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Chapter 2 - Key Points
Health promotion involves primary, secondary, and tertiary health prevention strategies.
Routine mammograms can help in diagnosing breast cancer early and reducing the morbidity from breast cancer.
The myometrium (middle muscular uterine layer) is functional in pregnancy and labour. The endometrium (inner uterine layer) is functional in menstruation and implantation of a fertilized ovum.
The female breasts are composed of fatty and fibrous tissue and of glands that can secrete milk.
The female reproductive cycle consists of regular changes in hormone secretions from the anterior pituitary gland and the ovary, maturation and release of an ovum, and buildup and breakdown of the uterine lining.
The pelvis is divided into a false pelvis above the linea terminalis and the true pelvis below this line. The true pelvis is most important in the childbirth process. The true pelvis is further divided into the pelvic inlet, the pelvic cavity, and the pelvic outlet.
The egg lives for only 24 hours after ovulation, and fertilization must occur during that time.
Amenorrhea can be caused by a lack of body fat, and often changing eating habits may result in resumption of a normal period.
Several self-help measures can relieve some symptoms of premenstrual syndrome.
Prevention of toxic shock syndrome involves not allowing microorganisms the time to grow in the patient’s reproductive tract.
Sexually transmitted infections (STIs) must be adequately treated in all sexual contacts to stop the transmission and to prevent resistance to antibiotics.
Contraception is an individual choice. The role of the nurse is to provide education to the patient about the effectiveness and risks and benefits of different contraceptive methods in a culturally safe manner.
Fertility awareness methods can be used both to prevent pregnancy and to increase the chance of achieving it.
Contraceptive choices include temporary contraception, such as barrier methods or hormones, or permanent contraception, such s sterilization or vasectomy.
Emergency contraception is a progestin-only medication taken within 2 to 5 day of unprotected sexual intercourse and is available without a prescription.
Condoms (male and female) offer the best protection from STIs.
Nursing care for someone experiencing infertility includes education regarding human reproduction, lifestyle changes, and assisted human reproduction technologies as well as providing emotional support.
Common menopausal symptoms, such as hot flashes and vaginal dryness, stem from the cessation of ovulation and the decrease in hormonal activity, particularly that of estrogen and progesterone.
Menopause symptoms can be treated with nonmedical treatments for some persons.
Chapter 2 Exam Review Questions
1. What would be the best method to screen for breast cancer in lowrisk patients?
a. Monthly breast self-examination
b. Yearly clinical breast examination by a health care provider
c. Mammograms every 2–3 years after the age of 50
d. Magnetic resonance imaging scan every 3 years after age 40
2. A patient can keep a diary of their menstrual cycles to help determine their fertile period. They understand that after ovulation they will remain fertile for:
a. 2 hours
b. 24 hours
c. 3 to 5 days
d. 7 to 14 days
3. The muscular layer of the uterus that is the functional unit in pregnancy and labour is the:
a. Perimetrium
b. Myometrium
c. Endometrium
d. Cervix
4. During a prenatal clinic visit, a pregnant patient states that they are not planning to breastfeed their newborn because they have very small breasts and believes they cannot provide adequate milk for a full-term newborn. The best response of the nurse would be:
a. “Ask the physician if they will prescribe hormones to build up the breasts.”
b. “I can provide you with exercises that will build up your breast tissue.”
c. “The fluid intake of the mother will determine the milk output.”
d. “The size of the breast has no relationship to the ability to produce adequate milk.”
5. To relieve or reduce symptoms of premenstrual dysphoric disorder, what should a nurse teach a patient to do?
a. Avoid simple sugars and caffeine consumption.
b. Use oral contraceptive medication.
c. Avoid physical exercise.
d. Limit water intake to 1 000 mL/day.
