BF
•. A breastfeeding client with an obstetrical history of G10 P6408, delivered 10 minutes ago. Which of the following assessments is most important for the nurse to perform at this time?
•1. Pulse.
•2. Fundus.
•3. Bladder.
4. Breast.
•2. Fundus. This client’s gravidity and parity indicate that she is a grand multipara. She has been pregnant 10 times, carrying 6 babies to term and 4 babies preterm. Because her uterus has been stretched so many times, she is at high risk for uterine atony during the postpartum period. The nurse must, therefore, monitor the postpartum contraction of her uterus very carefully. Breastfeeding can assist in stimulating the uterus to contract, and as a result, this client would likely benefit from taking an anti-inflammatory medication regularly in the immediate postpartum period to reduce the pain from uterine contractions.
•A breastfeeding mother is preparing for discharge at 3 days postpartum. She is not immune to rubella and has signed a consent form to receive the rubella vaccine at discharge. Which of the following must the nurse include in the client’s discharge teaching regarding the vaccine?
•1. The client should not become pregnant for at least 4 weeks.
•2. The client should pump and dump her breast milk for 1 week.
•3. Surgical masks must be worn by the mother when she holds the baby.
•4. Antibodies transported through the breast milk will protect the baby.
•1. The client should not become pregnant for at least 4 weeks. The rubella vaccine contains a live attenuated virus. Severe birth defects can develop if the woman becomes pregnant within 4 weeks of receiving the injection.
•16. The nurse in the obstetric clinic received a telephone call from a bottle-feeding mother whose baby is 3 days old. The mother states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform?
1. Intermittently apply ice packs to her axillae and breasts.
2. Apply lanolin to her breasts and nipples every 3 hours.
3. Express milk from the breasts every 3 hours.
4. Ask the primary healthcare provider to order a milk suppressant
•1. Intermittently apply ice packs to her axillae and breasts. Breast milk is produced in the glandular tissue of the breast. An adequate blood supply to the area is required for milk production. When cold is applied to the breast, the blood vessels constrict, decreasing the blood supply to the area. This is a relatively easy, nonhazardous action that helps to suppress breast milk production.
•During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see?
•1. Diaphoresis.
•2. Lochia alba.
•3. Cracked nipples.
•4. Hypertension.
. Lochia alba. The normal progression of lochial change is as follows: lochia rubra, days 1 to 3; lochia serosa, days 3 to 10; and lochia alba, days 10 until discharge stops. There is some variation in the exact timing of the lochial changes, but it is important for the client to know that the lochia should not revert backward. In other words, if a client whose lochia is alba begins to have bright red discharge, she should notify her primary healthcare provider.
•12. A breastfeeding client has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective?
1. She pumps her breasts after each feeding.
2. She feeds her baby every 2 to 3 hours.
3. She feeds her baby 10 minutes on each side.
4. She supplements each feeding with formula.
•2. She feeds her baby every 2 to 3 hours. The best way to prevent engorgement is to feed the baby on demand, or at least every 2 to 3 hours.
A nurse is assessing a client who is considering oral contraceptives. Which of the following findings is a contraindication?
A. History of thrombophlebitis
B. Regular menstrual cycles
C. No history of breast cancer
D. No history of liver disease
A. History of thrombophlebitis
•17. A multigravid, postpartum client reports severe abdominal cramping whenever she nurses her baby. Which of the following responses by the nurse is appropriate?
•1. Suggest that the client bottle feed for a few days.
•2. Instruct the client on how to massage her fundus.
•3. Instruct the client to feed using an alternate position.
•4. Discuss the action of breastfeeding hormones.
•4. Discuss the action of breastfeeding hormones. Oxytocin, the hormone of labor, also stimulates the uterus to contract in the postpartum period to reduce blood loss at the placental site. Oxytocin is the same hormone that regulates the milk ejection reflex. Therefore, whenever a mother breastfeeds, oxytocin stimulates her uterus to contract. In essence, breastfeeding benefits the mother naturally by contracting the uterus and preventing excessive bleeding. Taking a prescribed anti-inflammatory medication such as ibuprofen at least 30 minutes before breastfeeding can be of help for those with severe discomfort.
A nurse is counseling a client about the use of copper IUDs. Which of the following is a contraindication for its use?
