MCN Post partum

50問 • 1年前

問題一覧

Tasha Salad, student, 18 years old, primigravida, delivered to a baby boy forty hours ago. Transition from being single to being a mother entails strengths and courage. The response to change maybe different for every person. The patient has been seen crying and irritable. As her nurse, you know that Tasha is experiencing "baby blues". Which is the BEST description of her condition? It is a condition in which the patient experiences some feelings of

sadness

Related to hormonal changes

Tasha Salad, student, 18 years old, primigravida, delivered to a baby boy forty hours ago. Transition from being single to being a mother entails strengths and courage. The response to change maybe different for every person. In planning to help Tasha, the nurse has explained to her on the cause of baby blues, which ONE is these?

Increase or decrease on the levels of estrogen and progesterone.

Tasha Salad, student, 18 years old, primigravida, delivered to a baby boy forty hours ago. Transition from being single to being a mother entails strengths and courage. The response to change maybe different for every person. As a nurse, you should know the manifestations that Aira can present anytime. These are the following: 1. Crying 2. Anorexia 3. Feeling of inadequacy 4. Isolation 5. Disturbed sleep 6. Mood swings

1, 2, 3, 5, 6

Which of the following nursing measures can help Tasha in her condition? Pp blues

Support

During the postpartum period, a client can experience many changes due to hormonal fluctuations and physiological adjustments. Four hours postpartum, the client's temperature is 101°F. The most appropriate nursing action is to:

continue to monitor the temperature.

During the postpartum period, a client can experience many changes due to hormonal fluctuations and physiological adjustments. A woman is to receive ergonovine maleate (Methergine) by mouth during the first and second postpartum days. Prior to administering Methergine, it is most important to check the woman's:

blood pressure.

During the postpartum period, a client can experience many changes due to hormonal fluctuations and physiological adjustments. A multiparous client who is breastfeeding complains of severe cramps or afterpains 28 hours after cesarean delivery. The nurse explains that these are caused by:

release of oxytocin during the breastfeeding session

During the postpartum period, a client can experience many changes due to hormonal fluctuations and physiological adjustments. A postpartum client who has had complications of thrombophlebitis suddenly complains of chest pain and dyspnea. Prior to informing the care provider, the nurse should assess the client's:

vital signs.

During the postpartum period, a client can experience many changes due to hormonal fluctuations and physiological adjustments. While the RN is assessing a mother's perineum immediately after having a vaginal delivery. She notes a large ecchymotic area located to the left of the mother's perineum. Which one of the following interventions should the RN initiate at this time?

Apply ice to the perineum.

Nurse Beauty Contis is assigned at the postpartum ward. The following question refers to postpartum patients. Amy, a multiparous patient, 28 hours after Caesarian delivery (CS) who is breastfeeding, complains of severe abdominal cramps. Nurse Beauty Contis explains that these are caused by which of the following?

release of oxytocin during the breastfeeding session

Nurse Beauty Contis is assigned at the postpartum ward. The following question refers to postpartum patients. Three hours postpartum, a primiparous patient's fundus is firm and midline. On perineal inspection by Nurse Beauty Contis, she observes a small constant trickle of blood. What will the nurse suspect for the patient to have?

Perineal lacerations

Nurse Beauty Contis is assigned at the postpartum ward. The following question refers to postpartum patients. On the first postpartum day, a primiparous patient complains of perineal pain that was unrelieved by Ibuprofen 400mg given two hours ago. Nurse Beauty Contis should assess for which of the following?

Perineal hematoma.

Nurse Beauty Contis is assigned at the postpartum ward. The following question refers to postpartum patients. Twelve hours after vaginal delivery, Nurse Beauty Contis palpates the fundus of a primiparous patient and finds it to be firm, above the umbilicus and deviated to the right. What is the BEST thing for Nurse Beauty Contis to do for the patient?

Encourage patient to ambulate and to void.

Nurse Beauty Contis is assigned at the postpartum ward. The following question refers to postpartum patients. After instructing a primiparous patient about episiotomy care, which of the following indicates successful teaching?

"I will wipe from front to back using blotting motion."

It is important to provide comfort measures for the client during the fourth stage of labor. This recovery period starts with delivery of the placenta and includes at least the first 2 hours after birth. Immediately after delivery of the placenta, the nurse should be able to feel that the top of the uterus is:

firm, in the midline, above umbilicus.

When teaching a multipara, which of the following should the nurse mention as the most common contributing factor to puerperal infection?

frequent vaginal examinations during labor

A primiparous Mrs. Amanda Tori Meating is to receive a rubella vaccine on her second postpartum day. Included in the teaching plan are the potential risks of the vaccine. Based on these risks, the nurse cautions Mrs. Juan to avoid:

pregnancy for 2 to 3 months after vaccination.

The postpartum nurse is providing instructions to a client after birth of a healthy newborn. Which time frame should the nurse relay to the client regarding the return of bowel function?

3 days postpartum

The nurse is caring for four 1-day postpartum clients. Which client assessment requires the need for follow-up?

The client with lochia that is red and has a foul-smelling odor

A postpartum mother newly delivered her baby per vagina. She keeps on asking the nurse when the basic physiologic changes occur as her body returns to a pregnant state. The nurse explains to the mother that the uterus will return to its pregnancy state in _____ weeks.

six

In her capacity to teach, the nurse describes the changes of the uterus after childbirth to return to a non-pregnant state as

Involution

Which of the following conditions does the nurse explain to the patient the contributory factor that slows uterine involution?

