis d) Blood loss of 250 mL and WBC 25,000 cells/mL
B/P-P-R 90/50, 120, 24
On assessment of a 2-day postpartum patient the nurses finds the fundus is boggy, at U and slightly to the right. What is the most likely cause of this assessment finding? a) Uteruine atony b) Full bowel c) Bladder distention d) Poor bladder tone
Bladder distention
The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which of the following would the nurse expect to find when assessing the client's fundus? a) 6 cm below the umbilicus b) Cannot be palpated c) 10 cm below the umbilicus d) 2 cm below the umbilicus
Cannot be palpated
The nurse should teach the postpartum woman about perineal self-care by instructing her to: a) Cleanse with warm water in a squeeze bottle from front to back. b) Perform perineal self-care at least twice a day. c) Remove perineal pads from the rectal area toward the vagina. d) Use cool water to decrease edema of the perineum.
Cleanse with warm water in a squeeze bottle from front to back.
The nurse assesses a 4-inch stain of lochia rubra on a pad after it had been applied for one hour. The nurse would document this quantity as: a) Moderate b) Small c) Scant d) Large
Small
For several hours after delivery, Norah, a multigravida who experienced a much more difficult labor this time than any time previously, wants to talk about why the birthing process was so hard for her this time. In fact, she's focusing on this aspect to the point that she seems relatively indifferent to her newborn. How should you handle this situation? a) Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings b) Encourage her to discuss her experience of the birth and answer any questions or concerns she may have c) Point out positive features of her baby and encourage her to hold and cuddle the baby d) Redirect her attention to the baby by reminding her of the details of newborn care
Encourage her to discuss her experience of the birth and answer any questions or concerns she may have
The patient under your care is complaining she has not had a bowel moment since her infant was born 2 days ago. She asks the nurse what she can do to help her have a bowel movement. What intervention is appropriate to encourage having a bowel movement? a) Add dairy products to the patient's diet b) Have her hold her feces until she really feels the need to defecate c) Encourage the patient to eat more fiber rich foods d) Offer the patient a stimulant laxative
Encourage the patient to eat more fiber rich foods
The nurse is assessing a breastfeeding mom 72 hours after delivery. When assessing her breast, the patient complains of bilateral breast pain around the entire breast. What is the most likely cause of the pain? a) Mastitis b) Blocked milk duct c) Interductal yeast infection d) Engorgement
Engorgement
Twelve hours after delivery, the fundus of a woman who has just delivered her fifth child after 14 hours of labor is two fingers above the umbilicus and her uterus feels soft and spongy. What should you do first? a) Put on the call button to summon help b) Gently massage the fundus until it tones up c) Administer oxytocics to prevent uterine atony d) Teach the woman to perform periodic self-fundal massage
Gently massage the fundus until it tones up
When the nurse is assessing a postpartum client approximately 6 hours after delivery, which finding would warrant further investigation? a) Deep red, fleshy-smelling lochia b) Profuse sweating c) Voiding of 350 cc d) Heart rate of 120 beats/minute
Heart rate of 120 beats/minute
Given a prepartum hemoglobin value of 14 gm/dL and hematocrit of 42 percent, which postpartum measurements should you report to the health care provider? a) Hemoglobin 11 gm/dL and hematocrit 34 percent in a woman who has given birth by cesarean b) Hemoglobin 13 gm/dL and hematocrit 40 percent in a woman who has given birth vaginally c) Hemoglobin 12 gm/dL and hematocrit 38 percent in a woman who has given birth vaginally d) Hemoglobin 9 gm/dL and hematocrit 32 percent in a woman who has given birth by cesarean
Hemoglobin 9 gm/dL and hematocrit 32 percent in a woman who has given birth by cesarean
The nurse is aware the complication of most concern with the highest priority for assessment in the first hour is what? a) Dehydration b) Bladder distention c) Hemorrhage d) Infection
Hemorrhage
The process by which the reproductive organs return to the nonpregnant size and function is termed what? a) Evolution b) Involution c) Decrement d) Progression
Involution
When caring for a mother who has had a cesarean birth, the nurse would expect the client's lochia to be: a) Greater than after a vaginal delivery b) Saturated with clots and mucus c) Less than after a vaginal delivery d) About the same as after a vaginal delivery
Less than after a vaginal delivery
You assess a postpartum woman's perineum and notice that her lochial discharge is moderate in amount and red. You would record this as what type of lochia? a) Lochia normalia b) Lochia serosa c) Lochia rubra d) Lochia alba
Lochia rubra
The correct order for the phases of lochia during the postpartum period is: a) Lochia serosa, lochia rubra, lochia alba b) Lochia rubra, lochia serosa, lochia alba c) Lochia rubra, lochia alba, lochia serosa d) lochia alba, lochia rubra, lochia serosa
Lochia rubra, lochia serosa, lochia alba
Which lochia pattern should be reported immediately? a) Lochia progresses from rubra to serosa to alba within 10 days b) Moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5 c) Moderate lochia rubra on day 3, mixed serosa and rubra on day 4, light serosa on day 5 d) Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5
Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5
A client needs to void 3 hours after a vaginal delivery. Which risk factor necessitates assisting her out of bed? a) Orthostatic hypotension b) Breast engorgement c) b) Chest pain d) Separation of episiotomy incisio
Orthostatic hypotension
A client delivered vaginally 2 days prior and wishes to prevent getting pregnant again. She asks the nurse when she will need to begin birth control measures. How should the nurse respond? a) Ovulation may return as soon as 3 weeks after delivery b) You may have intercourse until next month with no fear of pregnancy c) You will not ovulate until your menstrual cycle returns d) Ovulation does not return for 6 months after delivery
Ovulation may return as soon as 3 weeks after delivery
During a postpartum exam on the day of delivery, the woman complains that she is still so sore that she can't sit comfortably. You examine her perineum and find the edges of the episiotomy approximated without signs of a hematoma. Which intervention will be most beneficial at this point? a) Apply a warm washcloth b) Notify a physician c) Place an ice pack d) Put on a witch hazel pad.
