Unit 1 - Postpardum Flashcards
A nurse is describing how the fetus moves through the birth canal. Which component would the nurse identify as being most important in allowing the fetal head to move through the pelvis?
A. biparietal diameter
B. sutures
C. frontal bones
D. fontanelles
Sutures are important because they allow the cranial bones to overlap in order for the head to adjust in shape (elongate) when pressure is exerted on it by uterine contractions or the maternal bony pelvis. Fontanelles are the intersections formed by the sutures. The frontal bones, along with the parietal and occipital bones are bones of the cranium that are soft and pliable. The biparietal diameter is an important diameter that can affect the birth process.
The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which intervention would the nurse identify as the priority?
A. immediate cesarean birth
B. position changes
C. pain relief measures
D. oxytocin administration
Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Counterpressure and backrubs may be helpful. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman’s ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman’s already high level of pain.
A female sex trade worker has been diagnosed with secondary syphilis. Which findings would most likely correlate with this diagnosis?
A. sore throat and flu-like symptoms
B. pain-free crusty genital lesions
C. painful dysurea
D. yellow vaginal discharge
With a secondary infection of syphilis, there would be no evidence of vaginal lesions present. Present would be a maculopapular rash (hands and feet); a sore throat; lymphadenopathy; and flu-like symptoms. Dysurea is not seen in the secondary infection. A yellow vaginal discharge is for gonorrhea.
A nurse is assisting with the delivery of a newborn. The fetal head has just emerged. Which action would be performed next?
A. clamping of the umbilical cord
B. checking for the cord around the neck
C. suctioning of the mouth and nose
D. drying of the newborn
Once the fetal head has emerged, the primary care provider explores the fetal neck to see if the umbilical cord is wrapped around it. If it is, the cord is slipped over the head to facilitate delivery. Then the health care provider suctions the newborn’s mouth first (because the newborn is an obligate nose breather) and then the nares with a bulb syringe to prevent aspiration of mucus, amniotic fluid, or meconium. Finally the umbilical cord is double-clamped and cut between the clamps. The newborn is placed under the radiant warmer, dried, assessed, wrapped in warm blankets, and placed on the woman’s abdomen for warmth and closeness.
A public health nurse is teaching a group of parents about sexually transmitted infection (STIs) and discusses the vaccine available for their children to prevent the most prevalent STI. What vaccine prevents the most prevalent STI?
A. the human papillomavirus vaccination
B. the syphilis vaccination
C. the genital herpes vaccination
D. the trichomonas vaginalis vaccination
Vaccination is available to prevent the most prevalent strains of HPV infection and may lead to a decrease in the cancer associated with HPV. There are no approved vaccinations available presently to prevent the other STIs.
After teaching the students about health and wellness, the nursing instructor identifies a need for further instruction when one of the students makes which of the following statements?
A. “Health is an active process.”
B. “Health is dynamic and ever-changing.”
C. “Health means the same to every person.”
D. “Health is more than just the absence of illness.”
Health is more than just the absence of illness; it is an active process in which a person moves toward his or her maximum potential. It also has different definitions for different people. It is not stagnant, but changes frequently.
What puts a postpartum woman at risk for DVT?
Clotting factors that increased during pregnancy tend to remain elevated during the early postpartum period. Giving birth stimulates this hypercoagulability state further. As a result, these coagulation factors remain elevated for 2 to 3 weeks postpartum (Silver & Major, 2010). This hypercoagulable state, combined with vessel damage during birth and immobility, places the woman at risk for thromboembolism (blood clots) in the lower extremities and the lungs.
Note:
Red blood cell production ceases early in the puerperium, which leads to mean hemoglobin and hematocrit levels to decrease slightly in the first 24 hours and then rise slowly over the next 2 weeks.
When describing the menstrual cycle to a group of young women, the nurse explains that estrogen levels are highest during which phase of the endometrial cycle?
A. proliferative
B. ischemic
C. secretory
D. menstrual
Estrogen levels are the highest during the proliferative phase of the endometrial cycle, when the endometrial glands enlarge in response to increasing amounts of estrogen. Progesterone is the predominant hormone of the secretory phase. Levels of estrogen and progesterone drop sharply during the ischemic phase and fall during the menstrual phase.
A new mother is changing the diaper of her 12-hour-old newborn and asks why the stool is black and sticky. Which response by the nurse would be most appropriate?
Meconium is greenish-black and tarry and usually passed within 12 to 24 hours of birth. This is a normal finding. Iron can cause stool to turn black, but this would not be the case here. The stool is a normal occurrence and does not need to be checked for blood or reported.
What is a normal WBC count?
4,000 - 11,000 /mCl
A diabetes nurse educator is teaching a client, newly diagnosed with diabetes, about his disease process, diet, exercise, and medications. What is the goal of this education?
The basic purpose of educating and counseling is to help clients and families develop the self-care abilities (knowledge, attitude, skills) needed to maintain and improve health.
