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Answer: A

The barrier iechniqu condom j ommonly pre cribed l bre tfeeding mother. mbin d oral coo ceptive pills are not rec mrnended a the b em n in th pill reduce ccr ti n f prolactin and mer re decrease

milk ·ecrerion. The pro tin- nly piU do not de rea e milk ecretion, Th lact cion amen [thea method

rna only be £6 cri e if the mother enga in ab olure rca' eeding for 6 m nth • i am norrheic for

6 month and the infant i und 6 moths. Bilateral tubal ligation, permanent surgical meth d f sterilization,

i not indicated in primipara.

100. . arl ,i bein pr parcel fo topera ivc c ughing. Which in rruction hould rh nur e her?

Lean forwa d, take th, and cough forcefully."

B. 'Take everal dee b rhs, then ri hten ur ab orninal m cl ,an cou h forcefully."

'Lie on y ur right ide, take a d ep bee rh and cough ndv."

D. .. xhale forcefully with y ur mouth pen and hen cough

An ex: B

Coughing j a f rm 0 f rc ul xpiratioa. -or e fecrive coughm , the eli nt a. sumes n uprigh p Irion, tak se eral de p r aths, righten her abd minal mu des and c ugh forceful). en don regularly, deep breathin and c ughin exerci with regular mcniog can promote maximum lung expansi 0 and prevent hypo tatic po urn nia, sr-abdorninal sur ry complication ..

2921 DR. RPS MATaHAL & NEW8()R;I C.w;

95. During a home vi i (! a primiparous client who deliver vaginally 14 da S 0 th eli nr a .. l' e been crying :.l Jot th last few days. I juSt el 0 awful. I am ( r tten m mer. just don't have any energy. Plus, my husb nd ju t gor laid off fr m this j b.' \Xlhieh of rh f U wing would be the nurse's best respon c?

. 'These feelings ftcn indi te symptom f stpartum blu and normal. The U go away in II few

days. '

B. (I think you're pr bably errea tin t the lab r pr ess. ou'r doing, ju [fine"

.. n t unusual for orne mothe feci d press d It, the birth of a bah . 1 think 1 h uJd coma l

your d tor:

"Thi may a symptom fa eri us mental illne requiring the help f psychiatrist."

Answer: C

The client j pc bably experiencing postpartum d pr . i n, and the doct r hould be con cted. 0 rpartum dcpr ion is usually treated ~th psychotherapy ocial upport ups, nd antidepr • an: medications.

ntributing factors inclu c horm nal flucru cion a hi ~ ry f d pr sion and envir nmentaJ facto (e.g.

job 10 s), Fal eas urance like "Y u're doing just fine" and judgmental r n e uch as "I think y u're

p bably erreaction ... ' h uld be . v idcd.

96. Irs. Mario, 29 years-ol and}P 2 days po r-partum i vi 'ted y the nurse r h me. ario' lochial

di charge i in peered by the nurse, The nur e will likely find her 1 chia wi h which characteri ti ?

A. yell wish, can' . reddi h moderate

B. browni h light D. bright red, p.r fu

ruarub

1 day' wb r t chis Jba

a . nal dt charge is a dan go

97.

f the followin mea ure will be

er: pre ing milk manually r with th use 0 br a t pum , and adequate fluid intake m y ntribute LO milk ec eli n, bur the most effi COve way [0 ensure milk ecreti n i th regular emptying of the breasts with ch feeding. The mother sh uld be in eructed (' all w her infant l em ty each breast alternately b startin n the br a t u ed la t in the previous eeding,

9.

ich of the foll wing h rmone i c;

A. oxytocin

human placental lactogen (HPL)

e=

pon iblc for the "letd wo' r flex in lactation?

D,

lee n

ccretion of the tenor pituitary gland. Thi is the horm ne that caus the milk ejection/ let-

d wn reflex. tr en and pr ge terone when elevated in maternal bl a in a c ntraceptive pill user will 1 sen milk ecrering r a or pr la tin reflex, uman placental lactogen i a placental h rmon ; not in ol ed in p tpanum lactation mechani m.

99. Wba method f c ntracep 'on can b used by breastfeedin m thers?

A. coo om with permatocide

mbined oral ntracepti q pill

LAM

D. TL

Am S NIl) RAT1OtW.ES 12i1

n a e men me nurse n teo . nurse h uld f T:

n for pain.

-parturn rdia ~ ich of the following

An wert A

uro mide is a p tassium-depl tiog diuretic. Serum electrolytes arc monitored for hypokalemia. The n rmal

range of s rum p tas ium i 3.5.5 /. bnormaliti in po . urn (b th h rkalemia and hypokalemia)

ect d in chan es, but these changes do not occur until th bnormaHty i vcre.

mi in and d ubl

bpm."

fter ee ching a primipar u client about treatment and elf-car nur c en rmines tha th eli n n ed further in tructi n when , 1 can apply localized heat t m ri t bre t.'

''1 h uld increase my fluid intake 3, pc d y,"

"111 need to take antibiotics for to 10 da s bef re my infection is cured,'

'I sh uld egin br tfeeding n the righ side tJ d cr th 'pain."

need to be compl ted.