A. History of migraines
B. Active pelvic inflammatory disease
C. Regular menstrual cycles
D. No history of sexually transmitted infections
B. Active pelvic inflammatory disease
•A postpartum client who is breastfeeding is being assessed. She delivered 3 days ago. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, “I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest.” Which of the following actions should the nurse take at this time?
1. Explain the benefits of exclusive breastfeeding.
2. Have the client massage her breasts hourly.
3. Obtain an order to culture her expressed breast milk.
4. Take the temperature and pulse rate of the client.
1. Explain the benefits of exclusive breastfeeding. Clients should be strongly encouraged to exclusively breastfeed their babies to prevent engorgement and to maintain milk supply.
A nurse is assessing a client who is considering levonorgestrel IUDs. Which of the following findings is a contraindication?
A. History of diabetes
B. Active sexually transmitted infections
C. Regular menstrual cycles
D. No history of liver disease
B. Active sexually transmitted infections
13. A breastfeeding client at 2 days postpartum states, “I am sick of being fat. When can I go on a diet?” Which of the following responses is appropriate?
1. “It is fine for you to start dieting right now as long as you drink plenty of milk.”
2. “Your breast milk will be low in vitamins if you start to diet while breastfeeding.”
3. “You must eat at least 3,000 calories per day in order to produce enough milk for your baby.”
4. “Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day.”
•4. “Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day.”
Mothers should be advised to eat a well-balanced diet and drink sufficient quantities of fluids while breastfeeding. There is no absolute number of calories that the mother should consume, but if she does go on a restrictive diet, it is likely that her milk supply may dwindle. Babies do take in about 600 calories a day at the breast, meaning mothers lose or burn approximately 600 calories a day. This includes calories required to make the milk and calories excreted in the milk for the baby to burn. Therefore, mothers can be advised that breastfeeding may result in at least some weight loss.
A nurse is assessing a client who is considering levonorgestrel IUDs. Which of the following findings is a contraindication?
A. History of diabetes
B. Active sexually transmitted infections
C. Regular menstrual cycles
D. No history of liver disease
B. Active sexually transmitted infections
•15. A client informs the nurse that she intends to bottle feed her baby. Which of the following actions should the nurse encourage the client to perform? Select all that apply.
1. Increase her fluid intake for a few days.
2. Massage her breasts every 4 hours.
3. Apply heat packs to her axillae.
4. Wear a supportive bra 24 hours a day.
5. Stand with her back toward the shower water.
•4. Wear a supportive bra 24 hours a day.
•5. Stand with her back toward the shower water.
•The postpartum body naturally prepares to breastfeed a baby. To suppress the milk production, the mother should refrain from stimulating her breasts. Both massage and heat stimulate the breasts to produce milk. Mothers, therefore, should be encouraged to refrain from touching their breasts and to direct the warm water toward their backs rather than toward their breasts when showering. A supportive bra will help to minimize any engorgement that the client may experience.
A nurse is providing education on contraceptive implants. Which of the following is a contraindication?
A. History of breast cancer
B. Regular menstrual cycles
C. No history of liver disease
D. No history of thrombophlebitis
A. History of breast cancer
•19. A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with latching the baby and recommends that the mother do which of the following?
•1. Use a nipple shield at each breastfeeding.
•2. Cleanse the nipples with soap 3 times a day.
•3. Rotate the baby’s positions at each feed.
•4. Bottle feed for 2 days and then resume breastfeeding.
3. Rotate the baby’s positions at each feed. If a mother rotates positions at each breastfeeding, the baby is likely to put pressure on varying points on the nipple. A good, deep latch, however, is the most important way to prevent nipple soreness and cracking. The mother could also apply lanolin to her breasts after each feeding
•10. To prevent infection, the nurse teaches postpartum clients to perform which of the following tasks for perineal care?
1. Apply antibiotic ointment to the perineum daily.
2. Change the peripad at each voiding.
3. Void at least every two hours.
4. Spray the perineum with povidone-iodine after toileting.
•2. Change the peripad at each voiding. Postpartum clients should be advised to perform three actions to prevent infections: (1) change their peripads at each toileting because blood is an excellent medium for bacterial growth; (2) spray the perineum from front to back with clear water to cleanse the area; and (3) wipe the perineum from front to back after toileting to prevent pulling the rectal flora forward and contaminating the urethra or perineum. This is especially important if the client had lacerations or an episiotomy and has stitches in the area.