Question 1

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?

Accepted Answer

During the immediate postpartal period,the respiratory rate should remain within the normal range of 12 to 20 respirations per minute.However,slightly elevated respirations may occur due to pain,fear,excitement,exertion,or excessive blood loss.The nurse should assess and treat any pain.Taking the pulse and blood pressure can provide information on the patient's hemodynamic status.If tachypnea continues despite appropriate interventions,the provider should be notified.Ongoing physical assessment is part of postpartum care.

Question 2

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?

Accepted Answer

During the letting-go stage,the mother begins to see the baby as separate from herself.The mother should be able to leave the baby with a sitter,make time for herself,and reconnect with her partner.Overprotective mothers have difficulty with this stage due to trouble accepting help and excluding others,especially the partner.There is no evidence that this mother is resentful,is neglecting all of her personal needs,or has time management problems.

Question 3

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

Accepted Answer

Rales are not uncommon postoperatively and indicate atelectasis.The nurse should have the woman use her spirometer,cough,and deep breathe.The other interventions are not warranted.

Question 4

The perinatal nurse knows that breastfeeding is contraindicated if a mother has which of the following conditions?

Accepted Answer

There are only a few situations in which breastfeeding is contraindicated: infants with galactosemia (due to an inability to digest the lactose in the milk),mothers with active tuberculosis or HIV infection,mothers with active herpes lesions on the nipples,mothers who are receiving certain medications such as lithium or methotrexate,and mothers who are exposed to radioactive isotopes (e.g.,during diagnostic testing).

Question 5

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?

Accepted Answer

After a cesarean birth with spinal or epidural anesthesia,the nurse must assess sensation in the woman's legs.She will not be allowed out of bed until sensation returns.Discontinuing the IV line may or may not be appropriate.Coughing and deep breathing are always important for a postoperative patient,but this action is not related to ambulating for the first time.Sitting on the edge of the bed prior to getting up would only be done if the woman had full sensation in her legs.

Question 6

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?

Accepted Answer

Women who have recently given birth are at risk for urinary stasis and retention,which can lead to a boggy uterus and increased lochia.Frequently voiding 150 mL or less is a sign of urinary stasis and retention.The nurse should assess these factors first.The woman may need assistance when ambulating to the bathroom,or the nurse may need to run the water in the bathroom faucet during voiding attempts.A last resort is straight catheterization for severe urinary retention.Because the woman should be on intake and output assessments,a voiding log will not be helpful.

Question 7

The postpartum nurse is aware that following childbirth there is an increased risk of maternal perineal infection related to which of the following factors?

Accepted Answer

The proximity of the perineum to the anus increases the risk of a laceration or surgical incision becoming contaminated with fecal material,and the continuous drainage of blood coupled with impaired tissue integrity creates a favorable medium for the proliferation of bacteria.Urinary stasis and retention can lead to urinary tract infections.Weakness and fatigue would not lead to an increased risk for infection.

Question 8

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?

Accepted Answer

Adolescent mothers may have difficulty with bonding and attachment because they have unrealistic ideas of the baby's level of functioning and may not be aware of the baby's level of vulnerability.Asking about the mother's expectations for the baby and their relationship is a good starting point to initiate a discussion about this topic.Plans for keeping or adopting the baby should have already been established.Family members can help give the mother a break from infant care,but the less the mother cares for the baby,the less bonding she will demonstrate.A referral may be needed,but this is not the first action.

Question 9

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?

Accepted Answer

Parents should be advised to read and follow the manufacturer's instructions explicitly when preparing the formula,as some require no water and some need to be diluted with water.Cold water should be used to mix the powder.Only the amount to be used for each feeding should be prepared,and any unused formula should be discarded.The nipples should be checked periodically during feedings for correct flow and should be replaced regularly.The cans of liquid formula should be shaken and washed before opening.

Question 10

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?

