Question 1

What would prevent early discharge of a postpartum woman?&#10;A) Afterpains when breastfeeding&#10;B) Birth at 38 weeks of gestation&#10;C) Has voided 130 mL since delivery&#10;D) Episiotomy that shows slight redness and edema, is dry and approximated

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?&#10;A) The woman leaves the infant on her bed while she takes a shower.&#10;B) The woman continues to hold and cuddle her infant after she has fed her.&#10;C) The woman reads a magazine while her infant sleeps.&#10;D) The woman changes her infant's diaper and shows the nurse the contents of the diaper.

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?&#10;A) Put on antiembolic stockings (TED hose).&#10;B) Have her avoid leg exercises.&#10;C) Have her sit in a chair.&#10;D) Keep her legs flat; do not elevate.

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?

A) Retained placental fragments
B) Unrepaired vaginal lacerations
C) Uterine atony
D) Puerperal infection

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?

A) Run warm water on her breasts during a shower.
B) Apply ice to the breasts for comfort.
C) Express small amounts of milk from the breasts to relieve pressure.
D) Wear a loose-fitting bra to prevent nipple irritation.

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?&#10;A) Begin an intravenous (IV) infusion of Ringer's lactate solution.&#10;B) Assess the woman's vital signs.&#10;C) Call the woman's primary health care provider.&#10;D) Massage the woman's fundus.

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?

A) Pouring water from a squeeze bottle over the woman's perineum
B) Placing oil of peppermint in a bedpan under the woman
C) Asking the physician to prescribe analgesics
D) Inserting a sterile catheter

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?&#10;A) Desire for a family-centred experience&#10;B) Budget-driven decision&#10;C) Hospitals&#10;D) The federal government

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?&#10;A) Vaginal or vulvar hematomas&#10;B) Unrepaired lacerations of the vagina or cervix&#10;C) Failure of the uterine muscle to contract firmly&#10;D) Retained placental fragments

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?

A) "Didn't you like your lunch?"
B) "Does your doctor know that you are planning to eat that?"
C) "What is that anyway?"
D) "I'll warm the soup in the microwave for you."

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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?

A) The woman is a gravida 2, para 2.
B) The woman had a vacuum-assisted birth.
C) The woman received epidural anaesthesia.
D) The woman has an episiotomy.

Accepted Answer

The answer of A woman gave birth vaginally to a...

Question 12

According to the Family-Centred Maternity and Newborn Guidelines (Health Canada,2000),what is the correct time frame for an early discharge?&#10;A) 12 hours&#10;B) 24 hours&#10;C) 36 hours&#10;D) 48 hours

Accepted Answer

The answer of According to the Family-Centred Maternity and Newborn...

Question 13

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to &#34;mother the mother.&#34; What does this expression refer to?&#10;A) Formally initializing individualized care by confirming the woman's and infant's identification ( ID ) numbers on their respective wrist bands&#10;B) Teaching the mother to check the identity of any person who comes to remove the baby from the room&#10;C) Including other family members in the teaching of self-care and child care&#10;D) Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood

Accepted Answer

The answer of Nursing care in the fourth trimester includes...

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?&#10;A) Rubella vaccine should be given.&#10;B) A blood transfusion is necessary.&#10;C) Rh immune globulin is necessary within 72 hours of birth.&#10;D) A Kleihauer-Betke test should be performed.

Accepted Answer

The answer of The laboratory results for a postpartum woman...

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?&#10;A) The father of the infant&#10;B) Her mother (the infant's grandmother)&#10;C) Her eldest daughter (the infant's sister)&#10;D) The nurse

Accepted Answer

The answer of The nurse knows that combined care is...

Question 16

Which woman should receive Rh immune globulin?&#10;A) Rh+, sensitized&#10;B) Rh+, not sensitized&#10;C) Rh-, sensitized&#10;D) Rh-, not sensitized

Accepted Answer

The answer of Which woman should receive Rh immune globulin?&#10;A)...

Question 17

Which finding could prevent early discharge of a newborn at 12 hours of age?&#10;A) Birth weight of 3000 g&#10;B) One meconium stool since birth&#10;C) Voided, clear, pale urine three times since birth&#10;D) Infant breastfed once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast

Accepted Answer

The answer of Which finding could prevent early discharge of...

Question 18

Which of the following is true with regard to rubella and Rh issues?&#10;A) Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.&#10;B) Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1 month after vaccination.&#10;C) Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant.&#10;D) Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

Accepted Answer

The answer of Which of the following is true with...

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?

A) Improving the accuracy of blood loss estimation, which usually is a subjective assessment
B) Determining which pad is best
C) Demonstrating that other nurses usually underestimate blood loss
D) Indicating to the nurse supervisor that one of them needs some time off

Accepted Answer

The answer of A hospital has a number of different...

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?&#10;A) 24 hours&#10;B) 48 hours&#10;C) 72 hours&#10;D) 7 days

Accepted Answer

The answer of How long should the nurse teach the...

Question 21

Discharge instruction,or teaching the woman what she needs to know to care for herself and her newborn,officially begins when?&#10;A) At the time of admission to the nurse's unit&#10;B) When the infant is presented to the mother at birth&#10;C) During the first visit with the physician in the unit&#10;D) When the take-home information packet is given to the couple

Accepted Answer

The answer of Discharge instruction,or teaching the woman what she...

Question 22

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup.What should the nurse be concerned about with regard to psychosocial outcomes not being met?&#10;A) The mother discusses her labour and birth experience excessively.&#10;B) The mother believes that her baby is more attractive and clever than any others.&#10;C) The mother has not given the baby a name.&#10;D) The mother has a partner or family members who react very positively about the baby.

Accepted Answer

The answer of A recently delivered mother and her baby...

Deck 21: Nursing Care During the Fourth Trimester