1
Q
What is the duration of the fourth stage of labor?
A
It starts with the delivery of the placenta and includes at least the first 2 hours after birth.
2
Q
What is the main goal during the immediate postpartum period?
A
To prevent postpartum hemorrhage.
3
Q
What are the three greatest risks during the postpartum period?
A
Hemorrhage, shock, and infection.
4
Q
The postpartum period, also known as the _____, is the interval between birth and the return of the reproductive organs to their nonpregnant state.
A
puerperium
5
Q
What is the function of oxytocin released from the pituitary gland?
A
It coordinates and strengthens uterine contractions.
6
Q
What is the term for the uncomfortable uterine cramping experienced postpartum?
A
Afterpains.
7
Q
Decreased estrogen in the postpartum period is associated with what three physiological effects?
A
Breast engorgement, diaphoresis (profuse perspiration), and diuresis of excess fluid.
8
Q
What effect does decreased progesterone have on the postpartum client’s body?
A
It results in an increase in muscle tone throughout the body.
9
Q
For a lactating client, approximately how long does it take for the first postpartum ovulation to occur?
A
Approximately 6 months.
10
Q
For a nonlactating client, when does ovulation typically occur after birth?
A
Ovulation occurs 7 to 9 weeks after birth.
11
Q
According to AAP and ACOG guidelines, how frequently should blood pressure and pulse be assessed for the first 2 hours after birth?
A
At least every 15 minutes.
12
Q
What does the postpartum assessment acronym BUBBLE-E stand for?
A
Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy.
13
Q
What is uterine involution?
A
The process where the uterus returns to its prepregnant state through contractions of the uterine smooth muscle.
14
Q
By how much should the fundus descend into the pelvis each day postpartum?
A
Approximately one fingerbreadth (1 cm) per day.
15
Q
Where should the fundus be palpable immediately following birth?
A
Firm, at the midline, and about 2 cm below the umbilicus.
16
Q
At 12 hours following birth, where can the fundus typically be palpated?
A
At 1 cm above the umbilicus.
17
Q
By what point postpartum should the uterus lie within the true pelvis and no longer be palpable?
A
After about 2 weeks.
18
Q
What is the first nursing intervention if a postpartum client’s fundus is found to be boggy?
A
Lightly massage the fundus in a circular motion.
19
Q
What might a fundus that is displaced laterally from the midline indicate?
A
A full bladder.
20
Q
Name two oxytocic medications that can cause hypotension.
A
Oxytocin and misoprostol.
21
Q
Name three oxytocic medications that can cause hypertension.
A
Methylergonovine, ergonovine, and carboprost.
22
Q
Term: Lochia rubra
A
Definition: Dark red, bloody uterine discharge lasting 1 to 3 days after birth.
23
Q
Term: Lochia serosa
A
Definition: Pinkish brown, serosanguineous uterine discharge lasting from approximately day 4 to day 10 after birth.
24
Q
Term: Lochia alba
A
Definition: Yellowish white, creamy uterine discharge lasting from approximately 10 days up to 6 weeks postpartum.
25
How is a 'heavy' amount of lochia defined in a postpartum assessment?
One perineal pad saturated within 2 hours.
26
What amount of lochia saturation indicates excessive blood loss?
One pad saturated in 15 minutes or less, or pooling of blood under the buttocks.
27
What might persistent heavy lochia rubra beyond day 3 postpartum indicate?
Retained placental fragments.
28
A foul odor in lochia is suggestive of what complication?
Infection.
29
What change in the external cervical os is a permanent result of vaginal birth?
It changes from a round-dimple shape to a slit-like appearance.
30
How long does initial healing of an episiotomy or perineal laceration take?
Initial healing occurs in 2 to 3 weeks.
31
For the first 24 hours postpartum, what is the rationale for applying ice packs to the perineum?
To reduce edema and provide an anesthetic effect.
32
What comfort measure can be used after the first 24 hours to increase circulation and promote perineal healing?
Heat therapies such as hot packs or sitz baths.
33
Term: Colostrum
Definition: The clear yellow fluid secreted from the breasts during pregnancy and for 2 to 3 days immediately after birth.
34
When does mature milk production typically begin after birth?
About 72 to 96 hours after the birth of the newborn.
35
What is breast engorgement?
