Deck 15: Caring for the Postpartal Woman and Her Family

Question 1

A nurse assesses a woman's temperature 6 hours after a vaginal birth and finds it to be 100.4°F (38°C).What action by the nurse is best?

A)Encourage the woman to drink plenty of fluids.
B)Document the findings and notify the provider.
C)Have the woman cough and deep breathe.
D)Prepare to administer acetaminophen (Tylenol).

Answer 1

Encourage the woman to drink plenty of fluids.

Question 2

The perinatal nurse observes the new mother watching her baby daughter closely,touching her face,and asking many questions about infant feeding.This is best described as which stage of mothering?

A)Taking charge
B)Taking hold
C)Taking in
D)Taking time

Answer 2

Taking charge

Question 3

A patient is receiving methylergonovine (Methergine)after a vaginal birth.What assessment finding by the nurse warrants immediate intervention?

A)Headache
B)Nausea
C)Palpitations
D)Uterine cramping

Answer 3

Palpitations

Question 4

A new mother is accompanied by her mother during her hospital stay on the postpartum unit.The patient's mother has made specific various requests of the nurses,including asking for a bottle so she can feed the baby after the new mother attempts to breastfeed for the first time.How would the perinatal nurse best respond to the patient's mother in a culturally sensitive way?

A)Ask both the patient and her mother about the preferred infant feeding method and assess what they already know.
B)Ask the patient's mother to leave for 30 minutes to allow for some alone time with the patient in order to explore her learning needs.
C)Ask the patient what she knows about breastfeeding and provide information to both women to support the patient's decision.
D)Convey to the patient and her mother an understanding of the concepts of "hot" and "cold" within their belief system.

Question 5

Two days after an uncomplicated vaginal birth,the nurse notes that the patient's hemoglobin is 13 mg/dL and the hematocrit is 48%.What does the nurse conclude about these values?

A)Patient is dehydrated
B)Needs further assessment
C)Normal for this situation
D)Serious anemia

Question 6

A woman has painful hemorrhoids after a vaginal birth.Her husband brings her a donut pillow to sit on.What response by the nurse is best?

A)"A lot of women get good pain relief from these."
B)"Donut pillows actually increase hemorrhoid pain."
C)"I will have to get permission for her to use this."
D)"That was nice of you,but these don't work well."

Question 7

A diabetic patient is 1 day postpartum after an uncomplicated vaginal birth.She wants to know why her blood sugar levels are so much lower than usual.What explanation by the nurse is best?

A)"Because you are dehydrated,your blood sugar decreases for a few days."
B)"I will call the dietician to see if you are getting enough calories."
C)"The levels of hormones that cause an anti-insulin effect are decreased."
D)"The exertion from childbirth is like a massive workout for your body."

Question 8

The perinatal nurse demonstrates the correct technique of postpartum uterine palpation for a student nurse.The nurse explains that support for the lower uterine segment is critical,because without it there is an increased risk of which complication?

A)Incorrect measurement
B)Intensifying the patient's pain
C)Uterine edema
D)Uterine inversion

Question 9

A postpartum woman who experienced a spontaneous vaginal birth 12 hours ago describes a headache that is worsening.The patient was given two regular-strength acetaminophen (Tylenol)tablets approximately 30 minutes ago but has had no relief from the pain.The most appropriate nursing action at this time is to do which of the following?

A)Ask any visitors to leave now or stay quiet.
B)Dim the lights in the patient's room.
C)Notify the patient's health-care provider.
D)Perform a comprehensive pain assessment.

Question 10

The perinatal nurse describes the need for an assessment for deep vein thrombosis (DVT)in the postpartum patient.Which of the following is one test that can be used as a screening measure for DVT?

A)Chadwick's sign
B)Homans' sign
C)Grey Turner's sign
D)McBurney's sign

Question 11

A postpartum woman is complaining of a headache that is worsening despite having taken Tylenol (acetaminophen)an hour ago.She delivered yesterday with epidural anesthesia.What action by the nurse is best?

A)Assess if the pain is worse when she sits upright.
B)Call the provider and ask for stronger analgesics.
C)Document the findings in the patient's chart.
D)Notify the health-care provider immediately.

Question 12

The perinatal nurse is teaching the patient about breastfeeding and explains that which of the following is the most appropriate time to breastfeed?