After the nurse teaches a client about ways to reduce the symptoms of premenstrual syndrome, which client statement indicates a need for additional teaching?
A. “I will make sure to take my estrogen supplements a week before my period.”
B. “I quit smoking about a month ago, so that should help.”
C. “I’ve signed up for an aerobic exercise class three times a week.”
D. “I’ll cut down on the amount of coffee and colas I drink.”
Lifestyle changes such as exercising, avoiding caffeine, and smoking cessation are a key component for managing the signs and symptoms of premenstrual syndrome. Estrogen supplements are not used. If medication is necessary, NSAIDs may be used for painful physical symptoms; spironolactone may help with bloating and water retention.
A child with persistent otitis media with effusion is to undergo insertion of pressure-equalizing tubes via a myringotomy. The child is to be discharged later that day. After teaching the parents about caring for their child after discharge, which statement indicates that the teaching was successful?
A. “He should wear earplugs when swimming in a pool or a lake.”
B. “His chances for ear infections now have dramatically decreased.”
C. “The tubes will stay in place for about a month and then fall out on their own.”
D. “We should keep the ears protected with cotton balls for the first 24 hours.”
When pressure-equalizing tubes are inserted, the surgeon may recommend avoiding water entry into the ears. Therefore, earplugs are suggested when the child is in the bathtub or swimming. When swimming in a lake, earplugs are especially important because lake water is contaminated with bacteria and entry of that water into the middle ear must be avoided. Typically, the tubes remain in place for at least several months and generally fall out on their own. Placement of pressure-equalizing tubes does not prevent middle ear infection. Other than earplugs for bathing and swimming, nothing else is placed in the child’s ear.
The fetus of a nulliparous woman is in a shoulder presentation. The nurse would most likely prepare the client for which type of birth?
A. vaginal
B. forceps-assisted
C. vacuum extraction
D. cesarean
The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate.
When making a home visit, the nurse observes a newborn sleeping on his back in a bassinet. In one corner of the bassinet is some soft bedding material, and at the other end is a bulb syringe. The nurse determines that the mother needs additional teaching because:
The nurse should instruct the mother to remove all fluffy bedding, quilts, stuffed animals, and pillows from the crib to prevent suffocation. Newborns and infants should be placed on their backs to sleep. Having the bulb syringe nearby in the bassinet is appropriate. Although a crib is the safest sleeping location, a bassinet is appropriate initially.
What pulse rate should you expect in a postpartum woman?
60-80 bpm is normal during the first week after birth, and is called puerperal bradycardia.
A pulse rate over 100 bpm should be investigated further to rule out complications such as infection, cardiac problems, or hemorrhage.
A nurse is conducting a class for a local woman’s group about recommendations for a Pap smear. One of the participants asks, “At what age should a woman have her first Pap smear?” The nurse responds by stating that a woman should have her first Pap smear at which age?
A. 21
B. 28
C. 25
D. 18
According to the American Cancer Society, a woman should have her first Pap smear at age 21.
A nurse educator uses models of health and illness when teaching. Which model of health and illness places high-level health and death on opposite ends of a graduated scale?
A. Health Belief Model
B. Health-Illness Continuum
C. Agent-Host-Environment Model
D. Health Promotion Model
The Health-Illness Continuum views health as a constantly changing state, with high-level wellness and death being on opposite ends of a graduated scale. The Agent-Host-Environment Model is useful in examining the causes of disease in an individual. The Health Belief Model describes health behaviors. The Health Promotion Model incorporates individual characteristics and experiences, as well as behavior-specific knowledge and beliefs, to motivate healthy behavior.
A new mother who is breast-feeding her newborn asks the nurse, “How will I know if my baby is drinking enough?” Which response by the nurse would be most appropriate?
(hint: how many diapers?)
Soaking 6 to 12 diapers a day indicates adequate hydration. Contentedness after feeding is not an indicator for adequate hydration.
A nurse is caring for a stable toddler diagnosed with accidental poisoning, due to the ingestion of cleaning solution. What must be included in educating parents about how to protect a toddler from accidental poisoning?
A. Keep cleaning solutions locked up.
B. Label poisonous solutions.
C. Do not leave the toddler alone.
D. Closely monitor the toddler’s activity.
The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the child are important, but not feasible all the time.
A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse prepares the client for this monitoring based on the understanding that which criterion must be present?
A. floating presenting fetal part
B. cervical dilation of 2 cm or more
C. a neonatologist to insert the electrode
D. intact membranes
For continuous internal electronic fetal monitoring, four criteria must be met: ruptured membranes, cervical dilation of at least 2 cm, fetal presenting part low enough to allow placement of the electrode, and a skilled practitioner available to insert the electrode.
A client with trichomoniasis is to receive metronidazole. What should the nurse instruct the client to avoid while taking this drug?
