Maternal & Child Nursing A

MATERNAL AND CHILD NURSING A 1. A client has given birth to a preterm male neonate. The client tells the nurse that she still wants to breast-feed her neonate. The nurse should explain to the mother that: a. b. c. d.

Breast milk contains antibodies that help protect her neonate Commercial formula will provide better nutrition for the neonate Breast-feeding can be started when the neonate is ready for discharge The neonate will be less likely to develop an infection on commercial formula

2. Which action best explains the main role of surfactant in the neonate? a. b. c. d.

Assists with ciliary body maturation in the upper airways Helps maintain a rhythmic breathing pattern Promotes clearing mucus from the respiratory tract Helps the lungs remain expanded after the initiation of breathing

3. While assessing a 2-hour-old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially? a. b. c. d.

Activate the code blue or emergency system Do nothing because acrocyanosis is normal in the neonate Immediately take the neonate’s temperature according to hospital policy Notify the physician of the need for a cardiac consult

4. When teaching parents of a neonate the proper position for the neonate’s sleep, the nurse stresses the importance of placing the neonate on his back to reduce the risk of which of the following? a. b. c. d.

Aspiration Sudden infant death syndrome (SIDS) Suffocation Gastroesophageal reflux (GER)

5. The nurse is aware that a neonate if a mother with diabetes is at risk for which complication? a. Anemia b. Hypoglycemia

c. Nitrogen loss d. Thrombosis

6. Which complication is common in neonates who receive prolonged mechanical ventilation at birth? a. Bronchopulmonary dysplasia b. Esophageal atresia

c. Hydrocephalus d. Renal failure

7. When performing neonatal assessment, which is the best indication of adequate hydration? a. Soft, smooth skin b. A sunken fontanel

c. Frequent spitting up d. No urine output in the 24 hours of life

8. When performing a neurologic assessment, which sign is considered a normal finding in a neonate? a. Doll eyes b. “Sunset” eyes

c. Positive Babinski’s sign d. Pupils that don’t react to light

9. At what gestational age us a conceptus considered viable (able to live outside the womb)? a. 9 weeks b. 14 weeks

c. 24 weeks d. 30 weeks

10. A client’s mother asks the nurse why her newborn grandson is getting an injection of vitamin K. Which best explains why this drug is given to neonates?

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a. b. c. d.

Vitamin k assists with coagulation Vitamin k assists the gut to mature Vitamin k initiates the immunization process Vitamin k protects the brain from excess fluid production

11. Neonates born to women infected with hepatitis B should undergo which treatment regimen? a. b. c. d.

Hepatitis B vaccine at birth and 1 month Hepatitis B immune globulin at birth; no hepatitis B vaccine Hepatitis B immune globulin within 48 hours of birth and hepatitis B vaccine at 1 month Hepatitis B immune globulin within 12 hours of birth and hepatitis B vaccine at birth, 1 month, and 6 months

12. When a neonate is delivered with meconium staining in the amnionic fluid, which sequence of events will most effectively decrease the risk of meconium aspiration? a. b. c. d.

Deliver the thorax, then suction the nose Clamp the umbilical cord, then suction the neonate’s mouth Deliver the head, then suction the mouth and then the nose Deliver the thorax, then suction the nose and then the mouth.

13. Erythromycin ointment is administered to the neonate’s eyes shortly after birth to prevent which disorder? a. Cataracts b. Diabetic retinopathy

c. Ophthalmia neonatorum d. Strabismus

14. A client with group AB blood whose husband has group O blood has just given birth. The major sign of ABO blood incompatibility in the neonate is which complication or test result? a. Negative Coombs’ test b. Bleeding from nose or ear

c. Jaundice after the first 24 hours of life d. Jaundice within the first 24 hours of life

15. Which circumstance of delivery would predispose a neonate to respiratory distress syndrome (RDS)? a. Premature birth b. Vaginal delivery

c. First born of twins d. Postdate pregnancy

16. Two days after circumcision, the nurse notes a yellow-white exudates around the head of the neonate’s penis. What would be the most appropriate nursing intervention? a. b. c. d.

Leave the area alone as this is a normal finding Report the findings to the physician and document it Take the neonate’s temperature because an infection is suspected Try to remove the exudates with a warm washcloth.

17. A client has just given birth at 42 weeks’ gestation. When assessing the neonate, which physical finding is expected? a. A sleepy, lethargic baby b. Lanugo covering the baby

c. Desquamation of the epidermis d. Vernix caseosa covering the body

18. The small-for-gestation neonate is at increased risk during the transitional period for which complication? a. b. c. d.

Anemia probably due to chronic fetal hypoxia Hyperthermia due to decreased glycogen stores Hyperglycemia due to decreased glycogen stores Polythermia probably due to chronic fetal hypoxia

19. Which finding might be seen in a neonate suspected of having an infection? a. Flushed cheeks

c. Decreased temperature

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b. Increased temperature

d. Increased activity level

20. Which symptom would indicate the neonate was adapting appropriately to extrauterine life without difficulty? a. Nasal flaring b. Light audible grunting

c. Respiratory rate 40 to 60 breaths/minute d. Respiratory rate 60 to 80 breaths/minute

21. After reviewing the client’s maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? a. Hypoglycemia b. Jitteriness

c. Respiratory depression d. Tachycardia

22. Which intervention is helpful for the neonate experiencing drug withdrawal? a. b. c. d.

Place the isolette in a quiet area of the nursery Withhold all medication to improve the liver’s metabolization of drugs Dress the neonate in loose clothing so he won’t feel restricted Place the isolette near the nurses station for frequent contact with health care

23. Neonates of mothers with diabetes are at risk for which complication following birth? a. Atelectasis b. Microcephaly

c. Pneumothorax d. Macrosomia

24. Neonates are given which medication to prevent hemorrhagic disease of the neonate? a. Vitamin K b. Heparin

c. Iron d. Warfarin

25. During the transition period, a neonate can lose heat in many different ways. A neonate who isn’t completely dried immediately after birth or a bath loses heat through which of the following methods? a. Conduction b. Convection

c. Evaporation d. Radiation

26. By keeping the nursery temperature warm and wrapping the neonate in blankets, the nurse is preventing which type of heat loss? a. Conduction b. Convection

c. Evaporation d. Radiation

27. Which statement is the best explanation for physiologic hyperbilirubinemia? a. b. c. d.

The neonate usually also has a medical problem In term neonates, it usually appears after 24 hours It’s caused by elevated conjugated bilirubin levels It’s usually progressive from the neonate’s feet to his head.

28. A neonatal has been diagnosed with caput succedaneum. Which statement is correct about caput succedaneum? a. b. c. d.

It usually resolves in 3 to 6 weeks It doesn’t cross the cranial suture line It’s a collection of blood between the skull and periosteum It involves swelling of the tissue over the presenting part of the fetal head.

29. The nurse is teaching a postpartum client about the normal stooling pattern of a neonate. Which color and consistency best describes the typical appearance of meconium? a. Soft, pale yellow

c. Sticky green, black

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b. Hard, pale brown

d. Loose, golden yellow

30. A 3-day-old neonate needs phototherapy for hyperbilirubinemia. Nursery care of a neonate receiving phototherapy would include which nursing intervention? a. b. c. d.

