Chapter 19: Nursing care of the family during the postpartum period
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1. 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.
Retained placental fragments.
b.
Unrepaired vaginal lacerations.
c.
Uterine atony.
d.
Puerperal infection
c.
Uterine atony.
2. 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:
a.
Begin an intravenous (IV) infusion of Ringer's lactate solution.
b.
Assess the woman's vital signs.
c.
Call the woman's primary health care provider.
d.
Massage the woman's fundus.
d.
Massage the woman's fundus.
3. 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?
a.
The woman is a gravida 2, para 2.
b.
The woman had a vacuum-assisted birth.
c.
The woman received epidural anesthesia.
d.
The woman has an episiotomy.
d.
The woman has an episiotomy.
4. 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?
a.
Rubella vaccine should be given.
b.
A blood transfusion is necessary.
c.
Rh immune globulin is necessary within 72 hours of birth.
d.
A Kleihauer-Betke test should be performed
a.
Rubella vaccine should be given.
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. The woman should be advised that this condition can best be treated by:
a.
Running warm water on her breasts during a shower.
b.
Applying ice to the breasts for comfort.
c.
Expressing small amounts of milk from the breasts to relieve pressure.
d.
Wearing a loose-fitting bra to prevent nipple irritation.
b.
Applying ice to the breasts for comfort.
6. 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:
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."
d.
"I'll warm the soup in the microwave for you."
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?
a.
The woman leaves the infant on her bed while she takes a shower.
b.
The woman continues to hold and cuddle her infant after she has fed her.
c.
The woman reads a magazine while her infant sleeps.
d.
The woman changes her infant's diaper and then shows the nurse the contents of the diaper.
a.
The woman leaves the infant on her bed while she takes a shower.
8. In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:
a.
Is inconsistent with the Baby Friendly Hospital Initiative.
b.
Promotes longer periods of breastfeeding.
c.
Is perceived as supportive to both bottle-feeding and breastfeeding mothers.
d.
Is associated with earlier cessation of breastfeeding.
a.
Is inconsistent with the Baby Friendly Hospital Initiative.
9. 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:
a.
"You have pitting edema in your ankles."
b.
"You have deep tendon reflexes rated 2+."
c.
"You have calf pain when the nurse flexes your foot."
d.
"You have a 'fleshy' odor to your vaginal drainage."
c.
"You have calf pain when the nurse flexes your foot."
10. 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:
a.
Has recovered from epidural or spinal anesthesia.
b.
Has hidden bleeding underneath her.
c.
Has regained some flexibility.
d.
Is a candidate to go home after 6 hours.
a.
Has recovered from epidural or spinal anesthesia.
11. 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.
a.
24, 73
b.
24, 96
c.
48, 96
d.
48, 120
c.
48, 96
12. 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:
a.
The father of the infant.
b.
Her mother (the infant's grandmother).
c.
Her eldest daughter (the infant's sister).
d.
The nurse.
d.
The nurse.
13. 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:
a.
Formally initializing individualized care by confirming the woman's and infant's identification (ID) numbers on their respective wrist bands. ("This is your baby.")
b.
Teaching the mother to check the identity of any person who comes to remove the baby from the room. ("It's a dangerous world out there.")
c.
Including other family members in the teaching of self-care and child care. ("We're all in this together.")
d.
Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood
d.
Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood
14. Excessive blood loss after childbirth can have several causes; the most common is:
a.
Vaginal or vulvar hematomas.
b.
Unrepaired lacerations of the vagina or cervix.
c.
Failure of the uterine muscle to contract firmly.
d.
Retained placental fragments
c.
Failure of the uterine muscle to contract firmly.
15. 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.
Improve the accuracy of blood loss estimation, which usually is a subjective assessment.
b.
Determine which pad is best.
c.
Demonstrate that other nurses usually underestimate blood loss.
d.
Reveal to the nurse supervisor that one of them needs some time off.
a.
Improve the accuracy of blood loss estimation, which usually is a subjective assessment.
16. 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:
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.
d.
Inserting a sterile catheter.
17. 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?
a.
Putting the patient in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots.
b.
Having the patient flex, extend, and rotate her feet, ankles, and legs.
c.
Having the patient sit in a chair.
d.
Notifying the physician immediately if a positive Homans' sign occurs.
c.
Having the patient sit in a chair.
18. As relates to rubella and Rh issues, nurses should be aware that:
a.
Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.
b.
Women should be warned that the rubella vaccination is teratogenic, and that they
must avoid pregnancy for 1 month after vaccination.
c.
Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant.
d.
Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations
b.
Women should be warned that the rubella vaccination is teratogenic, and that they
must avoid pregnancy for 1 month after vaccination.
19. Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins:
a.
At the time of admission to the nurse's unit.
b.
When the infant is presented to the mother at birth.
c.
During the first visit with the physician in the unit.
d.
When the take-home information packet is given to the couple.
a.
At the time of admission to the nurse's unit.
20. 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:
a.
Discusses her labor and birth experience excessively.
b.
Believes that her baby is more attractive and clever than any others.
c.
Has not given the baby a name.
d.
Has a partner or family members who react very positively about the baby
c.
Has not given the baby a name.
21. Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic?
a.
Gravida 5, para 5
b.
Woman who is bottle-feeding her first child
c.
Primipara who delivered a 7-lb boy
d.
Woman who wishes to breastfeed as soon as her baby is out of the neonatal intensive care unit
a.
Gravida 5, para 5
22. Postpartal overdistention of the bladder and urinary retention can lead to which complications?
a.
Postpartum hemorrhage and eclampsia
b.
Fever and increased blood pressure
c.
Postpartum hemorrhage and urinary tract infection
d.
Urinary tract infection and uterine rupture
c.
Postpartum hemorrhage and urinary tract infection
23. Rho immune globulin will be ordered postpartum if which situation occurs?
a.
Mother Rh?2-, baby Rh+
b.
Mother Rh+, baby Rh+
c.
Mother Rh?2-, baby Rh?2-
d.
Mother Rh+, baby Rh?2-
a.
Mother Rh?2-, baby Rh+
24. Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?
a.
Notify the physician of an impending hemorrhage.
b.
Assess the blood pressure and pulse.
c.
Evaluate the lochia.
d.
Assist the patient in emptying her bladder
d.
Assist the patient in emptying her bladder
25. When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is:
a.
Rectal suppositories.
b.
Early and frequent ambulation.
c.
Tightening and relaxing abdominal muscles.
d.
Carbonated beverages.
b.
Early and frequent ambulation
26. The nurse caring for the postpartum woman understands that breast engorgement is caused by:
a.
Overproduction of colostrum.
b.
Accumulation of milk in the lactiferous ducts and glands.
c.
Hyperplasia of mammary tissue.
d.
Congestion of veins and lymphatics
d.
Congestion of veins and lymphatics
27. Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?
a.
The mother should check the photo ID of any person who comes to her room.
b.
The baby should be carried in the parent's arms from the room to the nursery.
c.
Because of infant security systems, the baby can be left unattended in the patient's room.
d.
Parents should use caution when posting photos of their infant on the Internet.
e.
The mom should request that a second staff member verify the identity of any questionable person.
a.
The mother should check the photo ID of any person who comes to her room.
d.
Parents should use caution when posting photos of their infant on the Internet.
e.
The mom should request that a second staff member verify the identity of any questionable person.