Postpartum Care Of The Mother Exam NCLEX questions

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• Where should the fundus of the uterus be located 12

hours after delivery?the umbilicus

• What are the 3 types of Lochia and how long does

each last?

oLochia: fluid waste discharged after delivery

•Rubra: Bright-red drainage, first day or two after delivery

•Serosa: Pink to brown drainage; until day 7

•Alba: Yellow to white drainage: continues for an additional 10 days to 2 weeks

• What is colostrum and what color is it?yellowish tint; The first secretion produced by the breast
• What would you teach a patient about engorgement? Apply cold packs, massage your breast while breastfeeding, wear supportive bra,

stay hydrated

• What do you need to teach the bottle feeding mother

about care of her breasts after delivery and engorgement?Wear a tight-fitting bra, avoid breast stimulation, use ice packs, avoid hot showers.

• What is the normal variation in vital signs during the

postpartum period?•Vital signs usually stabilize within the first 2 hours after delivery; any abnormalities lasting longer should be reported •A temperature of 100.4 degrees or higher on 2 successive days during the first 10 days after delivery is considered indicative of a puerperal infection; the woman is monitored closely.•Bradycardia may persist up to 10 days following delivery; elevated or decreased blood pressure should be reported.

• What type of bleeding is abnormal in the postpartum

period?postpartum hemorrhage

• How do you properly assess the fundus in the

postpartum period?Place one hand on the lower uterine segment while the other hand locates the top (fundus) of the uterus.

• What interventions are appropriate for the postpartum

patient with a laceration in regards to bowel movements?Stool softeners, hydration, fiber, ice packs, medicine, sitz bath.

• What assessment is done prior to getting out of bed

after having spinal or epidural anesthesia?vital signs, pain, sensation

• What occurs during the taking in response?New mother may be somewhat passive for the first day or two; needs supportive

care

• What assessment findings would be normal for the

patient who is 1 day postpartum?fundus may be one finger breadth above or at the level of the umbilicus;

• What is priority after the nurse assesses a boggy

uterus?Massage uterus until firm

• What are warning signs that a mother may not be

bonding with her infant?Demonstrates apathy when the newborn cries, views the newborn's behavior as uncooperative during diaper changing

• What are signs of thrombophlebitis and what should

the nurse to do assess it?Pain, swelling, warmth and tenderness in extremity

• What is engrossment?Intense preoccupation or interest in the newborn
• What is hypovolemic shock and what are the signs and

symptoms?Blood loss of more than 20%; Tachycardia, pallor, mental confusion, dizzy, fainting, vomiting

• What would the nurse need to teach the new mother

about breastfeeding?•Manual pumping of the breasts may be necessary in some cases, such as an infant who is unable to suckle at the breast or a mother who must spend an extended period of time away from her infant. •Benefits of breastfeeding –There is a more rapid involution of the uterus –Mother enjoys social closeness with her infant –Human milk has antibacterial and antiviral properties, immunoglobulins, and anti- allergy factors to protect the infant.–The milk contains growth factors, digestive enzymes, and proteins

• What is the normal progression of involution? The uterus decreases in size (1cm/day)
• What assessments should be performed in regards to

the urinary system function? What limitations or hindrances may be present?Support the bladder above the symphasis pubis and palpate it to check for fullness. Assess voiding three times in measurable amounts of 300 mL or more after delivery to determine urinary elimination; May have a decreased urge to void, combined w postpartal diuresis may result in bladder distention

• What intervention would be appropriate for the

postpartum patient with a hematoma on the vulva?Cold compress, catheter, bed rest, analgesics.