Tube feedings Feeding the neonate under phototherapy lights Mask over the eyes to prevent retinal damage Temperature monitored every 6 hours during phototherapy

31. Which of the following neonates would be most likely to develop hyperbilirubinemia? a. b. c. d.

Blacks Neonate of Rh-positive mother Neonate with ABO incompatibility Neonate with Apgar scores 9 and 10 at 1 and 5 minutes

32. Gram-positive cocci are responsible for causing 15% to 25% of the major neonatal infections. Which is an example of a gram-positive bacteria? a. Escherichia coli b. Group B streptococci

c. Klebsiella species d. Pseudomonas aeruginosa

33. The most common neonatal sepsis and meningitis infection seen within 24 hours after birth are caused by which organism? a. Candida albicans b. Chlamydia trachomatis

c. Escherichia coli d. Group B beta-hemolytic streptococci

34. The nurse understands that erythromycin ointment is applied to a neonate’s eyes immediately after birth for what purpose? a. b. c. d.

To eliminate the incidence of viral infections To prevent Chlamydia infections To prevent syphilis infection of the eyes To reduce the incidence of group B streptococcal conjunctivitis

35. When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact? a. Gaze aversion b. Hiccups

c. Quite alert state d. Yawning

36. When teaching umbilical cord care to a new mother, the nurse would include which information? a. b. c. d.

Apply peroxide to the cord with each diaper change Cover the cord with petroleum jelly after bathing Keep the cord dry and open to air Was the cord with soap and water each day during a tub bath

37. When caring for an infant of a mother with diabetes, which physiological finding is most indicative of a hypoglycemic episode? a. Hyperalert state b. Jitteriness

c. Positive Babinski reflex d. Serum glucose level of 60 mg/dl

38. A mother of a term neonate asks what the thick, white, cheesy coating is on his skin. Which correctly describes this finding?

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a. Lanugo b. Milia

c. Nevus flammeus d. Vernix

39. Which drug is routinely given to the neonate within 1 hour of birth? a. b. c. d.

Erythromycin ophthalmic ointment Gentamycin Nystatin Vitamin A

40. Which condition or treatment best ensures lung maturity in a neonate? a. b. c. d.

Meconium in the amniotic fluid Glucocorticoid treatment just before delivery Lecithin to sphingomyelin ration more than 2:1 Absence of phosphatidylglycerol in amniotic fluid

41. Which assessment finding would be the most unlikely risk factor for respiratory distress syndrome (RDS)? a. Second born of twins b. Neonate born at 34 weeks

c. Neonate of a diabetic mother d. Chronic maternal hypertension

42. A nurse is performing an assessment on a neonate. Which of the following findings is considered common in the healthy neonate? a. Simian crease b. Conjunctival hemorrhages

c. Cystic hygroma d. Bulging fontanelle

43. When performing nursing care for a neonate after a birth, which intervention has the highest nursing priority? a. Obtain a Dextrostix b. Give the initial bath

c. Give the vitamin K injection d. Cover the neonate’s head with a cap

44. When assessing a neonate’s skin, the nurse observes small white papules surrounded by erythematous dermatitis. This finding is characteristic of which condition? a. Cutis marmorata b. Epstein’s pearls

c. Erythema toxicum d. Mongolian spots

45. Which nursing consideration is most important when giving a neonate his initial bath? a. Give a tub bath b. Use water and mild soap

c. Give it right after delivery d. Use hexachlorophene soap

46. The Centers for Disease Control and Prevention (CDC) recommends the hepatitis B vaccine be administered to which neonates? a. b. c. d.

All neonates Exposed neonates only Neonates showing symptoms Neonates of mothers with human immunodeficiency virus

47. A male neonate has just been circumcised. Which nursing intervention is part of the initial care of a circumcised neonate? a. Apply alcohol to the site b. Change the diaper as needed

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c. Keep the neonate in the supine position d. Apply petroleum gauze to the site for 24 hours 48. When a performing an assessment on a neonate, which assessment finding is most suggestive of hypothermia? a. Bradycardia b. Hyperglycemia

c. Metabolic alkalosis d. Shivering

49. Which nursing intervention helps prevent evaporative heat loss in the neonate immediately after birth? a. b. c. d.

Administering warm oxygen Controlling the drafts in the room Immediately drying the neonate Placing the neonate on a warm, dry towel

50. Which assessment finding in a neonate would indicate a metabolic response to cold stress? a. Arrhythmias b. Hypoglycemia

c. Increase in liver function d. Increase in blood pressure

51. Which would be the highest priority in regulating the temperature of a neonate? a. b. c. d.

Supply extra heat sources to the neonate Keep the ambient room temperature less than 100°F (37.8°C) Minimize the energy needed for the neonate to produce heat Block radiant, convective, conductive and evaporative losses

52. When maintaining thermoregulation, which neonatal characteristics negatively affect the establishment of a thermal neutral zone? a. b. c. d.

Flexed posture Blood vessels that aren’t close to the skin Decreased subcutaneous fat and thin epidermis Increased subcutaneous fat and thick epidermis

53. Which clinical finding is most suggestive of physiologic hyperbilirubinemia in a neonate? a. b. c. d.

Clinical jaundice before 36 hours of age Clinical jaundice lasting beyond 14 days Bilirubin levels of 12 mg/dl by 3 days of life Serum bilirubin level increasing by more than 5 mg/dl/day

54. What’s the desired effect of Phenobarbital used in neonates with hyperbilirubinemia? a. b. c. d.

To sedate the neonate during treatment To decrease the conjugation of bilirubin To increase the concentration of ligandin To convert unconjugated bilirubin into water-soluble bilirubin

55. A neonate undergoing phototherapy treatment needs to the monitored for which adverse effect? a. Hyperglycemia b. Increased insensible water loss

c. Severe decrease in platelet count d. Increased GI transit time

56. Which assessment finding might be seen in a neonate suspected of having breast-milk jaundice? a. b. c. d.

History of being a poor feeder Decreased bilirubin level around day 3 of life Clinical jaundice evident after 24 hours Interruption of breast-feeding, resulting in decreased bilirubin levels between 24 and 72 hours

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57. Which sign is the earliest indication of respiratory distress syndrome in a neonate? a. b. c. d.

Bilateral crackles Pale gray color Tachypnea more than 60 breaths/minute Poor capillary filling time (3 to 4 seconds)

58. Which of the following disorders is a non respiratory cause of respiratory distress? a. Choanal atresia b. Meconium aspiration

c. Pulmonary hemorrhage d. Retained lung fluid syndrome

59. A neonate is admitted to the neonatal intensive care unit with persistent pulmonary hypertension. Which pulmonary vasodilator is the drug of choice for this disorder? a. Dobutamine (Dobutrex) b. Isoproterenol (Isuprel)

c. Prostaglandin E2 d. Tolazoline (Priscoline)

60. Which neonatal respiratory disorder is usually mild and runs a self-limited course? a. b. c. d.

Pneumonia Meconium aspiration syndrome Transient tachypnea of neonate Persistent pulmonary hypertension

61. Which procedure should be avoided in a neonate born with diaphragmatic hernia? a. Chest X-ray b. Mask ventilation

c. Placement of orogastric tube d. Immediate endotracheal intubation

62. Which immunoglobulin (Ig) provides immunity against bacterial and viral pathogens through passive immunity? a. IgA c. IgG b. IgE d. IgM 63. Which cranio-facial change is most characteristic in a neonate with fetal alcohol syndrome (FAS)? a. Macrocephaly b. Microophthalmia

c. Wide palbebral fissures d. Well-developed philtrum

64. A 36 week neonate born weighing 1,800 g has microcephaly and microophthalmia. Based on these findings, which risk factor might be expected in the maternal history? a. Use of alcohol b. Use of marijuana

c. Gestational diabetes d. Positive group B streptococci

65. Which neonatal behavior is most commonly associated with fetal alcohol syndrome (FAS)? a. Hypoactivity b. High birth weight

c. Poor wake and sleep patterns d. High threshold of stimulation

66. Which GI disorder is most suggestive of cystic fibrosis? a. Duodenal obstruction b. Jejunal atresia

c. Malrotation d. Meconium ileus

67. Which orthopedic disorder of the neonate results in multiple fractures and skeletal deformities? a. Klippel-Feil syndrome

c. Congenital hip dislocation

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b. Osteogenesis imperfecta

d. Arthrogryposis multiplex congenital

68. A neonate has an imperforate anus, tracheoesophageal fistula, and a single umbilical artery. A nurse suspects that the neonate might have which congenital disorder? a. b. c. d.

