7. Well baby care (286-300) Flashcards
286 . Philippa is showing signs of having postpartum blues. Which of the following is not good advice for her?
a) Ensure Philippa has lots of contact with others, in person or virtually, including friends, family and other new parents.
b) Encourage seeking and accepting support from family and friends.
c) Reassure Philippa that this is common and usually resolves by 1-2 weeks postpartum.
d) Refer Philippa to a psychotherapist for counselling.
D
287 . Which of the following vital sign changes is normal postpartum?
a) A rise in blood pressure from 118/74 in labor to 132/86 on day 2 with client reporting this is due to upper abdominal pain.
b) A fall in blood pressure from 110/64 to 74/46 in the first few hours postpartum due to reduced blood volume.
c) A rise in pulse to 100 bpm on day 2 due to decreased blood volume.
d) A fall in pulse to 70 bpm in the first few hours postpartum due to an increased stroke volume.
D
288 . Which of the following describes a physiologic temperature rise postpartum?
a) A rise to 102 F following a report of clogged ducts in a client.
b) A rise to 100 F on day 3 in a breastfeeding client.
c) A rise to 102 F in the first 24 hours following a prolonged labor.
d) A rise to 100 F due to infection of a perineal tear.
B
289 . Which of the following would be a variation of normal lochia?
a) 1050ml blood loss within the first 24 hours of birth.
b) A foul smell to the lochia.
c) An increase in bleeding at 7-14 days postpartum due to secondary sloughing of placental eschar.
d) No decrease in bleeding by 5 days postpartum.
C
290 . You’re performing a vaginal exam 3 weeks postpartum and ask your client to tighten her muscles around the 2 fingers you have inserted. Her muscle tone is lax, and so you help teach her Kegels exercises. Which of the following is not an effect of improving muscle tone here?
a) May improve sexual satisfaction
b) May reduce the length of the second stage of any subsequent labors.
c) May decrease urinary continence.
d) May improve support of the pelvic organs.
C
291 . You’re teaching your client how to contract and release the ischiocavernosus and transverse perineal muscles, elevator and diaphragm muscles and the pubococcygeal muscle, separately and in unison. Why?
a) These exercises strengthen the muscles of the pelvic floor and birth canal.
b) These exercises strengthen the muscles of the birth canal.
c) These exercises stretch the muscles of the pelvic floor.
d) These exercises stretch the muscles of the pelvic floor and birth canal.
A
292 . Olivia is Rh negative and has decided she wants RhoGAM postpartum only if the baby is Rh positive. You took a cord blood sample, but have not yet had results back on blood type. By how many hours postpartum should Olivia have the RhoGAM to attempt to avoid isoimmunization?
a) 72 hours
b) 120 hours
c) 1 hour
d) 24 hours
A
293 . During a 6-week postpartum bimanual exam on Paula, you palpate the adnexal region. Lateral and posterior to the uterus, you palpate a 2-3cm mass, which is slightly tender. What do you suspect this is?
a) The bladder
b) The cervix
c) A normal ovary
d) An ovary with a large cyst
C
294 . Oralia transferred to hospital during labor because she wanted pharmacologic help with pain. She’s now 4 days postpartum and you’re visiting her at home. Oralia shows you her records from her time in hospital, which includes a CBC with WBC count around 19,000. She’s very concerned about this, as she worries she could have picked up an infection in hospital. What advice should you give her?
a) It’s normal for WBC count to rise to 15,000 or higher during labor, and may increase to 25,000 or 30,000 without being pathological if labor was prolonged. You can retest her today if she’d like, as levels should have begun to fall back towards prepregnant levels (3,900-12,500) by now.
b) Oralia may have picked up an infection, as that value is outside the normal pregnancy range of 6,000-17,000, so you should carefully screen her for any signs or symptoms, and recommend that she boost her immune system with a healthful diet high in Vitamin C and antioxidants.
c) It’s likely that she did pick up an infection in hospital, as they’re full of sick people, passing infections around between them all. It’s a shame that Oralia felt the need to deliver her baby in such a place!
d) Normal WBC count in pregnancy is 23,000-29,500, so Oralia’s WBC count is below normal range, and so it is possible that she picked up an infection in hospital. Oralia should ensure she has a healthy diet and should contact you if any signs/symptoms of infection arise.
A
295 . Olivia gave birth yesterday, and is now struggling with hemorrhoids. Which of the following is not a good recommendation for her?
a) Ice stiz bath
b) Witch hazel compresses
c) Hot sitz bath
d) Warm sitz bath
C
296 . You’re performing a vaginal exam postpartum. You insert 2 fingers and push posteriorly against the vaginal musculature. You ask your client to bear down. Which of these is not an accurate description of an observation and associated diagnosis?
a) Bulging of the distal end of the posterior vaginal wall: urethrocele
b) Bulging of the cervical end of the anterior vaginal wall: cystocele
c) Bulging of the vulvar end of the posterior vaginal wall: rectocele
d) Involuntary loss of urine on bearing down: stress incontinence
A
297 . Which of the following timings for return of menses is abnormal?
a) Return of menses at 6 weeks for a breastfeeding/pumping client.
b) Return of menses at 9 months for a breastfeeding/pumping client.
c) Return of menses at 5 months for a non-breastfeeding/pumping client.
d) Return of menses at 6 weeks for a non-breastfeeding/pumping client.
C
298 . Oonagh suffered a late second trimester stillbirth 4 days ago. She’s decided not to pump and donate milk, and wants help in stopping her milk production. You visit her today, and find her painfully engorged and in tears. Which of these is not a recommendation you might give her?
a) Expressing as much milk as possible while taking a warm shower can help relieve engorgement.
b) Acetaminophen or ibuprofen can be used for analgesia if needed.
c) Ice packs can be used (wrapped in a layer of cloth) to help ease the discomfort.
d) Whilst only small amounts of milk should be expressed if needed for comfort, Oonagh might want to consider saving some for having made into breastmilk jewelry. Hair or ashes can also be added, if desired.
A
299 . Which of the following would you not normally evaluate at a 3-4 day postpartum appointment?
a) Edinburgh Postnatal Depression Scale (should be <10)
b) The lochia for color, amount and odor (should be serosa, lighter flow)
c) The uterus for normal inversion (should be around 3-4 cm below umbilicus)
d) Breasts for engorgement or signs of clogged ducts, and nipples for signs of cracking
A
300 . Pamella is showing signs of mild postpartum depression. Which of the following is not good advice for her?
a) Encourage a healthful diet rich in amino acids, tryptophan, omega fatty acids, B complex Vitamins and magnesium and to avoid coffee, alcohol and cigarettes.
b) Refer for treatment from a physician and/or counsellor and ensure she has a good support system, including from other parents. Ensure she and her partner both know how to look for worsening depression.
c) Suggest you screen for thyroid problems, as postpartum thyroiditis can cause symptoms of depression and fatigue.
d) Reassure Pamella that postpartum depression generally resolves itself within 3-6 weeks, and ensure she knows there is no judgment from you.
D
