Question 1

What would prevent early discharge of a postpartum woman?

Accepted Answer

A normal voiding volume is 200 to 300 mL per void and so only voiding 130 mL since delivery indicates that the woman should not be discharged early.Afterpains when breastfeeding is not a reason to delay early discharge.The birth of an infant at term is not a criterion that would prevent early discharge.A normal episiotomy would show slight redness and edema and would be dry and approximated and would not prevent a woman from being discharged early.

Question 2

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl.Which behaviour 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 3

If a woman is at risk for thrombus and is not ready to ambulate,which intervention should the nurse perform?

Accepted Answer

Putting on antiembolic stockings (TED hose)is a preventative measure for women who are at risk.Sitting immobile in a chair will not help.Leg exercises are to be encouraged.Elevation of the legs would be encouraged.

Question 4

A 25-year-old gravida 2,para 2-0-0-2 gave birth 4 hours ago to a 4300 g boy after augmentation of labour with oxytocin.She puts on her call light and asks for her nurse right away,stating,"I'm bleeding a lot." What is the most likely cause of postpartum hemorrhage in this woman?

Accepted Answer

This woman gave birth to a macrosomic boy after oxytocin augmentation.The most likely cause of postpartum bleeding,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,but it typically would be detected 24 hours after delivery.

Question 5

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.What advise should the nurse offer the woman?

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 (since 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 6

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.What is the nurse's initial response?

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.

Question 7

Because a full bladder prevents the uterus from contracting normally,nurses intervene to help the woman empty her bladder spontaneously as soon as possible.Which would be the last intervention that the nurse would implement?

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 vapours,pain pills).Pouring water over the perineum may stimulate voiding.The oil of peppermint releases vapours that may relax the necessary muscles.Both interventions are easy,noninvasive,and should be tried early.If the woman is anticipating pain from voiding,pain medications may be helpful.Other nonmedical meAnswer could be tried first,but medications still come before insertion of a catheter.

Question 8

While admitting the pregnant woman,the nurse should be aware that shorter postpartum hospital stays are primarily the result of the influence of which of the following?

Accepted Answer

Consumers have demanded a more family-centred experience.Hospitals are obligated to follow standards of care.Early discharge was not primarily a budget decision.The early discharge is not influenced by the federal government.

Question 9

Excessive blood loss after childbirth can have several causes.What is the most common cause?

Accepted Answer

Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distension.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 10

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.What is the nurse's most appropriate response?

Accepted Answer

The statement "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 favourite or culturally appropriate foods to the hospital."What is that anyway?" does not show cultural sensitivity.

Question 11

A woman gave birth vaginally to a 4400 g 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 anaesthesia has no correlation with these orders.

Question 12

According to the Family-Centred Maternity and Newborn Guidelines (Health Canada,2000),what is the correct time frame for an early discharge?

Accepted Answer

The Family-Centred Maternity and Newborn Guidelines (Health Canada,2000)support early discharge at 24 hours after vaginal or Caesarean birth as long as there are no complications.

Question 13

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to "mother the mother." What does this expression refer 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 14

The laboratory results for a postpartum woman are as follows: blood type,A; Rh status,positive; rubella titre,1:8 (EIA 0.6); hematocrit,30%.How would the nurse best interpret these data?

Accepted Answer

For women who are serologically not immune (titre of 1:8 or enzyme immunoassay level less than 0.8),a subcutaneous injection of rubella vaccine is recommended in the immediate postpartum period.This patient's rubella titre indicates that she is not immune and that she needs to receive a vaccine.These data do not indicate that the patient needs a blood trAnswerfusion.Rh immune globulin is indicated only if the patient has a negative Rh status and the infant has a positive Rh status.A Kleihauer-Betke test should be performed if a large fetomaternal trAnswerfusion is suspected,especially if the mother is Rh negative.The data do not provide any indication for performing this test.

Question 15

The nurse knows that combined care is when the mother and infant share a room,and the mother shares the care of the infant with which of the following?

Accepted Answer

In combined care,the mother shares a room with the newborn and shares infant care with a nurse.

Question 16

Which woman should receive Rh immune globulin?

Accepted Answer

Rh immune globulin is given to a woman in the postpartum period who is Rh-,not sensitized.

Question 17

Which finding could prevent early discharge of a newborn at 12 hours of age?

Accepted Answer

The infant breastfeeding once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast indicates that the infant is having some difficulty with breastfeeding.The infant needs to complete at least two successful feedings (normal sucking and swallowing)before an early discharge can occur.Birth weight of 3000 g; one meconium stool since birth; and voided,clear,pale urine three times since birth are normal infant findings and would not prevent early discharge.

Question 18

Which of the following is true with regard to rubella and Rh issues?

Accepted Answer

Women should understand that 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 might thwart the rubella vaccination.

Question 19

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.What does this activity indicate that the nurse is doing?

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's 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.If anything,nurses usually overestimate blood loss.

Question 20

How long should the nurse teach the woman who is not breastfeeding to wear a well-fitted support bra or breast binder to suppress lactation in the postpartum period?

Accepted Answer

Women should wear a well-fitted support bra or breast binder for at least the first 72 hours after giving birth to suppress lactation.

Quiz 21: Nursing Care During the Fourth Trimester