Post-Partum Review Questions Handout 2 with answers /rationales

1. Immediately after delivery the nurse can anticipate the fundus to be located: A. B. C. D. at the umbilicus. 2 cm above the umbilicus. 1 cm below the umbilicus. midway between the symphysis pubis and umbilicus.

Immediately after delivery the uterus is about the size of a large grapefruit and the fundus can be palpated midway between the symphysis pubis and umbilicus. Within 12 hours the fundus rises to the level of the umbilicus. By the second day the fundus starts to descend approximately 1 cm per day.

Correct Answer:

2. When reading the postpartum chart the nurse notices that the client!s fundus is recorded as "u#1". $he nurse understands that this means the fundus is: A. B. C. D. 1 1 1 1 cm above the umbilicus. cm below the umbilicus. inch above the umbilicus. inch below the umbilicus.

escent of the fundus is documented in relation to the umbilicus and is measured in centimeters. %umbers with the "#" sign means the fundus is above the umbilicus& numbers with the "'" sign means the fundus is below the umbilicus.

Correct Answer: (

3.

uring the second postpartum day& a woman as)s the nurse& "Why are my afterpains so much worse this time than after the birth of my other child*" $he best answer by the nurse would be: A. B. C. D. +,ost women forget how strong the afterpains can be.+$hey should not be strong with you because you are breastfeeding.+.ou should not be feeling the pains now/ I will notify the physician for you.+(fterpains are more severe for women that have already had babies.-

(fterpains are more acute for multiparas because repeated stretching of muscle fibers leads to low muscle tone that results in repeated contraction and relaxation of the uterus. Breastfeeding increases the severity of afterpains. $he afterpains are self0limiting and will decrease rapidly after 12 hours.

Correct Answer:

4. $he nurse is assessing the client!s vaginal discharge. It is red and has about a 20inch stain on the peripad. $he nurse will record this finding as: A. B. C. D. light amount of lochia rubra. scant amount of lochia alba. moderate amount of lochia rubra. heavy amount of lochia alba.

3ochia rubra is red in color and occurs the first 4 or 1 days after birth. ( light amount of discharge is classified as a 10 to 10inch stain on the peripad.

Correct Answer: (

5. $he new mother is complaining of pain at the episiotomy site/ however& because she is breastfeeding she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain* A. B. C. D. (mbulation $opical anesthetics 5ot fluids to drin) 6tool softeners

$opical anesthetics can be applied directly to the site to numb the area. $his will not cause systemic effects li)e pain medications.

Correct Answer: B

6. ( mother that is 4 days postpartum calls the clinic and complains of "night sweats." 6he is afraid that she is going into early menopause. $he nurse should base her answer on the fact that: A. birth may put some women into early menopause/ an appointment is needed to have this chec)ed out. B. night sweats may be an indication of many other problems/ an appointment is

needed to assess the problem. C. diaphoresis is normal during the postpartum period& and comfort measures can be suggested to the mother. D. diaphoresis is normal only if the mother is breastfeeding. iaphoresis and diuresis rid the body of excess fluids that accumulated during the pregnancy. iaphoresis is not clinically significant& but can be unsettling for the mother who is not prepared for it. 7xplanations of the cause and provision of comfort measures& such as showers and dry clothing& are generally sufficient.

Correct Answer: 8

7. 9n the first day postpartum a client!s white blood cell count is 2:&;;;<mm 4. $he nurse!s next action should be to: A. B. C. D. notify the physician for an antibiotic order. assess the client=s temperature and blood pressure. re>uest the count be repeated. note the results in the chart.

,ar)ed leu)ocytosis occurs during the postpartum period. $he WB8 count increases to as high as 4;&;;;<mm4. $he WB8 count should fall to normal values by day ?. %eutrophils& which increase in response to inflammation& pain& and stress to protect against invading organisms& account for the ma@or increase in WB8s. Because this is a normal reading& noting the results in the chart is the appropriate action.

Correct Answer:

8. 9ne nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is: A. B. C. D. forcing fluids. perineal care. encouraging voiding every 2 to 4 hours. encouraging the use of stool softeners.

Arinary retention and overdistention of the bladder may cause both urinary tract infection and postpartum hemorrhage. 7ncouraging the mother to empty her bladder fre>uently will help prevent retention and overdistention. Borcing fluids and perineal care may assist with preventing urinary tract infections. 6tool softeners assist with return of normal bowel elimination.

Correct Answer: 8

9. While doing client teaching the woman tells the nurse& "I don!t have to worry about contraception because I am breastfeeding." $he nurse should base her answer on the fact that: A. breastfeeding can be considered a reliable system of birth control. B. breastfeeding can be used as a contraceptive method if strict guidelines are followed through. C. breastfeeding is not a reliable contraceptive method. ,enses in a breastfeeding mother may resume between 12 wee)s and 12 months. %ormally the first few cycles of menses are without ovulation/ however& ovulation may occur before the first menses. $herefore& other contraceptive measures are important considerations for this mother.