Beckwith-Wiedemann syndrome Trisomy 13 Turner’s syndrome VATER association

69. An initial assessment of a female neonate shows pink-streaked vaginal discharge. Which factor is the probable cause? a. Cystitis b. Birth trauma

c. Neonatal candidiasis d. Withdrawal of maternal hormones

70. When assessing for congenital anomalies in a neonate, which symptom is seen first with tracheoesophageal atresia? a. Torticollis b. Nasal stuffiness

c. Oligohydramnios d. Excessive oral secretions

71. The neonate is vulnerable to heat loss because of which anatomic characteristic? a. b. c. d.

Immature liver Immature brain Large skin surface area to body weight ration More brown fat (adipose tissue) than an adult

72. Maintaining thermoregulation in the neonate is an important nursing intervention because cold stress in the neonate can lead to which condition? a. Anemia b. Hyperglycemia

c. Metabolic alkalosis d. Increased oxygen consumption

73. Which initial nursing intervention best addresses the needs of a term neonate with adequate respiratory and heart rates but who has central cyanosis? a. b. c. d.

Provide tactile stimulation Give supplemental free-flow oxygen Assist ventilation with bag and mask Intubate and suction the lower airway

74. A woman delivers a 3,250 g neonate at 42 week’s gestation. Which physical finding is expected during an examination of this neonate? a. Abundant lanugo b. Absence of sole creases

c. Breast bud of 1 to 2 mm in diameter d. Leathery, cracked and wrinkled skin

75. Which performing an initial assessment on a term neonate with an Asian mother, a bluish marking is observed across the neonate’s lower back. What is the significance of this finding? a. b. c. d.

It’s probably a sign of birth trauma It’s probably a telangiectatic hemangioma It’s probably a typical marking in dark-skinned races It probably indicates that hyperbilirubinemia may follow

76. A nurse in the neonate nursery is serving as preceptor for a student nurse. The student asks the nurse why the neonate’s head is cone-shaped. Which response is accurate? a. “It results from caput succendum. The difficult labor caused bruising and swelling of the neonate’s head”

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b. “It results from molding. Overriding of the cranial sutures allows the neonate’s head to pass though the birth canal” c. “It results from cephalohematoma. Some blood has collected between the skull bone and periosteum” d. “It results from hydrocephalus. Either too much cerebrospinal fluid is being formed or too little is being absorbed” 77. A neonate receiving formula feedings is discharged from the neonate nursery. Twenty-four hours later, the mother calls the hospital, stating that the neonate is vomiting most of this feedings. Which statement by the mother indicates that she needs further discharge instructions? a. b. c. d.

“Every time I feed him, he spits up a about a teaspoonful of formula onto his bib” “I’m using prepared formula, and he takes ½ oz to 1 oz every 3 to 4 hours” “I feed him every time he cries. Sometimes he eats 4 oz at a time every couple of hours” “I burp him after each ½ oz of formula”

78. A healthy term neonate born by cesarean delivery was admitted to the transitional nursery 30 minutes ago and placed under a radiant warmer. The neonate has an axillary temperature of 99.5° F (37.5° C), a respiratory rate of 80 breaths/minute, and a heelstick glucose value of 60 mg/dl. Which action should the nurse take? a. b. c. d.

Wrap the neonate warmly and place her in an open crib. Administer an oral glucose feeding of dextrose 10% in water Increase the temperature setting on the radiant warmer Obtain an order for I.V. fluid administration

79. A home health nurse assesses a neonate who is 48 hours old and was discharged from the hospital 24 hours ago. Which assessment finding indicates a potential problem? a. b. c. d.

The neonate cries but no tears appear Small papules appear all over the neonate’s skin The neonate doesn’t turn his head in the direction that his cheek is stroked The neonate produces a greenish, tarry stool

80. A mother tells the nurse that her 22-month-old child says, “No” to everything. When the toddler scolded becomes angry and starts crying loudly but then immediately wants to be held. What is the best interpretation of this behavior? a. b. c. d.

The toddler isn’t effectively coping with the stress The toddler’s need for affection isn’t being met This is normal behavior for a 2 year old child This behavior suggests the need for counseling

81. The mother of a 12-month-old infant expresses concern about the effect of frequent thumb sucking on her child’s teeth. After the nurse teaches her about this matter, which response by the mother indicates that the teaching has been effective? a. “Thumb sucking should be discouraged at 12 months” b. “I’ll give the baby a pacifier instead” c. “Sucking is important to the baby” d. “I’ll wrap the thumb in a bandage” 82. An adolescent client has just had surgery and has a dressing on the abdomen. Which of the following questions would the nurse expect the client to ask initially? a. “Did the surgery go okay?” b. “Will I have a large scar?”

c. “What complications can I expect?” d. “When can I return to school?”

83. For an 8-month-old infant, the nurse should plan to provide which of the following toys to promote the child’s cognitive development? a. Finger-paints b. Jack-in-the-box

c. Small rubber ball d. Play gym strung across the crib

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84. Before a routine checkup in the pediatrician’s office, an 8-month-old infant is sitting contentedly on his mother’s lap, chewing on a toy. When preparing to examine this infant, which of the following actions should the nurse do first? a. b. c. d.

Measure the head circumference Auscultate heart and lung sounds Elicit papillary reaction Obtain body weight

85. Which comment by a 7-year-old boy to his friend best typifies his developmental stage? a. b. c. d.

“Girl are so yucky” “My mommy and I are always together” “I can’t decide if I like Amy or Heather better” “I can turn into Batman when I come out of my closet”

86. The nurse should expect a 3-year-old child to be able to perform which of the following actions? a. Ride a tricycle b. Tie shoelaces

c. Roller skate d. Jump rope

87. A 6-month-old infant is admitted to the pediatric unit for a 2-week course of antibiotics. His parents can visit only on weekends. Which action indicates that the nurse understands the infant’s emotional needs? a. b. c. d.

The nurse places the infant in a four-bed unit The nurse places the infant in a room away from other children The nurse assigns the infant to a different nurse each day The nurse assign the infant to the same nurse as often as possible

88. A term neonate weighs 7 ½ pounds at birth. When he’s 1 year old, approximately how much should he weight? a. 16 lb (7.3 kg) b. 22 lb (10 kg)

c. 28 lb (12.7 kg) d. 32 lb (14.5 kg)

89. Which behavior by a preschool child indicates that the child is in the proper stage of growth and development? a. b. c. d.

