Postpartum Assessment
Which type of lochia is expected during the first few days postpartum?
A) Lochia alba
B) Lochia serosa
C) Lochia rubra
D) Lochia purulenta
Correct Answer: C
Rationale: Lochia rubra is the expected vaginal discharge during the first 1-3 days postpartum, characterized by dark red blood.
What is the recommended practice for caring for a newborn’s umbilical cord stump?
A) Keep it covered with a bandage at all times.
B) Clean it with alcohol and keep it dry.
C) Allow it to fall off naturally without pulling.
D) Submerge it in water during baths.
Correct Answer: C
Rationale: The umbilical cord stump should be allowed to fall off naturally, and it should not be pulled. Keeping it clean and dry is important, but alcohol is no longer recommended for cleaning.
When is Rhogam administered to a postpartum patient, and why?
A) Within 24 hours to prevent infection
B) Within 72 hours to prevent Rh sensitization
C) At discharge to prevent postpartum depression
D) At the time of delivery for pain management
Correct Answer: B
Rationale: Rhogam is administered within 72 hours postpartum to prevent Rh sensitization in Rh-negative mothers with Rh-positive infants.
A postpartum nurse is assessing a patient who had a vaginal delivery 24 hours ago. The nurse notes that the patient’s fundus is firm but slightly displaced to the right. What is the most appropriate initial action by the nurse?
A) Massage the fundus to stimulate contraction.
B) Encourage the patient to void.
C) Administer oxytocin as ordered.
D) Assess the patient for signs of infection.
Correct Answer: B
Rationale: A firm but displaced fundus indicates that the bladder may be full, which can lead to uterine atony. Encouraging the patient to void is the appropriate first step before further interventions.
What is the best practice for the care of a newborn's umbilical cord stump until it falls off?
A) Clean the stump with alcohol daily.
B) Keep the stump clean and dry.
C) Apply a bandage to the stump for protection.
D) Use petroleum jelly to cover the stump.
Correct Answer: B
Rationale: The umbilical cord stump should be kept clean and dry to promote healing and prevent infection. Alcohol is not recommended for cleaning the stump.
The nurse is performing a postpartum assessment on a patient. Which finding would require further intervention?
A) Uterus is firm and midline.
B) Lochia rubra with small clots.
C) Bladder is full, and patient has not voided in 6 hours.
D) Perineum is slightly swollen but without pain.
Correct Answer: C
Rationale: A full bladder can displace the uterus and increase the risk of hemorrhage. The patient should be encouraged to void, and further intervention may be necessary if she is unable to do so.
A nurse is assessing a newborn who weighs 4,000 grams at birth. What is an expected weight change for this newborn in the first week of life?
A) Gain 500 grams
B) Lose 5-10% of birth weight
C) Lose 20% of birth weight
D) No significant weight change
Correct Answer: B
Rationale: It is normal for newborns to lose up to 10% of their birth weight during the first week of life due to fluid shifts and adaptation to feeding.
A nurse is preparing to administer Rh immune globulin (Rhogam) to a postpartum patient. What is the most important action the nurse must take before administering this medication?
A) Ensure the patient has signed the consent form.
B) Confirm the patient’s blood type and the baby’s blood type.
C) Assess the patient for any signs of infection at the injection site.
D) Educate the patient on potential side effects of the medication.
Correct Answer: B
Rationale: It is essential to confirm the mother’s negative Rh type and the baby’s positive Rh type to determine the need for Rhogam, as it prevents the formation of Rh antibodies.
The nurse is educating a postpartum patient on signs of mastitis. Which of the following statements by the patient indicates a correct understanding of the teaching?
A) "I should continue breastfeeding on both breasts even if one is infected."
B) "Mastitis usually occurs bilaterally, so I should monitor both breasts."
C) "If I notice redness and warmth on one breast, I should stop breastfeeding immediately."
D) "I can use ice packs to treat mastitis symptoms."