Correct Answer: 8

10. ( woman was admitted to the 7 with her newborn baby. $he baby was born 1 days ago at home. $he woman had no prenatal care. $he nurse is assessing the lab wor) and sees that the mother has 90negative blood type and the baby is 9 positive and the 8oombs test shows the mother is not sensitized to the positive blood. $he nurse!s next action should be: A. order ChD E immune globulin to be given to the mother. B. order ChD E immune globulin to be given to the baby. C. record the findings of the lab wor) and not plan on any further action at this time. $he mother is a candidate for ChD E immune globulin/ however& it should be given with ?2 hours after childbirth to prevent the development of maternal antibodies. Because she gave birth 1 days ago& that time period as passed and she is not sensitized to the positive blood.

Correct Answer: 8

11. $he first time a woman ambulates after the birth of the newborn& she has a nursing diagnosis of Cis) for In@ury. $he is due to the: A. B. C. D. ris) for developing orthostatic hypotension. development of bradycardia. increase in cardiac output. increase in circulatory volume.

(fter birth a rapid decrease in intraabdominal pressure results in dilation of blood vessels supplying the viscera. $he resulting engorgement of abdominal blood vessels contributes to a rapid fall in blood pressure when the woman moves from a recumbent to a sitting position. $he mother feels dizzy or lightheaded and may faint when she stands. Bradycardia is a normal change during the postpartum period. $he cardiac output increases during the postpartum period& but it does not produce orthostatic hypotension.

Correct Answer: (

12. When assessing a woman that gave birth 2 hours ago& the nurse notices a constant tric)le of lochia. $he uterus is well contracted. $he next nursing action should be to: A. B. C. D. massage the fundus. continue to monitor. notify the physician. assess the blood pressure and pulse for changes.

7xcessive lochia in the presence of a contracted uterus suggests lacerations of the birth canal. $he health care provider must be notified so that lacerations can be located and repaired. $he uterus is well contracted& so further massage is not necessary.

Correct Answer: 8

13.

uring the early post'cesarean section phase it is important for the woman to turn& cough& and deep breathe. $he rationale for this is to prevent: A. B. C. D. pooling of secretions in the airway. thrombus formation in the lower legs. gas formation in the intestinal tract. urinary retention.

$he post'cesarean section woman is usually on bed rest for the first 2 to 12 hours. 6he is at ris) for pooling of secretions in the airway. By assisting her to turn& cough& and expand the lungs by breathing deeply at least every 2 hours& the pooling of secretions will be decreased.

Correct Answer: (

14. $he postpartum woman has a blood pressure of 1:;<F;& pulse of ?2 beats per minute& and respirations of 11 breaths per minute. 6he continues to bleed heavily. $he order states she may have either methylergonovine D,ethergineE ;.2 mg I, or oxytocin DGitocinE 1; units I, for heavy bleeding. $he nurse should administer which medication* A. ,ethylergonovine B. 9xytocin ,ethylergonovine is contraindicated if the woman has an elevated blood pressure.

Correct Answer: (

15. (s part of the postpartum assessment& the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. (n expected finding would be: A. B. C. D. soft& nontender/ colostrum is present. lea)age of mil) at let0down. swollen& warm& and tender upon palpation. a few blisters and a bruise on each areola.

Breasts are essentially unchanged for the first 2 or 4 days after birth. 8olostrum is present and may lea) from the nipples. 9n day 4 or 1 lactation begins and engorgement can occur& resulting in the findings of b and c. Cesponse d indicates problems with the breastfeeding techni>ues used. Correct Answer: (

16. $he new mother comments that the newborn "has his father!s eyes." $he nurse recognizes this as: A. B. C. D. part of the bonding process called claiming. the mother trying to find signs of the baby=s paternity. the mother trying to include the father into the bonding process. part of the letting0go phase of maternal adaptation.

8laiming or binding0in begins when the mother begins to identify specific features of the newborn. 6he then begins to relate features to family members.

Correct Answer: (

17. ( new father of 1 day expresses concern to the nurse that his wife& who is normally very independent& is as)ing him to ma)e all of the decisions. $he nurse can best explain this as: A. B. C. D. a normal occurrence because the mother is in pain. an abnormal occurrence that needs to be assessed further. a normal occurrence because the mother is in the ta)ing0in phase. a normal occurrence because the mother is frustrated with the care of the newborn.

uring the ta)ing0in phase the mother is focused primarily on her own need for fluid& food& and sleep. 6he may be passive and dependent. $his is normal and lasts about 2 days.