A)Four to 5 hours after the last feeding
B)Only when her infant exhibits hunger-related crying
C)When her infant is in a quiet alert state
D)When her infant is in an active alert state

Question 13

A postpartum patient complains of severe perineal pain and a sensation of needing to defecate but cannot pass stool.What action by the nurse is best?

A)Administer a stool softener.
B)Document the findings in the chart.
C)Offer a warm sitz bath.
D)Palpate the perineal area.

Question 14

The perinatal nurse listens as the patient describes her labor and emergency cesarean birth.Providing an opportunity to review this experience may assist the patient in doing which of the following?

A)Decreasing her ambivalence about her labor and birth
B)Developing more positive feelings about her labor and birth
C)Initiating her role development in the "letting-go" stage
D)Understanding the various demands associated with the maternal role

Question 15

A nurse has brought a newborn to his mother's room.What action by the nurse takes priority?

A)Asking the mother her full name and her birth date
B)Comparing the baby to a photograph on the mother's bedside table
C)Having the mother wash her hands before taking the baby
D)Matching the information on the mother's and baby's wristbands

Question 16

A postpartum woman is Rh?(D)-negative and needs an injection of Rh?(D)immune globulin.Which of the following doses would the perinatal nurse expect to be ordered?

A)120 µg
B)250 µg
C)300 µg
D)350 µg

Question 17

The perinatal nurse and student nurse are conducting an assessment on a postpartal woman.The nurse demonstrates percussion of the bladder.They hear a dull,thudding sound.How should the nurse document this information?

A)A bladder containing about 500 cc of urine
B)A full bladder
C)An empty bladder
D)An overdistended bladder

Question 18

A woman gave birth 12 hours ago.The patient complains of severe abdominal cramping when she breastfeeds her infant.The perinatal nurse should document this condition as which of the following?

A)Afterpains
B)Bladder hypertonia
C)Rectus abdominis diastasis
D)Uterine hypertonia

Question 19

A nurse is assisting a postpartum woman to get up for the first time after an unmedicated vaginal birth.What action by the nurse is best?

A)Apply a properly fitting gait belt before assisting the woman.
B)Determine if the woman has normal sensation to her lower extremities.
C)Instruct the woman to sit on the edge of the bed prior to standing.
D)Take the patient's blood pressure lying down and then in a standing position.

Question 20

A nurse assessing a postpartum woman 12 hours after uncomplicated vaginal birth finds her pulse to be 110 beats/minute.What action by the nurse is best?

A)Assess the patient for causes of tachycardia.
B)Document the findings and notify the provider.
C)Facilitate a blood draw for laboratory studies.
D)Place the patient on a 1,000-mL fluid restriction.

Question 21

The perinatal nurse knows that breastfeeding is contraindicated if a mother has which of the following conditions? (Select all that apply.)

A)Active herpes lesion on her nipple
B)Active tuberculosis
C)Infant diagnosed with phenylketonuria
D)Small breasts
E)Taking venlafaxine (Effexor)for anxiety.

Question 22

A woman is 10 hours postpartum after an uncomplicated vaginal birth.She has voided four times,and each time the volume is less than 100 mL.What action by the nurse is best?

A)Ask the woman to keep a voiding log for 24 hours.
B)Palpate the fundus and assess the amount of lochia present.
C)Request an order for a straight catheterization.
D)Run the water in the bathroom faucet during voiding attempts.

Question 23

The perinatal nurse is teaching the new mother who has chosen to formula-feed her infant.Which of the following are appropriate instructions to give the parents? (Select all that apply.)

A)Discard any unused formula in the bottle following use.
B)Mix the powdered formula with hot water only.
C)Only prepare enough formula to last for 24 hours.
D)Periodically check the nipple for slow flow.
E)Wipe off the top of the liquid formula can before opening it.

Question 24

The nurse is assessing a woman in the immediate postpartum period.The patient's respiratory rate is 22 breaths/minute.The most important aspects of nursing care would be to do which of the following? (Select all that apply.)

A)Assess and provide pain management.
B)Assess the patient's blood pressure and pulse.
C)Increase the patient's fluid intake.
D)Notify the provider for continued tachypnea.
E)Provide ongoing physical assessment.

Question 25

A woman with a history of mild heart failure has just vaginally given birth to a healthy baby.What action by the nurse is most important?