He cries in protest when his mother leaves He asks for a bandage after having blood drawn He’s upset about having a scar after surgery He wants to know why his friends don’t visit

90. The nurse observes parents playing with their 10-month-old daughter. Which behavior indicates that the infant is developing object permanence? a. b. c. d.

She looks for the toy that her parents hid under the blanket She returns the play blocks to the same spot on the table She recognizes that a ball of clay is the same object even when it’s flattened out. She bangs two cubes in her hands and throws them to the floor

91. When completing the morning postpartum assessment the nurse notices the clients perineal pad is completely saturated with lochia rubra. Which of the following actions should be the nurse’s first response? a. b. c. d.

vigorously massage the fundus immediately call the primary care provider have the charge nurse review the assessment Ask the client when she last changed her perineal pad.

92. Which of the following factors might result in a decreased supply of breast milk in a post partum mother? a. supplemental feedings with formula b. maternal diet high in vitamin C

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c. an alcoholic drink d. frequent feedings 93. Which of the following interventions would be helpful to a breast-feeding mother who is experiencing engorged breasts? a. b. c. d.

applying ice applying a breast hinder teaching how to express her breasts in a warm shower administering Bromocroptine (parlodel)

94 Which of the following assessments should be performed routinely in the postpartum client? a. Antibody screen b. Babinski’s reflex

c. Homan’s reflex d. Patellar reflex

95. Which of the following reasons explains why Kegel exercises are advantageous to woman after they deliver a child? a. b. c. d.

They assist with lochia removal They promote the return of normal bowel function They promote blood flow, allowing for healing and strengthening the musculature. They assist the woman in burning calories for rapid postpartum weight loss.

96. When the nurse is performing a psychosocial assessment on a postpartum client, the nurse is aware that what percentage of women experience “postpartum blues”? a. 20 to 50% b. 50 to 80%

c. 30 to 45% d. 95 to 100%

97. Which of the following practices would the nurse recommend to a client who has a cesarean delivery? a. b. c. d.

frequent douching after she’s discharged coughing and deep-breathing exercises sit-ups at 2 weeks postoperatively side-rolling exercises

98 Which of the following reasons explains why client might express disappointment after having a cesarean delivery instead of a vaginal delivery? a. b. c. d.

cesarean deliveries cost more depression is more common after a cesarean delivery the client is usually more fatigued after cesarean delivery the client may feel a loss for not having experienced a “normal” birth

99. Which of the following findings is normal during the postpartum period of a client who has experienced a vaginal birth? a. b. c. d.

redness or swelling in the calves a palpable uterine fundus beyond 6 weeks postpartum vaginal dryness after the lochia flow has ended dark red lochia for approximately 6 weeks after the birth

100. On completing a fundal assessment, the nurse notes the fundus is situated on the client’s left abdomen. Which of the the following actions is appropriate? a. Ask the client to empty her bladder b. Straight catheterize the client immediately c. Call the client’s primary health care provider for direction d. Straight catheterize the client for half of her urine volume. 101. The nurse should inform the client with mastitis that the disorder is most commonly caused by which of the following organisms?

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a. b. c. d.

E. coli group A beta-hemolytic streptococci (GBS) Staphylococcus aureus Streptococcus pyogenes

102. A client had a spontaneous vaginal delivery after 18 hours of labor. Her excessive vaginal bleeding has now become a postpartum hemorrhage. Immediately nursing care of this should include which of the following preventions? a. b. c. d.

Avoiding massaging the uterus Monitoring vital signs every hour placing the client in Trendelenburg’s position elevating the head of the bed to increase blood flow

103. Which of the following complications should the nurse assess for in a client with type I Diabetes Mellitus whose delivery was complicated by polyhydramios and macrosomia? a. b. c. d.

Postpartum mastitis Increased insulin needs Postpartum hemorrhage pregnancy-induced hypertension (PIH)

104. Infections in mothers with diabetes tend to the more severe and can quickly lead to which of the following complications? a. Anemia b. Ketoacidosis

c. Respiratory acidosis d. Respiratory alkalosis

105. Which of the following statements regarding mastitis is correct? a. b. c. d.

The most common pathogen is Group A beta-hemolytic streptococci. A breast abscess is a common complications of mastitis Mastitis usually develops in both breasts of a breast feeding woman. Symptoms include fever, chills, malaise, and localized breast tenderness.

106. Which of he following measurements best describes delayed postpartum hemorrhage? a. b. c. d.

Blood loss exceed of 300 ml, occurring 24 hours to 6 weeks after delivery Blood loss exceed to 500 ml, occurring 24 hours o 6 weeks after delivery Blood loss exceed to 800 ml, occurring 24 hours o 6 weeks after delivery Blood loss exceed to 1000 ml, occurring 24 hours o 6 weeks after delivery

107. Which of the following assessments of the mother should made in the immediate post partum period (first 2 hours) a. Blood glucose level b. Electrocardiogram (ECG)

c. Height of fundus d. Stool test for occult blood

108. Is performing an assessment of a postpartum client 2 hours after delivery, the nurse notices heavy bleeding with large clots. Which of the following response is mops appropriate initially? a. b. c. d.

Massaging the fundus firmly Performing bimanual compressions Administering ergonivine Notifying he primary health care provider

109. The nurse is about to give a class B diabetic (age of onset greater than 20 years duration less than 10 years) her insulin before breakfast on her first day postpartum. Which of the following answers best describes insulin requirements immediately postpartum? a. Lower than during her pregnancy

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b. higher than during her pregnancy c. Lower than before she became pregnant d. higher than before she became pregnant 110. Which of the following findings would be expected when assessing the postpartum client? a. b. c. d.

fundus 1 cm above the umbilicus 1 hour postpartum fundus 1 cm above the umbilicus on post postpartum day 3 fundus palpable in the abdomen at 2 weeks postpartum fundus slightly to right: 2 cm above umbilicus on postpartum day 2

111. A client is complaining of painful contractions, or afterpains, on postpartum day 2. Which of the following conditions could increase the severity of afterpains? a. Bottle-feeding b. Diabetes

c. Multiple gestations d. Primiparity

112. When giving a postpartum client self-care instructions, the nurse instructs her to report heavy or excessive bleeding. Which of the following would indicate heavy bleeding? a. Saturating a pad in 15 minutes b. Saturating a pad in 1 hour

c. Saturating a pad in 4 to 6 hours d. Saturating a pad in 8 hours

113. On which of the following postpartum days the client except lochia serosa (old blood, serum, leukocytes and tissue debris)? a. Days 3 and 4 postpartum b. Days 3 to 10 postpartum

c. Days 10 to 14 postpartum d. Days 14 to 42 postpartum

114. A client and her neonate have a blood incompatibility, and the nurse has had a positive direct Comb’s test. Which of the following nursing interventions is appropriate? a. b. c. d.

Because the woman has been sensitized give Rh0 immune globulin (RhoGAM) Because the woman hasn’t been sensitized, give RhoGAM Because the woman has been sensitized, don’t give RhoGAM Because the woman hasn’t been sensitized, don’t give RhoGAM

115. Which of the following definitions best describes a puerperal infections? a. b. c. d.

An infections in the uterus of a postpartum woman An infection in the bladder of a postpartum woman An infection in the perineum of a postpartum woman An infection in the genital tract of a postpartum woman

116. Which of the following behaviors characterizes the postpartum mother in the taking in phase? a. b. c. d.

Passive and dependent Striving for independence and autonomy Curious and interested in care of the baby Exhibiting maximum readiness for new learning

117. Which of the following verbalizations should be cause to the nurse treating a postpartum client within a few days of delivery? a. b. c. d.