Correct Answer: 8

18. $he day after her delivery& the woman complains that she did not lose all the weight she had gained during the pregnancy. $he nurse can best respond to the mother with the )nowledge that: A. she has lost the ma@ority of the weight and the rest will be gone within 1 wee). B. she has lost some of the weight and the rest will slowly disappear within H wee)s. C. it will ta)e about H to 12 months for all of the weight gained with the pregnancy to disappear. D. most women do not lose all of the weight gained with each pregnancy. Women are very concerned about regaining their normal figures. %urses must emphasize that weight loss should be gradual and that about H to 12 months is usually re>uired to lose most weight gained during pregnancy.

Correct Answer: 8

19. $he home0care nurse is visiting a new mother who delivered 1 wee) ago. $he mother complains about not being able to sleep and that she is tired and cries easily. $he best response by the nurse would be: A. a. +5aving a baby is difficult/ it will be a long time before you get a good night=s sleep.B. b. +,aybe your mother can come in and help you out.C. c. +It is normal for this to happen and it should go away in 2 wee)s. It must be very difficult for you to feel this way with a new baby.D. d. +$he hospital nurses must not have taught you enough information about the changes you will experience during these first H wee)s.Gostpartum blues begins in the first wee) and usually last no longer than 2 wee)s. $he mother needs to be supported during this time and given accurate information about the process. Cesponses a and b belittle the mother and may ma)e her feel inade>uate. Cesponse d places blame on someone else and does not deal with the problem.

Correct Answer: 8

20. $he new parents express concern that their 10year0old son is @ealous of the new baby. $hey are planning on going home tomorrow and are not sure how the preschooler will

react when they bring the baby home. Which of the following suggestions by the nurse will be most helpful* A. Be aware that the child may regress to an earlier stage. B. 5ave the mother go into the house alone and spend time with the child before the father brings the baby in. C. 5ave the child stay with a grandparent until the parents ad@ust to the new baby. D. $ell the child that he is a +big boy- now and doesn=t need his crib so the new baby will be using it for a while. $he child needs to have the mother!s love reaffirmed. By giving the child some private time with the mother he will get the extra attention and reassurance he needs at this point.

Correct Answer: B

21. ( newborn is rooming0in with his teenage mother& who is watching $I. $he nurse notes that the baby is awa)e and >uiet. $he best nursing action is to: A. B. C. D. pic) the baby up and point out his alert behaviors to the mother. tell the mother to pic) up her baby and tal) with him while he is awa)e. focus care on the mother& rather than the infant& so she can recuperate. encourage the mother to feed the infant before he begins crying.

,odeling behavior by the nurse is an excellent way to teach infant care. $he inexperience teenage mother can observe the proper s)ills and then the nurse can encourage her to try those s)ills.

Correct Answer: (

22. When ma)ing a visit to the home of a postpartum woman 1 wee) after birth& the nurse should recognize that the woman would characteristically: A. express a strong need to review events and her behavior during the process of labor and birth. B. exhibit a reduced attention span& limiting readiness to learn. C. attempt to meet the needs of the infant and is eager to learn about infant care. D. have reestablished her role as a spouse<partner. 9ne wee) after birth the woman should exhibit behaviors characteristic of the ta)ing0hold phase. $his stage lasts for as long as 1 to : wee)s after birth. Cesponses a and b are characteristic of the ta)ing0in stage& which lasts for the first few days after birth. Cesponse d reflects the letting0 go stage& which indicates psychosocial recovery is complete.

Correct Answer: 8

23. Bour hours after a difficult labor and birth& a primiparous woman refuses to feed her baby& stating that she is too tired and @ust wants to sleep. $he nurse should: A. B. C. D. tell the woman she can rest after she feeds her baby. recognize this as a behavior of the ta)ing0hold stage. record the behavior as ineffective maternal0newborn attachment. ta)e the baby bac) to the nursery& reassuring the woman that her rest is a priority at this time.

$he behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. ,others need to reestablish their own well0being in order to effectively care for their baby.

Correct Answer:

24. ( primiparous woman is in the ta)ing0in stage of psychosocial recovery and ad@ustment following birth. $he nurse& recognizing women!s needs during this stage should: A. foster an active role in the baby=s care. B. provide time for the mother to reflect on the events of the childbirth. C. recognize the woman=s limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. D. promote maternal independence by encouraging her to meet her own hygiene and comfort needs. $he focus of the ta)ing0in stage is nurturing the new mother by meeting her dependency needs for rest& comfort& hygiene& and nutrition. 9nce they are met& she is more able to ta)e an active role& not only in her own care but also the care of the newborn. Women express a need to review their childbirth experience and evaluate their performance. 6hort teaching sessions and using written materials to reinforce the content presented are a more effective approach. Correct Answer: B