Post Partum
What hormones prepare the breasts for lactation?
a. Estrogen and Progesterone
b. Estrogen and Prolactin
c. Prolactin and Oxytocin
d. Progesterone and Prolactin
Correct: A. Estrogen and Progesterone
Prolactin also rises during pregnancy
Oxytocin is necessary for letdown (milk ejection)
The 2 greatest risks in the postpartum period?
Hemorrhage and infection
Immediately drying a newborn after birth prevents _________________
A. Evaporation
B. Convection
C. Conduction
D. Radiation
Yes. Evaporation: Heat loss as moisture from the newborn's skin (amniotic fluid) evaporates into the surrounding air.
B. Convection: Heat loss from a newborn's body to the surrounding air, like when a cool breeze passes over their skin.
C. Conduction: Heat loss when a newborn directly touches a cooler surface, such as a cold examination table.
D. Radiation: Heat loss through a newborn's body to cooler objects nearby, even if they aren't touching.
True/false: Acrocyanosis within the first 24 hours of birth indicates a serious cardiac anomaly.
False. This is a normal manifestation and occurs due to poor perfusion of blood to the periphery of the extremities.
Intervention for a boggy uterus
Massage Fundus
When is the need for Rhogam?
a. Mother is Rh + and infant RH-
b. Mother is Rh - and infant RH+
c. Mother is Rh- and the infant is RH-
d. Mother is Rh+ and the infant is RH+
b.Rh-negative women get a RhoGAM shot to prevent Rh isoimmunization. About 15% of people are Rh-negative. If the infant is also Rh - this is not necessary. This needs to be given in the 2nd trimester between 26 and 28th week.
What is the role of oxytocin after delivery?
Causes uterine contractions to control bleeding
Facilitates the letdown reflex. (More readily available than prolactin).
In an asymptomatic newborn, between 1-2 hours old, a glucose level between 40-45 mg/dL should prompt which one of the following interventions?
A. Immediate breast or formula feeding and another glucose check-in one hour.
B. Dextrose gel and another glucose check in 15 minutes.
C. IV Dextrose with an immediate feeding, and another glucose check in 30 minutes.
D. Watch and wait. The infant's blood glucose level will rise automatically after two hours.
A. Correct. The healthy, term neonate experiences a brief, period of relatively low blood glucose during the first two hours of life. Infants are normally asymptomatic during this time and they generally respond to feeding.
B. This choice may be correct in some facilities however, checking the blood glucose level in 15 minutes is not appropriate.
C. This is not routinely done for a healthy asymptomatic infant.
D. Feeding is the treatment of choice.
The nurse observes that when a finger is placed under the toes of a newborn, the toes will curl downward. This is known as the __________?
A. Babinski reflex
B. Plantar grasp reflex
C. Tonic Neck reflex
D. Step reflex
Correct B. Planter. This causes infants to curl their toes downward when a finger is placed on the sole of their foot. This reflex lasts between 6-12 months.
A. Babinski. The toes fan out, the large toe goes upward. This reflex lasts about 1 year.
C. Tonic neck. A baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This reflex lasts about 6 months
D.Step reflex. The baby appears to take steps or dance when held upright with his or her feet touching a solid surface. This reflex lasts about 2 months.
Color of the lochia on days 1-3
Rubra
A breastfeeding mother is 7 days post-partum. Her breasts are hard and firm. The RN instructs the mother.
a. To apply an ice pack to the breasts after feeds
b. Massage the breast
c. To breastfeed more at least q2-3
d. To take a warm shower
a/b/c/d
Where is the fundus located after birth? At 24 hrs.?
After birth: At the end of the third stage of labor, the uterus is in the midline, approximately 2 cm below the level of the umbilicus, with the fundus resting on the sacral promontory. Within 12 hours, the fundus can rise to approximately 1 cm above the umbilicus By 24 hours after birth, the uterus is about the same size as it was at 20 weeks of gestation.(at the umbilicus)
Education regarding breastfeeding includes (select all that apply).
