OB Chapter 9 NCLEX

The statement that indicates the new mother is breastfeeding correctly is: a. "I will put the baby first on the breast that she took last in the previous feeding." b. "I keep the baby on a 4-hour feeding schedule." c. "I let the baby stay on the first breast only 5 minutes." d. "I put only the nipple in the baby's mouth when I am breastfeeding."

A. "I will put the baby first on the breast that she took last in the previous feeding." Rationale: Alternating breasts increases milk production, particularly hindmilk, which has a higher protein and fat content.

The nurse counseling a lactating mother about diet would include instructions to: a. consume 500 more calories than her usual prepregnancy diet. b. eat less meat and more fruits and vegetables. c. drink 3 to 4 tall glasses of fluid daily. d. eat 1,000 more calories than her usual prepregnancy diet.

A. Consume 500 more calories than her usual prepregnancy diet. Rationale: To maintain nutrient stores while breastfeeding, the mother needs 500 additional calories each day over her prepregnancy diet.

A new mother has decided not to breastfeed her newborn. The nurse planning to teach the mother about formula feeding would include: a. positioning the bottle so that the nipple is full of formula during the entire feeding. b. heating infant formula in a microwave. c. burping the infant after 4 ounces and again when the bottle is empty. d. propping a bottle for a feeding.

A. Position the bottle so that the nipple is full of formula during the entire feeding. Rationale: The nipple of the bottle should be kept full of formula to reduce the amount of air the baby swallows.

The nurse can expect which of the following interventions to be ordered if the postpartum woman is not immune to rubella? a. The rubella virus vaccine should be administered before discharge. b. The woman should receive the rubella virus vaccine at her 6-week postpartum checkup. c. The woman should be instructed not to get pregnant until she receives the rubella vaccine. d. No intervention is indicated at this time because the woman is not at risk for rubella.

A. The rubella virus vaccine should be administered before discharge. Rationale: The woman who is not immune to rubella is immunized in the immediate postpartum period because there is no danger of her being pregnant.

The nurse explains that the physician will order RhoGam in the event that a/an: a. unsensitized Rh-negative mother has an Rh-positive infant. b. Rh-negative mother becomes sensitized. c. sensitized infant has a rising bilirubin level. d. unsensitized infant exhibits no outward signs.

A. Unsensitized Rh-negative mother has an Rh-positive pregnancy. Rationale: The Rh-negative woman should receive Rhogam within 72 hours after the birth of an Rh-positive infant.

A new mother states her preference to formula-feed her newborn. The nurse planning discharge instructions would tell her about a measure to help suppress lactation and promote comfort, which is: a. wear a well-fitting bra continuously for several days. b. stand in a warm shower, letting the water spray over the breasts. c. express small amounts of milk from the breasts several times a day. d. massage the breasts when they ache.

A. Wear a well-fitting bra continuously for several days. Rationale: When a mother does not wish to breastfeed, a snug bra worn around the clock can help alleviate discomfort from engorgement.

The nurse assessing the fundus of the uterus immediately after delivery would expect to find the uterus: a. well-contracted with its upper border at or just below the umbilicus. b. well-contracted with its upper border three or four fingerbreadths above the umbilicus. c. relaxed with its upper border level with the umbilicus. d. relaxed with its upper border two or three fingerbreadths below the umbilicus.

A. Well-contracted with its upper border at or just below the umbilicus. Rationale: Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a grapefruit, at the level of the umbilicus.

While instructing a new mother on formula preparations, what type(s) would the nurse include? Select all that apply. a. Ready-to-feed formula b. Concentrated liquid formula c. Powdered formula d. Cow's milk e. Canned evaporated milk

ANS: A, B, C Formula choices are ready-to-use, concentrated liquid formula that will be diluted according to the infant's needs, and powdered formula that is mixed as needed. Cow's milk and canned evaporated milk are unsuitable because they are nutritionally inadequate and stress the kidneys.

What postpartum exercise(s) should the nurse teach a patient who had a vaginal delivery yesterday? Select all that apply. a. Abdominal tighteners b. Head lift c. Pelvic tilt d. Kegel exercises e. Leg lifts

ANS: A, B, C, D Exercises for postpartum involution such as abdominal tighteners, head lifts, pelvic tilts, and Kegel exercises are acceptable. Leg lifts are too strenuous early in postpartum period.

Which assessment(s) would lead the nurse to determine the gestational age of the infant as preterm? Select all that apply. a. Thin, transparent skin b. Vernix only in the body creases c. Folded ear springs back slowly d. Breast tissue under the nipple e. Creases over entire sole

ANS: A, C The only signs of preterm are the thin skin and the slowly responding ear.

The nurse is giving a shower to a patient who had a cesarean section 2 days previously. What intervention(s) should be included before, during, and after the shower? Select all that apply. a. Leave abdominal dressing open to air. b. Position patient with back to water stream. c. Cover infusion site with rubber glove. d. Provide a shower chair. e. Confirm ambulation ability.