A. chocolate
B. alcohol
C. caffeine
D. nicotine
The client should be instructed to avoid consuming alcohol when taking metronidazole because severe nausea and vomiting could occur. There is no need to avoid nicotine, chocolate, or caffeine when taking metronidazole.
A client states that she is to have a test to measure bone mass to help diagnose osteoporosis. The nurse would most likely plan to prepare the client for:
A. pelvic X-ray.
B. ultrasound.
C. DEXA scan.
D. MRI.
The client most likely will be having a DEXA scan, which is a screening test that calculates the mineral content of the bone at the spine and hip. Ultrasound, MRI, and a pelvic X-ray would be of little help in determining bone mass.
A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U-shape. The nurse interprets these changes as reflecting which type of deceleration?
A. variable decelerations
B. late decelerations
C. early decelerations
D. prolonged decelerations
Variable decelerations present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. The shape of variable decelerations may be U, V, or W, or they may not resemble other patterns. Early decelerations are visually apparent, usually symmetrical and characterized by a gradual decrease in the FHR in which the nadir (lowest point) occurs at the peak of the contraction. They are thought to be a result of fetal head compression that results in a reflex vagal response with a resultant slowing of the FHR during uterine contractions. Late decelerations are visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. The FHR does not return to baseline levels until well after the contraction has ended. Delayed timing of the deceleration occurs, with the nadir of the uterine contraction. Late decelerations are associated with uteroplacental insufficiency. Prolonged decelerations are abrupt FHR declines of at least 15 bpm that last longer than 2 minutes but less than 10 minutes.
A nurse is conducting an in-service program for a group of labor and birth unit nurses about about cesarean birth. The group demonstrates understanding of the information when they identify which condition as an appropriate indication? Select all that apply.
A. placenta previa
B. active genital herpes infection
C. previous cesarean birth
D. fetal distress
E. prolonged labor
The leading indications for cesarean birth are previous cesarean birth, breech presentation, dystocia, and fetal distress. Examples of specific indications include active genital herpes, fetal macrosomia, fetopelvic disproportion, prolapsed umbilical cord, placental abnormality (placenta previa or abruptio placentae), previous classic uterine incision or scar, gestational hypertension, diabetes, positive HIV status, and dystocia. Fetal indications include malpresentation (nonvertex presentation), congenital anomalies (fetal neural tube defects, hydrocephalus, abdominal wall defects), and fetal distress.
What is another name for stretch marks? Do they go away?
Striae - typically don’t go away completely
When assessing cervical effacement of a client in labor, the nurse assesses which characteristic?
A. degree of thinning
B. extent of opening to its widest diameter
C. fetal presenting part
D. passage of the mucous plug
Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody show as a premonitory sign of labor. The fetal presenting part is determined by vaginal examination and is commonly the head (cephalic), pelvis (breech), or shoulder.
The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction?
A. “After bathing, I need to rub his skin everywhere to make sure he is completely dry.”
B. “I must make sure I use lukewarm water instead of hot water.”
C. “We should leave his skin moist before applying medication or moisturizer.”
D. “Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment.”
The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.
A woman has been in labor for some time, but her membranes have not yet ruptured. Artificial rupture of membranes is being considered. Which assessment findings would support the decision to perform the procedure? Select all that apply.
A. fetal head at -2 station
B. vertex presentation
C. cervical effacement 50%
D. uterine contractions every 2 minutes
E. cervical dilation of 4 cm
An amniotomy (artificial rupture of the fetal membranes) may be performed to augment or induce labor when the membranes have not ruptured spontaneously. Doing so allows the fetal head to have more direct contact with the cervix to dilate it. This procedure is performed with the fetal head at -2 station or lower, with the cervix dilated to at least 3 cm. Contractions, effacement, and presentation are not considerations for performing an amniotomy.
A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn?
A. asphyxia
B. clavicular fracture
C. central nervous system injury
D. cephalhematoma
Use of forceps or a vacuum extractor poses the risk of tissue trauma, such as ecchymoses, facial and scalp lacerations, facial nerve injury, cephalhematoma, and caput succedaneum. Asphyxia may be related to numerous causes, but it is not associated with use of a vacuum extractor. Clavicular fracture is associated with shoulder dystocia. Central nervous system injury is not associated with the use of a vacuum extractor.
A nurse is conducting a refresher program for a group of nurses working in the newborn nursery. After teaching the group about variations in newborn head size and appearance, the nurse determines that the teaching was successful when the group identifies which variation as normal? Select all that apply.
A. closed fontanels
B. posterior fontanel diameter 1.5 cm
C. caput succedaneum
D. cephalhematoma
E. molding
Normal variations in newborn head size and appearance include cephalhematoma, molding, and caput succedaneum. Microcephaly, closed fontanels, or a posterior fontanel diameter greater than 1 cm are considered abnormal.
Which of the following statements illustrates the effect of the sociocultural dimension on health and illness?