290 r DR. RPS MATERNAL & N

RN CARli

t

B.

od r pla menr T.

D.

lac tion

criptin c.

B.

u, I will h v 0 r port thi t the: re t of the

9.

D.

An er: B

An, uicidal id cion and talk o hurting elf j for all the mernb c ntracting f r clinician/ our

ct the

B.

client. 'J iich of the oll WlO indicate. learning.

Th

Answer: C

The anreri r urinary m tu lead r the terile bl dd r: th middle vagin J o I to clean agina with re idcnr b crena (Doderkin s boo/h); • nd th p reri anu I ad t the dirty rectum whi h i ceernin \ ith . (Oli. ipin fr m front t k and li carding the wipe rem. ontarnination f the urinary tra L and birth canal om rectal actcria, Perineal bygien i a lean procedure and d no r qui! the client t wear gl e.

car pr ider h ul wear glo c to adh re t univ r aJ prccauti ns.

CIUTlCAL THI G ANs~ AND RATJONALES I 289

\

2. The nurse h uld reach the parents' up that Chlam 'ma trothomplis j

no onJy neonatal conjunctiviti • but also;

A. discol ration 0 baby teeth.

B. oral thru it.

an intracellular bacterium tha cause

pneum ni in the newborn.

D. central hearin defec in infancy.

wet:

ewb rns can pneumonia manifested in t chypnea, mild hyp xia, c ugh, cosinophili and conjunctivitis

&om hlarn dia, Disc 1 red teeth are caused by tetracycline. ong nita! rubella caus e hearin d feet in infancy due to injury (0 he si; th cranial nerve. ther effec f early pr gaaney rub Ila ar congenital heart defects, congenit I cararac blindn and min ephaly. And monilial infection caused b MtldiJa AJbirans cau e ral thru h.

3. urin the tim h ur after a c arean delivery the: nurse notes tha (he eli nt's I hia has arurated one peripa

Base on the knowledge of normal lochial Ao me nur c c ndud th t this indicates:

scant lochial ow.

B. tpartum hemorrhage.

C. retained placental fragm nt .

D. I chial A ... within normal limits.

An er:

Up to two peripad can be saturated normally in th fir t hour post vaginal or ce arean deli ery. Hemorrhage would arurate m re than two pads in 1 hour. Po tpart:al hemorrha i the 10 of 5 mL r m re of blood. It is the leadin eau e of maternal monaliry, ther cau es of maternal m nali are sepsi and pregnane • induced hypcrten jon.

A birth hazard ciat d with breech deli ery may be:

. abrupti placenta. C. caput uccedaneum.

B. cephalherna oma. D. pr lap ed cord.

An wer: D

In breech pre en ri n the pr enting part i small and the c rd rna pr lap e, and rna b c mpre ed b the pr coting parr causing fetal hypoxia. Abrup '0 pi cents is as dated with PlH; i i n t attributable ro a br ch delivery. In a br ech delivery the head i n t the presentin pan bearing th brunt 0 pressure again t the pel ic oor so cephalhematom and caput ccedan um arc unlikely.

85. The nurse should anticipat melli ru swill:

pidly incr as .

B. remain unchanged.

that on the rst postpartal day the in ulin requiremen of a client with dia ere

C. dem 0 ace a I w dccreas .

D. decrease sharp] and udd nly.

An er: D

In ulin uir m n rna fall udd nly during the fir t 24 LO 48 h tpanum becaus th endocrine change f pregnancy are rcvc cd and cleo sed in ulin- mag nistic h rmones human placental lacn 0 QiP) crogen, pc ter ne and cortisol. oreover a diabetic w man in labor uall recei intravenous. Regular in ulio predisposing her to hypo ycemia in early po tpartal period.

6. u in intervention designed to d crea the 0 k f inf etion in a p r- client with an indwellin catheter:

include:

A. cleansin the area around b urina

B. empt in the catheter dralna ba t lea dail.

C. chan iog the ca he er tubing and bag ery h ur .

. D. m intaining the fluid inr ke of at least lL or 1

An wer: A

ather r ire arc i to b don . [ 1 t twice daily t preven pathogen Camerer drainage bags should alv a r be lower than the level of the bl dder, nd emptied evt!ry prevcnr urine tasi and patho n growth. Fluid intake sh uld be mere ed (200 -2500 mL ran irrigate the bladder and prevent infection.

288 I OR.. RPS MAmtNAL & NEWBOM CAM 77. M re than half the neonatal death are u eel y: . a lectasis, B. prematurity.

congenital heart disea

D. respirat cy eli tr ss yndrome,

swer: B

Death during the 6 r our w eks of life is n natal d ath, Abo r vo-rhirds of neonatal d ath are caus d by ptem ruriry; there ppears to be a correlation with teenage pregn ncy,lack of pr natal car ,n nwhin moth rs and hr rue health pc blem. tclccra i may occur from respiratory disrres • which in tum i ssoci ted with pc mr turi • the leadin cau e f n natal d ths, 0 t babies who die from congenir h n diseas die er th neonatal period.

B.

plan h uld includ :

78.

ordered.

e econd day after birth.

D.

79.

w ar cau ed by r mined

it a.:

8 . When new

. vitamin injection.

