Chapter 21: Nursing Care of the Family During the Postpartum Period My Nursing Test Banks

 

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 21: Nursing Care of the Family During the Postpartum Period

Test Bank

MULTIPLE CHOICE

1. A woman gave birth vaginally to a 9-lb, 12-oz girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?

a.

The woman is a gravida 2, para 2

b.

The woman had a vacuum-assisted birth

c.

The woman received epidural anesthesia

d.

The woman has an episiotomy

ANS: D

These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids.

A multiparous classification is not an indication for these orders.

A vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate these interventions.

Use of epidural anesthesia has no correlation with these orders.

DIF: Cognitive Level: Comprehension REF: 492

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

2. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?

a.

Rubella vaccine should be given

b.

A blood transfusion is necessary

c.

Rh immune globulin is necessary within 72 hours of birth

d.

A Kleihauer-Betke test should be performed

ANS: A

This clients rubella titer indicates that she is not immune and that she needs to receive a vaccine.

These data do not indicate that the client needs a blood transfusion.

Rh immune globulin is indicated only if the client has a negative Rh status and the infant has a positive Rh status.

A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is suspected, especially if the mother is Rh negative. The data do not provide any indication for performing this test.

DIF: Cognitive Level: Comprehension REF: 499

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:

a.

Running warm water on her breasts during a shower

b.

Applying ice to the breasts for comfort

c.

Expressing small amounts of milk from the breasts to relieve pressure

d.

Wearing a loose-fitting bra to prevent nipple irritation

ANS: B

Applying ice to the breasts for comfort is an appropriate intervention for treating engorgement in a mother who is bottle feeding. Ice should be applied for 15 minutes on and 45 minutes off to avoid rebound engorgement.

This woman is experiencing engorgement, which can be treated by using ice packs (since she is not breastfeeding) and cabbage leaves.

A bottle-feeding mother should avoid any breast stimulation, including pumping or expressing milk.

A bottle-feeding mother should wear a well-fitted support bra or breast binder continuously for at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation.

DIF: Cognitive Level: Application REF: 499

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

4. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurses most appropriate response is to ask the woman:

a.

Didnt you like your lunch?

b.

Does your doctor know that you are planning to eat that?

c.

What is that anyway?

d.

Ill warm the soup in the microwave for you.

ANS: D

Offering to warm the food shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response.

Cultural dietary preferences must be respected.

Women may request that family members bring favorite or culturally appropriate foods to the hospital.

Asking the woman to identify her food does not show cultural sensitivity.

DIF: Cognitive Level: Application REF: 502

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

5. A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

a.

The woman is disinterested in learning about infant care.

b.

The woman continues to hold and cuddle her infant after she has fed her.

c.

The woman reads a magazine while her infant sleeps.

d.

The woman changes her infants diaper and then shows the nurse the contents of the diaper.

ANS: A

The client should be excited, happy, and interested or involved in infant care. A woman who is sad, tearful, or disinterested in caring for her infant may be exhibiting signs of depression or postpartum blues and require further intervention.

Holding and cuddling her infant after feeding is an appropriate parent-infant interaction.

Taking time for herself while the infant is sleeping is an appropriate maternal action.

Showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infants elimination patterns.

DIF: Cognitive Level: Comprehension REF: 501

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

6. What will prevent early discharge of a postpartum woman?

a.

Hgb <10 g

b.

Birth at 38 weeks of gestation

c.

Voids about 200 to 300 ml per void

d.

Episiotomy that shows slight redness and edema and is dry and approximated

ANS: A

The mothers hemoglobin should be greater than 10 g for early discharge.

The birth of an infant at term is not a criterion that prevents early discharge.

A voiding volume of 200 to 300 ml per void is normal and does not indicate that the woman should not be discharged early.

An episiotomy that shows slight redness and edema and is dry and approximated is a normal finding and does not prevent a woman from being discharged early.

DIF: Cognitive Level: Comprehension REF: 488

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

7. Which finding could prevent early discharge of a newborn who is now 12 hours old?

a.

Birth weight of 3000 g

b.

One meconium stool since birth

c.

Voided, clear, pale urine three times since birth

d.

Infant breastfed once with some difficulty with latch and sucking and once with some success for about 5 minutes on each breast

ANS: D

An infant needs to complete at least two successful feedings (normal sucking and swallowing) before an early discharge.

Birth weight of 3000 g is a normal infant finding that does not prevent early discharge.

Passage of one meconium stool is a normal infant finding that does not prevent early discharge.

Having voided three times since birth is a normal infant finding that does not prevent early discharge.

DIF: Cognitive Level: Comprehension REF: 488

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

8. The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth for all of the following reasons except:

a.

A wellness orientation rather than a sick-care model

b.

A desire to reduce health care costs

c.

Consumer demand for fewer medical interventions and more family-focused experiences

d.

Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

ANS: D

Nursing time and care are in demand as much as ever; the nurse just has to do things more quickly.

A wellness orientation seems to focus on getting clients out the door sooner.