A. “Why shouldn’t I drink and drive? Everyone else does.”
B. “I used biofeedback to lower my blood pressure.”
C. “I know I have heart problems, so I have changed my diet.”
D. “My mother has sickle cell anemia, and so do I.”
Health practices and beliefs are strongly influenced by one’s sociocultural dimension, including lifestyle, family, and culture. These factors are involved in patterns of living (such as drinking and driving) and values about health and illness. Sickle cell anemia involves the physical dimension; changing one’s diet involves the intellectual dimension; and biofeedback involves the emotional dimension.
A client comes to the clinic with abdominal pain. Based on her history the nurse suspects endometriosis. The nurse expects to prepare the client for which evaluatory method to confirm this suspicion?
A. transvaginal ultrasound
B. pelvic examination
C. laparoscopy
D. hysterosalpingogram
The only certain method of diagnosing endometriosis is by seeing it. Therefore, the nurse would expect to prepare the client for a laparoscopy to confirm the diagnosis. A pelvic examination and transvaginal ultrasound are done to assess for endometriosis but do not confirm its presence. Hysterosalpingography aids in identifying tubal problems resulting in infertility.
In which patients might breastfeeding be contraindicated?
HIV, active TB, herpes, chemo, drug/alcohol abuse
A postpartum woman who is bottle-feeding her newborn asks the nurse, “About how much should my newborn drink at each feeding?” The nurse responds by saying that to feel satisfied, the newborn needs which amount at each feeding?
2-4 ounces
Newborns need about 108 cal/kg or approximately 650 cal/day. Therefore, a newborn will need to 2 to 4 ounces to feel satisfied at each feeding.
A woman has opted to use the basal body temperature method for contraception. The nurse instructs the client that a rise in basal body temperature indicates which event?
A. safe period for intercourse
B. pregnancy
C. ovulation
D. onset of menses
Basal body temperatures typically rise within a day or two after ovulation and remain elevated for approximately 2 weeks, at which point bleeding usually begins. Basal body temperature is not a means for determining pregnancy. Having intercourse while the temperature is elevated would increase the risk of pregnancy.
What respirations should you expect to find in a postpartum woman?
The normal range of 12-20 can be expected at rest. Once the organs return to their normal positions after birth, pulmonary function should return to normal.
Cytotec
Misopristol - Prostaglandin - Used to control postpartum bleeding not controlled by other medications
Note: Can also induce labor or abortion of pregnancy
Dosage:
Intravaginally: 25 mcg q3-6, if necessary
Why should a new mom be encouraged to ambulate?
To prevent DVT and PE
What would be an expected finding for hematocrit during the postpartum period?
Hematocrit should remain relatively stable or even slightly increase due to the loss of plasma from diuresis. An acute decrease in hematocrit would not be an expected finding in postpartum women, and may indicate hemmorhage.
Normal hematocrit for women is 42% (+/- 5%)
When educating parents of preschoolers, what is most important to include in your presentation?
A. Keep chemicals in a locked cabinet
B. Use wrist guards with rollerblades
C. Teach preschoolers to tread water
D. Strict discipline with potty training
Increasing mobility, lack of life experience and judgment, and immature musculoskeletal and neurologic systems lead to potentially hazardous encounters for toddlers and preschoolers.
What is Hemabate?
Carboprost tromethamine - prostaglandin - used to control postpartum bleeding (also able to induce labor)
Note: also used to induce abortion of pregnancy
Dosage:
For bleeding: IM Test dose of 100 mcg, then 250 mcg every 15-90 min (up to 2 mg/2000 mcg)
Bioterrorism has become a commonly used term. What is the definition of bioterrorism?
A. The deliberate spread of pathogens into a community
B. A worldwide plan to produce illness and injury
C. A verbal threat by those wishing to harm specific individuals
D. A written threat calculated to produce terror in a family
Bioterrorism involves the deliberate spread of pathogenic organisms into a community.
During a physical assessment of a newborn, the nurse observes bluish markings across the newborn’s lower back. The nurse interprets this finding as what?
(What are some other markings you may find?)
Mongolian spots are blue or purple splotches that appear on the lower back and buttocks of newborns.
Milia are unopened sebaceous glands frequently found on a newborn’s nose.
Stork bites are superficial vascular areas found on the nape of the neck and eyelids and between the eyes and upper lip.
Birth trauma would be manifested by bruising, swelling, and possible deformity.
The nurse is caring for an 8-year-old boy hospitalized for a bone marrow transplant. His parents are in and out of his room throughout the day. Which behaviors of the child would alert the nurse that he is in the second stage of separation anxiety?
A. He forms superficial relationships with his caregivers.
B. He sits quietly and is uninterested in playing and eating.
C. He cries uncontrollably whenever they leave.
D. He ignores his parents when they return to his room.
Separation anxiety consists of three stages—protest, despair, and detachment. In the protest stage, the child reacts aggressively to separation and exhibits great distress by crying, expressing agitation, and rejecting others who attempt to offer comfort. In the despair phase the child displays hopelessness by withdrawing from others, becoming quiet without crying, and exhibiting apathy, depression, lack of interest in play and food, and overall feelings of sadness. In the detachment stage the child shows interest in the environment, starts to play again, and forms superficial relationships with the nurses and other children. If the parents return, the child ignores them. A child in this phase of separation anxiety exhibits resignation, not contentment.