Fullness of the breast tissue resulting from lymphatic circulation, milk production, and temporary vein congestion.
36
What are two non-pharmacological comfort measures for breast engorgement in a non-breastfeeding client?
Applying ice packs or cold cabbage leaves to the breasts.
37
What is the average blood loss for an uncomplicated vaginal birth?
300 to 500 mL (10% of blood volume).
38
What is the average blood loss for a cesarean birth?
500 to 1,000 mL (15% to 30% of blood volume).
39
What condition are postpartum clients predisposed to due to increased coagulation factors and fibrinogen levels?
Thrombus formation and thromboembolism.
40
Postpartum leukocytosis is a common finding where WBC values can be between _____.
20,000 and 25,000/mm3
41
Why might orthostatic hypotension occur within the first 48 hours postpartum?
It can result from splanchnic (visceral) engorgement that can occur after birth.
42
A postpartum heart rate as low as 40/min is a common finding known as _____.
puerperal bradycardia
43
A temperature elevation to 38° C (100.4° F) during the first 24 hours postpartum is most likely due to what?
Dehydration after labor.
44
For clients who have third- or fourth-degree perineal lacerations, what two interventions are contraindicated?
Enemas and suppositories.
45
Postpartal diuresis, with an output of more than 3,000 mL/day, is considered normal within the first _____ days after birth.
2 to 3
46
Frequent voiding of less than 150 mL of urine in a postpartum client is indicative of what condition?
Urinary retention with overflow.
47
Term: Diastasis recti
Definition: The separation of the rectus abdominis muscles, which usually resolves within 6 weeks postpartum.
48
If a client is nonimmune to rubella, when should the MMR vaccine be administered?
During the postpartum period, before discharge.
49
Following a rubella or varicella vaccine, a client should be advised not to get pregnant for how long?
For at least 4 weeks (28 days) or 1 month.
50
When must Rho(D) immune globulin be administered to an Rh-negative client who has an Rh-positive newborn?
Within 72 hours of the newborn being born.
51
What is the primary purpose of administering Rho(D) immune globulin?
To suppress antibody formation in the mother.
52
Term: Dependent: taking-in phase
Definition: The first 24-48 hours postpartum, where the mother's focus is on meeting her own personal needs and she relies on others for assistance.
53
Term: Dependent-independent: taking-hold phase
Definition: Begins on day 2 or 3 and lasts several weeks; the mother focuses on baby care, improving competency, and wants to learn and practice.
54
Term: Interdependent: letting-go phase
Definition: A later phase where the mother's focus shifts to the family as a unit and she resumes her roles as an intimate partner and individual.
55
Holding a newborn face-to-face is known as the _____ position and is a behavior that facilitates bonding.
en face
56
List three behaviors that may indicate impaired parent-newborn bonding.
Apathy when the newborn cries, disgust at newborn functions, handling the newborn roughly, or ignoring the newborn.
57
What is the priority nursing action to promote parent-newborn bonding immediately after delivery?
Position the newborn skin-to-skin on the client’s chest.
58
What common adverse response might a toilet-trained sibling exhibit after the birth of a newborn?
Regression in toileting habits.
59
What type of bra should a breastfeeding client avoid using?
An underwire bra, which can cause clogged milk ducts.
60
How can a breastfeeding client relieve breast engorgement?
Take a warm shower or apply warm compresses before feeding and apply cool compresses after feedings.
61
What should a client do for sore nipples after breastfeeding?
Apply a small amount of breast milk to the nipple and allow it to air dry.
62
How should a non-breastfeeding client manage breast engorgement?
Apply cold compresses for 15 minutes on and 45 minutes off, and place fresh, cold cabbage leaves inside the bra.
63
Following a cesarean birth, when can abdominal exercises typically be resumed?
Postpone abdominal exercises until about 4 to 6 weeks after birth or as recommended by the provider.
64
What is the recommended daily caloric increase for a lactating client compared to their prepregnancy diet?
An additional 450 to 500 calories per day.
65
What advice should be given regarding contraception to a client who is breastfeeding?
Do not take oral contraceptives until milk production is well established, usually around 6 weeks postpartum.
66
What is a significant postpartum complication indicated by a fever greater than 38° C (100.4° F) after the first 24 hours?
Infection.
67
What finding in the calves, such as localized pain, redness, and swelling, should a postpartum client report to their provider?