Accepted Answer

Routine,comprehensive pain assessments enable the nurse to provide interventions in a timely manner to enhance the effectiveness of medications; they also ensure early identification of complications resulting in painful stimuli.Information and patient involvement increase the patient's perception of control and increase her personal satisfaction with postpartum pain management,thereby decreasing recovery time and the risk for depression.A pain-free patient can cope with the demands of a new baby better than a patient who is uncomfortable and dissatisfied with pain management.

Question 11

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?

Accepted Answer

An infant usually loses 5% of body weight during the first few days of life,and then begins gaining weight at the rate of ½ to 1 oz/day.That would result in an infant weighing 6 lb,4 oz to 7 lb at the end of 30 days.

Question 12

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?

Accepted Answer

Until bowel function returns following a cesarean birth,the patient should only be offered ice chips and small sips of water.The nurse assesses for return of bowel function by listening for bowel sounds and asking the woman if she is passing gas.The other actions are not appropriate.

Question 13

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?

Accepted Answer

The peri-pad is removed from front to back to avoid contaminating the vagina with the part of the peri-pad that has come into contact with the rectal area.The other steps are appropriate.

Question 14

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?

Accepted Answer

Maternal diuresis occurs almost immediately after birth,and urinary output reaches up to 3,000 mL each day by the second to fifth postpartum days.After childbirth,a decrease in the levels of oxytocin and estrogen naturally occurs and contributes to the diuresis.

Question 15

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?

Accepted Answer

Dramatic changes occur in the maternal hemodynamic system after the birth of the baby.This can lead to cardiac instability.In a woman with known heart failure,the nurse should be vigilant about assessing for signs of heart failure.Listening to heart sounds is part of the assessment,but is not sufficient.The woman may or may not need a catheter for hourly urine output assessments or an EKG.

Question 16

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?

Accepted Answer

Emotional difficulties after birth include the "baby blues," postpartum depression,and postpartum psychosis.The most important determinant rests with the knowledge that postpartum or baby blues do not interfere with the woman's ability to care for herself and her family.This question effectively triages the situation."Can you…" is a yes-no question and is never a good type of question to use when assessing a situation.In both baby blues and depression,appetite may be diminished.

Question 17

The perinatal nurse teaches the student nurse that deep breathing exercises following cesarean birth are critical to the prevention of what complications?

Accepted Answer

Incisional pain and abdominal distension often cause patients to adopt shallow breathing patterns that can lead to decreased gas exchange and a reduced tidal volume.To facilitate adequate lung functions,patients should be taught how to perform pulmonary exercises.Expectoration of secretions and deep breathing help prevent common complications,including atelectasis and pneumonia.Abdominal distension and gas pains are common after abdominal surgery and result from delayed peristalsis.Coughing and deep breathing won't prevent pulmonary embolism.

Question 18

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?

Accepted Answer

An ice pack,wrapped in cloth,can be applied to the perineum for 20 minutes every 2 to 4 hours for discomfort.Ice has vasoconstrictive and numbing effects.Cooled cabbage leaves can be placed against the woman's breasts to help with engorgement.Donut pillows are not recommended because they spread the buttocks and increase pain,especially if the woman has hemorrhoids.Sitz bath water should be no higher than 105°F (40.5°C).

Question 19

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?

Accepted Answer

Often siblings have a rough time adapting to the arrival of a new sibling.Some suggestions for the parents are to talk to the child about her feelings,teach the child how to play with the baby,praise age-appropriate behaviors and do not criticize regressive behaviors (regression is common),set aside special time each day for the older child,and give the older child a special chore to be a "big helper for Mommy." A special chore,such as bringing diapers when the baby needs changing,can help boost her self-esteem and make her feel important to the family.

Question 20

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?

Accepted Answer

The most critical action a nurse can take to enhance bonding is to minimize the time the mother and her baby are separated while in the hospital.This policy would be most beneficial to promote bonding.The other ideas are good ones that might be helpful to some new mothers,but the critical action is to minimize separation.

Quiz 15: Caring for the Postpartal Woman and Her Family