Question 1

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup.The nurse should be concerned that psychosocial outcomes are not being met if the woman:

Accepted Answer

If the mother is having difficulty naming her new infant,it may be a signal that she is not adapting well to parenthood.Other red flags include refusal to hold or feed the baby,lack of interaction with the infant,and becoming upset when the baby vomits or needs a diaper change.A new mother who is having difficulty would be unwilling to discuss her labor and birth experience.An appropriate nursing diagnosis could be Impaired parenting related to a long,difficult labor or unmet expectations of birth.A mother who is willing to discuss her birth experience is making a healthy personal adjustment.The mother who is not coping well would find her baby unattractive and messy.She may also be overly disappointed in the baby's sex.The client may voice concern that the baby reminds her of a family member whom she does not like.Having a partner and/or other family members react positively is an indication that this new mother has a good support system in place.This support system will help reduce anxiety related to her new role as a mother.

Question 2

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago.Today her husband brings a large container of brown seaweed soup to the hospital.When the nurse enters the room,the husband asks for help with warming the soup so that his wife can eat it.The nurse's most appropriate response is to ask the woman:

Accepted Answer

"I'll warm the soup in the microwave for you" shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response.Cultural dietary preferences must be respected.Women may request that family members bring favorite or culturally appropriate foods to the hospital."What is that anyway?" does not show cultural sensitivity.

Question 3

A woman gave birth 48 hours ago to a healthy infant girl.She has decided to bottle-feed.During your assessment you notice that both of her breasts are swollen,warm,and tender on palpation.The woman should be advised that this condition can best be treated by:

Accepted Answer

Applying ice to the breasts for comfort is appropriate for treating engorgement in a mother who is bottle-feeding.This woman is experiencing engorgement,which can be treated by using ice packs (because she is not breastfeeding)and cabbage leaves.A bottle-feeding mother should avoid any breast stimulation,including pumping or expressing milk.A bottle-feeding mother should wear a well-fitted support bra or breast binder continuously for at least the first 72 hours after giving birth.A loose-fitting bra will not aid lactation suppression.Furthermore,the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation.

Question 4

A woman gave birth vaginally to a 9-pound,12-ounce girl yesterday.Her primary health care provider has written orders for perineal ice packs,use of a sitz bath tid,and a stool softener.What information is most closely correlated with these orders?

Accepted Answer

These orders are typical interventions for a woman who has had an episiotomy,lacerations,and hemorrhoids.A multiparous classification is not an indication for these orders.A vacuum-assisted birth may be used in conjunction with an episiotomy,which would indicate these interventions.Use of epidural anesthesia has no correlation with these orders.

Question 5

A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means.The nurse's best response is:

Accepted Answer

Discomfort in the calf with sharp dorsiflexion of the foot may indicate deep vein thrombosis.Edema is within normal limits for the first few days until the excess interstitial fluid is remobilized and excreted.Deep tendon reflexes should be 1+ to 2+.A "fleshy" odor,not a foul odor,is within normal limits.

Question 6

A hospital has a number of different perineal pads available for use.A nurse is observed soaking several of them and writing down what she sees.This activity indicates that the nurse is trying to:

Accepted Answer

Saturation of perineal pads is a critical indicator of excessive blood loss,and anything done to aid in assessment is valuable.The nurse is noting the saturation volumes and soaking appearances.It is' possible that the nurse is trying to determine which pad is best,but it is more likely that the nurse is noting saturation volumes and soaking appearances to improve the accuracy of blood loss estimation.Nurses usually overestimate blood loss,if anything.

Question 7

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl.Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

Accepted Answer

Leaving an infant on a bed unattended is never acceptable for various safety reasons.Holding and cuddling the infant after feeding and reading a magazine while the infant sleeps are appropriate parent-infant interactions.Changing the diaper and then showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infant's elimination patterns.

Question 8

The laboratory results for a postpartum woman are as follows: blood type,A; Rh status,positive; rubella titer,1:8 (EIA 0.8); hematocrit,30%.How would the nurse best interpret these data?

Accepted Answer

This client's rubella titer indicates that she is not immune and that she needs to receive a vaccine.These data do not indicate that the client needs a blood transfusion.Rh immune globulin is indicated only if the client has a negative Rh status and the infant has a positive Rh status.A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is suspected,especially if the mother is Rh negative.The data do not provide any indication for performing this test.

Question 9

Under the Newborns' and Mothers' Health Protection Act,all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth.

Accepted Answer

The specified stays are 48 hours (2 days)for a vaginal birth and 96 hours (4 days)for a cesarean birth.The attending provider and the mother together can decide on an earlier discharge.