6. A patient comes to the health clinic with symptoms of vaginal itching and white curd-like discharge. What does the nurse suspect the patient has?
a. Candidiasis
b. Trichomoniasis
c. Gonorrhea
d. Chlamydia
7. A nurse who teaches a patient about the importance of scheduling a mammogram is practising which prevention strategy?
a. Primary
b. Secondary
c. Tertiary
d. Incidental
8. A nurse is teaching a teenager about effective birth control methods. Which method would the nurse teach the teen that is most recommended for someone their age?
a. Oral contraception
b. Male condom
c. Intrauterine contraception
d. Vaginal sponge
9. At which age would a nurse teach a sexually active patient that they should start having Papanicolaou screening done?
a. 18 years
b. 20 years
c. 23 years
d. 25 years
10. The nurse is leading a class discussing ovulation and menstruation. The nurse explains that ovulation occurs: (Select all that apply.)
a. 14 days after the last menstrual period
b. 14 days before the next menstrual period
c. At the eighteenth day of a 32-day menstrual cycle
d. 1 week before menses occurs
11. Which factors change the normal flora of the vagina and predispose to vaginal infection? (Select all that apply.)
a. Use of antibiotics
b. Douching
c. Sexual intercourse
d. Daily baths
e. Drinking caffeine
12. What is a reliable temporary (reversible) birth control method? (Select all that apply.)
a. Douching
b. Breastfeeding
c. Transdermal patch
d. Vasectomy
e. IUC
13. A nurse should teach the patient who is experiencing menopause which of the following? (Select all that apply.)
a. Calcium intake should be increased.
b. Weight-bearing exercise is important.
c. Lying down and resting after each meal is important.
d. Participating in yoga is beneficial.
e. Limiting alcohol intake will help decrease symptoms.
Chapter 2 Answers
C
B
B
D
A
A
B
C
D
A, C
A, B, C
C, E
A, B, E
Chapter 4 - Key Points
Preconception care is important to ensure optimum health prior to pregnancy, which can have an impact on the child’s health as well as assisting to promote a healthy pregnancy.
The goal of prenatal care is to develop collaborative relationships between the patient and the health care team to ensure the healthiest possible outcome for mother and infant.
The length of a pregnancy is 40 weeks after the last menstrual period. The expected date of birth can be determined by using Nägele’s rule, although a first-trimester ultrasound is more accurate.
Specific laboratory screening tests are performed during pregnancy to ensure a positive outcome for both pregnant patient and the newborn.
Obstetrical ultrasound has been incorporated into routine care.
Presumptive signs of pregnancy often have other causes. Probable signs more strongly suggest pregnancy but can still be caused by other conditions. Positive signs have no other cause except pregnancy. The three positive signs of pregnancy include detection of a fetal heartbeat, recognition of fetal movements by a trained examiner, and visualization of the embryo or fetus on ultrasound.
The optimal weight gain during pregnancy for a pregnant person with a normal body mass index is 11.5 to 16 kg (25 to 35 lb).
Normal microbes living in the pregnant person’s body play a role in maintaining pregnancy, preparing for labour, and establishing a microbiome in the gut of the newborn.
The uterus undergoes the most obvious changes in pregnancy: It increases in weight from approximately 60 g to 1 100 g; it increases in capacity from about 10 mL to 5 000 mL. Pregnancy affects all body systems.
The pregnant person’s blood volume is about 40 to 50% greater than their prepregnant volume to enable perfusion of the placenta and extramaternal tissues. The blood pressure does not increase, because resistance to blood flow in the arteries decreases. The fluid portion of their blood increases more than the cellular portion, resulting in a physiological anemia.
The common discomforts of pregnancy occur as a result of hormonal, physiological, and anatomical changes normally occurring during pregnancy. The nurse should teach relief measures and explain abnormal signs to report to the health care provider.
Supine hypotension, also known as aortocaval compression, may occur if the pregnant person lies flat on their back. Turning to one side or placing a small pillow under one hip can help relieve this hypotension.
To provide for the growth of the fetus and maternal tissues, the mother needs an extra snack per day. Important nutrients that must be increased are protein, iron, and folic acid. Calcium is also an important nutrient.
Adequate folic acid intake of 0.4 mg/day before conception can reduce the incidence of neural tube defects (NTDs) such as anencephaly or spina bifida in the newborn in the low-risk pregnant person. If the risk for an NTD is increased, pregnant patients should take 1.0 mg/day before conception and for the first 3 months of pregnancy.
Adequate vitamin intake is essential for optimum fetal development. However, excess vitamin intake can be toxic.
Live-virus vaccines are contraindicated during pregnancy.
The physiological changes during pregnancy influence the metabolism of ingested medications.
Medications and herbal remedies ingested during pregnancy can affect fetal development.
All pregnant patients should be screened for mental health concerns as well as intimate partner violence.
Partners should be included in prenatal care to the extent that they and the pregnant person desire.
The health history of the partner is important, because genetics, illness, or lifestyle practices may affect the health of all members of the family.