The client is nervous about taking the baby home The client feels empty since she delivered the baby The client would like to watch the nurse give the baby her first bath The client would like the nurse to take her baby to the nursery so she can sleep.

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118. Which of the following complications may be indicated by continous seepage of blood from the vagina of a postpartum client, when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus? a. Retained placental fragments b. Urinary tract infection (UTI)

c. Cervical laceration d. Uterine atony

119. Discharge teaching of the postpartum client who is receiving anticoagulant therapy for a deep venous thrombophlebitis includes which of the following instructions? a. b. c. d.

Avoid iron replacement therapy Avoid over the counter salicylates Wear girdles and knee high stockings when possible Shortness of breath is a common adverse effect of the medication

120. TORCH is an acronym for maternal infections associated with an increase in congenital malformations and disorders. Which of the following disorders does the H represent? a. Hemophilia b. Hepatitis B virus

c. Herpes simplex virus d. Human immunodeficiency virus

121. Which of the following signs of grieving is dysfunctional in a client 3 days after a prenatal loss? a. Lack of appetite b. Denial of the death

c. Blaming herself d. Frequent crying spells

122. Which of the following conditions in a postpartum client may cause fever not caused by infection? a. Breast engorgement b. Endometritis

c. Mastitis d. Uterine involution

123. An RH positive client delivers a 6 lb., 10 oz neonate vaginally after 17 hours of labor. Which of the following conditions puts this client at risk for infection? a. Length of labor b. Maternal Rh status

c. Method of delivery d. Size of the baby

124. Which of the management strategies should be implemented regarding breast feeding after cesarean delivery? a. b. c. d.

Delay breast feeding until 24 hours after delivery Breast feed frequently during the day and every 4 to 6 hours at night Use the cradle hold position to avoid incisional discomfort Use the football hold position to avoid incisional discomfort

125. What type of milk is present in the breasts 7 to 10 days postpartum? a. Colostrums b. Hind milk

c. Mature milk d. Transitional milk

126. Which of the following recommendations should be given to a client with mastitis who is concerned about breast feeding her neonate? a. b. c. d.

She should stop breast feeding until completing the antibiotic She should supplement feeding with formula until the infection resolve She shouldn’t use analgesics because they aren’t compatible with breast feeding She should continue to breast feed; mastitis won’t infect the infant

127. Which of the following terms is used to describe maladaption to the stress and conflicts of the postpartum period, characterized by disabling feelings of inadequacy and an inability to cope? a. Postpartum blues

c. Postpartum neurosis

14

b. Postpartum depression

d. Postpartum psychosis

128. In which of the following time periods is it most likely for a client who has delivered twins to experience late postpartum hemorrhage? a. b. c. d.

24 to 48 hours after delivery 24 hours to 6 weeks after delivery 6 weeks to 3 months after delivery 6 weeks to 6 months after delivery

129. Which of the following complications is most likely responsible for a delayed postpartum hemorrhage? a. Cervical lacerations b. Clotting deficiency

c. Perineal laceration d. Uterine subinvolution

130. A client needs to void 3 hours after a vaginal delivery. Which of the following risk factors necessitates assisting her out of bed? a. Chest pain b. Breast engorgement

c. Orthostatic hypotension d. Separation of episiotomy incision

131. Before giving a postpartum client the rubella vaccine, which of the following facts should the nurse include in client teaching? a. b. c. d.

The vaccine is safe in clients with egg allergies Breast feeding isn’t compatible with the vaccine Transient arthalgia and rash are uncommon adverse effects The client should avoid getting pregnant for 3 months after the vaccination because the vaccine has teratogenic effects

132. Which of the following medications is most commonly used to treat preeclampsia during the prenatal and postpartum periods? a. Diazepam (Valium) b. Hydralazine (Apresoline)

c. Magnesium sulfate d. Nitedipine (procardia)

133. Which of the following complications is associated with magnesium sulfate therapy? a. Hypotension b. Postpartum depression

c. Postpartum hemorrhage d. Uterine infection

134. Which of the following changes best describes the insulin needs of a client with type 1 diabetes mellitus who has just delivered an infant vaginally without complications? a. b. c. d.

Increase Degrease Remain the same as before pregnancy Remain the same as during pregnancy

135. Which of the following response is most appropriate for a mother with diabetes who wants to breast feed but is concerned about the effects of breast feeding on her health? a. b. c. d.

Mothers with diabetes who breast feed have a hard time controlling their insulin needs Mothers with diabetes shouldn’t breast feed because of potential complications Mothers with diabetes shouldn’t breast feed: insulin requirements are doubled Mothers with diabetes may breast feed insulin requirements may decrease from breast feeding

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136. A multiparous client vaginally delivered an infant at 38 weeks without complications. She has three other children at home, two of whom were full term and one a preterm. Which of the following classifications would accurately describe this client? a. gravida 3 para 4104 b. gravida 3 para 3113

c. Gravida 4 para 2103 d. Gravida 4 para 3104

137. Which of the following factors puts a multiparous client on her first postpartum day at risk for developing hemorrhage? a. Hemoglobin level of 12g/dl b. Uterine atony

c. Trombophlebitis d. Moderate amount of lochia rubra

138. On the first postpartum night, a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases? a. Depression phase b. Letting go phase

c. Taking hold phase d. Taking in place

139. Four clients each gave birth 12 hours ago. Which one would most likely suffer complications after birth? a. b. c. d.

Gravida 2 para 2002, cesarean birth, incisional site intact, hemoglobin level 9.8 g/dl Gravida 2 para 1011, cesarean birth, incisional site intact, pulse 84 beats per minute Gravida 1 para 1001, vaginal delivery, midline episiotomy, temperature 99.8 F (37.7 C) Gravida 1 para 1001, vaginal delivery, ruptured membranes 10 hours before delivery

140. Which of the following groups of symptoms is most commonly associated with preeclampsia? a. b. c. d.

Edema, hyporeflexia, and glycosuria Hypotension, hyporeflexia, and protenuria Hypertension, hyperreflexia and protienuria Hyperglycemia, hyperreflexia and glycosuria

141. A client has delivered twins. Which of the following interventions would be most important for the nurse to perform? a. b. c. d.

Assess fundal tone and lochia flow Apply a clod pack to the perineal area Administer analgesics as ordered Encourage voiding by offering the bedpan

142. Which of the following physiological response is considered normal in the early postpartum period? a. b. c. d.

Urinary urgency and dysuria Rapid diuresis Decrease in blood pressure Increased motility of the GI system

143. During the third postpartum day, which of the following observations about the client would the nurse be most likely to make? a. b. c. d.