• How would you explain to your postpartum patient

how to use a Peribottle for cleansing?Fill bottle with warm water, aim at perineal area and squeeze to clean

• What action needs to be taken for the postpartum

patient suffering from a persistent headache?Cold packs, sleep, dimmed/quiet room, small amounts of caffeine, massage, hydration, ibuprofen, acetaminophen

• What are the warning signs for the postpartum

period?Abdominal pain, baby blues, constipation, hemorrhoids, hormonal shift, perineum soreness, sore nipples/breast

• What medication would be appropriate in the

postpartum period for mild to moderate pain?ibuprofen and tylenol

• What time of day would infant abduction be most

likely to occur?during visiting hours

• What measures could help prevent infant abduction? Transport infant from patient room via crib; Staff required to wear appropriate ID

badges; Never leave infant unattended; Respond immediately when alarm sounds

• What observations by the nurse would indicate that

infant bonding is occurring?Mother- holding the baby, asking questions about the baby and it's health. looking into the baby's eyes and making positive comments about the baby's appearance.engaging in skin to skin contact.Father- shows engrossment and fascination with the new baby. talking with the mother and baby, assisting the mother with changing the baby and feeding.Infant- making eye contact with mother and father. making cooing noises and being most relaxed in parents arms.

• What assessment is required in the fourth stage of

labor?needs emotional support and close observations and assessment to ensure that no problems occur.

• What are signs and symptoms might the postpartum

patient experience following delivery?•Depressed mood or severe mood swings •Excessive crying •Difficulty bonding with your baby •Withdrawing from family and friends •Loss of appetite or eating much more than usual •Inability to sleep (insomnia) or sleeping too much •Overwhelming fatigue or loss of energy •Reduced interest and pleasure in activities you used to enjoy •Intense irritability and anger •Fear that you're not a good mother •Feelings of worthlessness, shame, guilt or inadequacy •Diminished ability to think clearly, concentrate or make decisions

• What are appropriate nursing diagnoses for the

breastfeeding mother?•Knowledge, deficient •Anxiety •Parenting, risk for impaired •Family processes, interrupted •Parenting, impaired •Self-esteem, situational low

•Nutrition: less than body requirements

•Nutrition: more than body requirements

•Pain, acute •Tissue integrity, impaired •Sleep pattern, disturbed

• What normal changes in mood might the postpartum

patient experience with perineal discomfort when seated?uncomfortable, unrelaxed, burning, irritation, exhaustion

• What signs/symptoms/restrictions would be included

in discharge teach of the postpartum patient?

• After delivery, the woman is instructed to make a follow-up appointment with

her PCP in 6 weeks. Infants are seen by the PCP at 2 weeks of age.

• How can the nurse facilitate attachment between

neonate and parents?Skin to skin immediately. Having the parents assist or watch the nurse change and bathe the baby. Letting the parents have an appropriate amount of alone time with the baby. Explaining to the parents what the nurse is doing to the baby during the assessment, bathing, and changing. Assisting with breast or bottle feeding.

• Be able to recognize symptoms of postpartum blues Postpartum baby blues symptoms

–last only a few days to a week or two after baby is born •Mood swings •Anxiety •Sadness •Irritability •Feeling overwhelmed •Crying •Reduced concentration •Appetite problems •Trouble sleeping postpartum psychosis signs and symptomsInability or refusal to discuss labor and birth experience • Refusal to interact with or care for baby • Refusal to discuss contraception • References to self as ugly and useless Excessive preoccupation with self (body image) • Marked depression • Lack of support system • Partner or other family members reacting negatively to baby • View of baby as messy or unattractive • Expression of disappointment over baby's sex • Baby reminding mother of family member or friend she does not like

• What discharge teaching can the nurse give to a

mother with urinary incontinence when sneezing or coughing?Do kegals and wear a pad or liner.

• Be able to recognize normal/abnormal postpartum

findings Abnormal- Passive reaction, verbal or nonverbal. Hostile reaction verbal or nonverbal. Disappointment over gender of baby. Lack of eye contact. Non- supportive interaction between parents.Normal- Making eye contact. Asking questions. Smiling at nurses and doctor.Making comments about baby's appearance. Parents excited, laughing, talking, and even crying.During a postpartum check, the nurse assesses the new mother's uterus and notes it to be boggy. What is the nurse's first intervention?

• Contact the health care provider for an oxytocic medication.
• Instruct the patient to void.
• Gently massage the fundus to increase contractility. Correct
• Direct the patient to assume a lateral position with her upper leg drawn toward

the chest.