A nurse is conducting an in-service program for a group of nurses working in the labor and birth suite of the facility. After teaching the group about the factors affecting the labor process, the nurse determines that the teaching was successful when the group identifies which component as part of the true pelvis? Select all that apply.
A. pelvic inlet
B. vagina
C. mid pelvis
D. pelvic floor muscles
E. cervix
F. pelvic outlet
The true pelvis is made up of three planes: the pelvic inlet, mid pelvis, and pelvic outlet. The cervix, vagina, and pelvic floor muscles are the soft tissues of the passageway.
Which finding would the nurse expect in a client with bacterial vaginosis?
A. fish-like odor of discharge
B. cervical bleeding on contact
C. yellowish-green discharge
D. vaginal pH of 3
Manifestations of bacterial vaginosis include a thin, white, homogenous vaginal discharge with a characteristic stale fishy odor, vaginal pH greater than 4.5, and clue cells on wet-mount examination. A yellowish-green discharge with cervical bleeding on contact would be characteristic of trichomoniasis.
What would the nurse include when teaching parents how to prevent otitis externa?
A. Using a hair dryer on high to dry the ear canals
B. Wearing ear plugs when swimming
C. Using hydrogen peroxide to dry the canal skin
D. Daily ear cleaning with cotton swabs
To prevent otitis externa, the nurse would teach parents and children to wear earplugs when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair dryer on a low setting can be used to dry the ear canals. A mixture of half rubbing alcohol and half vinegar can be used to dry the canal and alter the pH to discourage organism growth.
What is a LATCH assessment and what is the total possible score?
Assesses the five key components of breastfeeding:
Latch, audible swallowing, type of nipple, comfort, hold
Each component is rated 0-2, with a maximum possible score of 10.
A nurse is teaching a postpartum client how to do muscle-clenching exercises for the perineum. The client asks the nurse, “Why do I need to do these exercises?” Which reason would the nurse most likely incorporate into the response?
Muscle clenching perineal exercises help to improve pelvic floor tone, strengthen perineal muscles, and promote healing, ultimately helping to prevent urinary incontinence later in life.
Kegel exercises have no effect on lochia, involution, or pain.
Aside from actual blood loss, what else contributes to a blood plasma volume reduction in postpartum women?
Diuresis, which occurs during the early postpartum period.
What is an episiotomy?
A surgical cut made to aid delivery and prevent tissue rupture.
When teaching new parents about the sensory capabilities of their newborn, which sense would the nurse identify as being the least mature?
Vision is the least mature sense at birth. Hearing is well developed at birth, evidenced by the newborn’s response to noise by turning. Touch is evidenced by the newborn’s ability to respond to tactile stimuli and pain. A newborn can distinguish between sweet and sour by 72 hours of age.
When can intercourse safely resume after childbirth?
Typically, sexual intercourse can be resumed once bright-red bleeding has stopped and the perineum is healed from an episiotomy or lacerations. This is usually by the third to the sixth week postpartum. Fluctuations in sexual interest are normal. In addition, breast-feeding women may notice a let-down reflex during orgasm and find that breasts are very sensitive when touched by the partner. Precoital vaginal lubrication may be impaired during the postpartum period, especially in women who are breast-feeding. Use of water-based gel lubricants can help.
Where would you expect the fundus to be 12 hours after delivery?
At the umbilicus
Which type of medications are not indicated for asthmatics, when possible? Which medications does this include?
Prostaglandins - Hemabate and Cytotec
What causes postpartum diuresis?
Postpartum diuresis occurs as a result of several mechanisms: the large amounts of IV fluids given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the buildup and retention of extra fluids during pregnancy, and a decreasing production of aldosterone—the hormone that decreases sodium retention and increases urine production. All these factors contribute to rapid filling of the bladder within 12 hours of birth. Diuresis begins within 12 hours after childbirth and continues throughout the first week postpartum.
The mother of a toddler with asthma seeks support from the parents of other children with asthma. The nurse recognizes that seeking and utilizing support systems is an example of which human dimension?
A. Sociocultural dimension
B. Environmental dimension
C. Intellectual and spiritual dimension
D. Physical dimension
Communicating with others and the use of support systems relate to the sociocultural dimension. An individual’s relationship with others, being connected to a community, and feeling accepted and loved by others are also related to the sociocultural dimension.
A pregnant woman comes to the labor and birth unit in labor. The woman tells the nurse, “Yesterday, I had this burst of energy and cleaned everything in site, but I don’t know why,” Which response by the nurse would be most appropriate?
