Deck 35: Postpartum Family Adaptation and Nursing Assessment

Question 1

Which strategies would the nurse utilize to promote culturally competent care for the postpartum patient?

A) Examine one's own cultural beliefs, biases, stereotypes, and prejudices.
B) Respect the values and beliefs of others.
C) Limit the alternative food choices offered patients to minimize conflicts.
D) Incorporate the family's cultural practices into the care.
E) Evaluate whether the family's cultural practices might have negative consequences.

Answer 1

Examine one's own cultural beliefs, biases, stereotypes, and prejudices.
Respect the values and beliefs of others.
Incorporate the family's cultural practices into the care.
Evaluate whether the family's cultural practices might have negative consequences.

Question 2

To assess the healing of the uterus at the placental site, the nurse assesses:

A) Lab values.
B) Blood pressure.
C) Uterine size.
D) Type, amount, and consistency of lochia.

Answer 2

Type, amount, and consistency of lochia.

Question 3

The community nurse is working with a patient from southeast Asia who has delivered her first child. Her mother has come to live with the family for several months. The nurse understands that the main role of the grandmother while visiting is to:

A) Help the new mother by allowing her to focus on resting and caring for the baby.
B) Teach her son-in-law the right way to be a father, since this is his first child.
C) Make sure that her daughter does not become abusive towards the infant.
D) Pass on the cultural values and beliefs to the newborn grandchild.

Answer 3

Help the new mother by allowing her to focus on resting and caring for the baby.

Question 4

The nurse has received the end-of-shift report on the postpartum unit. Which patient should the nurse see first?

A) Multip, 2nd day post-cesarean, moderate lochia serosa
B) Primip, day of delivery, fundus firm 2 cm above umbilicus
C) Multip, 1st postpartum day, 4 cm diastasis recti abdominis
D) Primip, 1st postpartum day, hypoactive bowel sounds all quadrants

Question 5

The nurse is caring for a postpartum patient who is experiencing afterpains following the birth of her third child. Which comfort measure should the nurse implement to decrease her pain?

A) Offer a warm water bottle for her abdomen.
B) Call the physician to report this finding.
C) Inform her that this is not normal, and she will need an oxytocic agent.
D) Administer a mild analgesic to help with breastfeeding.
E) Administer a mild analgesic at bedtime to ensure rest.

Question 6

The nurse assesses for Homans' sign by:

A) Extending the foot and inquiring about calf pain.
B) Extending the leg and inquiring about foot pain.
C) Flexing the knee and inquiring about thigh pain.
D) Dorsiflexing the foot and inquiring about calf pain.

Question 7

A postpartum patient has inflamed hemorrhoids. Which nursing intervention would be appropriate?

A) Encourage sitz baths.
B) Position the patient in the supine position.
C) Avoid stool softeners.
D) Decrease fluid intake.

Question 8

The nurse is providing discharge teaching to a woman who delivered her first child 2 days ago. The nurse understands that additional information is needed if the patient makes which statement?

A) "I should expect a lighter flow next week."
B) "The flow will increase if I am too active."
C) "My bleeding will remain red for about a month."
D) "I will be able to use a pantiliner in a day or two."

Question 9

On the first postpartum day, the nurse teaches the patient about breastfeeding. Two hours later, the mother seems to remember very little of the teaching. The nurse understands this memory lapse to be related to:

A) The taking-hold phase.
B) Postpartum hemorrhage.
C) The taking-in phase.
D) Epidural anesthesia.

Question 10

Type: SEQ Put the following components specific to a postpartum examination in the proper sequential order: Standard Text: Click and drag the options below to move them up or down.

A) L-lochia
B) E-emotional
C) H-Homans'/hemorrhoids
D) B-breasts
E) E-episiotomy/lacerations
F) non of the above

Question 11

A nurse is assigning care of postpartum patients to a licensed vocational nurse (LVN). Which postpartum patient is at the greatest risk for postpartum bleeding from uterine atony, and should not be delegated to an LVN's care?

A) A breastfeeding postpartum patient
B) A postpartum patient who began early ambulation
C) A patient who delivered vaginally after a prolonged labor
D) A primiparous patient

Question 12

The nursing instructor is conducting a class about attachment behaviors. Which statement by a student indicates the need for further instruction?

A) "The en face position promotes bonding and attachment."
B) "Ideally, initial skin-to-skin contact occurs after the baby has been assessed and bathed."
C) "In reciprocity, the interaction of mother and infant is mutually satisfying and synchronous."
D) "The needs of the mother and of her infant are balanced during the phase of mutual regulation."