B. creening for P

An er: 8

By n \: the newborn will have ingc ted an arnpl m un f the amino jd phenylalanin , which. i 0 t m bolized becau e of a lack the Ii cr enzyme, can deposit injuriou metaboli In the blood tream and brain cau in mental retardation (phenylalanin hydro 'yla e). P can b treat WIth Lofenalac orrnula f [6-8 years to prevent retardati n. The baby will ha e a itamin injecti 0 immedir tely up n adrni sion to the nursery to prevent any bl edio obI rns. or related to a 36- to 48-h ur f rmula intake arc necr tizing enterocolitis (can occur anyrim ) and heel tick f r hypo lycemj (d ne n admission).

n n formula for 36 r

B. D.

6 wee po t:partum.

1.

it did

An wer:

A diaphragm hould be refitted after each pregnancy and d liv a und 6 w

be: r fitt if the woman lose or ai a ignificanr am un f wight (15 t 20 Ib) r ha uterine: or vaginal 'urg ry. omen may usc a diaphragm for po tpartwn c nrrscepri 0 once in oluti n i c mpleted, The h Ith teachings .. en a client who inten to u the diaphragm include waiting r 6- hour aft; r coitus ore its rem val and i fter care.

CRmCAI. THIHK.lNO ANSWERS AHO RATIONALES 1287

3.

due to n vul LOt)' C cle and di 'cu

.' and ibl trcatrncn indi tin th t

muldpl /

7.

75. nev 'mother i tfeedine her 2,day-old in am and tell th h m health nu that he cann l beli ve

her D b In want bre rf ed. in, ince he 'USt fed him 2 1/2 hour a . The nur e h uld plan t reach

th client that a new om u ually houJd be nursed:

h urly.

n emand. cry 4 h

D. at 5-h ur intervals.

di pl

nu

fren regucgi ate nfrer feeding and k the nu c ifh r baby i ill. Th i n rrnal nd du to:

76.

B.

n . ri rht id aft r feedin to pr mote

B. D.

2861 DR. RPS MATE;AIW. & N OM CAlI

anum ha n r v id d and ba n t ambuJ lJ d ye . Th at with h r last mfan be needed t e cathc iz d. ri n indicate learnin ?

9.

la 'f 6 hour ,

arcan irth, the n xamin s th ient and id rifie the

me: undu u.r fingerbr dths below [h umbilicus, Thi indi arcd hat

D.

1.

ccpri will 1 be able

with

au. e it do n t allov fcrtiliz d um to b me implant d

D.

ture, ient with dia

reliac

der. An

B.

th

mo t help r her? be msk b r own

72.

iion.

be can g wan lf-e teem.

Answer. B

xpecred urc m of maternal hormone influence in full-term infan includ witch's milk, pseudomenstruation, enlarged breasts and scrotum, and lin a nigra. They ar p rt of the 's nital ri j which are normal in fullterm inf 0 . od cende c ticle or ayt rchidi m i a c ndition unrelated co rna crnal hormonal in uence but i common in male premarur neonate. By 36-38 week 0 " t ti n, the te r hould be d cending rhrou h th inguinal canal and into the scrotal ae.

65. A n mother wam to r a tfeed. he ha had n pre i u experi nee or instruction. Which of the fI II win

shoul the nur e include in ching her b ut rood nipple care?

A. wa rung nipple and breasts daily with mild. P and water to prevent infection

ke ping nippl clean with warm '\ rer and then air-dryin t pr rent crackin and infection co ering the nipples with a plastic-tined br t hield to protect clothing

void wearing bra [ pre nt nipple irrieadon

r f r nippl is daily b th and change of underwear. ipple hould be dean ed with ided are me ollowing: ap because

66. Th plan f c d by our c. for pareo f drug-d p ndear baby include :

r commendati n for minimal contact tween par nes and the infant.

way 0 cnco par rn- ofant bonding and 0 iti e parental . pon e 0 the bab .

eli couraging artachrnen bel': e n th parents and baby.

D. cknowl gemen that drug-depen em parent are I likely to be inrere ted in their ba i

r:

Provi e ample opportunid ~ r maximized parents-infant contra t. positive parent-infant nding and l' pon

to th baby aJI ncou d; chis may help m tivare paren t enter drug rehabilita ion. The nur e cannot assume that drug-dependent paren are 1 likely be interested in their ba ies. Eno w:age paren provide:

p nalized care . the infant as this maximize parent-infant c ntact and promotes anachment/bondin .

67. Th nu e j to ign. a nurse' aide in the po tpartum unit car f r th pa' en . The aide h a common c. ld

that day. but no other health pr blems. \'Qhich patien shoul the nur not del te (0 this nurse aide.

, w man with controlled PH fI r BP

B. woman who h infected pi i myw und monitoring for daiJ p ricare. w man who ru d dy ocia

D. woman who ha AID

Answer: D

The woman with AID has compt mi d immunity. The nurse hould no igo thi patient to a health care provider wh h a viral or infecti u illness like c mmon c ldi beta c the aide can easil lnf cr the client with AlD . Thi is an application f th principle of rver e i lation v h re he client i pr tected from envir nrncntal microorgani m .