A. “You were looking forward to the birth of your baby.”
B. “You had a burst of adrenalin, which is common before labor.”
C. “You were trying to get everything ready for your baby.”
D. “You felt your mind telling you that you were about to go into labor.”
Some women report a sudden increase in energy before labor. This is sometimes referred to as nesting because many women will focus this energy toward childbirth preparation by cleaning, cooking, preparing the nursery, and spending extra time with other children in the household. The increased energy level usually occurs 24 to 48 hours before the onset of labor. It is thought to be the result of an increase in epinephrine (adrenalin) release caused by a decrease in progesterone. The burst of energy is unrelated to getting everything ready, the mind telling the woman that she will be going into labor, or looking forward to the birth.
What is the average blood loss associated with giving birth?
500 mL vaginal
1,000 mL cesarean
What might indicate Vitamin A Toxicity
Lethargy, headaches, orange hue to skin
When explaining how a newborn adapts to extrauterine life, the nurse would describe which body systems as undergoing the most rapid changes?
Although all the body systems of the newborn undergo changes, respiratory gas exchange along with circulatory modifications must occur immediately to sustain extrauterine life.
What would be a concerning temperature for a postpartum woman?
Above 100.4 degrees. Temperature up to this may be considered normal for the first 24 hours, partially due to fluid loss/dehydration during labor.
A woman in her third trimester comes to the clinic for a prenatal visit. During assessment the woman reports that her breathing has become much easier in the last week but she has noticed increased pelvic pressure, cramping, and lower back pain. The nurse determines that which event has most likely occurred?
A. lightening
B. Braxton-Hicks contractions
C. cervical dilation
D. bloody show
Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis. The uterus lowers and moves into the maternal pelvis. The shape of the abdomen changes as a result of the change in the uterus. The woman usually notes that her breathing is much easier. However, she may complain of increased pelvic pressure, cramping, and lower back pain. Although cervical dilation also may be occurring, it does not account for the woman’s complaints. Bloody show refers to passage of the mucous plug that fills the cervical canal during pregnancy. It occurs with the onset of labor. Braxton-Hicks contractions increase in strength and frequency and aid in moving the cervix from a posterior position to an anterior position. They also help in ripening and softening the cervix.
The nurse places a warmed blanket on the scale when weighing a newborn to minimize heat loss via which mechanism?
Using a warmed cloth diaper or blanket to cover any cold surface, such as a scale, that touches a newborn directly helps to prevent heat loss through conduction.
Drying a newborn and promptly changing wet linens, clothes, or diapers help reduce heat loss via evaporation.
Keeping the newborn out of a direct cool draft, working inside an isolette as much as possible, and minimizing the opening of portholes help prevent heat loss via convection.
Keeping cribs and isolettes away from outside walls, cold windows, and air conditioners and using radiant warmers while transporting newborns and performing procedures will help reduce heat loss via radiation.
What hormone causes afterpains and which group of women will likely have stronger afterpains?
Oxytocin.
All women experience afterpains, but they are more acute in multiparous women secondary to repeated stretching of the uterine muscles.
How often would you take vital signs on a postpartum woman?
q15x4, q30x2, q4 for 24 hours
What is the medication Pitocin? What might it be used for?
Exogenous oxytocin. Frequently used to induce labor.
Dosages:
For Postpartum hemorrhage:
- IV 10 units, 20-40 milliunits/min
- IM 10 units after delivery of placenta
For induction:
- IV 0.5-1 milliunits/min, increased by 1-2 q30-60
The nurse is developing a teaching plan for the mother of a 4-year-old girl with cold and fever. What would the nurse include in this teaching plan?
A. Keeping the child covered and warm
B. Ensuring fluid intake to prevent dehydration
C. Calling the doctor if the child’s fever lasts more than 36 hours
D. Observing for changes in alertness resulting from brain damage
Teaching the mother to ensure fluid intake is important because fever can cause dehydration. The child should be dressed lightly. There is no need to call the doctor unless the child’s fever lasts more than 3 to 5 days or the fever is greater than 105ºF. A rapid rise to a high fever can cause a febrile convulsion, but it does not lead to brain damage.
A nurse is preparing a class for a group of women at a family planning clinic about contraceptives. When describing the health benefits of oral contraceptives, which benefits would the nurse most likely include? Select all that apply.
A. reduced risk for endometrial cancer
B. protection against pelvic inflammatory disease
C. improvement in acne
D. reduced risk for migraine headaches
E. decreased risk for depression
The health benefits of oral contraceptives include protection against pelvic inflammatory disease, a reduced risk for endometrial cancer, and improvement in acne. Oral contraceptives are associated with an increased risk for depression and migraine headaches.
What additional nutritional needs does the breastfeeding mother need?
Increase diet by 500 calories
Which foods are highest in iron?
A. Black beans, Quinoa
B. Strawberries, green beans
C. Red meat, oysters
D. Red yeast
C
What are 1st, 2nd, 3rd, and 4th degree lacerations?