A)Assess the woman for signs of heart failure.
B)Facilitate an EKG.
C)Insert a Foley catheter for hourly urine output assessments.
D)Auscultate the woman's heart sounds.

Question 26

The perinatal nurse includes a pain assessment as part of the postpartum care provided to each patient.This action helps to do which of the following? (Select all that apply.)

A)Decrease the length of the hospital stay
B)Decrease the recovery time
C)Decrease the risk of depression
D)Help identify complications
E)Improve the patient's coping ability

Question 27

The perinatal nurse teaches the student nurse that deep breathing exercises following cesarean birth are critical to the prevention of what complications? (Select all that apply.)

A)Abdominal distension
B)Atelectasis
C)Increased tidal volume
D)Pneumonia
E)Pulmonary embolism

Question 28

A woman is 1 day post-cesarean birth.The nurse auscultates crackles in her lung bases.Which action by the nurse is best?

A)Call respiratory therapy for a breathing treatment.
B)Facilitate the woman having a chest x-ray.
C)Have the woman use her incentive spirometer.
D)Notify the provider and document the findings.

Question 29

A mother brings her 3-month-old baby to the clinic for a well-baby check.She appears exhausted and when the nurse questions her,the mother explains that she feels that she is the only person who can look after and care for her infant properly,so all of her time is devoted to this task.The nurse should document which of the following?

A)Difficulty with letting-go,as evidenced by excluding her partner from infant care
B)Poor bonding,as evidenced by resentment toward the baby and fatigue
C)Personal neglect,as evidenced by exhaustion and by not taking care of herself
D)Time management problems,as evidenced by needing the entire day to care for the baby

Question 30

A nurse is caring for a woman after a cesarean birth.Prior to ambulating her for the first time,which action by the nurse takes priority?

A)Assess sensation in the lower extremities.
B)Discontinue the patient's intravenous line.
C)Encourage the patient to cough and deep breathe.
D)Have the patient sit on the edge of the bed.

Question 31

A woman had a cesarean birth 2 hours ago.She now complains of being hungry and wants something to eat.What action by the nurse is best?

A)Assess for bowel sounds and ask if she is passing gas.
B)Inform the woman that she can't eat until her bowels move.
C)Order her a meal high in carbohydrates.
D)Provide her with a medical liquid diet.

Question 32

An infant was born weighing 6 lb (2.72 kg).At the end of 30 days,approximately how much should this infant weigh to demonstrate effective breastfeeding?

A)6 lb,4 oz to 7 lb (2.83-3.17 kg)
B)7 to 9 lb (3.17-4 kg)
C)9 to 11 lb (4-5 kg)
D)10 to 12 lb,6 oz (4.5-5.6 kg)

Question 33

The nursing faculty member explains to a class of nursing students the correct way to assist with perineal care (peri-care)after childbirth.Which action by a student nurse would warrant intervention by the faculty member?

A)Has woman squirt warm water toward the front of the perineum
B)Instructs the woman to wash her hands prior to peri-care
C)Removes the peri-pad from back to front and appropriately disposes of it
D)Washes the hands before assisting woman with her peri-care

Question 34

A husband calls the perinatal clinic because he is worried about his wife's emotional state after giving birth 2 weeks ago.Which question by the nurse would be most helpful?

A)"Can you explain specifically what you are worried about?"
B)"How is your wife's appetite? Is she eating enough?"
C)"Is your wife still able to care for herself and the baby?"
D)"When did all the symptoms start,before or after the birth?"

Question 35

The postpartum nurse is aware that following childbirth there is an increased risk of maternal perineal infection related to which of the following factors? (Select all that apply.)

A)Drainage of blood and lochia
B)Impaired tissue integrity
C)The anatomical proximity to the anus
D)Urinary retention
E)Weakness and fatigue

Question 36

An adolescent has vaginally given birth to a healthy baby.What action by the nurse would be most important in developing a plan to help this mother bond successfully?

A)Ask the mother about her expectations of the baby and their relationship.
B)Determine if the mother plans to keep the baby or give it up for adoption.
C)Inquire as to how many family members are available to help care for the baby.
D)Refer the mother and her baby to the social worker or to the visiting nurses.

Question 37

A woman complains of perineal pain.The nurse assesses swelling,but sees no other abnormalities.The woman does not wish pharmacological treatment.What suggestion by the nurse is most appropriate?