68. w man in the postpartum t h a diagnosi of deep ein thrornbosi (DVl) and i n umadin

treatment. Which in truction is important £ r the au e n include in ~ealth teaching?

'Have our blo checked for bl eding imc."

B. ''R £rain IT m eating green and leafy vegeeabl ."

, 0 no become pre an Or th m nth . ' "Take pirin for painful nd swollen perineal woun

n Coumadin

2841 DR. RPS MATERNAL & NE\N8ORH c .....

61. Th breastfeeding mother a ks the nu e "If my b by g protection from my milk, will it still b nece sary

to submit him for vaccination again t c mmon childhood diseases? ' The nu nswer h uJd be based on

an under tanding th t:

th mother can PI' teet bee b by again the di e es th t h he elf i PI) tected from; yet even with brcastfoecting, the aby need t be ccin ted against disease that the mother isn't pc tected from.

B. brea milk j compler 00 only in nutrien but so in antib dies again t all childhood dise e. to accinate or not to vaccinate i m ing t be di cu ed with her pediatrician.

D. brea t£ eding m y delay the need to v ccina early; but the iafan; still need be immunized again r

c mm n childh di eases,

An er:

If the m ther is immune to ari us childh eli ase became he enacted the disea es hersel (natural, ac ive immunity) or by receiving immunization in cluldbood (artificial acti e immunity) or for m rea ns received an ibodic / gamma globulin (artificial, pas ive immunity), men sh can tran ~ r the e an ibodie n her f tu through placental barrier, But If be no have antibodies again the comm n childhood eli then 'he ba nothing to 0 er t her fetu . b id ) natural pie immunity 0 e nly temp racy protec ion. The breastfed inf nt till need t rccei e immunizati n, 10 l gal bas of immuaiza 'on of children un er

eight yea Id include: 1) P . 9 6 f 1976: compulsory immunizad n of children bel eight ear f age again t rubercuL is, diphtheria, pert\.! S1 tetanus, measle and poli myelin, nd poli m elitis; 2) . o. 6972 of 199 . an ac establishing a Da are enter in ev ry baranga and provides the completion of the immunizati n erie for pre endon ofTB D P, T, mea le and poliornycliti ; 3) R. . o. 46 of 1994: n act [' quiring compuls ry immunization againSt h patiti B fi r in ants and children below ei be year ld.

62. 3 -y -old v man, 17 has deli ered heal hy term female n nate by 10 cervical ce arean delivery due

CJ a 0 rueassuriog etal h rr race trado. t 2 h urs P rpartum, U as es the clien 's retenti n catheter and observe th t the clien urine i red tinged. Which of the ollowing h uld you d ne: t?

A. ntacr the client' phy ician for further ord

B. ontinue t m nin r the diem s input and utpu

C. Palpate th client' n u genu e cry 15 minutes.

s 'c th pi cement of the retention catheter.

An wer:

Th finding of a red- tinged urine i abn anal and rna indic te that

ehe ces rean deliv ry. ou sh ul notify the physician as nap sible abou he urine color. ontinuin

t monitor the ellen's input and output should be done a ter the ph sician i c ntacted, Pal atin the fundus every 15 minutes i no nece ru:y unl th eli or' fundus becom soft or 'boggy." e smen of the retenti 0 catheter i . 0 rmaJ rt 0 the elimination assessment by tile nu e, but di placement i n t the cau of the red-tinged urine.

6 . In c sing a new moth s respon e to her

nurse expect t find pr ent?

talkadven and dependency

B. .autl D my d ind pendence

on birth 00 the 6.cst po artum d y which behavi r d

th

di intere t 10 her wn body function

D. interest in I ming t care f r th baby

Ans er:

TaJkativeo dep ndeney, and passivity arc all sign of the • taking-in" phase the po tpartuD'l pre at 00 day 1-3 po tpartum. Thi ph e is ch racrerized by depending and elf-centeredne s; the t orne to give instrucri n on elf-care. Th m ther need nurturin and P itivc reinforcement. "Taking-hold" pha e (day

14) is the phase when he woman is m re intere ted in her baby; the r time to give in tructi 0 on infant

care.

64. The po tpanum mother expresse concern 0 er the sage of Ught aginaJ bl ding of her baby. The nurse's

response shall incorporate the 'influence f mat mal hermon on me new m. Which is not an exp cted utc m f maternal bonne inB eace, an therefore should b reported?

• itch' milk. "

B. nde cended t ode

C. light gina1 bleeding D. Linea nigra

F [

C IT1CAl THI PtG AllIS RS AHO RATIONAlEs 1283

Dunn. h m

lienr k what c ntrac prion m th m t appropri (C m rh d r. r tb nut n

h uld use

59.

.. 1b nurse pc

tabl s,

crum calcium f c. ium-rich

6 . I mmunlry tran ferr d to th fetu from an immune m th r throu h br tmilk i :

j\. acti natural irnrnuruty; pctman nt pa ive natural immunity; t mp rary

B. ti arti oal immuni ; rem rar)' . pa Tv < rifici I immunity; permanent

B.

2821011. RPS MAWtHAL & N.EW8C)fIH CAAf.

ph! bid which nursing implemen ti 0 w d b moat appropriate.