A first-degree laceration involves only the skin and superficial structures above the muscle.
A second-degree laceration extends through the perineal muscles.
A third-degree laceration extends through the anal sphincter muscle.
A fourth-degree laceration continues through the anterior rectal wall.
The nurse is caring for a 4-year-old girl who has been hospitalized for over a week with severe burns. Which would be a priority intervention to help satisfy this preschool child’s basic needs?
A. Explain necessary procedures in simple language that she will understand.
B. Suggest that a family member be present with her 24 hours a day.
C. Allow her to make choices about her meals and activities as much as permitted.
D. Encourage friends to visit as often as possible.
Preschoolers fear mutilation and are afraid of intrusive procedures since they do not understand the body’s integrity. They interpret words literally and have an active imagination; therefore, procedures should be demonstrated and/or explained in simple terms. Adolescents typically do not experience separation anxiety from being away from their parents; instead, their anxiety comes from being separated from friends, and therefore encouraging friends to visit is a priority intervention. Toddlers are especially susceptible to separation anxiety and would benefit from a family member being present as much as possible. School-age children are accustomed to controlling self-care and typically are highly social; they would benefit from being involved in choices about meals and activities.
After teaching a group of parents about ear infections in children, which statement indicates that the teaching was successful?
A. Adenoids shrink as the child grows, allowing more bacteria to enter.
B. The shorter and wider eustachian tubes of an infant increase the risk.
C. Infants with congenital deformities have an increased risk for ear infections.
D. Ear infections typically increase as the child gets older.
The infant has relatively short, wide, horizontally placed eustachian tubes, allowing bacteria and viruses to gain access to the middle ear and resulting in an increased number of infections as compared to adults. Congenital deformities of the ear are associated with other body system anomalies, but not necessarily an increase in ear infections. As the child matures, the eustachian tubes assume a more slanted position, so older children and adults have fewer infections. A child’s adenoids are often enlarged, leading to obstruction of the eustachian tubes and infection.
Which of the following nutritional guidelines should a nurse provide to a client who is entering the second trimester of her pregnancy?
A. “The more food energy you consume, the greater the chances that you will have a healthy pregnancy.”
B. “You’ll need to eat more calories and to make sure you eat a balanced diet high in nutrients.”
C. “Maintain your regular calorie intake, but take some supplements and emphasize organic foods.”
D. “Try to eat your normal number of calories, but aim to eat a diet that’s higher in fruits and vegetables.”
Nutrient needs during pregnancy increase to support growth and maintain maternal homeostasis, particularly during the second and third trimesters. During the last two trimesters, women of normal weight need approximately 300 extra calories per day. Key nutrient needs include protein, calories, iron, folic acid, calcium, and iodine. It would be inaccurate to encourage the client to maximize calorie intake.
The nurse encourages a female client with human papillomavirus (HPV) to receive continued follow-up care because she is at risk for:
A. infertility.
B. cervical cancer.
C. dysmenorrhea.
D. dyspareunia.
Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer. Therefore, the client needs continued follow-up for Pap smears. HPV is not associated with an increased risk for infertility, dyspareunia, or dysmenorrhea.
When is the infant ready for solid foods? SELECT ALL
A. Moro reflex remains
B. Tongue extrusion reflex decreases
C. Infant will not sleep through the night
D. Able to sit upright and turn head away
E. Infant appears interested in food
F. Birth weight has doubled
A, C, D and F are correct. Not sleeping through the night, does not indicate the baby needs solid food. The Moro reflex disappears around 3-4 months, but is not related to solid food introduction.
A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which symptom?
A. pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds
B. contractions noted in the front of abdomen that stop when she walks
C. increased energy level with alternating strong and weak contractions
D. moderately strong contractions every 4 minutes, lasting about 1 minute
Moderately strong regular contractions 60 seconds in duration indicate that the client is probably in the active phase of the first stage of labor. Alternating strong and weak contractions, contractions in the front of the abdomen that change with activity, and pink-tinged secretions with irregular contractions suggest false labor.
Which of the following is true regarding regarding emergency preparedness:
A. Hospitals can be monetarily fined if they do not have a disaster plan in place.
B. The chief medical officer has the authority to mandate a quarantine.
C. The County Public Health commissioner has the regulatory power to mandate a quarantine.
D. Nurses can be mandated to report to duty when an emergency is declared.
Which of the following is true regarding emergency preparedness:
After teaching a group of pregnant women about breastfeeding, the nurse determines that the teaching was successful when the group identifies which hormone as important for the production of breast milk after birth?
A. placental estrogen
B. gonadotropin-releasing hormone
C. prolactin
D. progesterone
After birth and expulsion of the placenta, prolactin stimulates the production of milk. Placental estrogen and progesterone stimulate the development of the mammary glands during pregnancy. Gonadotropin-releasing hormone induces the release of follicle-stimulating hormone and luteinizing hormone to assist with ovulation.
