Exam 2 Review Qs Flashcards
The nurse manager of a postpartum unit is working on a quality improvement project to decrease postpartum complications. Which of the following should be included in the project? (Select all that apply)
- have provider-specific protocols in place for reference during emergencies
- conduct mock drills
- increase teamwork and communication
- educate nurses on recognition of potential problems
The nurse is assuming care for a postpartum patient who delivered vaginally two hours ago. What information in the shift-change report should the nurse alert the nurse to assess for uterine atony? (Select all that apply)
- the patient is not breastfeeding
- the patient’s labor was augmented with oxytocin
- this is the patient’s sixth baby
The labor nurse is preparing oxytocin for the prevention of postpartum hemorrhage (PPH) during the third stage of labor. Which dosage and route for oxytocin is correct for the prevention of PPH?
20 milliunits IV infusion
The nurse is assessing a postpartum patient. Her fundus is firm and midline but she is having a steady stream of vaginal bleeding without clots. What is the appropriate nursing intervention based on these assessment findings?
Notify the provider of a suspected lacteration
A nurse is checking several newborn reflexes on a 2-day-old neonate. Which reflex would require further investigation?
Asymmetrical abduction of the arms when the nurse jars the crib
The nurse is caring for a 12-hr-old neonate and incorporating measures to prevent heat loss through conduction. What is the priority nursing action?
Warming the stethoscope prior to assessment
The nurse is assessing a neonate 1 hr after birth. Which assessment data by the nurse will require further evaluation?
Axillary temperature at 97 F (normal is 97.7-99)
The nurse is assessing a 4-hr-old neonate. What behaviors would the nurse expect the newborn to exhibit? Select all.
- passage of meconium
- responsive to external stimuli
The nurse places the newborn on the mother skin-to-skin immediately after birth. What is the most appropriate teaching for the mother at this time?
Encourage the mother to initiate breastfeeding and provide support
A new mother who is breastfeeding is discussing feeding cues with the postpartum nurse. The nurse knows that education has been effective when the mother breastfeeds the baby after the baby displays what behavior?
The baby makes sucking motions
A postpartum woman calls the clinic about scheduled for a well-baby visit for another 10 days. The mother states, “I am worried that my baby is not getting enough to eat at the breast.” Which response by the nurse about effective breastfeeding would be appropriate?
You should anticipate your baby to void 8 times per day
The nurse is teaching a community education course that includes discussion of current recommendations for infant feeding. Which statement by a participant would indicate that further teaching is required?
Cereal should be added to bottles as a fortifier to increase caloric intake
The nurse is teaching a new mother on how to swaddle her newborn for comfort. Place the steps in order of the correct steps for swaddling.
- top fold
- first corner fold
- bottom fold
- other corner fold
A nurse is working in the ED when a family member brings in a 4 m.o infant. Upon assessment, the nurse suspects the infant has pediatric abusive head trauma (PAHT). Which assessment findings are consistent with a PAHT diagnosis. Select all
- breathing problems
- convulsions
- lethargy
- vomiting
What statement made by a primiparous patient 4 hours post-delivery requires further assessment by the nurse?
“My uterus is cramping really bad.”
A G4P4 patient who is 6 hours post-delivery is complaining of severe cramp-like uterine pains. What is a therapeutic nursing response?
“The pains are caused by your uterus contracting and should get better in a few days.” (intensity of afterpains will typically decrease after the 3rd postpartum day)
A G6P5 patient who is 24 hours post vaginal delivery reports severe cramp-like uterine pain. What is the priority nursing intervention for this patient?
Encourage warm packs to the abdomen
A multiparous patient asks the nurse why she is feeling contractions 8 hours after giving birth. What information should the nurse include in her teaching? Select all (2)
- “The intensity of the afterpains should decrease in a few days”
- “You probably don’t remember feeling afterpains after your first baby” (primiparous women usually do not experience afterpains)
A postpartum nurse is caring for a G1P1 patient 24 hours post vaginal delivery. What is the priority action for the nurse when preparing to assess for uterine involution?