The client appears interested in learning more about neonatal care The client talks a lot about her birth experience The client sleeps whenever the neonate isn’t present The client request helps in choosing a name for the neonate

144. Which of the following circumstances is most likely to cause uterine atony and lead to postpartum hemorrhage? a. Hypertension b. Cervical and vaginal tears

c. Urine retention d. Endometritis

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145. Which type of lochia should the nurse except to find a client 2 days postpartum? a. Foul smelling b. lochia serosa

c. Lochia alba d. Lochia rubra

146. Which percentage of postpartum clients experiences “postpartum blues”? a. 20% to 25% b. 50% to 80%

c. 30% to 45% d. 100%

147. When performing a comprehensive fundal check during a postpartum assessment, the nurse evaluates which fundal state? a. b. c. d.

fundal consistency, location and height fundal consistency and height fundal location and potential fundal distention fundal location and height

148. During the postpartum period, which situation does a firm fundus indicate? a. b. c. d.

A firm tumor at the top of the uterus Contraction of the uterus Continuing labor contractions Bladder distention

149. To encourage uterine involution in a primigravida client on the first postpartum day, the nurse should instruct her assume which position? a. Prone b. Knee to chest

c. Supine d. Side lying

150. A postpartum client is receiving anticoagulant therapy for deep vein thromboplebitis. Discharge teaching should include which instruction? a. b. c. d.

Avoid iron replacement therapy Wear a girdle and knee high stockings whenever possible Avoid over the counter salicylates be aware that shortness of breath is a common adverse effect of anticoagulants

151. For a breast feeding client on the fourth postpartum day, which breast examination findings are normal? a. b. c. d.

Symmetrical breast shape and size Engorged breasts with inflamed, radiating areas that are sore to the touch Slightly tender, crackled nipples, slightly firm, nontender breasts, transitional milk Tender intact nipples; firm, nontender breasts; transitional milk

152. How many additional calories should a breast feeding primiparous client consume to ensure high quality breast milk? a. 500 calories/day b. 300 calories/day

c. 400 calories/day d. 1,000 calories/day

153. The nurse is teaching a breast feeding primiparous client how to prevent sore nipple. Which client statement indicates the need for further instructions? a. b. c. d.

“I should breast feed for only 3 to 4 minutes at a time until my flow is established “I should position the baby properly during feedings “I should pull the baby gently away from my nipple after the feedings” “I should prevent the baby from feeding after my breast has been emptied”

154. Which of the following statements best describes lochia rubra?

17

a. b. c. d.

It contains a mixture of mucus, tissue debris, and blood It contains placental fragments and blood It contains mucus, placental fragments and blood It contains tissue debris and blood

155. On the second postpartum day a client complains that she’s urinating more than when she was pregnant. Which is the primary cause of increased urinary output after delivery? a. b. c. d.

Postpartum diuresis Postpartum renal malfunctioning increased postpartum fluid intake Postpartum breast feeding

156. Lochia Alba follows lochia serosa and usually lasts from the first to third week postpartum. Which of the following statements best describes lochia Alba? a. b. c. d.

Its creamy white to brown and may have a stale odor. Its creamy to brown, contains decidual cells and may have a stale odor its brown to red, contains tissue fragments, and may have an odor its brown to red and contains decidual vells and leukocytes

157. What’s the most common major complications of retained placental fragments? a. Puerperal infection b. Postpartum depression

c. Postpartum hemorrhage d. Postpartum subinvolution

158. Postpartum involution refers to which of the following descriptions? a. b. c. d.

Normal postpartum psychiatric developmental stages of the mother Normal postpartum coping stages of the mother Normal postpartum uterine contractions that force the uterus to shrink Abnormal postpartum uterine activity

18

BULLETS IN MCN A                       

     

Studies have proven that breast milk provides preterm neonates with better protection from infection such as necrotizing enterocolitis because of the antibodies contained in breast milk. Surfactant works by reducing surface tension in the lung. Surfactant allows the lung to remain slightly expanded, decreasing the amount of work required for inspiration. Acrocyanosis, or bluish discoloration of the hands and feet in the neonate (also called peripheral cyanosis), is a normal finding and shouldn’t last more than 24 hours after birth. Supine positioning is recommended to reduce the risk of SIDS in infancy. Neonates of mothers with diabetes are at risk for hypoglycemia due to increased insulin levels. During gestation, an increased amount of glucose is transferred to the fetus through the placenta. The neonate’s liver can’t initially adjust to the changing glucose levels after birth. Bronchopulmonary dysplasia commonly results from the high pressures that must sometimes be used to maintain adequate oxygenation. Soft, smooth skin is a sign of adequate hydration. Positive Babinski’s sign is present in infants until approximately age 1. A positive Babinski’s reflex is normal in neonates but abnormal in adults. At approximately 23 to 24 week’s gestation, the lungs are developed enough to sometimes maintain extrauterine life. The lungs are the most immature system during the gestational period. Vitamin K deficient in the neonate is needed to activate clotting factors II, VII, IX, and X. In the event of trauma, the neonate would be at risk for excessive bleeding. Hepatitis B immune globulin should be given as soon as possible after birth but within 12 hours. Neonates should also receive hepatitis B vaccine at regularly scheduled intervals. To minimize the risk of aspiration of meconium after delivery, the neonate’s mouth then nose should be suctioned after delivery of the head. Eye prophylaxis is administered to the neonate immediately or soon after birth to prevent ophthalmia neonatorum. The neonate with an ABO blood incompatibility with its mother will have jaundice within the first 24 hours of life. Prematurity is the single most important risk factor for developing RDS. The yellow-white exudates is part of the granulation process and a normal finding for a healing penis after circumcision. Therefore notifying the physician isn’t necessary. Postdate fetuses lose the vernix caseosa, and the epidermis may become desquamated. The small-for-gestation neonate is at risk for developing polycythemia during the transitional period in an attempt to decrease hypoxia. Temperature instability, especially when it results in a low temperature in the neonate, may be a sign of infection. The neonate’s color often changes with an infection process but generally becomes ashen or mottled. A respiratory rate 40 to 60 breaths/minute is normal for a neonate during the transitional period. Magnesium sulfate crosses the placenta and adverse neonatal effects are respiratory depression, hypotonia, and bradycardia. Neonates experiencing drug withdrawal often have sleep disturbance. The neonate should be moved to a quiet area of the nursery to minimize environmental stimuli. Neonates of mothers with diabetes are at increased risk for macrosomia (excessive fetal growth) as a result of the combination of the increased supply of maternal glucose and an increase in fetal insulin. Along with macrosomia, neonates of diabetic mothers are at risk for respiratory distress syndrome, hypoglycemia, hypocalcemia, hyperbilirubinemia and congenital anomalies. Neonates have coagulation deficiencies because of a lack of vitamin K in the intestines, which helps the liver synthesize clotting factors II, VII, IX, and X. Evaporation is the loss of heat that occurs when a liquid is converted to a vapor. In the neonate, heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Convection heat loss is the flow of heat from the body surface to cooler air. Physiologic jaundice in term neonates first appears after 24 hours. Caput succedaneum is the swelling of tissue over the presenting part of the fetal scalp due to sustained pressure. This boggy edematous swelling is present at birth, crosses the suture line, and most commonly occurs in the occipital area. Meconium collects in the GI tract during gestation and is initially sterile. Meconium is greenish black because of occult blood and is viscous.

