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Foundations of Maternal and Pediatric 3rd Edition White Test Bank

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Foundations of Maternal and Pediatric 3rd Edition White Test Bank

 

SBN-13: 978-1455733064

ISBN-10: 1455733067

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Foundations of Maternal and Pediatric 3rd Edition White Test Bank

 

SBN-13: 978-1455733064

ISBN-10: 1455733067

 

 

 

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Free Nursing Test Questions:

Chapter 4—Postpartum Care

 

MULTIPLE CHOICE

 

  1. During the first 30 to 60 minutes after birth, which attachment takes place between parent and child?
a. bonding c. engrossment
b. claiming d. entrainment

 

 

ANS:  A

Bonding is a rapid process of attachment that takes place during the first 30 to 60 minutes after birth. The bonding is enhanced when parent and infant touch and interact with each other.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. When a client is 12 hours postpartum, the nurse would expect the client’s fundus to be in which of these positions?
a. at the level of the umbilicus
b. below the symphysis pubis and no longer palpable
c. 1 centimeter above the umbilicus
d. 1 centimeter below the umbilicus

 

 

ANS:  A

Note the size, consistency, and placement of the uterus. It should be the size of a grapefruit, firm, and in the midline. It should descend approximately one fingerbreadth each day. At 12 hours postpartum, the fundus should be approximately at the level of the umbilicus.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. During the first 24 hours postpartum, a client states her vaginal discharge is bright red with small pieces of mucus. Which of these actions should the nurse take?
a. Hold her NPO, and immediately notify her health care provider.
b. Observe the sanitary pad, and document your findings.
c. Verify that the amount and appearance are normal at this time.
d. Compress her fundus vigorously to express clots.

 

 

ANS:  A

Palpate the bladder to assess for distention and position. A distended bladder may cause hemorrhage. If the bladder is off to the side or the fundus is higher than usual, it is distended. Keep the client NPO, and immediately notify her health care provider.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. During the immediate postpartum period, a client’s fundus is firmly contracted, midline, and at the appropriate level, but she is exhibiting an excessive amount of bleeding. The nurse should suspect the cause of bleeding to be:
a. a full bladder c. breastfeeding
b. ambulation d. cervical or vaginal tears

 

 

ANS:  D

Postpartum hemorrhage can occur rapidly and may not be recognized until the client is in shock. It can either be early, within the first 24 hours, or late, within the first 1 to 2 weeks after birth, but may occur up to 6 weeks after the birth. It can be caused by cervical or vaginal tears, prolonged labor, clotting disorders, manual removal of the placenta, or overdistention of the uterus.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. What are the usual causes of maternal afterpains?
a. cesarean delivery and prolonged labor
b. multiparity and breastfeeding
c. postpartal hemorrhage and puerperal infection
d. uterine involution and breast engorgement

 

 

ANS:  B

The causes of maternal afterpains may be related to the contracting uterus, the “let-down reflex” of breastfeeding, or multiparity.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. A nurse would expect a postpartum client’s uterine and vaginal discharge on the 4th postpartum day to be lochia:
a. absent c. rubra
b. alba d. serosa

 

 

ANS:  D

Lochia, the uterine or vaginal discharge after delivery, is initially bright red, then changes to pink or pinkish brown, and finally becomes a yellowish-white color. It has a musty odor, but should not have a foul odor. Foul odor may be a sign of infection. Lochia rubra lasts 3 days and is mostly blood that is bright red. Lochia serosa begins at approximately 4 days and is a pink to pinkish-brown color. After 10 days, lochia alba begins, and the discharge becomes a yellowish-white color and may last 6 weeks.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. When conducting a telephone follow-up of all clients who are 2 weeks postpartum, the nurse would expect clients to describe their uterine and vaginal discharge as:
a. bright red c. pinkish brown
b. nonexistent d. yellowish white

 

 

ANS:  D

Lochia, the uterine or vaginal discharge after delivery, is initially bright red, then changes to pink or pinkish brown, and finally becomes a yellowish-white color. It has a musty odor, but should not have a foul odor. Foul odor may be a sign of infection. Lochia rubra lasts 3 days and is mostly blood that is bright red. Lochia serosa begins at approximately 4 days and is a pink to pinkish-brown color. After 10 days, lochia alba begins, and the discharge becomes a yellowish-white color and may last 6 weeks.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. A postpartum client has a midline episiotomy and states there is a great deal of discomfort whenever she moves. To decrease the discomfort, the nurse should instruct the client to:
a. ask for medication as needed
b. sit on a large pillow at all times
c. walk around frequently to restore circulation
d. tighten the buttocks and perineum before sitting and relax the area once seated

 

 

ANS:  D

Assess the episiotomy for redness, ecchymosis, edema, discharge, and approximation of suture line. Encourage client to tighten the buttocks and perineum before sitting, and once seated, relax the area to decrease the stress placed on the incision line.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. A postpartum client who is breastfeeding asks the nurse when her menstrual period will return. Which of these responses should the nurse make?
a. “It will largely depend on your breastfeeding pattern.”
b. “It will occur within 3 months after the birth.”
c. “It usually returns by 120 days postpartum.”
d. “It usually takes place between 27 days and 2 months after birth.”