Indications of a possible deep-vein thrombosis (DVT).
68
When can a postpartum client typically resume sexual intercourse safely?
By the second to fourth week after birth, when bleeding has stopped and the perineum has healed.
69
What muscle group is strengthened by performing Kegel exercises?
The pelvic floor muscles.
70
How should a client cleanse the perineal area to prevent infection?
Use a squeeze bottle with warm water from front to back after each voiding or bowel movement.
71
Why are tampons contraindicated during the postpartum period?
Due to the increased risk for infection.
72
Excessive spurting of bright red blood from the vagina postpartum may indicate what type of injury?
A cervical or vaginal tear.
73
Continued flow of lochia serosa or alba beyond the normal time frame, especially with fever, can indicate what condition?
Endometritis.
74
The hormone _____ remains elevated in lactating clients and suppresses ovulation.
prolactin
75
How is the amount of lochia saturation for 'moderate' bleeding documented?
More than 10 cm of saturation on the perineal pad.
76
A postpartum client experiences a gush of dark red blood upon standing. The uterus is firm and midline. How should the nurse interpret this finding?
As a normal postural discharge of pooled lochia.
77
What is the recommended frequency for taking sitz baths to promote perineal comfort and healing?
For 20 minutes at least twice a day.
78
What is mastitis?
An infection in a milk duct of the breast, often accompanied by flu-like manifestations.
79
What is the recommended nutrition in kcal/day for nonlactating postpartum clients?
1,800 to 2,200 kcal/day.
80
What is a recommended intervention for a client experiencing flatus after a cesarean birth?
Encourage ambulation or rocking in a chair to promote the passage of flatus.
81
What is the time period known as the 'fourth stage of labor'?
The recovery period starting with the delivery of the placenta and including at least the first 2 hours after birth.
82
What is the main goal during the immediate postpartum period?
To prevent postpartum hemorrhage.
83
The postpartum period, also known as the _____, is the interval between birth and the return of the reproductive organs to their nonpregnant state.
puerperium
84
What are the three greatest risks during the postpartum period?
Hemorrhage, shock, and infection.
85
Which hormone, released from the pituitary gland, coordinates and strengthens uterine contractions?
Oxytocin.
86
What action stimulates the release of endogenous oxytocin from the pituitary gland postpartum?
Breastfeeding.
87
Uncomfortable uterine cramping in the postpartum period is referred to as ____.
afterpains
88
Decreased levels of which hormone are associated with breast engorgement, diaphoresis, and diuresis postpartum?
Estrogen.
89
Decreased estrogen levels postpartum can lead to what vaginal symptom until ovarian function returns?
Vaginal dryness and intercourse discomfort.
90
A decrease in which hormone postpartum results in an increase in muscle tone throughout the body?
Progesterone.
91
In lactating clients, elevated blood levels of which hormone suppress ovulation?
Prolactin.
92
For a lactating client, approximately how long does it take for the first postpartum ovulation to occur?
Approximately 6 months.
93
In nonlactating clients, when does ovulation typically occur after birth?
7 to 9 weeks after birth.
94
How frequently should blood pressure and pulse be assessed for the first 2 hours after birth?
At least every 15 minutes.
95
The focused postpartum physical assessment acronym BUBBLE-E stands for what?
Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy.
96
What is uterine involution?
The process where the uterus returns to its prepregnant state through contractions of the uterine smooth muscle.
97
By how much should the fundal height descend into the pelvis each day postpartum?
Approximately one fingerbreadth (1 cm) per day.
98
Where should the fundus be palpable immediately following birth?
Firm, at the midline, and about 2 cm below the umbilicus.
99
Where should the fundus be palpable 12 hours following birth?
At 1 cm above the umbilicus.
100
By what postpartum day should the fundus be halfway between the symphysis pubis and the umbilicus?
By 6 days postpartum.
101
After approximately how many weeks should the uterus lie within the true pelvis and not be palpable?
After about 2 weeks.
102
What is the proper technique for palpating the uterine fundus to prevent uterine inversion?
Cup one hand just above the symphysis pubis to support the lower segment while the other hand palpates the fundus.
103
What action should a nurse take if the postpartum fundus is found to be boggy?
Lightly massage the fundus in a circular motion.
104
What is the most likely cause of a fundus that is displaced laterally from the midline?