19

                                   

The neonate’s eyes must be covered with eye patches to prevent damage. The mouth of the neonate doesn’t need to be covered during phototherapy. The mother’s blood type which is different from the neonate’s has an impact on the neonate’s bilirubin level due to the antigen-antibody reaction. Group B streptococci are gram-positive cocci that the neonate is exposed to if these bacteria are colonized in the vaginal tract. Transmission of group B beta-hemolytic streptococci to the fetus results in respiratory distress that can rapidly lead to septic shock. Both Chlamydia and gonorrhea are common cause of neonatal conjunctival infections, and erythromycin effectively treats these infections. When caring for a neonate experiencing drug withdrawal, the nurse needs to be alert for distress signals from the neonate. Stimuli should be introduced one at a time when the neonate is in a quite alert state. Keeping the cord dry and open to air helps reduce infection and hastens drying. Hypoglycemia in a neonate is expressed as jitteriness, lethargy, diaphoresis and a serum glucose level below 40 mg/dl Vernix is a white, cheesy material present on the neonate’s skin at birth. Erythromycin ophthalmic ointment is given for prophylactic treatment of ophthalmic neonatorum. Lecithin and sphingomyelin are phospholipids that help compose surfactant in the lungs; lecithin peaks at 36 weeks, and sphingomyelin concentrations remain stable. Chronic maternal hypertension is an unlikely factor because chronic fetal stress tends to increase lung maturity. Conjunctival hemorrhages are commonly seen in neonates secondary to the cranial pressure applied during the birth process. Covering the neonate’s head with a cap helps prevent cold stress due to excessive evaporative heat loss from a neonate’s wet head. Erythema toxicum has lesions that come and go on the face, trunk and limbs. They’re small white or yellow papules or vesicles with erythematous dermatitis. Use only water and mild soap on a neonate to prevent drying out the skin. The mild bath is given when the neonate’s temperature is stable. The CDC recommends hepatitis B vaccine be given to all neonates, including those born to hepatitis B surface antigen-negative mothers. Petroleum gauze is applied to the site for the first 24 hours to prevent the skin edges from sticking to the diaper. Hypothermic neonates become bradycardic proportional to the degree of core temperature. Immediately drying the neonate decreases evaporative heat loss from his moist body from birth. Hypoglycemia occurs as the consumption of glucose increases with the increase in metabolic rate. Prevention of heat loss is always the first goal in thermoregulation to avoid hypothermia. The second goal is to minimize the energy necessary for neonates to produce heat. Decreased subcutaneous fat and a thin epidermis affect the establishment of a thermal neutral zone. Increased bilirubin levels in the liver usually cause bilirubin levels of 12 mg/dl by the 3 rd day of life. This is from the impaired conjugation and excretion of bilirubin and difficulty clearing bilirubin from plasma. Phenobarbital increases the concentration of ligandin, which transports bilirubin for conjugation. Increased insensible water loss is due to absorbed photon energy from the lights. The exact cause of breast-milk jaundice is unknown. If bilirubin levels don’t decreased after 3 days, human milk is eliminated as a cause. These babies are typically good eaters will good weight gain. Bilirubin levels increase, rather than decrease at 3. Jaundice in the 24 hours of life is characteristic of hemolytic disease. Tachypnea and expiratory grunting occur early in respiratory distress syndrome to help improve oxygenation. Choanal atresia is caused by protrusion of bone or membrane into nasal passages, causing blockage or narrowing. Tolazoline dilates pulmonary arteries and decreases pulmonary vascular resistance. Transient tachypnea has an invariably favorable outcome after several hours to several days. Mask ventilation should be avoided to prevent air from being introduced into the GI tract by his technique. IgG is a major Ig of serum and interstitial fluid that crosses the placenta. Distinctive facial dysmorphology of children with FAS most commonly involves the eyes (microophthalmia). The most common sign of the effects of alcohol on fetal development is retarded grow in weight, length and head circumference. Altered sleep patterns are caused by disturbances in the central nervous system from alcohol exposure in utero.

20

                              

Meconium ileus is a luminal obstruction of the distal small intestine by abnormal meconium seen in neonates with cystic fibrosis. Osteogenesis imperfecta is a connective tissue disorder with the primary defect involving the collagen structure. VATER association clinically presents with three or more defects, including the three mentioned. Withdrawal of maternal estrogen can produce pseudo menstruation Accumulated secretions are copious because the neonate can’t swallow. The neonate has proportionally more surface area through which heat can dissipate. The neonate’s metabolic rate increases as a result of cold stress, which leads to an increased oxygen requirement. Cold stress doesn’t increase erythrocyte destruction. Room air is currently insufficient, seen by the central cyanosis. Tactile stimulation is only needed if the neonate is apneic or gasping. Intubation is only indicated in special circumstances, such as prematurity or a diaphragmatic hernia. Bag and mask ventilation is only indicated if the heart rate is less than 100 beats/minute. Neonatal skin thickens with maturity and is often peeling by postterm. This is Mongolian spot, commonly found over the lumbosacral area in neonates of Black, Asian, Latin American, or Native American origin. Molding refers to overlapping of the cranial sutures, which causes the neonate’s head to appear cone-shaped Feeding the neonate every time he cries results in overfeeding. A neonate’s crying doesn’t always signal hunger, sometimes it means his diaper is wet, he needs to suck or he wants to be held. For the first few days, the neonate’s normal stomach capacity is 15 ml so he should be fed every 3 to 4 hours. Assessment findings indicate that the neonate is in respiratory distress – most likely from transient tachypnea, which is common after cesarean delivery. The normal respiratory rate is 30 to 60 breaths/minute; a neonate with a rate of 80 breaths/minute shouldn’t be fed but should receive I.V. fluids until the respiratory rate returns to normal. A normal healthy neonate turns in the direction that the cheek is stroked. Failure to do so may indicate a neurologic problem which the nurse should report to the physician. Toddlers are confronted with the conflict of achieving autonomy, yet relinquishing the much enjoyed dependence on – and affection of – others. Sucking is the infant’s chief pleasure. However thumb sucking can cause malocclusion if it persists after age 4. Many fetuses begin sucking their fingers in utero and as infants, refuse a pacifier as a substitute. Adolescents are deeply concerned about their body image and how they appear to others. An adolescent wouldn’t ask how the surgery went or what complications to expect, although an adult probably would. According to Piaget’s theory of cognitive development, an 8 month old child will look for an object after it disappears from sight to develop the cognitive skill of object permanence. Heart and lung auscultation shouldn’t distress the infant, so it should be done early in the assessment. During the school-age years, the most important social interactions typically are those with peers. Peer-to-peer interactions lead to the formation of intimate friendships between same sex children. At age 3, gross motor development and refinement in hand-eye coordination enable a child to ride a tricycle. Building a sense of trust is crucial with an infant at this stage of growth and development. Placing him in a 4 bed unit isn’t the best choice because a 6 month old child doesn’t play with other children. A term neonate who weighs 7 ½ pounds at birth should triple his birth weight by age 1 year, therefore he should weigh approximately 22 to 23 pounds. A preschooler typically asks for a bandage after having blood drawn because he as poorly defined body boundaries and believes he will lose all of his blood from the hole the needle has made. Object permanence is exhibited by the infant looking for objects that have been hidden from sight. If the morning assessment is done relatively early, it’s possible that the client hasn’t yet been to the bathroom, in which case her perineal pad may have been in place all night. Routine formula supplementation may interfere with establishing an adequate milk volume because decreased stimulation to the mother’s nipple affects hormonal levels and milk production. Teaching the client how to express her breasts in a warm shower aids with let down reflex and will give temporary relief. Homan’s sign or pain on dorsiflexion of the foot may indicate deep vein thrombosis (DVT). Exercising the pubococcygeal muscle increase blood flow to the area. The increased blood flow brings oxygen and other nutrients to the perineal area to aid in healing. The “postpartum blues” are a transient mood alteration that arise within the first 3 postpartum weeks and are typically self-limiting, occurring in 50 – 80 % of clients.