Question 13

The nurse assesses the postpartum patient who has not had a bowel movement by the third postpartum day. Which nursing intervention would be appropriate?

A) Encourage the new mother to be patient, saying, "It will happen soon."
B) Instruct the patient to eat a low-fiber diet.
C) Decrease fluid intake.
D) Obtain an order for a stool softener.

Question 14

The nurse determines the fundus of a postpartum patient to be boggy. Initially, the nurse should:

A) Document the findings.
B) Catheterize the patient.
C) Massage gently and reassess.
D) Call the physician immediately.

Question 15

The nurse is working with a new mother who follows Muslim traditions. Which expectations and actions are appropriate for this patient?

A) Be sure she gets a kosher diet.
B) Expect that most visitors will be women.
C) Uncover only the necessary skin when assessing.
D) The father will take an active role in infant care.
E) She will prefer a male physician.

Question 16

The nurse would expect a physician to prescribe which medication to a postpartum patient with heavy bleeding and a boggy uterus?

A) Methylergonovine maleate (Methergine)
B) Rh immune globulin (RhoGAM)
C) Terbutaline (Brethine)
D) Docusate (Colace)

Question 17

The nurse expects an initial weight loss for the average postpartum patient to be:

A) 5-8 pounds.
B) 10-12 pounds.
C) 12-15 pounds.
D) 15-20 pounds.

Question 18

Which statement by a new mother 1 week postpartum indicates maternal role attainment?

A) "I don't think I'll ever know what I'm doing."
B) "This baby feels like a real stranger to me."
C) "It works better for me to undress the baby and to nurse in the chair rather than the bed."
D) "My sister took to mothering in no time. Why can't I?"

Question 19

The postpartum nurse is caring for a patient who gave birth to full-term twins earlier today. The nurse will know to assess for symptoms of:

A) Increased blood pressure.
B) Hypoglycemia.
C) Postpartum hemorrhage.
D) Postpartum infection.

Question 20

Every time the nurse enters the room of a postpartum patient who gave birth 3 hours ago, the patient asks something else about her birth experience. The nurse should:

A) Answer questions quickly and try to divert her attention to other subjects.
B) Review the documentation of the birth experience and discuss it with her.
C) Contact the physician to warn him the patient might want to file a lawsuit, based on her preoccupation with the birth experience.
D) Submit a referral to Social Services because of possible obsessive behavior.

Question 21

The nurse is caring for a patient who recently emigrated from a southeast Asian country. The mother has been resting since the birth, while her sister has changed the diapers and fed the infant. The most likely explanation for this behavior is that the patient:

A) Is not attaching to her infant appropriately.
B) Is not going to be a good mother, and the baby is at risk.
C) Has no mother present to role-model behaviors.
D) Is exhibiting normal behavior for her culture.

Question 22

A nurse is preparing to discharge a postpartum client. The nurse notes on her chart that she is nonimmune to rubella. The nurse:

A) Administers a rubella vaccine prior to discharge.
B) Instructs the client to obtain a rubella vaccine after 1 month has elapsed.
C) Charts this information in the discharge summary notes.
D) Takes no action because none is needed.

Question 23

A nurse is caring for several postpartum patients. Which patient is demonstrating a problem attaching to her newborn?

A) The patient who is discussing how the baby looks like her father
B) The patient who is singing softly to her baby
C) The patient who continues to touch her baby with only her fingertips
D) The patient who picks her baby up when the baby cries

Question 24

The nurse is teaching a prenatal class about postpartum changes. The nurse explains that factors that might interfere with uterine involution include:

A) Prolonged labor.
B) Difficult birth.
C) Full bladder.
D) Breastfeeding.
E) Infection.

Question 25

The nurse is preparing a class for mothers and their partners who have just recently delivered. One topic of the class is infant attachment. Which statement by a participant indicates an understanding of this concept?

A) "We should avoid holding the baby too much."
B) "Looking directly into the baby's eyes might frighten him."
C) "Talking to the baby is good because he'll recognize our voices."
D) "Holding the baby so we have direct face-to-face contact is good."
E) "We should expect the baby to smile when we talk to him."

Question 26

The community nurse is meeting a new mother for the first time. The patient delivered her first child 5 days ago after a 12-hour labor. Neither the mother nor the infant had any complications during the birth or postpartum period. Which statement by the patient would indicate to the nurse that the patient is experiencing postpartum blues?