A full bladder.
105
Name two oxytocic medications that can cause hypotension.
Oxytocin and misoprostol.
106
Name three oxytocic medications that can cause hypertension.
Methylergonovine, ergonovine, and carboprost.
107
What is lochia?
Post-birth uterine discharge containing blood, mucus, and uterine tissue.
108
Describe the characteristics of lochia rubra.
Dark red color, bloody consistency, fleshy odor, lasting 1 to 3 days after birth.
109
Describe the characteristics of lochia serosa.
Pinkish brown color, serosanguineous consistency, lasting from approximately day 4 to day 10 after birth.
110
Describe the characteristics of lochia alba.
Yellowish white creamy color, fleshy odor, lasting from approximately 10 days to 6 weeks postpartum.
111
How is 'heavy' lochia amount defined in terms of perineal pad saturation?
One pad saturated within 2 hours.
112
How is 'excessive blood loss' defined in terms of perineal pad saturation?
One pad saturated in 15 minutes or less, or pooling of blood under the buttocks.
113
What might excessive spurting of bright red blood from the vagina indicate postpartum?
A cervical or vaginal tear.
114
Persistent heavy lochia rubra beyond day 3 postpartum can indicate what complication?
Retained placental fragments.
115
Continued flow of lochia serosa or alba beyond the normal time frame, especially with fever or pain, can indicate what condition?
Endometritis.
116
How does the external cervical os change in appearance after a vaginal birth?
It changes from a round-dimple shape to a slit-like appearance.
117
What is the recommended comfort measure for the perineum in the first 24 hours postpartum to reduce edema?
Apply ice or cold packs.
118
After the first 24 hours, what comfort measures can be used to increase circulation and promote perineal healing?
Heat therapies like hot packs, moist heat, and sitz baths.
119
What is the proper method for cleansing the perineal area after voiding postpartum?
Use a squeeze bottle with warm water and blot dry from front to back.
120
What is the clear yellow fluid secreted from the breasts during pregnancy and for 2-3 days after birth called?
Colostrum.
121
Milk is typically produced about ____ to ____ hours after the birth of the newborn.
72 to 96
122
What is the term for the fullness of breast tissue resulting from lymphatic circulation, milk production, and temporary vein congestion?
Engorgement.
123
For a client who is not breastfeeding, what are recommended non-pharmacological comfort measures for engorgement?
Breast binders, support bras, ice packs, or cabbage leaves.
124
What is the average blood loss for an uncomplicated vaginal birth?
300 to 500 mL (10% of blood volume).
125
What is the average blood loss for a cesarean birth?
500 to 1,000 mL (15% to 30% of blood volume).
126
Postpartum leukocytosis is a common finding where WBC values can be between ____ and ____.
20,000 and 25,000/mm³.
127
Why are postpartum clients at an increased risk for thrombus formation?
Coagulation factors and fibrinogen levels increase during pregnancy and remain elevated in the immediate postpartum period.
128
What might orthostatic hypotension within the first 48 hours postpartum indicate?
Splanchnic (viscera/internal organs) engorgement.
129
A heart rate as low as 40/min in the first two days postpartum is a common finding called ____.
puerperal bradycardia
130
A temperature elevation to 38° C (100.4° F) in the first 24 hours postpartum is often due to what?
Dehydration after labor.
131
When might a spontaneous bowel movement occur after birth, and why?
It might not occur for 2 to 3 days due to decreased intestinal muscle tone, prelabor diarrhea, dehydration, or medication effects.
132
For which clients are enemas and suppositories contraindicated postpartum?
Clients who have third- or fourth-degree perineal lacerations.
133
A distended bladder can cause what uterine complication?
Uterine atony and displacement to one side.
134
Excessive urine diuresis of more than _____ mL/day is normal within the first 2 to 3 days after birth.
3000
135
Frequent voiding of less than 150 mL of urine is indicative of what condition?
Urinary retention with overflow.
136
What is diastasis recti?
The separation of the rectus abdominis muscles.
137
Following a cesarean birth, abdominal exercises should be postponed until about ____ weeks after birth.
4 to 6
138
A client who is nonimmune to rubella receives the vaccine postpartum and should be educated not to get pregnant for how long?
For 4 weeks (28 days).
139
Rho(D) immune globulin must be administered to an Rh-negative client with an Rh-positive newborn within how many hours of birth?