A. The infant should have 2 soft bowel movements daily by day 4.
B. At least 6 wet diapers a day by day 4.
C. Feeding on a schedule 6-8 times a day.
D. Feeding 8-12 times a day.
E. If the breast begins to get soft, contact the pediatrician to supplement with formula.
Correct: B. and D.
A. A breastfed infant will have several soft yellow seedy stools a day.
B. Six wet diapers a day indicates good fluid intake.
C. Breast milk is digested more quickly than formula. Feeding on a schedule, every 3-4 hours is not appropriate.
D. 8-12 times a day (2-3 hours or more a day ) is appropriate.
E. After a few weeks, it is completely normal for the breasts to soften. This does not indicate a decrease in milk production.
When assessing a neonate. which assessment finding is most suggestive of hypothermia?
A.Hypoglycemia
B. Metabolic alkalosis
C. Hyperglycemia
D. Shivering
A. Correct. Hypoglycemia
B. May cause metabolic acidosis
C. Hypoglycemia is expected
D. Infants do not shiver
Unrelenting perineal pain postpartum is a sign of what?
Perineal Hematoma
A nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which of the following instructions would be included on the list?
A. Wear a supportive bra
B. Rest during the acute phase
C. Stay Hydrated
D. Continue to breastfeed or pump to empty the breast
E. Full course of antibiotics
A. Yes
B. Rest and a nutritious diet helps the new mother recover from infection.
C. Drinking plenty of water will help keep your milk supply up. More milk means more feeding sessions and more opportunities to clear clogs and discomfort.
D. Breastfeeding or pumping will prevent milk stasis
E. Fully treat and prevent recurrence
Rubins Stages of Maternal Attachment
Taking in / Taking Hold/ Letting Go
Who has the most lanugo and vernix? Preterm/ Term/ Post Term
Preterm babies have copious lanugo and vernix
Results in a delay of fluid reabsorption of the fetal lungs.
A. RDS: respiratory distress syndrome
B. TTN: Transient tachypnea of the newborn
C. Normal breathing process of newborns lasting 24 hours or less.
D. An early sign of neonatal asthma.
Correct B. Transient tachypnea of the newborn. Some reasons include macrosomia, c/s, prolonged labor, and prematurity with low surfactant production.
A. RDS is caused by a lack of surfactant in the lungs.
C. Tachypnia is not a normal breathing process.
D. This is incorrect.
Signs of Subinvolution
Prolonged bleeding and papable uterus
The new mother with mastitis asks the nurse what is the best way to breastfeed her infant.
Begin on the affected breast first. Then switch to the unaffected breast
The Babinski reflex in infants and toddlers presents in the following manner:
A. The sole is stroked, and the big toe bends forward and the other toes fan out.
B. The sole is stroked, and all of the toes bend forward.
C. The sole is stroked, and the great toe fans out and the other toes bend back.
D. The sole is stroked and all of the toes fan out
A. Correct-This is a normal reflex up to about 2 yrs.
A nursing student is preparing to administer an injection of vitamin K, 1 mg IM, to a newborn. The student asks a nurse, “Where should I give the injection?” Which is the most accurate response by the nurse?
a. Gluteus maximus.
b. Vastus medialis.
c. Gluteus minimus.
d. Vastus lateralis.
Correct: D Vastus Lateralis
A nurse is performing an initial assessment on a newborn. Which of the following findings would require immediate intervention?
A. Heart rate of 140 beats per minute
B. Respiratory rate of 50 breaths per minute
C. Bluish discoloration of the hands and feet
D. Nasal flaring and grunting
A, B, and C are all normal.
D. Indicates respiratory distress or an infection.
Identify three signs of Endometritis
A. pain in uterus
B. Fever > 100.4°F on day 2
C. foul smelling lochia
D.Temperature 100 on day 1
A/B/C