3. T

ation th I w r tr miri

D.

agulan

5.

mplain

p in her right calf.

at as e sment technique

f alf rnu de

rh thi h

f maternal m rralit . If a u c rnplains

inflamm j n: r does (rub r), inflammati n (tumo ). rh n

55.

pill . ntraindication

3. urina

4. hypertension 1 ·4

1,2 &4

56. 3O-y ar- ld multipara client ha be n pc crib d om ined ral contraceptives pill method irth

ott L Th nu in rruc the: client that decrea d e ctiven m y cur if h client j pr cribcd with;

Indomethacin (Indocio).

Am i illin. Amimptylin D. mep z I

CIV'IlCAL THI ING A

S N/O RAT10f0/AJ.£S 1281

49. When performing a eli. cha e reaching for a normal po tpa rum client. he our e h uld info her en t;

A. she may no have any bowel m vemen r up to a week after deli

B. the episior m utur will be removed at th ir po tpartum vi it,

C. he has to come for checkup '\ hen her men rerum.

D. th P rineal tightening exe i e Started aft r elivery hould c minued indefini I.

Poll wing deli ery, the nurse teaches eli n 0 cleanse her episi com t preven infccti n. Th nurse derermin that the reaching was eft; c ive " hen d,C client

chan her perineal pad. rwic dail.

B. rinses with water fter appl ring an analge ic spray.

wa h her h nds bef re an after changing her P tineal pads.

D. cleanses her perineum from the am toward the symphysi pubi .

51. Jane, .P4' i h ur postpartum. hile br tfeeding he tell the nur «I m h ing ) I of cram pin

didn't happen when I nur ed my other babie ." Which of the f, Uowing w uld be he nur c's bes rc pon e?

A. I will n cify your doer r. It' iblc ths t there ar some plae ntal fragm nrs rem nmg.

B. "I n to check your lochial B w. Y U may have cl r thar i being dislodeed.'

u are having normal afterpain ."

D. 'The cram jng is n anal and i cau ed by or baby' udcing, which 'rimulae the: ( xyt cin.'

An er: D The cramping i cau d b r the baby' sucking and ub crarnpin i n rmal and is termed . fterpain bu by sim ly aying it i afterpains will not explain th cau and will e ineffecti e in allayin anxiety. x lain that with ach ub

m rched" and the r 1 e of 0 ytocin cau th uterus 0 ontract h re ultin 10 the fi din

nd more cramping. Facto to afterpain include brcastfeeding xyt cin and multi ariry.

52. Lactating po rp rturn clien often do not return [0 men trua 'on for ev ral months fter deli until the di continue bee. [feeding. Given rhi iruation which 0 the f U wing hould rhe nur th e clients?

A. A long th yare breastfeeding, their e tr gcn levels will n t r tum to normal 1 vels. vul ci n I DO suppres ed and pregnancy' pos i 1 e en though they. brea tf din Th uterus will no rerum l it norm ize while they re brea eedin.

D. If they do n t be in t menstruate in three month, they should br asrf eding.

o t totally suppr

280 I DR. RPS MAT!JUW. & NEWBO~ CARE

In pite f pren tal and to tal m tivati naJ eachin lated t br rfecdin po t pactum Jane decides to

b rdef ed her baby. Which of the foll win statemen means h need mor health run?

I'll take th medication £i [ pain pr crib by rh d C Of."

B. "Ill take the ill ordered Y my d crt h Ip 'top the producti 0 f milk. I

. '1'JI pump my breasts and use warm ck to relieve br disc mfon.'

D. "I U u e tight bra and ic pack to r lj e engorgement eli comf rt.

An

ts, the more milk will be produced. r a non-lactating mother the

tirnulate more milk secretion cau in crncn and disc rnf rt.

S. ~t' me normal period f tim between deli ery and di A. four weeks B. i w k

5 t their Xl rmal ta ?

46. In ell cus log P to tal nuuiti n, which of th foUowing do the nur e c n idcr?

1. breas eding eli n hould have n in rea f 3 calorie daily.

2. itamins and minerals, e pecially vitamin and in n will haVi (; c incrca ed in the pucrpe di t,

3. Fluid will b limited 1 , m 2 mL

4. F od high in r idue willha to be limited .

. 1&2 1 4

. 2 1.2. & 4

feeding)

kcal (bre t[; eding);

7.

m her b t, The nur e houJd re pond .

4 . The nurse i awar that one 0 the factor in Auencing th . milk ejection r letd wn refl in the c ring woman

i the: '

mount of erectile ri sue in the nlppJ . ag few man a: the time f delivery.

attitude of the w man amily ward br feedinz.

D. amoun of milk nd milk produc consumed durin pregnancy.

ANsWERS FV.1'IOMLES I 279

39. In th takin -u, pha .which f the 011 normalcy 0 her infan

B. her hu b nd's t' spon l the b. b

de rnf IT

D.

Th B.

I: •

unplanned pr ocy.

D. lack of rna emal uppon y rem.

41.

e C Deem over h r ina Wry have: ad quat milk for her ab.

uc es ful brea tfeeding?