Within 72 hours.
140
A client who receives both a rubella vaccine and Rho(D) immune globulin should be tested after 3 months for what reason?
To determine whether immunity to rubella has been developed.
141
What is the name of the first phase of maternal role attainment, which occurs in the first 24-48 hours?
Dependent: taking-in phase.
142
During which phase of maternal role attainment is the focus on baby care and improving caregiving competency?
Dependent-independent: taking-hold phase.
143
In which phase of maternal role attainment does the focus shift to the family as a unit?
Interdependent: letting-go phase.
144
What is the 'en face' position?
A face-to-face position where the parent and newborn maintain eye contact.
145
Name three behaviors that indicate a lack of parent-newborn bonding.
Apathy when newborn cries, disgust at newborn's bodily functions, expressing disappointment in the newborn, turning away from the newborn, handling roughly, ignoring the newborn.
146
What is the priority nursing action to promote parent-newborn bonding immediately after delivery?
Position the newborn skin-to-skin on the client's chest.
147
What is a common adverse response in a sibling to a new baby?
Regression in toileting and sleep habits, aggression, or attention-seeking behaviors.
148
How should a client who plans to breastfeed relieve breast engorgement?
Take a warm shower before feeding, empty each breast completely, and apply cool compresses after feedings.
149
What advice should be given to a client who does not plan to breastfeed regarding breast care?
Wear a supportive bra for 72 hours, avoid breast stimulation, and use cold compresses for engorgement.
150
How long after a cesarean birth should a client wait before performing strenuous exercise or heavy lifting?
Until the 4- to 6-week follow-up visit.
151
Lactating clients should add an additional ____ to ____ calories/day to their prepregnancy diet.
450 to 500
152
Nonlactating clients are encouraged to consume ____ to ____ kcal/day.
1,800 to 2,200
153
When can clients safely resume sexual intercourse after birth?
By the second to fourth week, when bleeding has stopped and the perineum has healed.
154
For clients who are breastfeeding, when should oral contraceptives be started?
Not until milk production is well established, usually around 6 weeks.
155
What is a key indicator of a potential postpartum complication that a client should report to their provider?
Chills or fever greater than 38° C (100.4° F) after 24 hours.
156
A change in vaginal discharge back to bright red bleeding after it has progressed to serosa or alba should be ____.
reported to the provider
157
Sore nipples with cracks and fissures should be reported to the provider as they are a sign of potential ____.
complication or infection
158
What urinary symptoms should a postpartum client report to their provider?
Burning, pain, frequency, or urgency with urination.
159
What are the characteristics of the taking-in phase of maternal adaptation?
Focus on personal needs, reliance on others for assistance, excited and talkative, need to review birth experience.
160
What are the characteristics of the taking-hold phase of maternal adaptation?
Focus on baby care, desire to take charge but needs acceptance, wants to learn and practice, may experience 'baby blues'.
161
What are the characteristics of the letting-go phase of maternal adaptation?
Focus on family as a unit and resumption of roles as an intimate partner and individual.
162
When should Kegel exercises be initiated after a vaginal birth?
Soon after birth, to regain pelvic floor muscle control.
163
What is the primary goal during the immediate postpartum period, also known as the fourth stage of labor?
The main goal is to prevent postpartum hemorrhage.
164
The postpartum period, or puerperium, is the interval between birth and the return of the reproductive organs to their ____ state.
nonpregnant
165
What are the three greatest risks during the postpartum period?
Hemorrhage, shock, and infection.
166
What hormone, released from the pituitary gland, coordinates and strengthens uterine contractions?
Oxytocin.
167
Uncomfortable uterine cramping that occurs after birth is referred to as _____.
afterpains
168
What physiological effects are associated with decreased estrogen levels in the postpartum period?
Breast engorgement, diaphoresis, diuresis, and diminished vaginal lubrication.
169
In non-lactating clients, when does ovulation typically occur after birth?
Ovulation occurs 7 to 9 weeks after birth.
170
For a lactating client, approximately how long does it take for the first postpartum ovulation to occur?
Approximately 6 months.
171
What is the recommended frequency for assessing blood pressure and pulse for the first 2 hours after birth?
At least every 15 minutes.
172
What does the postpartum assessment acronym BUBBLE stand for?