Adaptation to pregnancy occurs in the mother, the partner, and other family members. Prenatal care involves physical and psychological aspects and should be family- centred.
Childbirth education includes formal classes and informal counselling. Education may include appropriate nutrition, healthy lifestyle, breathing and relaxation techniques for labour, the birth process, newborn care, safety issues, and parenting skills.
Chapter 4 Exam Review Questions
1. A woman arrives in the clinic for her prenatal visit. She states that she is currently 28 weeks pregnant with twins; has a 5-year-old son who was born at 39 weeks’ gestation and a 3-year-old daughter born at 34 weeks’ gestation; and her last pregnancy terminated at 16 weeks’ gestation. The nurse will interpret her obstetrical history as:
a. G4 T2 P2 A1 L4
b. G3 T2 P0 A1 L2
c. G3 T1 P1 A1 L2
d. G4 T1 P1 A1 L2
2. Exercise during pregnancy should be practised to achieve which of the following goals?
a. Improving obstetrical outcomes
b. Minimizing weight gain
c. Achieving weight loss
d. Improving physical fitness
3. During a prenatal examination at 30 weeks of gestation, a patient is lying on their back on the examining table. They suddenly state they feel dizzy and feel faint. The most appropriate response of the nurse would be to:
a. reassure the patient and take measures to reduce their anxiety level.
b. offer the patient some orange juice or other rapidly absorbed form of glucose.
c. place a pillow under the patient’s head.
d. turn the patient onto their side.
4. A woman being seen for her first prenatal care appointment has a positive home pregnancy test, and her chart shows her obstetrical history to be G4 T3 P0 A1 L2. The nurse would anticipate that:
a. minimal prenatal teaching will be required because this is her fourth pregnancy.
b. the woman will need help in planning the care of her other children at home during her labour and birth.
c. the woman should experience minimal anxiety because she is familiar with the progress of pregnancy.
d. this pregnancy will be considered high risk, and measures to reduce anxiety will be needed.
5. A woman’s last menstrual period (LMP) was on April 1, 2023. She has been keeping her prenatal clinic appointments regularly but states she needs to alter the dates of a future appointment becauseshe and her partner are going on an ocean cruise vacation for the New Year’s celebration from December 30 through January 7, 2024. The best response of the nurse would be:
a. “Prenatal visits can never be altered. Every visit is important.”
b. “Be sure to take antinausea medication when going on an ocean cruise.”
c. “Perhaps you might consider rescheduling your vacation earlier rather than the New Year’s dates.”
d. “I will reschedule your clinic appointment to accommodate your vacation plans.”
6. During a prenatal clinic visit, a nurse provides interventions to a patient who has experienced intimate partner violence. The nurse’s interventions should focus on which of the following?
a. Persuading them to leave their abusive partner
b. Informing them of safety options
c. Convincing them to notify the police
d. Placing them in a shelter for abused patients
7. A nurse is explaining probable signs of pregnancy with a group of patients. Probable signs of pregnancy include which of the following? (Select all that apply.)
a. Fetal heart beat
b. Abdominal enlargement
c. Amenorrhea
d. Braxton Hicks contractions
e. Hegar sign
8. A nurse has noted a pregnant patient’s obstetrical history as G4 T1 P1 A1 L2. This means she has had four __#_1___, one #2___, one __#_3___, one __#_4___, and two #5__.
a. Term birth
b. Abortion
c. Living children
d. Pregnancies
e. Preterm birth
9. A 22-year-old person is being seen to confirm a pregnancy. Calculations using the patient’s LMP puts the client in the twenty-third week of their first pregnancy. Which data that is collected requires further assessment by the nurse? (Select all that apply.)
a. Hemoglobin 105 g/L
b. White blood cells 12.0 × 109/L
c. Breasts tender to the touch with darkened areolae
d. Body mass index (BMI): 17.8
e. Fetal heart rate: 150 beats/minute with Doppler
f. Blood pressure: 124/74 mm Hg (sitting); 122/74 mm Hg (lying)
Chapter 4 Answers
D
A
D
B
C
B
B, D, E
1-D, 2-A, 3-E, 4-B, 5-C
A, D
Chapter 6 - Key Points
All labouring patients and their family need to be provided care that respects their wishes, values, and cultural beliefs.
True labour and prelabour have several differences; however, the conclusive difference is that true labour results in cervical change (effacement or dilation).