In most cases less hospitalization results in lower costs.

People believe the family gives more nurturing care than the institution.

DIF: Cognitive Level: Comprehension REF: 486

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning, Implementation

9. Under the Newborns and Mothers Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth.

a.

24; 72

b.

24; 96

c.

48; 96

d.

48; 120

ANS: C

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge.

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. A client may be discharged either 24 hours after a vaginal birth or 72 hours after a cesarean birth if she is stable and her provider is in agreement.

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. A client may be discharged 24 hours after a vaginal birth if she is stable and her provider is in agreement.

The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. A client is unlikely to remain in the hospital for 120 hours after a cesarean birth unless there are complications.

DIF: Cognitive Level: Knowledge REF: 488

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning

10. Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically, this expression refers to:

a.

Formally initializing individualized care by confirming the womans and infants ID numbers on their respective wrist bands (This is your baby)

b.

Teaching the mother to check the identity of any person who comes to remove the baby from the room (Its a dangerous world out there)

c.

Including other family members in the teaching of self-care and child care (Were all in this together)

d.

Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood

ANS: D

Many professionals believe that the nurses nurturing and support function is more important than providing physical care and teaching.

Matching ID wrist bands is more of a formality but also a get-acquainted procedure. Mothering the mother is more a process of encouraging and supporting the woman in her new role.

Having the mother check IDs is a security measure for protecting the baby from abduction. Mothering the mother is more a process of encouraging and supporting the woman in her new role.

Teaching the whole family is just good nursing practice. Mothering the mother is more a process of encouraging and supporting the woman in her new role.

DIF: Cognitive Level: Comprehension REF: 492

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

11. What is not a postpartum practice for preventing infections?

a.

Not letting the mother walk barefoot at the hospital

b.

Educating the client to wipe from back to front after voiding

c.

Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay home

d.

Instructing the mother to change her perineal pad from front to back each time she voids or defecates

ANS: B

Proper perineal care helps to prevent infection and aids in the healing process. Educating the woman to wipe from front to back (urethra to anus) after voiding or defecating is a simple first step.

Walking barefoot and getting back into bed can contaminate the linens.

Staff members with infections need to stay home until they are no longer contagious.

She should also wash her hands before and after these functions.

DIF: Cognitive Level: Comprehension REF: 493

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

12. A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:

a.

Improve the accuracy of blood loss estimation, which usually is a subjective assessment

b.

Determine which pad is best

c.

Demonstrate that other nurses usually underestimate blood loss

d.

Reveal to the nurse supervisor that one of them needs some time off

ANS: A

Saturation of perineal pads is a critical indicator of excessive blood loss, and anything done to aid in assessment is valuable. The nurse is noting the saturation volumes and soaking appearances.

Instead of determining which pad is best, the nurse is more likely noting saturation volumes and soaking appearances to improve the accuracy of blood loss estimation.

Nurses usually overestimate blood loss.

Soaking perineal pads and writing down results does not indicate the need for time off from work.

DIF: Cognitive Level: Application REF: 493

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

13. What is not a reliable indicator of impending shock from early hemorrhage?

a.

Respirations

b.

Blood pressure

c.

Skin condition

d.

Urinary output

ANS: B

Blood pressure is not a reliable indicator; several more sensitive signs are available.

Respiratory rate is a more sensitive and reliable indicator than blood pressure.

Skin condition is a more sensitive and reliable indicator than blood pressure.

Urinary output is a more sensitive and reliable indicator than blood pressure.

DIF: Cognitive Level: Knowledge REF: 494

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

14. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse might try is:

a.

Pouring water from a squeeze bottle over the womans perineum

b.

Placing oil of peppermint in a bedpan under the woman

c.

Asking the physician to prescribe analgesics

d.

Inserting a sterile catheter

ANS: D

Invasive procedures usually are the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills).

Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried early on.

The oil of peppermint releases vapors that may relax the necessary muscles. It is easy, noninvasive, and should be tried early on.

If the woman is anticipating pain from voiding, pain medications may be helpful. Other nonmedical means could be tried first, but medications still come before insertion of a catheter.

DIF: Cognitive Level: Comprehension REF: 494

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

15. If a woman is at risk for thrombus and is not ready to ambulate, nurses might intervene by doing all of these interventions except:

a.

Putting her in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots

b.

Having her flex, extend, and rotate her feet, ankles, and legs

c.

Having her sit in a chair

d.

Notifying the physician immediately if a positive Homans sign occurs

ANS: C

Sitting immobile in a chair does not help. Bed exercise and prophylactic footwear might.

Antiembolic stockings (TED hose) and SCD boots are recommended. Just sitting in a chair will not help.

Bed exercises such as these are useful. Just sitting in a chair does not help.

A positive Homans sign (calf muscle pain or warmth, redness, or tenderness) requires the physicians immediate attention.

DIF: Cognitive Level: Comprehension REF: 496

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

16. With regard to rubella and Rh issues, nurses should be aware that:

a.

Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus

b.