Question 10

In a variation of rooming-in,called couplet care,the mother and infant share a room,and the mother shares the care of the infant with:

Accepted Answer

In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care.

Question 11

Excessive blood loss after childbirth can have several causes; the most common is:

Accepted Answer

Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention.Although vaginal or vulvar hematomas,unpaired lacerations of the vagina or cervix,and retained placental fragments are possible causes of excessive blood loss,uterine muscle failure (uterine atony)is the most common cause.

Question 12

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother.Specifically this expression refers to:

Accepted Answer

Many professionals believe that the nurse's nurturing and support function is more important than providing physical care and teaching.Matching ID wrist bands is more of a formality,but it is also a get-acquainted procedure."Mothering the mother" is more a process of encouraging and supporting the woman in her new role.Having the mother check IDs is a security measure for protecting the baby from abduction.Teaching the whole family is just good nursing practice.

Question 13

Discharge instruction,or teaching the woman what she needs to know to care for herself and her newborn,officially begins:

Accepted Answer

Discharge planning,the teaching of maternal and newborn care,begins on the woman's admission to the unit,continues throughout her stay,and actually never ends as long as she has contact with medical personnel.

Question 14

Because a full bladder prevents the uterus from contracting normally,nurses intervene to help the woman empty her bladder spontaneously as soon as possible.If all else fails,the last thing the nurse could try is:

Accepted Answer

Invasive procedures usually are the last to be tried,especially with so many other simple and easy methods available (e.g.,water,peppermint vapors,pain medication).Pouring water over the perineum may stimulate voiding.It is easy,noninvasive,and should be tried early.The oil of peppermint releases vapors that may relax the necessary muscles.If the woman is anticipating pain from voiding,pain medications may be helpful.Other nonmedical means and pain medication should be tried before insertion of a catheter.

Question 15

If a woman is at risk for thrombus and is not ready to ambulate,nurses may intervene by performing a number of interventions.Which intervention should the nurse avoid?

Accepted Answer

Sitting immobile in a chair will not help.Bed exercise and prophylactic footwear may.TED hose and SCD boots are recommended.Bed exercises,such as flexing,extending,and rotating her feet,ankles,and legs,are useful.A positive Homans' sign (calf muscle pain or warmth,redness,or tenderness)requires the physician's immediate attention.

Question 16

A 25-year-old gravida 2,para 2-0-0-2 gave birth 4 hours ago to a 9-pound,7-ounce boy after augmentation of labor with Pitocin.She puts on her call light and asks for her nurse right away,stating,"I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

Accepted Answer

This woman gave birth to a macrosomic boy after Pitocin augmentation.The most likely cause of bleeding 4 hours after delivery,combined with these risk factors,is uterine atony.Although retained placental fragments may cause postpartum hemorrhage,this typically would be detected in the first hour after delivery of the placenta and is not the most likely cause of hemorrhage in this woman.Although unrepaired vaginal lacerations may cause bleeding,they typically would occur in the period immediately after birth.Puerperal infection can cause subinvolution and subsequent bleeding; however,this typically would be detected 24 hours after delivery.

Question 17

As relates to rubella and Rh issues,nurses should be aware that:

Accepted Answer

Women should understand they must practice contraception for 1 month after being vaccinated.Because the live attenuated rubella virus is not communicable in breast milk,breastfeeding mothers can be vaccinated.Rh immune globulin is administered intramuscularly; it should never be given to an infant.Rh immune globulin suppresses the immune system and therefore could thwart the rubella vaccination.

Question 18

In the recovery room,if a woman is asked either to raise her legs (knees extended)off the bed or to flex her knees,place her feet flat on the bed,and raise her buttocks well off the bed,most likely she is being tested to see whether she:

Accepted Answer

If the numb or prickly sensations are gone from her legs after these movements,she has likely recovered from the epidural or spinal anesthesia.

Question 19

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula.This practice:

Accepted Answer

Infant formula should not be given to mothers who are breastfeeding.Such gifts are associated with earlier cessation of breastfeeding.Baby-Friendly USA prohibits the distribution of any gift bags or formula to new mothers.

Question 20

On examining a woman who gave birth 5 hours ago,the nurse finds that the woman has completely saturated a perineal pad within 15 minutes.The nurse's first action is to:

Accepted Answer

The nurse should assess the uterus for atony.Uterine tone must be established to prevent excessive blood loss.The nurse may begin an IV infusion to restore circulatory volume,but this would not be the first action.Blood pressure is not a reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be the nurse's first action.The physician would be notified after the nurse completes the assessment of the woman.

Quiz 19: Nursing Care of the Family During the Postpartum Period