Breasts, Uterus, Bowel, Bladder, Lochia, Episiotomy.
173
Term: Uterine Involution
The process where the uterus returns to its prepregnant state through contractions of the uterine smooth muscle.
174
Immediately after birth, where should the uterine fundus be palpable?
Firm, at the midline, and about 2 cm below the umbilicus.
175
By 12 hours after birth, where can the uterine fundus be palpated?
At 1 cm above the umbilicus.
176
At what rate should the fundus descend into the pelvis postpartum?
Approximately 1 to 2 cm every 24 hours.
177
After about 2 weeks postpartum, where should the uterus be located?
Within the true pelvis, where it should not be palpable.
178
What is the first nursing action if the uterine fundus is found to be boggy?
Lightly massage the fundus in a circular motion.
179
What is a common cause of the uterine fundus being displaced laterally from the midline?
A full bladder.
180
Which two oxytocic medications can cause hypotension as an adverse effect?
Oxytocin and misoprostol.
181
Which three oxytocic medications can cause hypertension as an adverse effect?
Methylergonovine, ergonovine, and carboprost.
182
Term: Lochia
Post-birth uterine discharge containing blood, mucus, and uterine tissue.
183
Describe the characteristics and duration of lochia rubra.
It is dark red, has a bloody consistency and fleshy odor, and lasts 1 to 3 days after birth.
184
Describe the characteristics and duration of lochia serosa.
It is a pinkish brown color with serosanguineous consistency and lasts from approximately day 4 to day 10 after birth.
185
Describe the characteristics and duration of lochia alba.
It is a yellowish white creamy color with a fleshy odor and lasts from approximately day 10 up to 6 weeks postpartum.
186
How is 'heavy' lochia amount defined in a postpartum assessment?
One perineal pad saturated within 2 hours.
187
How is 'excessive blood loss' defined in a postpartum assessment?
One perineal pad saturated in 15 minutes or less, or pooling of blood under the buttocks.
188
Persistent heavy lochia rubra beyond day 3 can indicate what complication?
Retained placental fragments.
189
Continued flow of lochia serosa or alba beyond the normal length of time, especially with fever or pain, can indicate what complication?
Endometritis.
190
For the first 24 hours postpartum, what is the recommended comfort measure for perineal edema?
Apply ice or cold packs to the perineum.
191
What is the clear, yellow fluid secreted from the breasts during pregnancy and for the first 2-3 days after birth?
Colostrum.
192
Mature milk is typically produced about _____ to _____ hours after the birth of the newborn.
72 to 96
193
For a client who is not breastfeeding, what are recommended comfort measures for breast engorgement?
Use breast binders or support bras, apply ice packs, or use cabbage leaves.
194
What is the average blood loss for an uncomplicated vaginal birth?
300 to 500 mL.
195
What is the average blood loss for a cesarean birth?
500 to 1,000 mL.
196
Postpartum diaphoresis and diuresis, which occur in the first 2-5 days, serve what purpose?
They rid the body of excess extracellular fluid accumulated during pregnancy.
197
In the first 4 to 7 days after birth, it is common for WBC values to be between 20,000 and 25,000/mm³. This is called _____.
postpartum leukocytosis
198
Increased coagulation factors and fibrinogen levels in the immediate postpartum period predispose the client to what condition?
Thrombus formation and thromboembolism.
199
A heart rate as low as 40/min in the first 2 days after birth is a common finding known as _____.
puerperal bradycardia
200
An elevated temperature up to 38° C (100.4° F) in the first 24 hours postpartum is often due to what?
Dehydration after labor.
201
A postpartum temperature that remains elevated after 24 hours or persists for 2 days could indicate ____.
infection
202
Why might a spontaneous bowel movement not occur for 2 to 3 days after birth?
Due to decreased intestinal muscle tone, prelabor diarrhea, dehydration, or medication adverse effects.
203
For which clients are enemas and suppositories contraindicated postpartum?
Clients who have third- or fourth-degree perineal lacerations.
204
What are four signs of a distended bladder in a postpartum client?
Fundus above baseline/umbilicus, fundus displaced from midline, bladder bulge above symphysis pubis, and excessive lochia.
205
A postpartum client who voids frequently in amounts less than 150 mL is showing signs of what condition?
Urinary retention with overflow.
