Passpoint

Question 1

Preciptious birth…

Major complication…

Answer 1

Born within three hours of regular contractions starting.

Average labor lasts between 6 and 18 hours

Uterine Atony

Question 2

Oxytocin has this affect in the uterus

Answer 2

Firms it up

Question 3

Uterotonics (Pitocin bolus) have this affect…

Answer 3

Stimulates uterine contractions

Question 4

Hand posistion for fundus evaluation

Answer 4

Dominant hand at umbilicus
Non Dom hand at pubic symphysis

Question 5

Is a C/S ever a Contradictions for VBAC?

Answer 5

Yes, if it was a classic (vertical) incision. Transverse incision it is still possible

Question 6

4 hrs post vag birth with manual removal of placental pieces. The nurse notes that the fundus is 1 cm above umbilicus and slightly firm and devianted to left side with moderate lochia rubia.

Which is the problem

1. Perinal laceration
2. Retained placental fragments
3. Cervical laceration
4. Urine retention

Answer 6

2. Retained placental fragments

4 hrs postpartum the fundus should be midline and level with umbilicus.

Client is exhibiting signs of retained placental fragments and will continue to bleed until all are removed.

Perineal & Cervical lacerations = Bright red bleeding and firmly contracted fundus

Urinary retention = bulge or fullness above the symphysis pubis and boggy, deviation of the fundus

Question 7

Nurse meets a neighbor who states that their colleagues took great care of them.

Would it be a breach of confidentially for the nurse to provide this complement with their coworker

Answer 7

No

Question 8

Which is indicated for a client with cystitis receiving IV antibiotics SATA

1. Limiting fluid intake to 1 L
2. Emptying bladder every 2 - 4 hrs
3. Washing the perineal area with providone-iodine after voiding
4. Drinking acidic fruit juices

Answer 8

2. Emptying bladder every 2 - 4 hrs
3. Drinking acidic fruit juices

Question 9

Which is true for teaching about vaginal discharge that needs to be reported to HCP

1. Bleeding that increases with breastfeeding
2. Clots the size of a grape
3. Saturating a pad in less than 1 hour.
4. Lochia that last longer than 1 week

Answer 9

3. Saturating a pad in less than 1 hour.

This is a hemorrhage risk.

Passing clots larger than a fist is a reportable problem

Lochia varies in duration up to 6 weeks

Question 10

Is consent needed before adminster Rho-gam immuno globulin?

Answer 10

Yes, it’s like vaccines

Question 11

Which is priority complication for a preciptious birth?

Answer 11

Hemorrhage

Infection risk decreases

Question 12

Pelvic floor muscle exercises (Kegel) How to perform them

Answer 12

Actions that are similar to stopping the flow of urine

Question 13

How long after delivery should the fundus be at the Umbilicus

Answer 13

6 - 12 hrs

Question 14

Each day postpartum the fundus should decrease how far?

Answer 14

1 finger breadth = 1 cm

Question 15

Rho(D) immunoglobulin prevents the mother from forming which defense mechanism

Answer 15

Antibodies

Question 16

Breast are hard and tender. Which action should be taken before breastfeeding

1.Discontinue breastfeeding
2.Apply ice packs 20 minutes before breastfeeding
3.Take a moderately strong painkiller after infant feeds on both sides
4.Express small amount of milk before breastfeeding

Answer 16

Express small amount of milk before breastfeeding

Expression of milk will stimulate milk flow and relieve engourgement.

As soon as aerolas are soft start breastfeeding

Frequent feedings that empty all milk will help engourgement

Question 17

Vacuum assisted birth may cause cephalohematoma.

What is cephalohematoma?

Caput Succedaneum, describe….

Answer 17

Swelling of the Scalp that doesn’t cross the suture line

Caput Succedaneum is scalp swelling that does cross the suture line

Question 18

Breastfeeding neonates do not swallow as much air when feeding a bottle fed babies.

When should a breast fed baby be burped

Answer 18

When mother is switching breast and at the end of the feeding session

Question 19

Mother wants to wean her infant from breastmilk in 6 months. How can they best accomplish this.

1. Gradual decrease in milk supply as the baby nurses less
2. They need to get a prescription for lactation Suppressant
3. Wear a tight fitting sports bra
4. Milk naturally diminishes at about 6 months

Answer 19

1. Gradual decrease in milk supply as the baby nurses less

If you don’t use it, you lose it.

Sports bras are most effective immediately after birth

Question 20

Describe best baby’s mouth posistion and direction of the nipple.

Answer 20

Baby’s mouth wide open and nipple pointed towards roof of babies mouth

Question 21

Swollen ecchymosed to the right of a laceration on a primiparous client 6 hrs after vag delivery. What should the nurse do next?

1. Apply ice packs to perineal area
2. Assess clients temperature
3. Have client take a sitz bath
   4 . Contact HCP for antibiotic

Answer 21

1. Apply ice packs to perineal area

During first 24 hrs postpartum ice packs are applied to perineal area for reduction of swelling and comfort. NOT EFFECTIVE AFTER 24 HRS.

After 24 hrs a sitz bath will help to increase circulation.

Hematomas go away in about 6 weeks.

Question 22

3 hrs postpartum the fundus is firm and midline. On perineal inspection the nurse observes small, constant trickle of blood. Which condition should the nurse assess further?

1. Retained placental tissue
2. Uterine inversión
3. Bladder distention
4. Perineal lacerations

Answer 22

4. Perineal lacerations

Small constant trickle of blood is indicate vaginal tear or cervical laceration.

Retained placental tissue = Boggy Fundus & Vag Bleeding

Uterine Inversion is Prolapse of uterus out of the vagina

Question 23

Client has labor induced by Oxytocin. Which problem should the nurse assess for most frequent

1. Respiration
2. Increased Pulse
3. HTN
4. Uterine Atony

Answer 23

4. Uterine Atony

Uterine Atony is more common in women who recieve Oxytocin.

This is due to the uterus becoming fatigued and doesn’t contract effectively

Question 24

12 hrs after giving birth the clients VS are: 99.6 temp, HR82, RR 18, BP 116/70

Which nursing action is most appropriate.

1. Administer aspirin
2. Encourage fluid intake
3. Reassessment of VS q15min
4. Requesting antibiotic

Answer 24

Fluid intake

1st day postpartum Mild Dehydration causes Rise in Temp.

Reasses VS q4h is sufficient

Request antibiotics if >100.4

Question 25

4th stage of labor. Client has a 60 BPM pulse. What is the priority?

Answer 25

Nothing. This is a normal finding 6 - 10 days postpartum and to be expected.

Question 26

How long should a woman breast feeding during each session

Answer 26

Determine by newborns signs of satiety: Self Detachment & Relaxed hands and arms