 

 

ANS:  A

Ovulation in women who are breastfeeding usually returns by 190 days postpartum, but largely depends on the breastfeeding pattern.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. A client who is breastfeeding experiences engorgement on the 4th postpartum day. The nurse should explain to the client that engorgement is the result of:
a. a blocked milk duct
b. milk stasis that has resulted in inflammation of the breast
c. the breasts beginning to fill with colostrum
d. vasocongestion of breast tissues as milk production begins

 

 

ANS:  D

Engorgement of the breasts occurs at day 3 or 4. If the breasts are not emptied, the engorgement will spontaneously disappear and discomfort will decrease in 24 to 48 hours. This is a result of vasocongestion of breast tissues as milk production begins or “let down” occurs.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. A postpartum client who is a primipara and her husband prepared for their baby’s birth by taking Lamaze classes, but the client had to have an emergency cesarean delivery. According to Reva Rubin’s restorative/adaptive phases, the nurse would expect this couple to experience the MOST difficulty during which phase?
a. letting go c. taking in
b. taking hold d. postpartum blues

 

 

ANS:  A

The letting-go phase occurs when the couple give up the role and lifestyle of being a “couple” and move to being a couple with a child. They move toward the new role and lifestyle as parents.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. A client is exhibiting signs of postpartum depression. Which of the following symptoms would indicate the client’s condition has advanced to that of postpartum psychosis?
a. decreased concentration
b. insomnia
c. obsessive concerns about the infant’s health
d. spontaneous crying

 

 

ANS:  C

Postpartum psychosis is more severe and is characterized by delusions and thoughts of self-harm or infant harm. Symptoms, which usually begin within 2 to 3 weeks after birth, include fatigue, restlessness, insomnia, crying, labile emotions, inability to move, irrational statements, incoherence, confusion, and obsessive concerns about the infant’s health. Postpartum psychosis is a psychiatric emergency.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. The Newborns’ and Mothers’ Health Protection Act of 1995 mandates that all health care plans require a minimal postpartum hospital stay of how many hours for vaginal and cesarean births?
a. vaginal, 24; Cesarean, 48 c. vaginal, 72; Cesarean, 72
b. vaginal, 48; Cesarean, 96 d. vaginal, 72; Cesarean, 96

 

 

ANS:  B

The Newborns’ and Mothers’ Health Protection Act of 1995 mandates that all health care plans require a minimal postpartum hospital stay of 48 hours for a vaginal birth and 96 hours for a cesarean birth.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. Which of these actions is essential when a nurse is caring for a postpartum client who is getting out of bed for the first time?
a. Stay with the client during ambulation.
b. Ask a family member to walk with the client.
c. Administer pain medication before getting the client up.
d. Have a walker or cane readily available.

 

 

ANS:  A

The first time a mother gets out of bed, the nurse should be at her side and be ready to assist in case the mother becomes light-headed, weak, or dizzy.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. A client delivered her baby vaginally 1 week ago today. The nurse would expect to palpate the client’s uterine fundus at which of these levels?
a. 1 centimeter below the level documented on the day of delivery
b. 7 centimeters below the level documented on the day of delivery
c. 7 centimeters below the umbilicus
d. The uterus should not be palpable 1 week after a vaginal delivery.

 

 

ANS:  B

The fundus should be the size of a grapefruit, firm, and in the midline. It should descend approximately one fingerbreadth (1 cm) each day.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. The normal postpartum uterus has which of these characteristics?
a. firm and in the midline
b. firm and slightly to the left of the umbilicus
c. firm when breastfeeding in varied positions, and within abdominal cavity
d. soft and within the pelvic inlet

 

 

ANS:  A

Palpate the uterus to find the fundus. Note the size, consistency, and placement of the uterus. It should be the size of a grapefruit, firm, and in the midline.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. While palpating a client’s uterus postpartum, the nurse notes the fundus position to be 2 centimeters higher than on previous assessments and off to the left side. Which of these actions should the nurse take?
a. Ask the client to urinate, and then reassess the fundus position.
b. Initiate a Pitocin IV drip according to the health care provider’s routine orders.
c. Note the position of the uterus on the nurse’s notes because these findings are normal.
d. Notify the health care provider immediately.