The five components, or “five P’s,” of the birth process are the powers, the passageway, the passenger, maternal position, and the psyche. All interrelate during labour to either facilitate or impede birth.
The labouring person should go to the hospital if they are havingpersistent, regular contractions (every 4–5 minutes for nulliparas, and every 5–7 minutes for multiparas); if the membranes rupture; if there is bleeding other than normal bloody show; if fetal movement decreases; or for other concerns not covered by the basic guidelines.
Three key assessments on admission are fetal condition, maternal condition, and nearness to birth.
There are four stages of labour, and each stage includes different characteristics. The first stage is dilation and effacement, lasting from labour’s onset to full (10 cm) cervical dilation. The first stage of labour is subdivided into two phases: latent (early) and active. Second-stage labour, the stage of expulsion, extends from full cervical dilation until birth of the newborn. The third stage, the placental stage, is from the birth of the newborn until the placenta is delivered. The fourth stage is the immediate postbirth recovery period and includes the first 1 to 2 hours after birth.
Nursing care during the first and second stages focuses on observing the fetal and maternal conditions and on helping the patient cope with labour.
Intermittent auscultation is the recommended method of fetal monitoring for low-risk healthy labouring patients. Continuous electronic fetal monitoring is used for labouring patients who have increased risk for adverse perinatal outcomes.
The normal baseline fetal heart rate (FHR) should be between 110 and 160 beats/min.
An FHR tracing demonstrates the relationship between the baseline FHR and uterine contractions.
The presence of accelerations and moderate variability in the FHR pattern is a normal pattern and confirms that the fetus is well oxygenated.
Abnormal FHR patterns require specific interventions to try to reverse the FHR pattern. If the pattern cannot be changed, the health care provider must be notified.
Labouring patients can assume many positions. Upright positions add gravity to the forces promoting fetal descent. Hands-andknees and leaning-forward positions promote normal internal rotation of the fetus if “back labour” is a concern. Squatting facilitates fetal descent during the second stage. The supine position should be discouraged because it causes the heavy uterus to compress the mother’s main blood vessels, which can reduce fetal oxygen supply.
The main fetal risk during first- and second-stage labour is fetal compromise caused by interruption to the fetal oxygen supply. The main maternal risk during fourth-stage labour is hemorrhage caused by uterine relaxation.
Nursing care after episiotomy or perineal lacerations includes comfort measures such as cold applications, analgesics, and wound assessment.
The immediate care of the newborn after birth includes maintaining warmth, maintaining cardiorespiratory function, maintaining skin-to-skin contact, assessing for major anomalies, encouraging parent–infant bonding and breastfeeding, and providing proper identification and documentation.
Chapter 6 Exam Review Questions
1. To determine the duration of uterine contractions, the nurse should note the time from the:
a. beginning to end of the same contraction.
b. end of one contraction to the beginning of the next contraction.
c. beginning of one contraction to the beginning of the next contraction.
d. contraction’s peak until the contraction begins to relax.
2. Excessive anxiety and fear during labour may result in which of the following?
a. An ineffective labour pattern
b. An abnormal fetal presentation or position
c. The release of oxytocin from the pituitary gland
d. A rapid labour and uncontrolled birth
3. A person who is pregnant with their first child phones the labour unit and says their “water broke.” What should a nurse tell the patient to do?
a. Wait until they have contractions every 5 minutes for 1 hour.
b. Take their temperature every 4 hours and come to the hospital if it is over 38°C (100.4°F).
c. Come to the hospital for assessment.
d. Call an ambulance to bring them to the hospital.
4. A labouring patient suddenly begins making grunting sounds and bearing down during a strong contraction. What is the nursing priority?
a. Leave the room to find an experienced nurse to assess the patient.
b. Look at their perineum for increased bloody show or perineal bulging.
c. Ask the patient if they need pain medication.
d. Tell them that these are common sensations in late labour.
5. A patient in active labour has contractions every 3 minutes lasting 60 seconds, and their uterus relaxes between contractions. The electronic fetal monitor shows the fetal heart rate reaching 90 beats/min for periods lasting 20 seconds during a uterine contraction. What is the priority nursing action?
a. Continue to monitor closely.
b. Administer oxygen by mask at 10 L/min.
c. Notify the health care provider.
d. Prepare for a Caesarean birth.