A) "I am so happy and blessed to have my new baby."
B) "One minute I'm laughing and the next I'm crying."
C) "My husband is helping out by changing the baby at night."
D) "Breastfeeding is going quite well now that the engorgement is gone."

Question 27

The nurse is beginning the postpartum teaching of a mother who has given birth to her first child. What aspect of teaching is most important?

A) Describe the likely reaction of siblings to the new baby.
B) Discuss adaptation to grandparenthood by her parents.
C) Determine whether father-infant attachment is taking place.
D) Assist the mother in identifying the baby's behavior cues.

Question 28

Which of the following behaviors noted in the postpartum client would require the nurse to assess further?

A) Responds hesitantly to infant cries.
B) Expresses satisfaction about the sex of the baby.
C) Numerous friends visit the client and give advice.
D) Talks to and cuddles with the infant frequently.

Question 29

The patient delivered her first child vaginally 7 hours ago. She has not voided since delivery. She has an IV of lactated Ringer's solution running at 100 ml/hr. Her fundus is firm, 1 FB U, to the right of midline. The best nursing action is to:

A) Massage the fundus vigorously.
B) Assess the patient's pain level.
C) Increase the rate of the IV.
D) Assist the patient to the bathroom.

Question 30

At her 6-week postpartum checkup, a new mother voices concerns to the nurse. She states that she is finding it hard to have time alone to even talk on the phone without interruption. Her family lives in another state, and she has contact with them only by phone. She is still having difficulty getting enough sleep and worries that she will not be a good mother. Appropriate nursing interventions would include providing:

A) Anticipatory guidance about the realities of being a parent.
B) Parenting literature and reference manuals.
C) Phone numbers and locations of local parenting groups.
D) Referral for specialized interventions related to postpartum blues.
E) Phone numbers and names of postpartum doulas.

Question 31

The community nurse is working with a client whose only child is eight months old. Which statement does the nurse expect the mother to make?

A) "I have a lot more time to myself than I thought I would have."
B) "My confidence level in my parenting is higher than I anticipated."
C) "I am constantly tired. I feel like I could sleep for a week."
D) "My baby likes everyone, and never fusses when she's held by a stranger."

Question 32

During a postpartum examination of a patient who delivered an 8-pound newborn 6 hours ago, the following assessment findings are noted: fundus firm and at the umbilicus, and moderate lochia rubra with a steady trickle of blood from the vagina. The assessment finding that would necessitate follow-up would be the:

A) Firm fundus.
B) Fundus at the umbilical level.
C) Moderate lochia rubra.
D) Steady trickle of blood.

Question 33

The nurse is performing a postpartum assessment on a newly delivered patient. When checking the fundus, there is a gush of blood. The patient asks why that is happening. The best response is:

A) "We see this from time to time. It's not a big deal."
B) "The gush is an indication that your fundus isn't contracting."
C) "Don't worry. I'll make sure everything is fine."
D) "Blood pooled in the vagina while you were in bed."

Question 34

When preparing for and performing an assessment of the postpartum patient, the nurse would:

A) Ask the patient to void before assessing the uterus.
B) Inform the patient of the need for regular assessments.
C) Defer patient teaching to another time.
D) Perform the procedures as gently as possible.
E) Take precautions to prevent exposure to body fluids.

Question 35

Which physical assessment findings would the nurse consider normal for the postpartum patient following a vaginal delivery?

A) Elevated blood pressure
B) Fundus firm and midline
C) Moderate amount of lochia serosa
D) Edema and bruising of perineum
E) Inflamed hemorrhoids

Question 36

The postpartum patient is about to go home. The nurse includes which subject in the teaching plan?

A) Puerperal tachycardia
B) Striae and chloasma
C) Diastasis of the recti muscles
D) HELLP syndrome

Question 37

Which factors would the nurse observe that would indicate a new mother's early attachment to the newborn?

A) Face-to-face contact and eye contact
B) Failure to choose a name for the baby
C) Decreased interest in the infant's cues
D) Pointing out familial traits of the newborn
E) Displaying satisfaction with the infant's sex

Question 38

The nurse is observing a new graduate perform a postpartum assessment. Which action requires intervention by the nurse?

A) Asking the patient to void and donning clean gloves
B) Listening to bowel sounds, then asking when her last BM occurred
C) Telling visitors the assessment will be quick, then checking the fundus
D) Completing the assessment and explaining the results to the patient

Question 39

A postpartum client asks the nurse to weigh her. The nurse expects an initial weight loss of:

A) 10-12 pounds.
B) 5-8 pounds.
C) 15-20 pounds.
D) 12-15 pounds.