Correct Answer: A
Rationale: It is important to continue breastfeeding to help clear the infection and prevent engorgement. Breastfeeding can usually continue unless otherwise instructed by a healthcare provider.
During the first assessment of a newborn, the nurse notes that the baby is displaying retractions, grunting, and nasal flaring. What should the nurse recognize as the most concerning interpretation of these findings?
A) The baby is experiencing normal newborn transition.
B) The baby may be exhibiting signs of respiratory distress.
C) The baby is likely adjusting to oral feeding.
D) The baby is demonstrating typical post-delivery behavior.
Correct Answer: B
Rationale: Retractions, grunting, and nasal flaring are indicators of respiratory distress and warrant immediate assessment and intervention.
Which of the following are risk factors for postpartum hemorrhage? (Select all that apply)
A) Atonic uterus
B) Prolonged labor
C) Multiple pregnancies
D) Full bladder
E) Maternal age over 35
Correct Answers: A, B, C, D
Rationale: Atonic uterus, prolonged labor, multiple pregnancies, and a full bladder are all recognized risk factors for postpartum hemorrhage.
The nurse assesses a 2-day-old newborn and notices a yellowish tint to the skin and sclera. Which of the following actions should the nurse take next?
A) Notify the healthcare provider immediately.
B) Assess the bilirubin level.
C) Document the finding as normal.
D) Initiate phototherapy.
Correct Answer: B
Rationale: It is important to assess bilirubin levels to determine if the jaundice is physiologic or pathologic before taking further action.
A postpartum patient is prescribed methylergometrine (Methergine) to promote uterine contractions. What is the most important assessment the nurse should perform before administering this medication?
A) Assess the patient's pain level.
B) Monitor the patient's blood pressure.
C) Check for signs of lochia.
D) Assess for bladder distention.
Correct Answer: B
Rationale: Methylergometrine can raise blood pressure, so it is crucial to monitor the patient’s blood pressure prior to administration, especially in patients with a history of hypertension.
What signs of infection should parents be educated to monitor in their newborn? (Select all that apply) A) Persistent fever above 100.4°F (38°C)
B) Difficulty feeding or persistent vomiting
C) Increased irritability and lethargy
D) Presence of a rash that doesn’t fade
E) Weight loss of 5-10%
Correct Answers: A, B, C, D
Rationale: Parents should monitor for fever, feeding difficulties, irritability, and rashes as potential signs of infection. Normal weight loss of 5-10% is typical in newborns.
A postpartum patient exhibits fever, tachycardia, and foul-smelling lochia on day 3 after delivery. What is the most likely diagnosis the nurse should suspect? A) Uterine atony
B) Endometritis
C) Mastitis
D) Thromboembolism
Correct Answer: B
Rationale: The combination of fever, tachycardia, and foul-smelling lochia on day 3 suggests endometritis, an infection of the endometrium that commonly occurs after delivery.
During a postpartum assessment, the nurse notes the following findings. Which findings are considered normal? (Select all that apply)
A) Soft, non-tender breasts
B) Lochia rubra present on day 4
C) Fundus firm and midline
D) Moderate perineal swelling
E) Temperature of 101°F (38.3°C)
Correct Answers: A, C, D
Rationale: Soft, non-tender breasts, a firm midline fundus, and moderate perineal swelling can be normal. Lochia rubra should not be present on day 4, and a temperature of 101°F may indicate infection.
A nurse is assessing a breastfeeding newborn. Which findings indicate that the newborn is feeding effectively? (Select all that apply)
A) The newborn latches onto the breast with mouth wide open.
B) The mother reports feeling pain during breastfeeding.
C) The newborn swallows milk during feeding.
D) The newborn feeds 8-12 times a day.
E) The newborn has fewer than 3 wet diapers in 24 hours.
Correct Answers: A, C, D
Rationale: An effective latch, swallowing during feeding, and a frequency of 8-12 feedings per day indicate successful breastfeeding. Pain during breastfeeding and fewer than 3 wet diapers may indicate problems.