. ch f be Uowing

letd wn reB x

D. r tin rcA.

2.

ncoura sitz b th

by:

hen ked' on' m mall reasrs af ct the am un

milk. '

milk produced.'

rn bre

An

278 I DR. RPS MA~AL & NEWBOftH CAlI£:

35.

ttm the n 109 ti nth t b P m t th

hrn ~pr

(W en th m mer and

B. C.

y.

fa [0 the m

36.

nu e palpa a finn, uterine ~

gnize that thi Ending rna indi ate; ~.,

A. B .

.

O.

An w r:A

[1 hour fter ivcry, the fun us i expected to finn, midline and at the Ie el 0 th umbilicus. If ir j n

in th midline and in. ( d, displaced to the id (right or left) the nurs h uld u, peel bladder di ncntion. Th . • app priat initial etion i to palpate h low r abdomen for a full bJ dd r; stimulat oiding when pre imple rn a sure • to emulate: iding Include letting clien hear und f running water, lternaring and cold perineal Au hing, and pr vidin privacy.

B. D.

in he mi line and at 1 m ow the

cu l intcrpretari n th n 'mply

a full bladder j places th uterus upward and (

6P~. \ a a e ed two hour a t r deli v _ry a g baby boy. Th fundu w,

in impl menu ti n i a rioriryi

ggy midline

rm.

er: B

F r andmultipara h rio k f r P lP r al uterine tony and hero rrh j ery hlgh; her ut rinc fundu

ha to e monitored & qucndy eery 15 t 30 minut , durin 7 the r co ery period. The Nndin of a b ggy utero above [he urn ilicu is n indication for immediate uterine rna sage until it i finn. The palpati n the bladd r at thi orne: is 00 a pri riry b cue a midline fundu indicate rna i is not b ing displaced by a full bladder. The pby ici n ne d t b ummoned if the uteru fall to contract

and bl d I i increa in . you I R lea a pucrpe with urerin at oy 1 oe tcrine atony i th

leading caus of maternal m rr Ii r.

CAfTlCAL T"I 0 W£RS AND RAf'fOHAtES I 277

r complicated

n th fir [p rpartum day, you ooscrv airl

hem rrhoi or dditional reaching?

D.

Answer: A

Th clien b uld lie in th im po I n a much as po ibl to aid en u return I the rectal ar nd [:

reduce di c mfort, code manual replacement f the bern rrhoid i an p ropri re m ure to help relieve the di comfort and p vent enlargement. nal ic spray nd wit h hazel pa are helpful in reducing the di comfort of hem rrhoids, Drinking I 0 water and ating rougha aid in bowel eliminati n, minimizing me risk or training and su scqu nr hemorrhoid d v rei pmcD or cnlar em nt, Th m t ornmon caus e hemorrh i i pre ancy.

f a chill

D crcs the rat intra eo us fluids.

e the amount of blood 1 s.

on care c h me. Which of the U wing

hy ical nd mental r t, To implement this he hould i br nd a oid tr fuJ situation, he hould

afternoon nap. id heavy meal and take ample

ilion i an upri ht po ition like rni- wier's.

276 I OA. RPS MATERHAL & NfiWIIOM CAM

2 . wing the admini tration of methyJer ono ine maleate cthergin ) to a woman in the imm diate

srparrum, the nurse evaluates th medicari 0 as . e when thi i verbalized:

c. lit n 'W I can I p.' C. "My afterpains are reall trong."

B. "1 f 11 MU eated. D. 'The pain is less inten e:'

age her ureru

29. . Juan is tin on her coo po tpartum day.lndu ed in the teaching

pL'l11 th ten ial ri nth. ri ks the nurse caution' Mr .Ju n (0 avoid:

A. sunlight for 3 day.

B. crarching the injection site.

pregnancy for 23m nth after th ccinati n.

sexual interc ur f r 2 to 3 m nth after the v ccina ion.

An wer: C

M emal erman m asle or rubella and congenital rubella can be prcv~t d by receiving the rubella vaccine. J f w m 0 i £i UI1d t ri k in pregnancy, she h uld be immunized in he immediate postpartum. R in pI gnancy, and av id pregnancy f, r at lea t 1 m n r fo b nee protecd a, 2 [0 3 m nth after a tin tion, Because: of the: potential . k involved i is t en ure dun an informed cons nt is obtained. The vaccin . i n t c ntraindicated in w men who are brea eedin r wh at exually cove. Rubella vaccine should

n t be giv n with Rh i will e. render d n n-p rent.

30. Th n e.i carin r multiparous client after agi.oal deliv of et of male ideo 'cal twin tw h urs

all' . Which f the following hould the nurse encourage: the the parent'S t do?

A. Botdefeed th twins to pre em maternal xhau ti n.

B. Relate t tach twin indi idu U T t Mance the artachm nt proc s.

Plan ~ r each par nt t pend qual am un f time with each twin.

D. oid assi ran e rom other famil members and upport groups.

bee me attached to

C«mCAL T

oAN SMORA ~1275

22.

f th uterus I :

umbili u .

nurse plain hat th intrauterine device

24.

or ral ntra cpriv . Which of the follo in would the provider immediat ly?

nau ca

O. mild head me:

25.

li nl tell the nurse that he' u in moo" xypr t

th client to incr. her intake of which f h

ern) or ontraceprion.

