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 3 greatest risks in the post-Partum period?
Infection, hemorrhage and shock
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.
Maternal pushing efforts are which of the 4P's? Fill in the blank. __________.
A. Correct. Powers: Contractions and Maternal pushing efforts.
B. Passage: Bony structures
C. Passenger: infant and placenta
D. Psyche: anxiety, culture, birth experience, support.
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+
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?
Coordinate and generate uterine contractions
Facilitates the letdown reflex. (More readily available than prolactin).
In an asymptomatic newborn, between 1-2 hours old, a glucose level between 25-40 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.
Failure to progress in labor is known as __________
and occurs in the ____________phase of labor.
1. Labor dystocia
2. Active (corrected by position changes, increase in fluids).
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
b. To apply hot pack
c. To breast feed more frequently
d. To take a warm shower
Take a warm shower which will assist in let down and soften the breast making it easier to breast feed.
Where is the fundus location after birth? At 24 hrs.?
After birth: midway between the umbilicus and symphysis pubis.
24 hours: 1 cm below the umbilicus, is firm and midline.
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. Bradycardia
B. Metabolic alkalosis
C. Hyperglycemia
D. Shivering
A. Correct. Bradycardia
B. May cause metabolic acidosis
C. Hypoglycemia is expected
D. Infants do not shiver
Turtle sign is one of the first signs of which birthing complication.
A. Footling breech
B. Posterior presentation
C. Shoulder dystocia
D. Occiput transverse position
C. Shoulder dystocia. The fetal head retracts and emerges.
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. Maintain a fluid intake of at least 3000 ml
D Continue to breast-feed if the breasts are not too sore.
E.Start on the affected breast.
F.Start on the unaffected breast.
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 will cause an engorged
E. The new infant will likely suck harder on the affected breast, emptying the breast and resulting in relief.
f. No
The RN knows that there are four stages of infant attachment. Which stage and age is the pre-attachment stage?
Pre-attachment (newborn to 6 weeks) The first stage of attachment is from birth to 6 weeks.
The second stage is attachment (6 weeks to 6-8 months).
The third stage is clear-cut attachment (6-8 months to 18-24 months).
The fourth stage is the formation of reciprocal relationships (24 months +).
The Babinski reflex in infants and toddlers up to two years of age presents in the following manner:
A. The sole is stroked, the big toe bends back and the other toes fan out.
B. The sole is stroked, and the toes bend forward.
C. The sole is stroked, the great toe fans out and the other toes bend back.
D. The sole is stroked, the big toe moves upward and the other toes fan out.
Correct D. The sole is stroked, the big toe moves upward and the other toes fan out.
The other options are incorrect.
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.
The artificial rupture of the membranes is known as _____________. Is performed in conjunction with _____________.
A. Amniotomy
B. Induction
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 two signs of Chorioamnionitis.
A. Brownish fluid
B. Yellow fluid
C. Polyhydramnios
D. Oddly sweet-smelling odor
E. Foul smelling fluid
B (or cloudy)
E. Foul smell