6. The nurse is assessing the fetal heart rate of a labouring patient who is 40 weeks’ gestation. Which finding should the nurse recognize as normal?
a. Fetal heart rate of 140–150 beats/min with accelerations 15 beats above the baseline
b. Fetal heart rate of 130–140 beats/min with late decelerations
c. Fetal heart rate of 160–170 beats/min with variable decelerations
d. Fetal heart rate of 100–110 beats/min
7. Which fetal presentation would be considered the most favourable for birth?
a. Face
b. Frank breech
c. Vertex
d. Sinciput
8. The nurse is caring for a patient in labour. Which of the following observations require immediate nursing intervention? (Select all that apply.)
a. Fetal heart rate of 90 beats/min between contractions
b. Maternal tachysystole with fetal heart rate changes
c. Contractions lasting 60 seconds with a resting period of 90 seconds
d. Moderate variability in fetal heart rate
Chapter 6 Answers
C
A
C
B
A
A
C
A, B
Chapter 7 - Key Points
Pain during childbirth is different from other types of pain, because it is part of a normal process that results in the birth of a baby. The pregnant person has time to prepare for it, and the pain is selflimiting.
A labouring patient’s pain threshold is fairly constant. Pain tolerance varies, and the aim of nursing actions is to support the ability to tolerate pain.
The pain of labour is caused by cervical dilation and effacement, uterine ischemia, and stretching of the vagina and perineum.
Poorly relieved pain can decrease patient satisfaction with the labour process.
Childbirth preparation classes provide pain-management information and tools for the pregnant person and their partner to use during labour. Some tools, such as breathing techniques and effleurage, can also be taught at the time of labour.
The nurse supports the patient to practice relaxation during labour because it enhances the effectiveness of all other pain management methods, both nonpharmacological and pharmacological.
Any medication taken by the labouring patient may cross the placenta and have an effect on the fetus. Effects may persist much longer after birth in the newborn than in an adult.
Regional anaesthetics are a common choice for pain relief during labour because they allow the labouring patient to remain awake, including for Caesarean birth.
It is important to determine any medication allergies that the patient has upon admission to the labour and birth unit.
It is important to assess for reactions to dental anaesthetics because medications used for regional anaesthesia are related to those used in dentistry.
The nurse assesses blood pressure and the fetal heart rate frequently after epidural or spinal block to identify hypotension or fetal compromise. The nurse also assesses for urinary retention.
The nurse needs to observe the postpartum patient and newborn for respiratory depression if opioids were received, including epidural opioids, during the intrapartum period.
Chapter 7 Exam Review Questions
1. Which of the following is most appropriately used for pain relief during labour when the cervix is dilated less than 4 cm?
a. Narcan (naloxone) via intramuscular (IM) route
b. Demerol (meperidine) via IM route
c. Morphine sulphate (morphine) via IM route
d. Fentanyl (Sublimaze) via IV route
2. Which technique is likely to be most effective for back labour?
a. Stimulating the abdomen by effleurage
b. Applying firm pressure in the sacral area
c. Blowing out in short breaths during each contraction
d. Rocking from side to side at the peak of each contraction
3. What medication should be immediately available for emergency use in the labouring patient when opioids are received during labour?
a. Fentanyl (Sublimaze)
b. Diphenhydramine (Benadryl)
c. Lidocaine (Xylocaine)
d. Naloxone (Narcan)
4. Which is the most important nursing assessment immediately after a labouring patient receives an epidural block?
a. Bladder distension
b. Condition of intravenous site
c. Respiratory rate
d. Blood pressure
5. A labouring patient asks to have epidural analgesia. When is the best time for this method of analgesia to be given?
a. Anytime during labour
b. During prelabour
c. During the first stage of labour
d. During the third stage of labour
6. A patient who is in the early first stage of labour asks for help to relieve the discomfort. The nurse knows that nonpharmacological techniques that can relieve discomfort include which of the following? (Select all that apply.)
a. Sacral pressure
b. Effleurage
c. Sitz bath
d. Laxatives
e. Massage
7. Match the nonpharmacological pain-relief measure with its description that can be helpful to a patient in active labour.
1. Hydrotherapy
2. Thermal stimulation
3. Effleurage
4. Diversion and distraction
5. Neuromuscular dissociation
6. Progressive relaxation
a. ______ Concentrating on a specific object
b. ______ Sitting in a tub of warm water
c. ______ Light, circular massage of the abdomen
d. ______ A warmed pad placed behind the lower back
e. ______ Contracting one muscle group forcefully and consciously relaxing others
f. ______ Contracting one muscle group forcefully and consciously relaxing others
Chapter 7 Answers
C
B
D
D
C
A, B, E
A – 1, B – 2, C – 3, D – 4, E – 5, F – 6.