206
Term: Diastasis Recti
The separation of the rectus abdominis muscles, which usually resolves within 6 weeks postpartum.
207
A client who is nonimmune to rubella receives the vaccine postpartum. What is the key education regarding future pregnancy?
The client should not get pregnant for 4 weeks (28 days) following the immunization.
208
When must an Rh-negative client who has an Rh-positive newborn receive Rho(D) immune globulin?
Within 72 hours of the newborn being born.
209
Term: Dependent (taking-in) phase
The first 24-48 hours postpartum, where the focus is on meeting personal needs and the mother is excited and talkative.
210
Term: Dependent-independent (taking-hold) phase
Begins on day 2 or 3 and lasts several weeks; the focus shifts to baby care and improving caregiving competency.
211
Term: Interdependent (letting-go) phase
The phase where the focus is on the family as a unit and the mother resumes her roles as an intimate partner and individual.
212
What is the 'en face' position, which indicates parent-newborn bonding?
Holding the newborn face-to-face, maintaining eye contact.
213
What are two examples of behaviors that indicate impaired parent-newborn bonding?
Apathy when the newborn cries, or expressing disgust when the newborn voids, stools, or spits up.
214
What is the priority nursing action to promote parent-newborn bonding immediately after delivery?
Position the newborn skin-to-skin on the client’s chest.
215
What is a common adverse response in a young sibling to the birth of a newborn?
Regression in toileting and sleep habits or increased attention-seeking behaviors.
216
What is a helpful intervention for a preschool-aged sibling adapting to a new baby?
Provide the sibling with a doll to care for.
217
To relieve breast engorgement, a breastfeeding client should apply _____ compresses before feeding and _____ compresses after feeding.
warm; cool
218
How should a client who is not breastfeeding manage breast engorgement pain?
Apply cold compresses for 15 minutes on and 45 minutes off.
219
Following a cesarean birth, when can abdominal exercises typically be resumed?
Postpone abdominal exercises until about 4 to 6 weeks after birth.
220
What is the recommended daily caloric increase for a lactating client compared to their prepregnancy diet?
An additional 450 to 500 calories per day.
221
When can a postpartum client safely resume sexual intercourse?
By the second to fourth week after birth, when bleeding has stopped and the perineum has healed.
222
A breastfeeding client should not take oral contraceptives until milk production is well established, which is usually at _____ weeks.
6
223
What is a key sign of a postpartum complication that the client should report to their provider regarding temperature?
Chills or a fever greater than 38° C (100.4° F) after the first 24 hours.
224
What is a key sign of a postpartum complication that the client should report to their provider regarding lochia?
A change in vaginal discharge with increased amount, large clots, change back to bright red bleeding, or a foul odor.
225
What symptoms in the calves should a postpartum client report to their provider?
Localized pain, tenderness, redness, and swelling.
226
What is the recovery period that starts with the delivery of the placenta and includes at least the first 2 hours after birth?
The fourth stage of labor.
227
Stimulation of the pituitary gland by breastfeeding releases what endogenous hormone?
Oxytocin.
228
Decreased progesterone in the postpartum period results in an increase in _____ throughout the body.
muscle tone
229
During a postpartum fundal assessment, what should the nurse do with one hand just above the symphysis pubis?
Cup the hand to support the lower segment of the uterus.
230
A client is 2 days postpartum and has a perineal pad saturated approximately 12 cm with dark red lochia and small clots. How should this be documented?
Moderate lochia rubra.
231
A bright red trickle of blood from an episiotomy site in the early postpartum period is considered what kind of finding?
A normal finding.
232
The external cervical os of a client who has given birth will have what kind of appearance?
A slit-like appearance, rather than a round dimple.
233
What are the four traditional positions for breastfeeding?
Football hold (under the arm), cradle, across the lap (modified cradle), and side-lying.
234
What should a client do to help prevent nipple soreness related to breastfeeding?
Ensure a proper latch, where the newborn takes in part of the areola and nipple, not just the tip.
235
What is a common gastrointestinal effect of operative vaginal birth (forceps or vacuum-assisted)?
An increased risk of temporary postpartum anal incontinence.
236
A postpartum client who had no immunity to varicella receives the vaccine. What education about a future dose is needed?
A second dose of the vaccine is given at 4 to 8 weeks.
OB Proctor Exam ATI
flashcards
Decks in class (11)
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