A)Applying a covered ice pack to the perineum every 2 to 4 hours for 20 minutes
B)Placing cool cabbage leaves on the woman's peri-pad
C)Sitting on a donut-type pillow when out of bed
D)Immersing in a sitz bath with a water temperature of 120°F (48.9°C)

Question 38

The perinatal nurse teaches the postpartum woman about the normal process of diuresis that she can expect to occur approximately 6 to 8 hours after childbirth.Which hormones are responsible for the diuresis? (Select all that apply.)

A)Estrogen
B)Norepinephrine
C)Oxytocin
D)Prolactin
E)Progesterone

Question 39

A nurse manager has many at-risk mothers in the labor and birth unit.What policy can the manager adapt that would best facilitate mother-baby bonding?

A)Encourage attendance at a support group with other at-risk mothers.
B)Limit separation of mother and baby to exceptional circumstances only.
C)Offer the mother the services of a one-to-one mentor for 1 year.
D)Teach breastfeeding and promote its use exclusively for 1 full year.

Question 40

A new mother is concerned that her 3-year-old child is not adapting well to the birth of a new sibling 1 month ago.What suggestion can the nurse provide to best help this mother?

A)Explain to the child that she will always have a special bond with the new sibling.
B)Give the 3-year-old a special chore that only she does to help her mom.
C)Promise the 3-year-old that she can have a pet if she is good to her new sibling.
D)Tell the child she will need to get used to having a new baby in the house.

Question 41

The perinatal nurse explains to students that certain groups of women are less likely to breastfeed.Which of the following women would the nurse identify as needing extra education,support,or encouragement to breastfeed? (Select all that apply.)

A)African American
B)Asian
C)Those with a college education
D)Those older than 25
E)Those who participate in federal nutrition programs

Question 42

A nurse is observing a student nurse prepare a sitz bath.Which actions should be performed by the student? (Select all that apply.)

A)Confirm that the patient can ambulate to the bathroom.
B)Fill the water bag with water heated to 120°F (48.9°C).
C)Help the patient remove the peri-pad from front to back.
D)Ensure that the patient is covered enough to prevent chilling.
E)Place the sitz bath in the toilet with the overflow opening directed toward the front.

Question 43

A visiting nurse is concerned that a mother has not properly bonded with her infant.The nurse should assess for what factors that could impact this process? (Select all that apply.)

A)Chaotic home life
B)Disappointment in her birth experience
C)Lack of family support
D)Poverty
E)Substance abuse

Question 44

A nursing faculty member is explaining to a class of students that women experiencing cesarean birth have more challenges than do women who give birth vaginally.The faculty member is referring to what challenges? (Select all that apply.)

A)Delayed mother-infant bonding
B)Difficulty in choosing an infant feeding method
C)Increased risk of deep vein thrombosis
D)Pain from the surgical incision and intestinal gas
E)Slower initiation and pace of ambulation

Question 45

A nurse uses the acronym REEDA to perform a perineal assessment on a postpartum woman.What are the components of this exam? (Select all that apply.)

A)Approximation of the episiotomy
B)Drainage or discharge
C)Ecchymosis
D)Estimated length of the episiotomy
E)Redness

Question 46

A nurse is caring for a woman who just experienced a cesarean birth under epidural anesthesia.What interventions are important to include on this woman's care plan? (Select all that apply.)

A)Apply compression stockings or sequential compression devices.
B)Encourage ankle exercises while the woman remains in bed.
C)Keep the woman NPO until she is allowed out of bed into a chair.
D)Maintain bedrest until sensation returns to the woman's legs.
E)Only allow the woman to hold her infant with supervision while in bed.

Question 47

The perinatal nurse describes infant feeding cues to a new mother.These feeding cues include which of the following behaviors? (Select all that apply.)

A)Mouth movements
B)Moving the hand to the mouth
C)Sticking the tongue out
D)Vocalizations
E)Yawning

Question 48

A woman is considering abandoning breastfeeding attempts because of severe afterpains.What actions by the nurse are most helpful? (Select all that apply.)

A)Administer pain medication 30 minutes prior to breastfeeding.
B)Encourage ambulation.
C)Have the woman lie prone with a pillow under her stomach.
D)Offer the woman information on commercial baby formula.
E)Prepare a sitz bath for the woman after she has breastfed.