 

 

ANS:  A

Palpate the uterus to find the fundus. Note the size, consistency, and placement of the uterus. It should be the size of a grapefruit, firm, and in the midline. It should descend approximately one fingerbreadth each day. Palpate the bladder to assess for distention and position.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. Which of these descriptions of lochia is expected of a mother who had a cesarean delivery?
a. contains more clots than that of a mother who has had a vaginal birth
b. has rubra for a longer period of time than that of a mother who has had a vaginal birth
c. is greater in amount than that of a mother who has had a vaginal birth
d. is smaller in amount than that of a mother who has had a vaginal birth

 

 

ANS:  D

Lochia, the uterine or vaginal discharge after delivery, is initially bright red, then changes to pink or pinkish brown, and finally becomes a yellowish-white color. It has a musty odor but should not have a foul odor. Cesarean delivery will decrease the amount of lochia the client experiences.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. A postpartum client reports calf discomfort when the nurse supports her left knee and dorsiflexes her foot. Which of these actions should the nurse take?
a. Allow the client to rest, and reassess her later in the shift.
b. Chart this finding as a negative Homans’ sign.
c. Massage the affected calf, and apply moist heat.
d. Report this finding to the health care provider at once.

 

 

ANS:  D

Both the hemoglobin and hematocrit rise by the 7th day, unless excessive blood loss occurs. There is an increased risk for clots because of increased levels of clotting factors. Clients who have varicose veins, a cesarean birth, or a history of thrombophlebitis are at greater risk for thrombus formation. The health  care provider should be contacted immediately if a client exhibits any sign of thrombus formation.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. A client with blood type B negative has given birth to an infant with blood type O positive. When should the client receive Rh immune globulin?
a. only if she plans any future pregnancies
b. only if she has had an Rh-negative infant
c. right after the delivery of her infant
d. within 72 hours after delivery

 

 

ANS:  D

Rh immune globulin is given 72 hours after birth to prevent sensitization of Rh-negative mothers who gave birth to Rh-positive infants.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. If a nurse observes an increased pulse rate and decreased blood pressure in a new postpartum client, the nurse should suspect the client has developed which of these conditions?
a. positive Homans’ sign c. dehydration
b. postpartum hemorrhage d. uterine distention

 

 

ANS:  B

Postpartum hemorrhage and urinary tract infection are two complications related to urinary retention and bladder overdistension. A full bladder displaces the uterus and causes excessive bleeding.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. A client who has a puerperal infection is receiving intravenous (IV) antibiotic treatment. The nurse should recognize that the infant will:
a. receive prophylactic antibiotics
b. be kept separate from the mother until her fever is gone for 24 hours
c. remain with the mother
d. be discharged home before the mother

 

 

ANS:  C

A puerperal (postpartum period) infection in the mother would not be considered contagious; therefore, it poses no threat to the infant.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. A breastfeeding client who is 2 weeks’ postpartum tells the nurse her nipples are very sore and she is able to breastfeed for only short periods. The nurse should recognize the client is at risk for developing:
a. metritis c. thrombophlebitis
b. mastitis d. vaginitis

 

 

ANS:  B

Mastitis is the inflammation of the breast during breastfeeding. Symptoms appear 2 to 4 weeks after birth and result in shorter periods of breastfeeding.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. To decrease the incidence of thromboembolic conditions in a postpartum client, the nurse would encourage the client to:
a. ambulate early and frequently after delivery
b. cross legs when sitting
c. rest in bed as much as possible
d. massage extremities and apply heat if discomfort or pain occurs

 

 

ANS:  A

There is an increased risk for clots because of increased levels of clotting factors. Clients who have varicose veins, a cesarean birth, or a history of thrombophlebitis are at greater risk for thrombus formation. Early ambulation helps decrease the formation of clots.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

  1. What is the main goal of medical management of the postpartum client with disseminated intravascular coagulation (DIC)?
a. administration of heparin therapy c. correction of the underlying cause
b. administration of platelets d. symptomatic treatment only

 

 

ANS:  C

Disseminated intravascular coagulation (DIC) is an abnormal stimulation of the clotting mechanism, which consumes clotting factors, causing small clots throughout the vascular system and widespread bleeding internally, externally, or both. Correction of the underlying cause is the main aspect of medical management.

 

PTS:   1                    DIF:    Comprehension                               REF:   White (2010)

 

MULTIPLE RESPONSE

 

  1. The nurse caring for an expectant mother would monitor for which of the following that predisposes the mother for a risk of bleeding? (Select all that apply.)
a. decreased platelet level d. increased hematocrit level
b. history of alcohol abuse e. taking NSAIDs
c. a mother who is obese f. taking herbal medications

 

 

ANS:  A, B, C, E, F

All the following predisposes the mother for a risk of bleeding: decreased platelet level, history of alcohol abuse, a mother who is obese, poor nutrition, taking NSAIDs or aspirin, taking herbal medications, and history of bleeding.

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

  1. When the nurse is caring for a postpartum client, assessment would be focused on which priority areas? (Select all that apply.)
a. cervical enlargement d. depression
b. episiotomy or incision e. lochia
c. bladder distention f. breasts

 

 

ANS:  B, C, E, F

BUBBLE = breasts, uterus, bowels, bladder, lochia, episiotomy (laceration or c-section incision)

 

PTS:   1                    DIF:    Application    REF:   White (2010)

 

 

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