Place an ice pack
During the fourth stage of labor, the nurse assesses the client's fundal height and tone. When completing this assessment, the nurse does which of the following to prevent prolapse or inversion of the uterus? a) Places index and middle fingers across the muscle b) Placing a gloved hand just above the symphysis pubis c) Massaging the fundus carefully to expel any blood clots d) Palpates the abdomen while feeling the uterine fundus
Placing a gloved hand just above the symphysis pubis
What is the primary function of uterine contractions after delivery of the infant and placenta? a) Return the uterus to normal size b) Seal off the blood vessels at the site of the placenta c) Stop the flow of blood d) Close the cervix
Seal off the blood vessels at the site of the placenta
In which position is it most appropriate to place the client when assessing the perineum? a) Supine b) Prone c) Sims d) Lithotomy
Sims
A postpartum client comes to the clinic for her 6-week postpartum check-up. When assessing the client's cervix, the nurse would expect the external cervical os to appear: a) Shapeless b) Slit-like c) Triangular d) Circular
Slit-like
You are providing postpartum care to a woman who has delivered by cesarean section. According to her records, simethicone, diphenhydramine, and naloxone have been ordered. Which of the following signs and symptoms should you report immediately to the RN or anesthesiologist? a) Slow respiration, less than 12 breaths per minute b) Intense itching manifested by scratching c) Difficulty coughing and turning d) Abdominal distension and pain
Slow respiration, less than 12 breaths per minute
A nurse is caring for a client in the postpartum period. The nurse observes that distention of the abdominal muscles during pregnancy has resulted in separation of the rectus muscles. What intervention should the nurse perform to assist in healing the distended abdominal muscles? a) Massaging the muscles b) Applying moist heat c) Applying warm compresses d) Suggesting proper exercise
Suggesting proper exercise
The nurse is assessing a postpartum patient's uterus. Which position will the nurse have the patient for this assessment? a) Supine b) Semi-fowlers c) Left-lateral side lying d) High-fowlers
Supine
Which of the following patients would the nurse be most concerned about on post partum day 1? a) Temp: 99.4F, HR 90, RR 18, BP 112/67 b) Temp: 100.4F, HR 65, RR 22, BP 130/78 c) Temp: 97.0F, HR 80, RR 20, BP 120/72 d) Temp: 98.6F, HR 74, RR 16, BP 150/85
Temp: 98.6F, HR 74, RR 16, BP 150/85
Identify the false statement: a) Exfoliation is important to the healing of the placental site because it helps to prevent scarring, which could prevent future pregnancies b) The decrease in size of the uterus as a result of involution is due to a decrease in the number of myometrial cells after delivery c) The mother may experience afterpains for 2-3 days following delivery d) When assessing the psychosocial aspects of the PP woman, it is not unusual to find that she needs to discuss her labor and birth experience
The decrease in size of the uterus as a result of involution is due to a decrease in the number of myometrial cells after delivery
Which reason explains why women should be encouraged to perform Kegel exercises after delivery? a) They assist the woman in burning calories for rapid postpartum weight loss. b) They promote the return of normal bowel function. c) They assist with lochia removal. d) They promote blood flow, enabling healing and muscle strengthening.
They promote blood flow, enabling healing and muscle strengthening.
Based on the nurse's knowledge about the postpartum period and an increase in blood coagulability during the first 48 hours, the nurse closely assesses the client for which of the following? a) Calcium depletion b) Thromboembolism c) Varicose veins d) Hyperglycemia
Thromboembolism
A nurse is caring for a client with postpartum hemorrhage. Which of the following should the nurse identify as the significant cause of postpartum hemorrhage? a) Iron deficiency b) Hemorrhoid c) Uterine atony d) Diuresis
Uterine atony
The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? a) Lochia serosa b) Edematous vagina c) Diaphoresis d) Uterus 1 cm below umbilicus
Uterus 1 cm below umbilicus
The nurse is providing education to a mother who is going to bottle feed her infant. What information will the nurse provide to this mom regarding breast care? a) Express small amounts of milk when they are too full b) Run warm water over the breast in the shower c) Massage the breast when they are painful d) Wear a tight, supportive bra
Wear a tight, supportive bra
While visiting a client at home on the 10th day postpartum, the nurse assesses the client's lochia. Which of the following would the nurse interpret as an expected finding? a) Yellowish white b) Yellowish pink c) Pink d) Red
Yellowish white
A woman who gave birth to a healthy newborn 2 months ago comes to the clinic and reports discomfort during sexual intercourse. Which suggestion by the nurse would be most appropriate? a) "This is entirely normal, and many women go through it. It just takes time." b) "Try doing Kegel exercises to get your pelvic muscles back in shape." c) "It takes a while to get your body back to its normal function after having a baby." d) "You might try using a water-soluble lubricant to ease the discomfort."
You might try using a water-soluble lubricant to ease the discomfort."
The nurse working on a postpartum must check lochia in terms of amount, color, change with activity and time, and: a) pH b) specific gravity c) consistency d) odor
odor