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406 5 Flashcards

1
Q

it is normal for _____ to occur for 12 to 24 hours post-delivery due to high oxytocin levels

A

contractions

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2
Q

post-delivery: pulse

A

may decrease to 50 (normal puerperal

bradycardia)

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3
Q

24 to 48 hours postpartum, cardiac output remains

A

elevated

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4
Q

post-delivery: ____ (especially at night) helps restore normal plasma volume.

A

sweating

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5
Q

post-delivery: WBC count is

A

elevated (so you can’t really use that to determine infection since it’s a normal finding)

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6
Q

post-delivery: changes in the blood increase the risk for

A

thrombus

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7
Q

post-delivery: GU

A

Diuresis occurs; woman excretes up to 3000 mL/ day of urine.

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8
Q

post-delivery: ____ distention and incomplete emptying are common.

A

Bladder

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9
Q

post-delivery: No bowel movements are expected for

A

2 to 3 days

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10
Q

remember the first step in teaching is

A

assess the current knowledge level and readiness to learn

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11
Q

post-delivery: RR

A

should be normal range

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12
Q

On the first postpartum day (first day following birth), the top of the fundus is located approximately

A

1 cm below the umbilicus

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13
Q

The fundus should be midline and ___ immediately after delivery

A

firm

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14
Q

blood-tinged discharge, including shreds of tissue and decidua

A

Lochia rubra

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15
Q

lochia ___ lasts 2 to 3 days postpartum

A

Lochia rubra

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16
Q

pale pinkish to brownish discharge lasting 1 week postpartum

A

Lochia serosa

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17
Q

discharge with leukocytes and degenerated cells

A

Lochia alba

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18
Q

lochia alba lasts up to _ weeks postpartum

A

4

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19
Q

after the first post partum day, the most common cause of uterine atony is

A

retained placental parts

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20
Q

The nurse must check for the presence of retained placental parts in the

A

lochia

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21
Q

placental site does not heal; lochia persists, with brisk periods of lochia rubra

A

Subinvolution

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22
Q

Women can tolerate __ __ in postpartum because the plasma volume has increased

A

blood loss

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23
Q

If not breastfeeding, teach woman nonpharmacologic measures of milk suppression:

A

supportive bra or binder, ice packs, and avoiding breast stimulation.

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24
Q

Clients should void within _ hours of delivery

A

4 hours

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25
Q

__ exercises can improve urine retention

A

kegel

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26
Q

diet during breastfeeding

A

add 500 cal to the prepregnancy intake

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27
Q

the most common reason for decreased milk production is

A

stress

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28
Q

tests for antibodies against RBCs

A

Coombs test

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29
Q

RhoGAM is given to Rh-negative mother who has a ___ ___ test

A

negative Coombs test

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30
Q

Because Rh immune globulins suppress the immune system, the client who receives both RhoGAM and the rubella vaccine should be

A

tested for rubella immunity at 3 months

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31
Q

Postpartum: Instruct client to notify health care provider or clinic promptly of: Heavy

A

Heavy vaginal bleeding with clots

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32
Q

Postpartum: Instruct client to notify health care provider or clinic promptly of: Pain on

A

urination

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33
Q

Postpartum: Instruct client to notify health care provider or clinic promptly of: Tenderness in

A

in calf

34
Q

abstain from __ until lochia

has ceased.

A

sex

35
Q

newborn: drug that causes depressed respirations, hypocalcemia, and hypotonia.

A

Magnesium sulfate given during labor

36
Q

newborn: RR

A

30 to 60

37
Q

newborn: HR

A

110 to 160

38
Q

newborn: HR sleeping

A

low as 100

39
Q

newborn: HR crying

A

high as 180

40
Q

newborn: auscultate heart at which landmark

A

3rd or 4th intercostal

41
Q

newborn: BP

A

80/50 (BP is not usually measured in new borns)

42
Q

newborn: weight during the 1st week

A

they usually lose about 10%

43
Q

suction ___, then ___

A

mouth, then nose (Hesi hint)

44
Q

Aspiration: Turn neonate on side or stomach and pat firmly on the back, holding head

A

10 to 15 degrees lower than feet

45
Q

newborn: frog position indicates

A

premature

46
Q

Tiny white bumps that commonly appear on a baby’s face.

A

milia

47
Q

newborn: caput succedaneum

A

edema under the scalp

48
Q

cord abnormalities could indicate

A

cardiac or kidney problems

49
Q

reflex: baby extends and abducts limbs

A

moro

50
Q

reflex: when neck is turned to side, baby assumes fencing position

A

tonic neck

51
Q

reflex: touch the base of the toe, causes the toe to curl

A

plantar

52
Q

difference between caput succedaneum and cephalohematoma

A

caput crosses suture lines and is present at birth

53
Q

If newborn’s temperature falls below 97.6° F (36.4° C),

A

place in radiant warmer and apply skin temperature

probe

54
Q

to keep infant warm its acceptable to put skin to skin or

A

double wrap

55
Q

Hypothermia -> Use up glucose -> must start using the brown fat ->

A

causes ketoacidosis and shock

56
Q

small-for-gestational-age: Perform a ___ blood glucose assessment

A

heelstick

57
Q

large-forgestational-age: Perform a ___ blood glucose assessment

A

heelstick

58
Q

infants of diabetic mothers: Perform a ___ blood glucose assessment

A

heelstick

59
Q

jittery babies: Perform a ___ blood glucose assessment

A

heelstick

60
Q

babies with high-pitched cries: Perform a ___ blood glucose assessment

A

heelstick

61
Q

Report any blood glucose levels under __ mg/dL in

the full-term infant

A

40

62
Q

Report any blood glucose levels under __ mg/dL in the preterm infant

A

30

63
Q

newborn: Normal serum glucose is

A

40 to 80

64
Q

Large for gestational weight means the weight is above what percentile

A

90th

65
Q

heelstick: use only the ___ surface of the heel

A

lateral

66
Q

heelstick: after you puncture

A

wipe away the first drop of blood

67
Q

which site do you administer the vit K

A

vastus lateralis

68
Q

escalate if a newborn has not had a BM within

A

24 h

69
Q

starting on day 6, the baby should use how many diapers a day

A

at least 6 to 8

70
Q

There may be brick-red “dust” in the first

A

voiding

71
Q

to find the urine output: weigh the wet diaper, for every

A

gram added, that’s 1 mL urine

72
Q

Screen for phenylketonuria (PKU) after

A

24 hours

of breast milk or formula ingestion

73
Q

Do not feed a new born is the RR is

A

over 60

74
Q

Most ___-fed newborns eat every 3 to 4 hours

A

bottle

75
Q

___fed infants eat every 2 to 3 hours

A

breast

76
Q

After the initial weight loss period, the infant should

gain approximately

A

1 oz (30 g) per day

77
Q

An infant needs about __ calories/lb for the first 6 months.

A

50

78
Q

needs medical attention: stools ___, ___

A

green, liquid

79
Q

needs medical attention: refusal of __ feedings in a row

A

2

80
Q

rectal temp: insert for __ minutes

A

5

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