ANS: B, C, D, E The patient should be evaluated for ambulatory ability, and the abdominal dressing and infusion site should be covered with a waterproof cover. The patient should be provided a shower chair and positioned with her back to the water stream.

The nurse is aware that the newborn is considered hypoglycemic if the blood glucose level is below _____ mg/dL. a. 70 b. 60 c. 50 d. 40

ANS: D A blood glucose level of less than 40 mg/dL is considered hypoglycemic. If the screening sample is below 40 mg/dL a venous sample will be drawn. After the blood has been drawn the infant should be fed to prevent a further drop.

For security purposes, when the nurse brings the infant from the nursery to the mother the nurse should: a. ask, "Is this your band number?" b. confirm room number of mother. c. ask the mother to identify herself verbally. d. check the band number of the infant to that of the mother.

ANS: D The nurse should check the band number of the infant with that of the mother by asking the mother to verbally read the number.

The nurse should teach the postpartum woman about perineal self-care by instructing her to: a. perform perineal self-care at least twice a day. b. cleanse with warm water in a squeeze bottle from front to back. c. remove perineal pads from the rectal area toward the vagina. d. use cool water to decrease edema of the perineum.

B. Cleanse with warm water in a squeeze bottle from front to back Rationale: Cleansing from front to back prevents contamination from the rectal area.

Following delivery, the nurse's assessment reveals a soft, boggy uterus located above the level of the umbilicus. The appropriate intervention is to: a. notify the physician. b. massage the fundus. c. initiate measures that encourage voiding. d. position the patient flat.

B. Massage the fundus Rationale: A poorly contracted uterus should be massaged until firm to prevent hemorrhage.

When a woman asks about resumption of her menstrual cycle after childbirth, the nurse responds that: a. a woman will not ovulate in the absence of menstrual flow. b. most nonlactating women resume menstruation about 2 months postpartum. c. generally, a woman does not ovulate in the first few cycles after childbirth. d. the return of menstruation is delayed when a woman does not breastfeed.

B. Most nonlactating women resume menstruation about 2 months postpartum. Rationale: Menstrual periods resume about 6-8 weeks if the woman is not breastfeeding

The nurse assesses the initial lochia postdelivery, which is: a. serosa. b. rubra. c. alba. d. vaginalis.

B. Rubra Rationale: The initial vaginal discharge after delivery is called lochia rubra. It is red and moderately heavy. Lochia rubra lasts for up to 3 days postpartum.

On the second postpartum day, a mother bathed her newborn for the first time. She tells the nurse, "I don't think I did it right." Based on the mother's comment, she is most likely in the postpartum psychological stage of: a. taking in. b. taking hold. c. letting go. d. settling down.

B. Taking hold Rationale: In phase 2, talking hold, the mother begins to initiate action and becomes interested in caring for the baby. In doing so, she may become critical of her performance.

The nurse instructed a postpartum woman about storing and freezing breast milk. The nurse determines that the teaching was effective when the woman says: a. "I can thaw frozen breast milk in the microwave." b. "I'll put enough breast milk for one day in a container." c. "Breast milk can be stored in glass containers." d. "Breast milk can be kept in the refrigerator for up to 3 months."

C. "Breast milk can be stored in glass containers." Rationale: Breast milk can be safely stored in glass ore clear hard plastic containers.

A primipara tells the nurse, "My afterpains get worse when I am breastfeeding." The most appropriate nursing response would be: a. "I'll get you some aspirin to relieve the cramping that you feel." b. "Afterpains are more intense with your first baby." c. "Breastfeeding releases a hormone that causes your uterus to contract." d. "A change of position when you're breastfeeding might help."

C. "Breastfeeding releases a hormone that causes your uterus to contract." Rationale: Breastfeeding mothers may have more afterpains because infant suckling cause the posterior pituitary to release oxytocin, which is a hormone that contracts the uterus.

A woman will be discharged 48 hours after a vaginal delivery. When planning discharge teaching, the information the nurse would include about lochia is: a. lochia should disappear 2 to 4 weeks postpartum. b. it is normal for the lochia to have a slightly foul odor. c. a change in lochia from pink to bright red should be reported. d. a decrease in flow will be noticed with ambulation and activity.

C. A change in lochia from pink to bright red should be reported. Rationale: A return to bright red lochia rubra may indicate a late postpartum hemorrhage.

After birth, the nurse quickly dries and wraps the newborn in a blanket to prevent heat loss by: a. conduction. b. radiation. c. evaporation. d. convection.

C. Evaporation Rationale: Newborns lose heat quickly after birth as fluid evaporates from their bodies.

The nurse's instructions for a new mother to care for the baby's umbilical cord will include: a. keeping the area covered with a sterile dressing. b. dressing the stump with antibiotic ointment at every diaper change. c. fastening diaper low to allow for air circulation. d. giving the newborn a daily tub bath until the cord falls off.

C. fastening diaper low to allow for air circulation. Rationale: Diaper placement below the umbilical stump allows for drying by air circulation.