Chapter 9 - Key Points
It is essential to consider all patients individually in order to better incorporate their culture, values, beliefs, and special needs into the plan of care.
The uterus should descend about one finger’s width per day after birth, starting at the level of the umbilicus. It should no longer be palpable at approximately 14 days postpartum.
A slight increase in maternal heart rate is common in the first hour after birth. A maternal pulse rate that continues to be high may indicate hemorrhage or infection in the postpartum patient.
A full bladder interferes with uterine contraction, which can lead to hemorrhage.
Measures to promote bowel movements should be emphasized at each assessment: fluid intake, a high-fibre diet, and activity.
Rho(D) immune globulin is given within 72 hours to the Rh-negative patient who gives birth to an Rh-positive newborn.
The postpartum check should include the status of breasts, fundus, bowel and bladder elimination, lochia, legs, perineum, emotions, vital signs, pain, and evidence of parent–newborn attachment.
The ideal interval between pregnancies is 24 months to prevent adverse outcomes in subsequent pregnancies.
Bonding and attachment require contact between parents and newborn. The nurse should promote this contact whenever possible.
Skin-to-skin contact should be initiated immediately after birth at least until the first breastfeeding occurs.
More breast milk removed means more milk is produced. Early, regular, and frequent nursing promotes milk production and lessens engorgement.
Early breastfeeding support can help decrease the risk of breastfeeding challenges.
Newborns should be fed on demand, using cues to determine when they need to be fed.
The breastfeeding mother needs an extra snack each day plus enough fluid to replace liquid lost via breastfeeding; they should drink to thirst.
Weaning from the breast should be gradual, starting with the feeding the infant is least interested in and ending with the one in which they have the most interest.
Commercially prepared formulas are available in ready-to-feed, concentrated liquid or in powdered form. Dilution, if required, must be followed exactly according to instructions.
Discharge planning should take place with every instance of mother or newborn nursing care as the nurse teaches the postpartum patient normal findings, their significance, and what to report to the health care provider. Written materials should be provided to augment all teaching.
Chapter 9 Exam Review Questions
1. Breastfeeding the newborn promotes uterine involution because it does which of the following?
a. It uses maternal fat stores accumulated during pregnancy.
b. It stimulates additional secretion of colostrum.
c. It causes the pituitary to secrete oxytocin to contract the uterus.
d. It promotes maternal formation of antibodies.
2. Eight hours postpartum a patient states that they prefer that the nurse take care of the newborn. The patient talks in detail about their birthing experience on the phone and to anyone who enters the room. The patient states they are hungry, thirsty, and sleepy and are unable to focus on the newborn care teaching being offered to them. The nurse would interpret this behaviour as which of the following?
a. Inability to bond with the newborn
b. Development of postpartum psychosis
c. Inability to assume the parenting role
d. The normal taking-in phase of the postpartum period
3. Which of the following statements from a patient who is trying to use hand expression are correct?
a. “I will use a milking motion to get milk flowing.”
b. “I will use a cold compress to help soothe the skin before expressing.”
c. “I will try to do skin-to-skin contact prior to hand expression.”
d. “I will use the statement ‘Press, compress, relax’ to remember.”
4. Which of the following statements is true as it relates to Rh factor in the blood? (Select all that apply.)
a. The postpartum person only needs Rho(D) immune globulin if they are Rh positive.
b. The timing of the administration of Rho(D) immune globulin is within 72 hours postpartum.
c. The administration of Rho(D) immune globulin is intramuscular in the postpartum patient.
d. Complications of Rh incompatibilities can include fetal or neonatal anemia.
5. Which of the following are considered abnormal signs that should be reported during the postpartum period? (Select all that apply.)
a. Foul-smelling lochia, with or without fever
b. Lochia rubra that persists beyond the fourth day
c. An unusually heavy flow of lochia
d. Lochia that returns to a bright red colour after it has progressed to serosa or alba
e. Firm breasts assessed at day 3 postpartum.