21

                                     

As for any postoperative client, coughing and deep-breathing exercises sgould be taught to keep the alveoli open and prevent infection. Clients occasionally feel a loss after a cesarean delivery. They may feel they are inadequate because they couldn’t deliver their infant vaginally. Vaginal dryness is a normal finding during the postpartum period due to hormonal changes. A full bladder may displace the uterine fundus to the left or right side of the abdomen. The most common cause of mastitis is S. aureus, transmitted from the baby’s mouth. The client should be placed in Trendelenburg’s position to prevent or control hypovolemic shock. The client is at risk for a postpartum hemorrhage from the overdistention of the uterus because of the extra amniotic fluid and the large baby. Women with diabetes who become pregnant tend to become sicker and develop illnesses quicker than pregnant woman without diabetes. Mastitis is an infection of the breast characterized by flulike symptoms, along with redness and tenderness in the breast. Postpartum hemorrhage involves blood loss in excess of 500 ml. A complete physical assessment should be performed every 15 minutes for the forst 1 to 2 hours postpartum, including assessment of the fundus, lochia, perineum, blood pressure, pulse, and bladder function. Initial management of excessive postpartum bleeding is firm massage of the fundus along with a rapid infusion of oxytocin or lactated Ringer’s solution. Postpartum insulin requirements are usually significantly lower than prepregnancy reqiuremens. Within the first 12 hours postpartum, the fundus usually is approximately 1 cm above the umbilicus. Multiple gestation, breast feeding, multiparity, and conditions hat cause overdistention of the uterus will increase he intensity of afterpain. Bleeding is considered heavy when a woman saturates a sanitary pad in 1 hour. On the third and fourth postpartum days, the lochia becomes a pale pink or brown and contains old blood, serum, leukocytes and tissue debris. A positive Coomb’s test means that the Rh- negative woman is now producing antibodies o he Rh – positive blood of the neonate. A puerperal infection is an infection of the genial tract, after delivery through the first 6 weeks postpartum. During the taking-in phase, which usually lasts 2 o 3 days, the mother is passive and dependent and expresses her own needs rather than neonate’s needs. A mother experiencing postpartum blues may say she feels empty now ha the infant is no longer in her uterus. Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting. Discharge teaching should include informing the client to avoid salicylates, which may potentiate the effects of anticoagulants therapy. TORCH – Toxoplasmosis, Others such as gonorrhea, syphilis, varicella, Rubella, Cyomegalovirus and Herpes simplex virus. Denial of the perinatal loss is dysfunctional grieving in the client. Breast engorgement and dehydration are noninfectious causes of postpartum fevers. A prolonged length of labor places the mother at increased risk for developing an infection. When breast feeding after a cesarean delivery, the client should be encourage to use the football hold to avoid incisional discomfort. Transitional milk comes after colostrums and usually lass until 2 weeks postpartum. The client with mastitis should be encouraged to continue breast feeding while taking antibiotics for the infection. Postpartum depression occurs in approximately 10% to 15 % of all postpartum women. Late or secondary postpartum hemorrhages occur more than 24 hours but less than 6 weeks postpartum. Late postpartum bleeding is often the result of subinvolution of the uterus. The rapid decrease in intra-abdominal pressure occurring after birth causes splanchnic engorgement. The client is at risk for orthostatic. The client must understand that she must not become pregnant for 2 to 3 months after the vaccination because of its potential teratogenic effects. Magnesium sulfate is commonly used in the treatment of preeclampsia to prevent seizures. Because magnesium sulfate produces a smooth muscle depressive effect, the uterus should be assessed for uterine atony, which would increase the risk of postpartum hemorrhage. The placenta produces the hormone human placental lactogen, an insulin antagonist.

22

                       

Breast feeding has an anidiabetogenic effects. Gravida is the number of times a woman has been pregnant. Parity is he number of pregnancies that have reached viability. Multiparous women often experience a loss of uterine tone due to frequent distention’s of the uterus from past pregnancies. The taking- in phase occurs in the first 24 hours after birth. Women who are anemic in pregnancy may experience more complications, such as poor wound healing and inability to tolerate activity. The hallmark signs and symptoms of preeclamsia include hypertension, hyperreflexia, and proteinuria. Women who deliver twins are a higher risk for postpartum hemorrhage due to overdistention of the uterus, which causes uterine atony. In the early postpartum period, there’s an increase in he glomerular filtration rate and a drop in progesterone levels, which result in rapid diuresis. The third o tenth days of postpartum care are he “taking-hold” phase, in which the new mother strives for independence and is eager for her neonate. Uterine reunion causes a distended bladder o displace the uterus above the umbilicus and to the side, which prevents the uterus from contracting. lochia rubra lasts about 4 days. “Postpartum blues” – a transient mood alteration that arises during the first 3 weeks postpartum and is typically self – limiting – affects 50 – 80% of postpartum clients. A comprehensive fundal check includes evaluation of fundal consistency, height, and location. A firm postpartum fundus means that the uterus has contracted and is constricting blood vessels, thereby decreasing lochia flow. A prone position supports the abdominal muscles and aids uterine involution. Discharge teaching should include an instruction o avoid salicylates, which may magnify the effects of anticoagulant therapy. Tender, intact nipples, firm, nontender breasts, and transitional milk are normal in a breast feeding client on the fourth postpartum day. A breast feeding client should consume an additional 500 calories/ day to ensure that she produces high-quality breast milk. In some cases, it takes 7 minutes for the let down reflex to cause milk to fill the breast. lochia rubra contains a mixture of mucus, tissue debris, and blood. Postpartum diuresis occurs as the body starts to reduce the extracellular fluid volume. lochia alba is creamy white to brown, contains decidual cells, and may have a stale odor. Retained placental fragments, which prevent the uterus from contracting properly, increase postpartum blood loss. Uterine involution is the normal contraction of the uterus during the immediate and prolonged postpartum periods.

23

Answer in LGAC in MCN A 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47.

A D B B B A A C C A D C C D A A C D C C C A D A C B B D C C C B D B C C B D A C D B D C B A D

51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97.

D C C C B D C A D C B C B A C D B D D D C D B D C B C D C C C B B B A A D B B A D A C C C B B

101. 102. 103. 104. 105. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 139. 140. 141. 142. 143. 144. 145. 146. 147.

C C C B D B C A C A C B B C D A B C B C B A A D D D B B D C D C C B D D B D A C A B A C D B A

151 D. 152. A 153. A 154. A 155. A 156. B 157. C 158. C ANSWER IN MCN B 1. D 2. A 3. D 4. C 5. B 6. D 7. D 8. D 9. C 10. B 11. C 12. B 13. B 14. D 15. B 16. B 17. A 18. C 19. D 20. D 21. D 22. D 23. A 24. D 25. C 26. A 27. B 28. B 29. D 30. C 31. A 32. B 33. B 34. B 35. D 36. B 37. B 38. C

42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80.

B A C B A A A A B C D C C C C C C C A D C A D C D B B D A B A D D B B B D B B

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48. A 49. C 50. B

98. D 99. C 100. A

148. B 149. A 150. C

39. C 40. B 41. A

25