Assist the woman to a supine
A new mother asks the nurse, “Why is my baby opening his mouth and turning his head?” What are the appropriate encouraging responses from the nurse? Select all (3)
- “Your baby is hungry. Great job on noticing the signs that he needs you.”
- “This is called ‘rooting’ and it is a normal infant response
- “Why do you think? What could he be telling you?”
What actions can the nurse suggest for the patient to provide assistance to the multiparous mother who has concerns about her child feeling abandoned when the new baby arrives? Select all (3)
- spend time with the older child
- make her the older child a little helper
- invest in an infant carrier
The nurse is teaching a new mother about sibling adjustment. Which statements made by the patient indicate an understanding of the adjustment actions. Select all (3)
- “I will let my son read to his brother”
- “We will give the sibling presents from the new baby”
- “I will explain how babies communicate to my three year old”
When discussing feeding options with a lesbian couple for their newborn, the nurse notes that both women would like to breastfeed. What is the appropriate nursing response?
“It’s not uncommon for both mothers to breastfeed. I will get you in touch with a lactation consultant nurse to help.”
The postpartum is reviewing the chart of a lesbian couple. When answering the patient’s questions, which would prompt the nurse to provide further education?
“We both plan to breastfeed, but can we start with a bottle?” (mothers do not understand the initiation of lactation starts with skin to skin contact)
A nurse is caring for a patient who gave birth 30 minutes ago. Upon fundal assessment, the nurse notes moderate vaginal bleeding and a boggy uterus that does not respond to fundal massage. What is the priority nursing action?
Increase IV oxytocin rate
A postpartum nurse is caring for multiple patients on the mother-baby unit. Which patient should the nurse evaluate first?
A G6P5 who gave birth 6 hours ago and reports passing a basketball-sized blood clot
The postpartum nurse is caring for a patient who gave birth vaginally 2 hours ago. The nurse notices continued heavy bleeding with a firm fundal tone. What nursing action is a priority for this patient?
Assess for the presence of a vaginal hematoma
The postpartum nurse is caring for a patient with an anterior laceration following the vaginal delivery of a 9 lb infant. What information is a priority for the nurse to include in her teaching?
“You may experience difficulty with urination because of swelling.”
A nurse is educating a patient on the mother-baby unit about breastfeeding. Which statements made by the patient indicate the need for further teaching? Select all (2)
“Colostrum is thick and whitish in color.” (colostrum is a clear, yellowish fluid)
“Colostrum has more carbohydrates than breast milk.” (colostrum is lower in carbohydrates than breast milk)
The nurse is providing discharge teaching to a 20-year-old primiparous woman. In teaching the woman how to bathe her infant, if given a choice, which method should the nurse use?
Have the patient provide a return demonstration for bathing the infant after the nurse shows her
The father of a 5-week-old newborn calls the L&D department. He mentions his wife is constantly crying and won’t sleep. What are appropriate nursing interventions based on this information? Select all (4)
- Explain signs and symptoms of postpartum depression
- Provide resources
- Ask what he has done at home so far
- Ask to speak to her and refer to physician
The nurse manager of a postpartum unit is working on a quality improvement project to decrease postpartum complications. Which of the following should be included in the project? Select all (3)
- Conduct mock drills
- Increase teamwork and communication
- Educate nurses on recognition of potential problems
The nurse is assuming care for a postpartum patient who delivered vaginally two hours ago. What information in the shift-change report should alert the nurse to assess for uterine atony? Select all. (3)
- The patient is not breastfeeding (breastfeeding stimulates oxytocin, helps uterus contract)
- The patient’s labor was augmented with oxytocin
- This is the patient’s sixth baby
The labor nurse is preparing oxytocin for the prevention of postpartum hemorrhage (PPH) during the third stage of labor. Which dosage and route for oxytocin are correct for the prevention of PPH?
20 milliunits IV infusion
Which bilirubin level in a healthy term or near-term neonate would the nurse determine is concerning, but not critical, at 36 hours after birth?
10-14 mg/dL
The nurse is admitting a 28-week neonate to the NICU. Which assessment would indicate an intraventricular hemorrhage (IVH)?
Hypotonia