Prolonged labor

The nurse assesses the uterine fundus of the mother. Which part of the abdomen will The nurse begin?

Umbilicus

The FIRST PRIORITY nursing intervention during the immediate postpartum period is focused on

Observing postpartum hemorrhage

In a birthing station, five postpartum mothers delivered 2 hours, 4 hours, and 6 hours ago, respectively. All of them are multigravida patients. Adalynn, the nurse educator opted to conduct health education on a postpartum hemorrhage. Nurse Adalynn explains to the mothers that early indication for hypovolemia caused by postpartum hemorrhage is

Increasing pulse and decreasing blood pressure

In a birthing station, five postpartum mothers delivered 2 hours, 4 hours, and 6 hours ago, respectively. All of them are multigravida patients. Adalynn, the nurse educator opted to conduct health education on a postpartum hemorrhage. The nurse educator Adalyn reviewed the risk factors for postpartum hemorrhage for the mothers. Which of the following factors is NOT included?

overdistended uterus

During normal postpartum course, when would the nurse expect to note fundal assessment that will be in line with the umbilicus?

Immediately after the delivery

A postpartum patient asks nurse Adalynn when she may safely resume sexual activity. Which of the following information should the nurse tell the patient on resumption of sexual activity?

After the 6-week physician check-up

Nurse Adalynn discusses the possibilities of future postpartum hemorrhage with the patients. Which of the following increases the absorption of vitamin K?

Fats

When performing a postpartum assessment on a client, the nurse notes the following situations and patients. A postpartal woman is having difficulty voiding following delivery. What should the nurse expect as the most reasonable cause for the difficulty voiding?

Perineal edema makes voiding difficult.

A patient who gave birth 5 hours ago has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first?

Assess the fundus.

A new mother is concerned that she will not have enough breast milk because of small breasts. How should the nurse respond?

"The size of breasts does not impact the amount of breast milk that is made."

The postpartum patient delivered 4 hours ago. She has a mediolateral episiotomy and large hemorrhoids. She is rating her pain at 7 on a scale of 1-10. She has a history of anaphylactic reaction to Tylenol (acetaminophen). Which nursing action would be best?

Offer the patient 800 mg Advil (ibuprofen) orally with food.

A postpartum patient is prescribed methylergonovine (Methergine) 0.2 mg for uterine subinvolution. Which action should the nurse take before administering the medication to the patient?

Measure blood pressure.

Nurse Kathy Ting is caring for a postpartum patient. Routine postpartum is rendered to the patient. Which assessment is finding would lead the nurse to suspect a postpartum hemorrhage? Blood loss of

More than 500ml/24 hours

Which is caused by the markedly distended uterus and intermittent uterine contractions within 2 to 3 days after birth?

Retained placenta

The nurse prepares a care plan for the patient. Based on Ramona Mercer's becoming a mother (BAM) theory, which statement fosters the process of becoming a mother?

It encompasses the dynamic transformation and evolution of woman's persona.

The mother asks why she has a gush of blood coming out from the vagina that occurs when she first arises from bed. The nurse's CORRECT response should be

"Because of the normal pooling of blood in the vagina when the women lies down to test or sleep”

Some postpartum mothers will experience difficulty voiding because of the edema and trauma of the perineum. Which PRIORITY nursing measures stimulate the sensation of voiding?

Running water in the sink or shower

During postpartum period following a cesarean birth, nurse examines client and identifies presence of lochia serosa and feels the fundus four fingerbreadths below the umbilicus. This indicated that time elapsed is:

4 to 5 days postpartum

You teach clients that more than half of the neonatal deaths are caused by.

prematurity.

A birth hazard associated with breech delivery:

prolapsed cord.

The nurse should anticipate that on the first postpartal day, the insulin requirements of a client with diabetes mellitus will:

demonstrates a slow decrease.

The FIRST and most important nursing action in postpartal hemorrhaging is to:

check fundus and massage if boggy.

Dracule Mihawk, 29 years old, has just given birth 3 hours ago. She asked Nurse Silvers Rayleigh to help her cope post-partially. One of the discussions was about the postpartum vaginal discharge called lochia. The nurse assesses Mihawk's perineum and noticed that the lochia discharge is moderate in amount and red in color.

rubra

When Mihawk was helped for ambulation for the first time, she mentioned that she had heavy lochial discharge. Which of the following assessment finding would BEST help Nurse Rayleigh decide that the flow is within normal limits?

The color of the flow is red

Which of the following findings would make nurse Rayleigh think that Mihawk is developing a postpartum complication?

An absence of lochia

What is the condition of Mihawk if pinkish red or reddish brown colored vaginal discharge continues to occur after 3 to 4 weeks after birth with fever, pain, and abdominal tenderness?

endometritis

It is difficult to judge the amount of lochial flow based only on observation of perineal pads. Which among the following factors should be considered as IMPORTANT indicator of complete and accurate measurement of lochia? This is the number of perineal pads saturated And

color

Astignars random QS

Kyla Angelique Son · 19問 · 1年前

Astignars random QS