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: Estrogen and Progesterone
Prolactin also rises during pregnancy
Oxytocin is necessary for letdown (milk ejection)
The 3 greatest risks in the post-Partum period?
Hemorrhage, infection and shock
Movement of heat away from the body occurs when the newborns have direct contact with objects that are cooler.
a. Evaporation
b. Convection
c. Conduction
d. Radiation
Correct is conduction
Evaporation: airdrying of the skin
Convection: Transfer of heat from the infant to surrounding areas.
Radiation: transfer of heat to cooler areas.
A new mother asks the nurse why the baby is dried off with towels before skin-to-skin contact. The nurse answers.
A. to prevent conduction
B. To prevent convection
C. To warm the infant through the process of radiation.
D. To prevent the loss of heat through the process of evaporation.
the four primary mechanisms by which heat is transferred from a body to its surroundings
A. No. Conduction occurs through direct contact
B. No. Convection occurs through moving air or liquid
C. No. Radiation occurs through electromagnetic waves.
D. Yes. Evaporation through the phase change of liquid to gas, taking heat with it as it evaporates.
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
Shoulder dystocia. The infants head emerges and then retracts.
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+
Moms who are Rh negative 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 second trimester between 26 and 28 weeks and within 72 hours after birth.
What is the role of oxytocin?
Coordinate and generate uterine contractions
Facilitates the letdown reflex. (More readily available than prolactin).
In the first 24 hours in a term infant blood sugar should be:
a. 70-100 mg/dl
b. 50-70 mg/dl
c. 40-60 mg/dl
d. 50-90 mg/dl
40-60mg/dl the first 24hrs
50-90 mg/dl thereafter
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
Failure to progress in labor is known as __________
and occurs in the ____________phase of labor.
1. Labor dystocia. A delay or difficult labor.
2. Early latent phase or active phases.
A breastfeeding mother is 10 days post-partum. Her breasts are hard and firm. The RN instructs the mother
a. Apply an ice pack to the breasts
b. Apply a hot pack to the breasts
c. Breastfeed more frequently
d. 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 at birth? and at 24 hrs.?
After birth: midway between umbilicus and symphysis pubis
24 hours: 1 cm below umbilicus and is firm and midline
A nursing student is performing an initial newborn assessment. The newborn is observed to have a caput succedaneum. What are likely causes of this condition? Select all that apply.
a. Scheduled cesarean delivery.
b. Prolonged second stage of labor.
c. Breech presentation.
d. Vacuum-assisted vaginal delivery.
e. Prolonged active phase of labor.
Correct: B, D, E
True/false: Acrocyanosis within the first 24 hours of birth indicates a serious cardiac anomaly.
False: This is a normal manifestation and is due to poor perfusion of blood to the periphery of the extremities.
The nurse knows maternal pushing efforts are which of the 4P's _______?
1. Powers. Contractions and Maternal pushing efforts.
2. Passage. Bony structures
3. Passenger. Infant and uterus
4. Psyche. Anxiety, culture, birth experience, support.
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 daily
D Continue to breastfeed
E. Apply heat directly to the breasts
F. Temporarily stop breastfeeding
A. Yes. Keep the breast well supported in a well-fitting, comfortable bra
B. Yes. Fatigue is common
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. Emptying the breasts and will clear out milk ducts
E. Heat can increase inflammation and worsen mastitis
F. Continued breastfeeding is recommended
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.
Second stage is attachment in Making (6 weeks to 6-8 months).
Third stage is clear-cut attachment (6-8 months to 18-24 months).
Fourth stage is formation of Reciprocal Relationships (24 months +)
Education regarding breast feeding includes (select all that apply).
A. At least 2 bowel movements 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.
B., D.
Breast milk is digested more quickly than formula. 8-12 times a day is appropriate (Q 2-3 hours).
If the breasts gets soft that is completely normal and does not indicate a decrease in production.
A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first?
a. Assess Apgar score.
b. Remove wet blankets.
c. Insert eye prophylaxis.
d. Elicit the Moro reflex.
A. No. the one-minute Apgar score to assess how the infant tolerated the birthing process.
B. Yes. Immediately remove wet blankets
C. No. Typically administered one hour after birth
D. No. primitive reflexes such as the Moro are typically evaluated after the above is completed.
The artificial rupture of the membranes are known as _____________. Is performed in conjunction with _____________.
1. Amniotomy 2. Induction
The new mother asks what is the best way to feed the infant with mastitis?
Start on the affected breast. Breastfeed on the side with mastitis first to relieve some of the pressure.
What are at least 3 important discharge instructions the nurse should discuss with the new mother?
Bleeding and soaking through more than 1 pad/hr. Blood clots the size of an egg or bigger. An incision that isn't healing. A red or swollen leg that's painful or warm to the touch. Chest pain or difficulty breathing. Thoughts of self-harm or harm to infant.
The Babinski reflex in infants and early toddlers presents in the following manner:
A. The sole is stroked, the big toe lifts upward and the other toes fan out
B. The sole is stroked, and all of 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, and all of the toes bend downward
A. Yes. This is a normal reflex until 12-24 months
Results from a delay in fluid absorption of the fetal lungs.
A. RDS: respiratory distress syndrome
B. TTN: Transient tachypnea of the newborn
C. Normal breathing process of the newborn lasting 24 hours or less.
D. Causes neonatal asthma.
B. TT: Some reasons include macrosomia, c/s, prolonged labor, prematurity with low surfactant production. (lipid and proteins with a specific function to reduce surface tension).
The provider informs the nurse that they suspect chorioamnionitis. The nurse knows this is a serious infection of the amniotic sac and presents with
A. Sweet-smelling fluid
B. Foul smelling fluid
C. Brownish colored fluid
D. Yellow colored fluid
E. Polyhydramnios
B. Foul-smelling fluid.
D. yellow or (cloudy fluid).
A common cause of preterm labor and delivery.