Chapter 21

Question 1

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 4300 g boy after augmentation of labour with oxytocin. She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” What is the most likely cause of postpartum hemorrhage in this woman?
a.
Retained placental fragments
b.
Unrepaired vaginal lacerations
c.
Uterine atony
d.
Puerperal infection

Answer 1

C

Question 2

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurse’s initial response?
a.
Begin an intravenous (IV) infusion of Ringer’s lactate solution.
b.
Assess the woman’s vital signs.
c.
Call the woman’s primary health care provider.
d.
Massage the woman’s fundus.

Answer 2

D

Question 3

A woman gave birth vaginally to a 4400 g 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 anaesthesia.
d.
The woman has an episiotomy.

Answer 3

D

Question 4

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titre, 1:8 (EIA 0.6); 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.

Answer 4

A

Question 5

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 of her breasts are swollen, warm, and tender on palpation. What advise should the nurse offer the woman?
a.
Run warm water on her breasts during a shower.
b.
Apply ice to the breasts for comfort.
c.
Express small amounts of milk from the breasts to relieve pressure.
d.
Wear a loose-fitting bra to prevent nipple irritation.

Answer 5

B

Question 6

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. What is the nurse’s most appropriate response?
a.
“Didn’t you like your lunch?”
b.
“Does your doctor know that you are planning to eat that?”
c.
“What is that anyway?”
d.
“I’ll warm the soup in the microwave for you.”

Answer 6

D

Question 7

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behaviour indicates a need for further intervention by the nurse before the woman can be discharged?
a.
The woman leaves the infant on her bed while she takes a shower.
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 infant’s diaper and shows the nurse the contents of the diaper.

Answer 7

A

Question 8

What would prevent early discharge of a postpartum woman?
a.
Afterpains when breastfeeding
b.
Birth at 38 weeks of gestation
c.
Has voided 130 mL since delivery
d.
Episiotomy that shows slight redness and edema, is dry and approximated

Answer 8

C

Question 9

Which finding could prevent early discharge of a newborn at 12 hours of age?
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 latching on and sucking and once with some success for about 5 minutes on each breast

Answer 9

D

Question 10

While admitting the pregnant woman, the nurse should be aware that shorter postpartum hospital stays are primarily the result of the influence of which of the following?
a.
Desire for a family-centred experience
b.
Budget-driven decision
c.
Hospitals
d.
The federal government

Answer 10

A

Question 11

How long should the nurse teach the woman who is not breastfeeding to wear a well-fitted support bra or breast binder to suppress lactation in the postpartum period?
a.
24 hours
b.
48 hours
c.
72 hours
d.
7 days

Answer 11

C

Question 12

Which woman should receive Rh immune globulin?
a.
Rh+, sensitized
b.
Rh+, not sensitized
c.
Rh–, sensitized
d.
Rh–, not sensitized

Answer 12

D

Question 13

According to the Family-Centred Maternity and Newborn Guidelines (Health Canada, 2000), what is the correct time frame for an early discharge?
a.
12 hours
b.
24 hours
c.
36 hours
d.
48 hours

Answer 13

B

Question 14

The nurse knows that combined care is when the mother and infant share a room, and the mother shares the care of the infant with which of the following?
a.
The father of the infant
b.
Her mother (the infant’s grandmother)
c.
Her eldest daughter (the infant’s sister)
d.
The nurse

Answer 14

D

Question 15

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to “mother the mother. ” What does this expression refer to?
a.
Formally initializing individualized care by confirming the woman’s and infant’s identification (ID) numbers on their respective wrist bands
b.
Teaching the mother to check the identity of any person who comes to remove the baby from the room
c.
Including other family members in the teaching of self-care and child care
d.
Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood

Answer 15

D

Question 16

Excessive blood loss after childbirth can have several causes. What is the most common cause?
a.
Vaginal or vulvar hematomas
b.
Unrepaired lacerations of the vagina or cervix
c.
Failure of the uterine muscle to contract firmly
d.
Retained placental fragments

Answer 16

C

Question 17

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. What does this activity indicate that the nurse is doing?
a.
Improving the accuracy of blood loss estimation, which usually is a subjective assessment
b.
Determining which pad is best
c.
Demonstrating that other nurses usually underestimate blood loss
d.
Indicating to the nurse supervisor that one of them needs some time off

Answer 17

A

Question 18

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. Which would be the last intervention that the nurse would implement?
a.
Pouring water from a squeeze bottle over the woman’s perineum
b.
Placing oil of peppermint in a bedpan under the woman
c.
Asking the physician to prescribe analgesics
d.
Inserting a sterile catheter

Answer 18

D

Question 19

If a woman is at risk for thrombus and is not ready to ambulate, which intervention should the nurse perform?
a.
Put on antiembolic stockings (TED hose).
b.
Have her avoid leg exercises.
c.
Have her sit in a chair.
d.
Keep her legs flat; do not elevate.

Answer 19

A

Question 20

Which of the following is true with regard to rubella and Rh issues?
a.
Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.
b.
Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 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.

Answer 20

B

Question 21

Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins when?
a.
At the time of admission to the nurse’s unit
b.
When the infant is presented to the mother at birth
c.
During the first visit with the physician in the unit
d.
When the take-home information packet is given to the couple

Answer 21

A

Question 22

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. What should the nurse be concerned about with regard to psychosocial outcomes not being met?
a.
The mother discusses her labour and birth experience excessively.
b.
The mother believes that her baby is more attractive and clever than any others.
c.
The mother has not given the baby a name.
d.
The mother has a partner or family members who react very positively about the baby.

Answer 22

C