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?
A. side-lying
B. sitting
C. knee–chest
D. supine
Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee–chest position. Supine, side-lying, or sitting would not provide relief of cord compression.
A client with genital herpes simplex infection asks the nurse, “Will I ever be cured of this infection?” Which response by the nurse would be most appropriate?
A. “Once you have the infection, you develop an immunity to it.”
B. “There is a new vaccine available that prevents the infection from returning.”
C. “There is no cure, but drug therapy helps to reduce symptoms and recurrences.”
D. “All you need is a dose of penicillin and the infection will be gone.”
Genital herpes is a lifelong viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection.
What is engorgement?
Engorgement is the process of swelling of the breast tissue as a result of an increase in blood and lymph supply as a precursor to lactation (Figure 15.4). Breast engorgement usually peaks in 3 to 5 days postpartum and usually subsides within the next 24 to 36 hours (Chapman, 2011). Engorgement can occur from infrequent feeding or ineffective emptying of the breasts and typically lasts about 24 hours. Breasts increase in vascularity and swell in response to prolactin 2 to 4 days after birth. If engorged, the breasts will be hard and tender to touch.
Involution refers to the process of the uterus returning to its prepregnant state.
Mastitis refers to an infection of the breasts.
Engrossment refers to the bond that develops between the father and the newborn.
A nurse is providing care to a woman during the third stage of labor. Which finding would alert the nurse that the placenta is separating?
A. sudden gush of dark blood from the vagina
B. shortening of the umbilical cord
C. uterus becoming discoid shaped
D. boggy, soft uterus
Signs that the placenta is separating including a firmly contracting uterus, a change in uterine shape from discoid to globular ovoid, a sudden gush of dark blood from the vaginal opening, and lengthening of the umbilical cord protruding from the vagina.
Which of the following populations, based on their development stage, would benefit from strategies to prevent falls? Select all that apply.
A. Adolescents
B. Older Adults
C. Adults
D. Toddlers
E. Newborns
Educate parents never to leave newborns alone on a changing table, and also teach parents of toddlers to childproof the home. Parents of preschoolers should make sure their children wear proper safety equipment when riding bicycles or scooters. Adolescents and adults are not at high risk for falls. Older adults, however, are at risk for falls due to the effects of aging on the body systems.
What is the leading cause of death in postpartum women?
PPH - Postpartum hemmorhage
Defined as >500 mL of blood loss
A woman is diagnosed with a vaginal infection. After teaching the client about measures to reduce her risk, the nurse determines that the client needs additional teaching when she states which factor as increasing her risk?
A. antibiotic therapy
B. douching
C. use of feminine hygiene sprays
D. menstruation
The vagina has an acidic environment, which protects it against ascending infections. Antibiotic therapy, douching, perineal hygiene sprays, and deodorants upset the acid balance within the vaginal environment and can predispose women to infections. Menstruation is not considered a risk factor.
Which of the following is not one of the six general types of risk factors in regard to increasing an individual ‘s chances for illness and injury?
A. Age
B. Lifestyle
C. Gender
D. Environment
The six general types of risk factors are age, genetics, physiologic factors, health habits, lifestyle, and environment. Gender is not a risk factor per se, but certain conditions, such as pregnancy, can contribute to risk.
An adolescent has recently had a ring inserted into her navel. Which of the following is the greatest risk facing the adolescent as a result of this activity?
A. A scar over the navel
B. A greater acceptance by peers
C. A local and/or systemic infection
D. A strained relationship with parents
Body piercing is a quick procedure that does not require anesthesia, but the risk for infection is great. This risk includes local infection, hepatitis B virus, and HIV.
What information do anthropometric measurements provide in adults?
Indirect measure of protein and fat stores.
Anthropometric measurements are used to determine body dimensions. In children, they are used to assess growth rate; in adults, they give indirect measurements of body protein and fat stores.
The nurse conducting a community emergency preparedness education class includes which of the following as an example of a natural disaster?
A. Earthquake
B. War
C. Terrorist event
D. Toxic spill
A disaster is broadly defined as a tragic event of great magnitude that requires the response of people outside the involved community. Disasters can be categorized as natural (e.g., massive flooding following a hurricane or an earthquake) or man-made (e.g., a toxic spill, war, or a terrorist event).
A woman telephones her health care provider and reports that her water just broke. Which suggestion by the nurse would be most appropriate?
A. “Drink 3 to 4 glasses of water and lie down.”
B. “Come in as soon as you feel the urge to push.”
C. “Call us back when you start having contractions.”
D. “Come to the clinic or emergency department for an evaluation.”
When the amniotic sac ruptures, the barrier to infection is gone and there is the danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that the woman come in for an evaluation. Calling back when contractions start, drinking water, and lying down are inappropriate because of the increased risk for infection and cord prolapse. Telling the client to wait until she feels the urge to push is inappropriate because this occurs during the second stage of labor.