Women should be warned that the rubella vaccination is teratogenic and they must avoid pregnancy for at least 1 month after vaccination

c.

Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant

d.

Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations

ANS: B

Women should understand they must practice contraception for at least 1 month after being vaccinated.

Because the live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated.

Rh immune globulin is administered IM; it should never be given to an infant.

Rh immune globulin suppresses the immune system and therefore might thwart the rubella vaccination.

DIF: Cognitive Level: Comprehension REF: 499

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

17. A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:

a.

Discusses her labor and birth experience excessively

b.

Feels that her baby is more attractive and clever than any others

c.

Has not given the baby a name

d.

Has a partner or family members who react very positively about the baby

ANS: C

If the mother is having difficulty naming her new infant, it may be a signal that she is not adapting well to parenthood. Other red flags include refusal to hold or feed the baby, lack of interaction with the infant, and becoming upset when the baby vomits or needs a diaper change.

A new mother who is having difficulty is unwilling to discuss her labor and birth experience. An appropriate nursing diagnosis might be impaired parenting related to a long, difficult labor or unmet expectations of birth. A mother who is willing to discuss her birth experience is making a healthy personal adjustment.

The mother who is not coping well finds her baby unattractive and messy. She may also be overly disappointed in the babys sex. The client might voice concern that the baby reminds her of a family member whom she does not like.

Having a partner and/or other family members react positively is an indication that this new mother has a good support system in place. This support system helps reduce anxiety related to her new role as a mother.

DIF: Cognitive Level: Synthesis REF: 501

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

MULTIPLE RESPONSE

1. Many new mothers experience some type of nipple pain during the first weeks of initiating breastfeeding. Should this pain be severe or persistent, it may discourage or inhibit breastfeeding altogether. The nurse should be aware of a variety of factors that may contribute to nipple pain. These include:

a.

Improper feeding position

b.

Large-for-gestational age infant

c.

Fair skin

d.

Progesterone deficiency

e.

Flat or retracted nipples

ANS: A, C, E

Nipple lesions may manifest as chapped, cracked, bleeding, sore, erythematous, edematous, or blistered. Factors that contribute to nipple pain include improper positioning or failure to break suction before removing the baby from the breast. Flat or retracted nipples along with the use of nipple shields, breast shells, or plastic breast pads also contribute. Women with fair skin are more likely to develop sore and cracked nipples. Prevention of nipple soreness is preferable to treatment after it appears.

Vigorous feeding may be a contributing factor. This may be the case with any size infant, not just those who are large for gestational age. Estrogen or dietary deficiencies can contribute to nipple soreness.

DIF: Cognitive Level: Knowledge REF: 495

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

2. Infant abduction from hospitals in the United States has increased over the past few years. As a result many maternity units have put practices into place to protect infants from possible abduction. These practices include:

a.

Limited-entry systems

b.

Photo identification badges

c.

Fingerprint identification of all newborns

d.

Infant should always be transported in a bassinet

e.

Staff wear special scrubs or unique ID badges

ANS: A, B, C, D, E

Limited-entry systems, photo identification badges, fingerprint identification of all newborns, transport of the infant in a bassinet, and special staff scrubs or unique identification badges are all practices that limit the ability of an abductor to remove an infant from the hospital. Nurses must also teach new parents to check the identity of any person attempting to remove an infant from the room and question the reason why. Clients and staff must work together to ensure the safety of newborns in the hospital environment.

DIF: Cognitive Level: Application REF: 492

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning, Implementation

COMPLETION

1. The _________________________ test is used to detect the amount of fetal blood in the maternal circulation.

ANS:

Kleihauer-Betke

This test is ordered if a large fetomaternal transfusion is suspected. If more than 15 ml of fetal blood is present in maternal circulation, a higher dose of Rh immune globulin must be given.

DIF: Cognitive Level: Comprehension REF: 500

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

2. During the immediate postpartum period, saturation of one pad within 1 hour or less is considered ____________________ blood loss.

ANS:

Heavy

Any estimation of lochial flow is inaccurate and incomplete without consideration of the time factor. The woman who saturates a perineal pad in 1 hour or less is bleeding much more heavily than the woman who saturates a pad in 8 hours.

DIF: Cognitive Level: Comprehension REF: 493

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

TRUE/FALSE

1. Regardless of her obstetric status, no woman should be discharged from the recovery area until she has completely recovered from the effects of anesthesia and has been cleared by a member of the anesthesia care team. Is this statement true or false?

ANS: T

It takes several hours to recover from anesthesia. Obstetric recovery areas are held to the same standard of care expected for any postanesthesia recovery.

DIF: Cognitive Level: Comprehension REF: 486

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

2. If a mother and her family have freely chosen early discharge from the hospital, the nurse and the health care provider are not legally responsible if complications occur and her condition had not been stabilized within normal limits. Is this statement true or false?

ANS: F

Even if the mother chose to leave, the medical and nursing staffs still could be sued for abandonment.

DIF: Cognitive Level: Comprehension REF: 489

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Evaluation

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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