26.

Th nurs in truces dl n a-lactating client nor to • pr

can lead to which me f 11 win ?

. overfeedin

B. pica 'on of the f rmula D.

p' tb bottle while f din

e neonate be u

thi

tooth decay in th rmativc m

u den infant death syndrom

it can I d to aspiration. del red bonding, ~ lin of mi trust quickly imple

19. The nurse is j ed to d a hom c erna and a slight f er are n ted. in truct her t :

eleva the le

B. decrea e I em nt

27"1 DR.. RPS KAlal & NEW8CWI CARE

18. ich f the following m ur hould the our ex ct t includ in the tea hing plan for a multi ar

client who d liv red 24 h or ) and i ceiving in enou anribi tic th rap' fi r ti . ?

limiting raJ fluid in k t 1 L daily.

B. emptying the bJacid r e 2 t 4 h

a, hing the p 'rineum with povid ne iodin ( eta in ) after voidi

D. avoidin the intak )f cidic fruit juic until tho tt atment i di continued.

en B

dtis is inflarnmari n f the urinary lad day, avi id urinary ta i by regular voiding -rich juices and dequs perineal hygien B bing f m front [ b k, Th r i n need fi r i

wa h when the part infected i the urinary bladder. nether ffectivc measur 0 pre ntin cove wom n i to oid aft r coitus.

visi fi r a new m th r in 00 we k p rpartum. to the as sment,

id om advising her ee he physici n immedi tel th nur

appl warmth to rh leg

D. All of the b ve

An wer: D

The li 0 has all the sign f throm phlebiti which can b managed b eire t with 1

applic. '00 and an' agulation with dru urn as Heparin and oumadin, Throm by arly po rpartal ambulati n,

2.

ec nd P tp rtum day after havin a vaginal deliv ry es m nt, \Vba i me be p

the ch

21. Thirty- ix h urs after a aginaJ delive • a multipa us clien is di ed with endometriti ue t fJ-h 'fI1ofytic

IIn!pIlJCO«m. 0 asse in the eli nt, -; hich f the ~ 11 win w uld the au c ~C[ to find?

fev [and chills

11. browni h an ul I chia

. mar ed abd minal tcnderne . all of rh ab e.

3. l

f'

F Uowing deli ry of health baby the nurse complete po tpactum a

of the II wing mptom w uld indi tiv of Ii full bladder?

· increa ed uterin conrracti n C. ecr ed lochi

B. fundu 2F ab ve umbilicus to the id D. pulse 52 bpm

An wee: B'

If the bla der is full, it will push the ureru up u f the pelvis ab ve the umbilicus and [ either left or right side, The uteru will not contract ufficicotly, which could lead to ina d bleeding r I chia and increased

pulse rate. The puerpera' pulse may ran m 60-8 pm. sli he bradycardia i n rmal in th pu rpe:ra.

ment 0 tb new m ther. Which

Mrs. e, II po {CC arean ecti n, i bein cated for throrn phlebitis. Th nur e know th t the clien 5

re pon e n treatmen will be e aluated by regularly a e sing the client f r:

d uria, fr qucncy urg ncy. hematuria, ecchymo i • an epistaxis.

B. red, wollen, painful calf D. udden chest pain and d s

While th i a es ing mother's perineum on her 3rd po tpartum day after h ving vaginal delivery.

he nores large ecchymo ic area I cared to the lefr of the mother' p meum. Whl h ne the foU win

intervention hould the RN initiate this tim ? A. Have the client c: p sc the arc to, ir.

B. ppl ice to the perineum. .

• IlC urage the client [ take warm itz b h.

O. Inform the ph ici n TAT.

An wet: C

itz bath are u eful if the erin um has been traum tized, because th mit heat incr ase circulation t the area t promon healing, tela es ti uc: and decreas edema. itz bath j usuall not u ed in the fi 'l 24 h urs after deli cry if the eli nt has perineal w unds nd repair. Ic i effective immc:d.ia el ter birth t reduce edema and d' c mort, bur not on the 2nd rparrum day. The hy ician is n notified of bruising. but j a hematoma j presen, then the ph)' ician is notified.

ben teaching a multip ra, which fac r to puerperal in eetion?

A. maternal a older than

B. frequ nt vaginal e

f the followio houJd the nurs mention a the most c mmon contributin

of 300 m during d li ery

D.

An we:r:

Inva i e pr frequent vaginal examination in lab

intacr can b factor to puerp ral ep is. n mia, prenatal and intranatal (l' sultin m exces I s of blood 5 mL and abo e) i an important factor. P olonged, difficult La or (dystocia) may als be a factor and usuall r

OT precipitated labor. an important precaution avoid frequent internal vaginal examin tion ) during

1 bor: one IE evezy four h ur i acccp ble.

17. po tpartum client wh bas had complic tion f th mbophlebiti ud cnl c mplain f chest pain an

dyspnea. Prior l inforrnin the care pr vidcr, the nurse hould ass th client

· levcl 0 c . usne ~. fundal height.

· Homan vital igns.

