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With regard to afterbirth pains, nurses should be aware that these pains are:
a) Can feel quite intense and may be helped by ibuprofen or tylenol.
b) More common in first-time mothers.
c) Caused by mild, continuous contractions for the duration of the postpartum period.
d) Alleviated somewhat when the mother breastfeeds
Postbirth uterine/vaginal discharge, called lochia:
a) Is usually greater after cesarean births.
b) Will usually decrease with ambulation and breastfeeding.
c) Should smell like normal menstrual flow unless an infection is present.
d) Is similar to a light menstrual period for the first 6 to 12 hours.
The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:
a) Involutionary period because of what happens to the uterus.
b) Mini-tri period because it lasts only 3 to 6 weeks.
c) Lochia period because of the nature of the vaginal discharge.
d) Puerperium, or fourth trimester of pregnancy.
Puerperium, or fourth trimester of pregnancy.
What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?
a) My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter.”
b) My first menstrual cycle will be heavier than normal and then will be light for several months after.”
c) I will not have a menstrual cycle for 6 months after childbirth.”
d) “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
“My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
a) Human placental lactogen
Which description of postpartum restoration or healing times is accurate?
a) The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth
b) Hemorrhoids usually decrease in size within 2 weeks of childbirth.
c) Most episiotomies heal within a week
d) The cervix shortens, becomes firm, and returns to form within a month postpartum.
The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth
Although all other joints return to their normal prepregnancy state, those in the parous woman’s feet do not. The new mother may notice a permanent increase in her shoe size.
With regard to the postpartum uterus, nurses should be aware that:
a) At the end of the third stage of labor it weighs approximately 500 g.
b) After 2 weeks postpartum it weighs 100 g.
c) It returns to its original (prepregnancy) size by 6 weeks, postpartum
d) After 2 weeks postpartum it should not be palpable abdominally.
A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman’s bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:
a) Excessive uterine bleeding
b) A ruptured bladder
c) Urinary tract infection
d) Bladder wall atony
The nurse caring for the postpartum woman understands that breast engorgement is caused by:
a) Hyperplasia of mammary tissue
b) Accumulation of milk in the lactiferous ducts
c) Overproduction of colostrum
d) Congestion of veins and lymphatic
congestion of the veins and lymphatics
With regard to the postpartum changes and developments in a woman’s cardiovascular and respiratory system, nurses should be aware that:
a) A hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth.
b) Cardiac output, the pulse rate, and stroke volume all return to prepregnancy normal vlues within a few hours of childbirth.
c) Respiratory function returns to nonpregnant level by 6 to 8 weeks of birth
d) The lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections
Respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth.
Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is:
a) Elevated temperature caused by postpartum infection
b) Loss of increased blood volume and edema associated with pregnancy.
c) Increased basal metabolic rate after giving birth.
d) Increased venous pressure in the lower extremities.
A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus?
a) At the umbilicus or one centimeter above the umbilicus
b) Midway between the umbilicus and the symphysis pubis
c) Nonpalpable abdominally
d) Two centimeters below the umbilicus
At the umbilicus or one centimeter above the umbilicus
Childbirth may result in injuries to the vagina and uterus. Pelvic floor exercises also known as Kegel exercises will help to strengthen the perineal muscles and encourage healing. The nurse knows that the client understands the correct process for completing these conditioning exercises when she reports:
a) “I pretend that I am trying to stop the flow of urine midstream.”
b) I do 10 of these exercises every day.”
c) I contract my thighs, buttocks, and abdomen.”
d) “I stand while practicing this new exercise routine.”
“I pretend that I am trying to stop the flow of urine midstream.”
A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?
a) Lochia serosa
b) Lochia rubra
c) Lochia alba
d) Lochia sangra
A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 ml. When assessing the woman’s vital signs, the nurse would be concerned to see:
a) Temperature 37.0° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.
b) Temperature 38° C, heart rate 80, respirations 16, BP 110/80.
c) Temperature 37.4° C, heart rate 88, respirations 36, BP 126/68.
d) Temperature 36.8° C, heart rate 60, respirations 18, BP 140/90.
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?
a) The woman leaves the infant on her bed while she takes a shower.
b) The woman reads a magazine while her infant sleeps.
c) The woman changes her infant’s diaper and then shows the nurse the contents of the diaper.
d) The woman continues to hold and cuddle her infant after she has fed her.
The woman leaves the infant on her bed while she takes a shower.
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:
a) Determine which pad is best.
b) Improve the accuracy of blood loss estimation, which usually is a subjective assessment.
c) Demonstrate that other nurses usually underestimate blood loss.
d) Reveal to the nurse supervisor that one of them needs some time off.
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:
a) Puerperal infection.
b) Uterine atony.
c) Retained placental fragments
d) Unrepaired vaginal lacerations.
Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the management of the environment. While providing routine mother-baby care, the nurse should ensure that:
a) An environment that fosters as much privacy as possible should be created.
b) Routine times for care are established to reassure the parents.
c) The father should be encouraged to go home at night to prepare for mother-baby discharge.
d) The baby is able to return to the nursery at night so that the new mother can sleep
An environment that fosters as much privacy as possible should be created.
The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?
a) Tells visitors how well her son is feeding
b) Seldom makes eye contact with her son
c) Talks and coos to her son
d) Cuddles her son close to her
Seldom makes eye contact with her son
During a phone follow-up conversation with a woman who is 4 days’ postpartum, the woman tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let down. I seem to cry for no reason!” The nurse would recognize that the woman is experiencing:
a) Attachment difficulty
c) Postpartum depression (PPD).
d) Postpartum (PP) blues.
The nurse can help a father in his transition to parenthood by:
a) Pointing out that the infant turned at the sound of his voice.
b) Encouraging him to go home to get some sleep.
c) Telling him to tape the infant’s diaper a different way
d) Suggesting that he let the infant sleep in the bassinet.
The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression (PPD). Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?
a) PPD symptoms are consistently severe
b) PPD can easily go undetected
c) Only mental health professionals should teach new parents about this condition
d) This syndrome affects only new mothers
Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom might say:
a) A mother’s breast milk has no distinctive odor.
b) Infants can learn to distinguish their mother’s voice from others soon after birth.
c) High-pitched voices irritate newborns
d) All babies in the hospital smell alike
Infants can learn to distinguish their mother’s voice from others soon after birth.
The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to:
a) Demonstrate for the mother different positions for holding her infant while feeding.
b) Tell the mother she must pay attention to her infant
c) Show the mother how the infant initiates interaction and pays attention to her.
d) Arrange for the mother to watch a video on parent-infant interaction
The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the woman’s behavior with her infant, the nurse realizes that:
a) The woman is inexperienced in caring for newborns.
b) Extra time needs to be planned for assisting the woman in bonding with her newborn.
c) What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.
d) The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn.
With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to:
a) Realize that this is a common occurrence that affects many women.
b) Be certain that you are the only caregiver for your baby to facilitate infant attachment.
c) Stay home and avoid outside activities to ensure adequate rest.
d) Keep feelings of sadness and adjustment to your new role to yourself
A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist, who informs them of their son’s prognosis. When the father sees his son, he says, “He looks just fine to me. I can’t understand what all this is about.” The most appropriate response by the nurse would be:
a) Didn’t the doctor tell you about your son’s problems?”
b) To stand beside him quietly.
c) “This must be a difficult time for you. Tell me how you’re doing.”
d) “You’ll have to face up to the fact that he is going to die sooner or later.”
A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination the nurse notices warmth and redness over an enlarged, hardened area. The nurse should suspect __________ and should confirm the diagnosis by ___________.
a) Coagulopathies; drawing blood for laboratory analysis
b) von Willebrand disease; noting whether bleeding times have been extended
c) Thrombophlebitis; using real-time and color Doppler ultrasoundDisseminated intravascular coagulation; asking for laboratory tests
The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by:
a) Wearing a supportive bra 24 hours a day.
b) Washing the nipples and breasts with mild soap and water once a day.
c) Using proper breastfeeding techniques.d) Wearing a nipple shield for the first few days of breastfeeding
The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to:
a) Administer the standing order for an oxytocic.
b) Assess maternal blood pressure and pulse for signs of hypovolemic shock.
c) Call the woman’s primary health care provider.Palpate the uterus and massage it if it is boggy.
The most appropriate statement that the nurse can make to bereaved parents is:
a) “You have an angel in heaven.”
b) “I understand how you must feel.”
c) “I’m sorry.”
d) “You’re young and can have other children.”
According to Beck’s studies, what risk factor for postpartum depression is likely to have the greatest effect on the woman’s condition?
a) Prenatal depression
b) Unplanned or unwanted pregnancy
c) Low socioeconomic status
d) Single-mother status
When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may:
a) Lose interest in her husband.
b) Harm her infant
c) Neglect her hygiene.
d) Have outbursts of anger
What woman is at greatest risk for early postpartum hemorrhage (PPH)?
a) A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress
b) A primigravida in spontaneous labor with preterm twins
c) A woman with severe preeclampsia on magnesium sulfate whose labor is being induced
d) A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor
b) Pelvic floor support devices
c) Bladder training and pelvic muscle exercisesd) Surgery
A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:
a) Prepare the woman for surgical intervention
b) Catheterize the bladder
c) Establish venous access
d) Perform fundal massage.
With regard to rubella and Rh issues, nurses should be aware that
a) Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations.
b) Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.
c) Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1-3 month after vaccination.
d) Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant.
One of the first symptoms of puerperal infection to assess for in the postpartum woman is:
a) Fatigue continuing for longer than 1 week
b) Profuse vaginal bleeding with ambulation
c) Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.
d) Pain with voiding
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