Which medications are commonly administered to a postpartum patient to prevent or treat hemorrhage? (Select all that apply)
A) Oxytocin
B) Methylergonovine
C) Carboprost (Hemabate)
D) Folic acid
E) Misoprostol
Correct Answers: A, B, C, E
Rationale: Oxytocin, Methylergonovine, Carboprost (Hemabate), and Misoprostol are used to manage postpartum hemorrhage. Folic acid is not typically used for this purpose.
A nurse is reviewing the medical history of a postpartum patient who had a vaginal delivery 12 hours ago. Which factor in the patient's history places her at the highest risk for postpartum hemorrhage?
A) Previous cesarean delivery
B) Use of oxytocin during labor
C) Moderate vaginal laceration
D) History of gestational diabetes
Correct Answer: B
Rationale: The use of oxytocin during labor can increase the risk of uterine atony, which is a major cause of postpartum hemorrhage.
Which statements regarding newborn care and safety are correct? (Select all that apply)
A) Always place the baby on their back to sleep.
B) Use soft bedding and pillows in the crib for comfort.
C) Keep the crib free of toys and blankets to reduce suffocation risk.
D) Ensure the baby's temperature is monitored regularly.
E) Newborns should be swaddled tightly in blankets for sleep.
Correct Answers: A, C, D
Rationale: Placing the baby on their back to sleep and keeping the crib free of soft items are essential safety measures. Monitoring the baby’s temperature is also important. Soft bedding and tight swaddling can pose risks for suffocation or overheating.
Which signs and symptoms should a nurse educate a postpartum patient to report as potential signs of infection? (Select all that apply)
A) Fever greater than 100.4°F (38°C)
B) Foul-smelling lochia
C) Increased pain at the incision site
D) Chills and fatigue
E) Redness and warmth at the fundus
Correct Answers: A, B, C, D, E
Rationale: All listed signs and symptoms could indicate infection and warrant further evaluation.
The nurse is monitoring a newborn for signs of infection. Which findings would warrant immediate notification of the healthcare provider? (Select all that apply)
A) Fever greater than 100.4°F (38°C)
B) Presence of a cephalohematoma
C) Poor feeding or lethargy
D) Foul-smelling lochia from the mother
E) Elevated white blood cell count
Correct Answers: A, C, E
Rationale: A fever greater than 100.4°F, poor feeding or lethargy, and an elevated white blood cell count can indicate infection and require further assessment. A cephalohematoma is not an immediate concern, and lochia is related to the mother, not the newborn.
Which of the following medications might a nurse expect to administer to a postpartum patient who had a C-section? (Select all that apply)
A) Analgesics for pain management
B) Antibiotics to prevent infection
C) Anticoagulants to prevent thromboembolism
D) Oxytocin to promote uterine contractions
E) Antidepressants for mood stabilization
Correct Answers: A, B, C, D
Rationale: Analgesics, antibiotics, and anticoagulants are commonly administered for pain management, infection prevention, and thromboembolism prevention. Antidepressants are not routinely administered unless indicated.
Which information should be included in patient education regarding breastfeeding? (Select all that apply)
A) Breastfeeding should be initiated within the first hour after birth.
B) Mothers should feed the baby 8-12 times a day.
C) It’s okay to skip feedings if the mother is tired.
D) The mother should switch sides after the baby has let down on one side.
E) Breast milk typically comes in within 2-3 days after delivery.
Correct Answers: A, B, D, E
Rationale: Initiating breastfeeding early, frequent feedings, switching sides after let-down, and the timing of milk coming in are all essential points of education. Skipping feedings is not advisable.
The nurse is caring for a newborn at risk for hypoglycemia. Which findings would indicate hypoglycemia? (Select all that apply)
A) Tremors or jitteriness
B) High-pitched crying
C) Increased temperature
D) Lethargy or poor feeding
E) Rapid breathing
Correct Answers: A, B, D, E
Rationale: Tremors, high-pitched crying, lethargy, and rapid breathing can all indicate hypoglycemia in newborns. Increased temperature is not typically associated with hypoglycemia.