An er:D

Labor, exhau . n ad deb dration, imm biliry facr urgery and epidural an sthe ia, plus

de ated p ges crone 1 el which increase brinogen and thus bl coagul ility, Ilt aJ.I factO the

dcv pmen f thr mbosi and thrornb emboli m. Two maio type f thrombo i during puerperium are

uperficial thr mbophlebiti and de p vein thrornb i. dcfiniti c sign of thr mbophlebiti i 'H man's

sign' which m be demon trated by an incn e in calf pain with dor iflexi n rh f complic . n of

272 lOR. RPS MAmuw. & NEW80RH CARl

9. llowing epi io my and delivery fa newb In infan the nurs orm a perineal s es meat

mother, The ours 0 res a trickle of right red blood coming & m the erineum, The nurse fundu and n tes mar i i firm. Tb our e det rrninc that:

A. th.i i a normal expecta 'on f U wing episiotomy,

B. the perineal rnenr should be performed more frequently.

th . bright red bleeding is abnormal and • h uld be r ported,

rh mother shoul e aU wed b throom privileges only.

",n"Ul'''r: C

The Ieadin cause of early po rparral bleeding is uterine atony manife t d by pr fuse bleeding and ft. boggy uterus. The cardinal sign f lace ran ns i bright red vaginal bleeding in the pre ence f firm fundu .

when th e ian rmal vaginal bleedin 1 in a po tpartum woman, the { nur iog acti a i ( check the

fundus; rna sage when soft until finn. Bu when the fundus is finn in the p ence of vaginal bleedin ,ch ck for laceration and rep rt s t, Th phy lcian will thorou bly examine the rcpr uctiv trac f r I cerati 0 and make the n c ary repair. Bleeding in the pr oee of an inc mplete placenta is du t r tain d placental

membrane • the leading cause of tal rpartal bleeding.

10. nur e i as igned l do a home visit for a new m thcr in on week P tp rtum.ln the as c sment, the nurse

found chat her 1 ft calf j wollen, warm touch: r ddencd and painful. Temp rature i 37. 0c. ide from

advisin her 0 c the ph 'ciao immediately the nu h uld tell her that he h uld OOt

A decrea e I movement.

B. apply \: armih 0 the le .

elevate th leg.

D. endy rna age the paiafuJ area of the leg.

Answer:

The sib'11 gi 0 indicate leg thrombophJe itis. The nurse may validate by elicldn the Horn ' ign. Thi war n rnedi al ttenti 0 and treatment, 00 y mana~,'emeot includes I elev ri n, hea application, and anricoaguJant eparin 0 umadin) preparsti n, The area h uJd 00 rna d t prevent emboli m. The sen a '00 f sudden che ( pain in a client with leg rhrornbophl bitis j a danger ign f pulm nary embolism.

11. gravida 2 pant t client delivered full-reno newbern 12 hour . The nurs find her utero to be be>gbl)'.

high, and d . red 0 the right. The m t appr p . te ou ill action it:

n tify the ph ician, .

B. place the client on a pad count.

mas age the uterus and reevaluate in 3 rninun

D. have the client v id and then reevalu te the fundus.

Ans er: D

The rn t common <:aUS of p tpartal ut cine di 1 cern nt is a full bladder. Th ours h uld initiate a ti 0 to remove the most &equ nt cau e of uterine i placement, which tOV Iv . emptying he bladder. a

m r firm the uteru temp rarity, ut if a full bl dder i n t mptied, the uterus will rem in eli plac :d and i likel t relax again. The puerperal client h old b in tructcd to oid regularly even in th b ence of

en ati n to v H

12. A client deliv red her first-born s n four hours . he asks the nurse wha th ~ hit ch elike su lance

under the baby's arm is. Th nurse h uld re pond;

'This i a normal kin variation in new om that a\V2y in a few weeks."

"The baby rna r ha e a kin infection.

"Thi material, called ernix, coy d th bab r ef re it wa born. t wiU disapp at in a few day.'

D. "Babie s mctimes ha e ebaceous glands th e plu d at birth. Thi ub ranee is an ample 0 that

c nditi 0."

wee: C

Thi r pense 0 erectly id ntifies thi neonatal variati nand help th client unde rand simpl medical terms weU the characteristics of her newborn. T simply ay it i normal does no ach the client medical terms that m be useful in understanding other hcalthc re pe onnel. J n giving clien in truCUOD and teachin

imple t ems and av id highly technical words. V mix ca a i mor on the kin f term n 03

e ce v mix may be pread (and n t washed away) in rder [0 help warm the 0 om.

"1 f get pregn nt s in, ill J ne to ha e a keep in mind ab ut vaginal birth aft r cc ean deli cry

B. D. ADs

for ge tati nal g .

6.

of he e

o.

mort.

re cramps r afterpain 2 hour after e. at an the fi llo . ?

dju tm nt reaction haracterized by cl pre :lCId cryinE7' TIll i a comm n

arriza Robinst n, 1997) u uall

~ 3 THE POSTNATAL PERIOD

~

2.

ethcrgin) y mouth dwiog the fin and most im rtanr [ che k the \: man's:

B. D.

3.

1 1° . The roo tQPpr

numng acti n ito:

ral epsis.

or nipple orene during f. dings, rhe e following?

4.

same way f reach prev ot rep at d th nippl