Nursing the infant promotes uterine involution because it:

Causes the pituitary to secrete oxytocin to contract the uterus

What would be considered risk factor(s) for low blood glucose after birth? Select all that apply.

Cold stress Large size for gestational age Preterm Maternal diabetes

List and describe the three phases of milk production after birth.

Correct Answer(s): Colostrum is a yellowish fluid rich in protective antibodies that is secreted late in pregnancy and for the first few days after birth. Transitional milk emerges approximately 7 to 10 days after birth, has fewer immunoglobins and proteins, but has increased lactose, fat, and calorie content. Mature milk is secreted by 14 days after birth, has bluish color, and contains all of the nutrients the infant needs.

Summarize the nursing interventions when preventing heat loss in newborns.

Correct Answer(s): Dry infant quickly; dry and cover head of infant; prewarm radiant warmer and stethoscope; place scale paper on scale, and place a warm blanket on other surfaces; place crib away from windows and vents; place crib away from cold walls; and wrap infant warmly.

When putting the newborn down to sleep, what position is now recommended?

Correct Answer(s): It is now recommended that newborns be placed on their side or on their back to sleep.

What is lochia, and how does it change during the early postpartum period?

Correct Answer(s): Lochia is vaginal discharge after delivery. Lochia gradually changes characteristics during the early postpartum period. Lochia rubra is red and lasts for about 3 days after birth. Lochia serosa is pinkish and lasts from the third to the tenth day after birth. Lochia alba is mostly mucus and is clear and colorless or white. It lasts from the tenth through twenty-first day after birth.

Identify the measures that are used to help a woman void her bladder after birth.

Correct Answer(s): Provide as much privacy as possible; remain near the woman, but do not rush her by constantly asking her if she has urinated; run water in the sink; have the woman place her hands in warm water; and have the woman use the peribottle to squirt warm water over her perineal area to relax the urethral sphincter.

The acronym REEDA helps the nurse remember what signs when assessing the perineum?

Correct Answer(s): REEDA stands for Redness, Edema, Ecchymosis, Discharge, and Approximation.

Describe the changes in the cervix after birth.

Correct Answer(s): The cervix regains its muscle tone but never closes as tightly as during the prepregnant state. Some edema, associated with lacerations of the cervix or vagina, persists for a few weeks.

How is hunger recognized in newborns?

Correct Answer(s): The newborn may exhibit hand-to-mouth movements, mouth and tongue movements, sucking motions, and rooting movements. The infant may clench the fists, kick, and cry. Crying is a late sign of hunger, which may result in shutdown and poor feeding if needs are not met.

Explain how and when ovulation and menstruation return after birth.

Correct Answer(s): The production of placental estrogen and progesterone stops when the placenta is delivered, causing a rise in the production of follicle-stimulating hormone (FSH) and the return of ovulation and menstruation. Menstrual cycles resume in about 6 to 8 weeks if the woman is not breastfeeding. The early menstrual periods may or may not be preceded by ovulation. Return of ovulation is delayed further if the woman is breastfeeding.

The statement made by a new mother that indicates she needs additional information about breastfeeding is: a. "I let the baby nurse 10 to 15 minutes on the first breast and then switch to the other breast." b. "The baby needs to nurse at least 5 minutes on the breast to get the hindmilk." c. "The baby has been nursing every 2 to 3 hours." d. "If the baby gets fussy between feedings, I give her a bottle of water."

D. "If the baby gets fussy between feedings, I give her a bottle of water." Rationale: Supplemental feedings of formula or water should not be offered to a healthy newborn who is breastfeeding.

The nurse assessing a newborn recognizes a sign of hypoglycemia, which is: a. increased nasal mucus. b. increased temperature. c. active muscle movements. d. high-pitched cry.

D. High-pitched cry Rationale: There are many signs of hypoglycemia in the newborn. One is a high-pitched cry.

The best way to maintain the newborn's temperatures immediately after birth is to:

Dry the infant thoroughly, including her hair

Which assessment is an expected finding 24 hours after birth

Fundus firm and in the midline of the abdomen

Put the following types of lochia in the order that they occur during the postpartum period.

Lochia rubra Lochia serosa Lochia alba

A new mother asks how often she should nurse her infant. The nurse should tell her to feed the infant:

On demand, about every 2 to 3 hours

Eight hours postpartum the woman states she prefers the nurse to take care of the infant. The woman talks in detail about her birthing experience on the phone and to anyone who enters her room. She complains of being hungry, thirsty, and sleepy and is unable to focus on the infant care teaching offered to her. The nurse would interpret this behavior as:

The normal taking-in phase

A breastfeeding mother reports that she has cramping after every time she feeds her baby. The nurse informs her that these are afterpains, intermittent uterine contractions similar to menstrual cramps. The best physician-ordered pharmacological nursing intervention is to administer a(n):

mild analgesic

The hormone responsible for the production of breast milk is:

prolactin.