6. Which maternal assessment is expected to be seen at 24 hours after birth in a multiparous patient? (Select all that apply.)
a. Moderate amount of lochia alba on the perineal pad
b. Fundus firm and in the midline of the abdomen
c. Increased discharge with ambulation
d. Breasts distended and hard, with flat nipples
e. Bradycardia
f. Return of uterus to prepregnancy size
g. Abdominal pain during breastfeeding
7. Which of the following nursing assessments are part of the BUBBLLEE assessment? (Select all that apply.)
a. Observing the perineum
b. Assessing dorsiflexion
c. Assessing weight loss
d. Monitoring urination
e. Evaluation of bonding
f. Measuring cardiac output
g. Documenting breast tenderness.
h. Evaluating appetite
i. Determining joint laxity
j. Observation of striae
k. Recording passage of stool
l. Locating fundus
8. A 32-year-old patient gave birth to their third child 3 hours ago. They successfully breastfeed in the birthing room and had put the baby to breast twice since returning to their room. Their fundus is palpated at the level of the umbilicus, as a firm fist-sized mass. A moderate amount of lochia rubra with a few small clots has been observed. The patient has been up to bathroom to urinate a small amount of yellow urine. The perineum is swollen and tender but no bruising is observed. A small hemorrhoid is noted. The patient reports a cramping-like pain in their abdomen and states, “It’s like bad menstrual cramps.” Choose the most likely options for the information missing from the statement below by selecting from the lists of options provided. The nurse recognizes that, based on the patient’s report and description of pain, they are currently experiencing _____1_____. This conclusion is supported by assessment and history data that include _____2_____, and _____2_____.
Option 1
Edematous perineum
Extended bladder
A boggy uterus
Afterpains
Option 2
Moderate lochia flow
Urinary output
Location of fundus
Firmness of uterus
Breastfeeding
Colour of urine
Size of uterus
Hemorrhoid
Multipara
Age
Chapter 9 Answers
C
D
D
B, C, D
A, B, C, D
B
A, D, E, G, H, K, L
The nurse recognizes that, based on the patient’s report and description of pain, they are currently experiencing _____afterpains_____. This conclusion is supported by assessment and history data that include _____breastfeeding_____, and _____multipara_____.
Chapter 11 - Key points
Assessment of the newborn includes gestational age assessment, weight and length measurements, reflexes, an assessment of each system, as well as parental interaction with the newborn.
Transition of the newborn to extrauterine life occurs during the first 6 to 8 hours of life.
The newborn has an unstable heat-regulating system and must be kept warm.
Heat loss occurs in the newborn via conduction, convection, evaporation, and radiation.
The newborn will lose up to 10% of their birth weight in the first few days of life but should return to the birth weight by the age of 2 weeks.
The newborn is born with certain reflexes, which are important for healthy growth and development. Three of these are the Moro reflex, the rooting reflex, and the tonic neck reflex.
The fontanelles are spaces between the skull bones of the newborn that allow for moulding and provide space for the brain to grow. They are known as “soft spots” on the newborn’s head.
Caput succedaneum is edema of the newborn’s scalp that occurs during the birth process.
Cephalohematoma is a collection of blood under the periosteum of a cranial bone. The swelling does not cross the suture lines of the skull bones.
Physiological jaundice becomes evident after the second and third days of life and lasts for about 1 week.
Although the kidneys function at birth, they are not fully developed. Likewise, the immune system is not fully activated.
The hydration status of newborns can be evaluated by determining the number and consistency of stools, frequency of voiding, appearance of sunken fontanelles, and status of tissue turgor.
Vernix caseosa is a cheeselike substance that covers the skin of the newborn at birth.
Meconium, the first stool of the newborn, is a mixture of amniotic fluid and secretions of the intestinal glands. These stools change in colour from tarry greenish black, to greenish yellow (transitional stools), to yellow gold (milk stools).
Hand hygiene is essential for preventing infection in newborns.
Newborn screening tests are used to identify potential metabolic disorders, hearing impairment, and critical congenital heart disease.
The nurse must always keep the possibility of newborn abductions in mind when providing care.
Discharge teaching begins before birth and continues until discharge. It includes newborn care, follow-up visits, community resources, and safety.
Newborn bath time is used to cleanse the skin, assess the newborn, and teach about newborn behaviours to the parents.
Newborns should sleep on their back in order to decrease the risk of sudden infant death syndrome (SIDS).
When swaddling the infant, the hips and knees should remain in a flexed, abducted position.
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