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Published by: stuffednurse on Nov 13, 2008
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NURSING PRACTICE 2Situation 1 - Nurse Minette is an independent Nurse Practitioner following-upreferred clients in their respective homes. Here she handles a case of POSTPARTALMOTHER AND FAMILY focusing on HOME CARE.Nurse Minette needs to schedule a first home visit to OB client Leah, when is afirst home-care visit typicallymade?Within 4 days after dischargeWithin 24 hours after dischargeWithin 1 hour after dischargeWithin 1 week of dischargeCORRECT ANSWER: ARATIONALE: Recommended Schedule of Post partum Care visits:1st visit – 1st week post Partum preferably 3-5 days2nd visit- 6 weeks post partumSOURCE: DOH: Public Health Nursing in the Philippines. Pp 125Leah is developing constipation from being on bed rest, what measures would yousuggest she take to helpprevent this?a. Eat more frequent small meals instead of three large one dailyb. Walk for at least half an hour daily to stimulate peristalsisc. Drink more milk, increased calcium intake prevents constipationd. Drink eight full glasses of fluid such as water dailyCORRECT ANSWER: BRATIONALE: Early ambulation, a good diet with adequate roughage and adequate fluidintake all aid in preventing the problem of constipation. Options A and D arepossible answers but in the situation, bed rest causes the constipation.Therefore, in order to prevent this allow the postpartal woman to ambulate.SOURCE:Maternal & Child Health Nursing by Adele Pillitteri, 5th edition, Pp.644If you were Minette, which of the following actions, would alert you that a newmother is entering a postpartalat taking-hold phase?a. She urges the baby to stay awake so that she can breast-feed him in herb. She tells you she was in a lot of pain all during laborc. She says that she has not selected a name for the baby as yet.d. She sleeps as if exhausted from the effort of laborCORRECT ANSWER: ARATIONALE: Taking hold phase the second phase of the postpartal period where thewoman begins to initiate action. The mother is independent and show care for herbaby.OPTION B: Taking in phase- the first phase of the postpartal period experiencedwhen the woman is usually 2-3 days postpartum, she is dependent to others and doesnot show interest in taking care of the baby.OPTION C: Taking in phaseOPTION D: Taking in PhaseSOURCE: Maternal & Child Health Nursing by Adele Pillitteri, 5th edition, Pp6234. At 6-week postpartum visit what should this postpartal mother's fundic height
be?a. Inverted and palpable at the cervixb. Six fingerbreadths below the umbilicusc. No longer palpable on her abdomend. One centimeter above the symphysis pubisCORRECT ANSWER: CRATIONALE: On the first postpartal day, it will be palpable one fingerbreathbelow the umbilicus; on the second day, two fingerbreadths below the umbilicus;and so on. Because a fingerbreadth is about 1cm, this can be recorded as 1cm belowthe umbilicus, 2cm below it and so forth. In the average woman by the ninth ortenth day, the uterus will have contracted so much that it is withdrawn into thepelvis and can no longer be detected by abdominal palpation.SOURCE: Maternal & Child Health Nursing by Adele Pillitteri, 5thedition, Pp 628This postpartal mother wants to loose the weight she gained in pregnancy, so sheis reluctant to increaseher caloric intake for breast-feeding. By how much should a lactating motherincrease her caloric intake during the first 6 months after birth?a.350 cal/dayb.500 cal/dayc.200 cal/dayd.1,000 cal/dayCORRECT ANSWER: BRATIONALE: A woman who is breast-feeding needs an additional 500 calories (i.e.,a 2700-kcal diet) and an additional 500ml of fluid ( this may be from the samesource) each day to encourage the production of high quality breast milk.SOURCE: Maternal & Child Health Nursing by Adele Pillitteri, 5th edition, Pp 641Situation 2 – Nurse Lisa manages her own Reproductive and Children’s NursingClinic in Sorsogon and necessarily she attends to health conditions of mothers andchildren. The following questions pertains to the growing fetus.Obstetrical client Marichu asks how much longer Nurse Lisa will refer to the babyinside her as an embryo.What would be your best explanation?a. Her baby will be a fetus as soon as the placenta formsb. From the time of implantation until 5 to 8 weeks, the baby is an embryoc. After the 20th week of pregnancy, the baby is called a zygoted. This term is used during the time before fertilizationCORRECT ANSWER: BRATIONALE: Under fetal development:Pre embryonic period- the 1st 2 weeks after conceptionEmbryonic period- beginning of the third week through the 8 weeks after conceptionFetal period- beginning of the 9th week after conception and ending with birthSOURCE: Saunder’s Comprehensive review for the NCLEX-RN. 3RD Edition.pp.253Marichu is worried that her baby will be born with a congenital heart disease.What assessment of a fetusat birth is important to help detect congenital heart defect?a. Determining that the color of the umbilical cord is not greenb. Assessing whether the umbilical cord has two arteries and one veinc. Assessing whether the Wharton’s jelly of the cord has a pH higher than 7.2d. Measuring the length of the cord to be certain that it is longer than 3 feet
CORRECT ANSWER: BRATIONALE: A normal cord contains one vein and two arteries. The absence of theumbilical arteries is associated with congenital heart and kidney anomalies,because the insult that caused the loss of the vessel may have affected othermesoderm germ layer structures as well.SOURCE:Maternal & Child Health Nursing by Adele Pillitteri, 5th edition, Pp. 615-616Additionally, Nurse Lisa would gather more information about Marichu’s worry aboutwhat may threaten thehealth of her baby. What would Nurse Lisa hope to find?Has Marichu been overly anxious about somethingHas Marichu suffered from any communicable/contagious disease at the time of herearly stage of pregnancyHas Marichu engage in sexual activity during the fetal development state of herchildHas Marichu engaged in any detrimental activities during the fetal developmentstage (e.g. smoking, drinking, taking drugs, a bad fall, or attempts to terminatepregnancy.)CORRECT ANSWER: DRATIONALE: During the early time of organogenesis (organ formation) the growingstructure is most vulnerable to invasion by teratogens. (any factors that affectsthe fertilized ovum, embryo, fetus adversely, such as alcohol). It is important toteach women how to minimize their exposure to teratogens during these timesOPTION B: A number of infections are not teratogenic to a fetus during pregnancybut are harmful if they are present at the time of birth.OPTION C: Sexual intercourse does not affect fetal development.SOURCE:Maternal & Child Health Nursing by Adele Pillitteri, 5th edition, Pp.190,290, 94Marichu is scheduled to have an ultrasound examination. What instruction would yougive her before herexamination?a.You can have medicine for pain for any contraction caused by the testb.Drink at least 3 glassess of fluid before the procedurec.The intravenous fluid infused to dilate your uterus does not hurt thefetusd.Void immediately before the procedure to reduce your bladder sizeCORRECT ANSWER: BRATIONALE: Before ultrasound, the mother needs to have a full bladder in order forthe sound waves to reflect best and the uterus to be held stable. In order toensure a full bladder, a woman should drink a full glass of water 15 minutesbeginning, 90 minutes before the procedure and should not void before theprocedure.SOURCE:Maternal & Child Health Nursing by Adele Pillitteri, 5th edition, Pp. 615-616Marichu is scheduled to have an amniocentesis to test for fetal maturity. Whatinstruction would you giveher before this procedure?a. The x-ray used to reveal your fetus position has no long term effectsb.The intravenous fluid infused to dilate your uterus does not hurt thefetusc.No more amniotic fluid form afterward, which is why only a small amountis removedd.Void immediately before the procedure to reduce your bladder size.

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