ATI MATERNAL NEWBORN PROCTORED 2019
Remove perineal pads from which direction Correct Answer: front to back
Always do what before breasfeeding
... [Show More] Correct Answer: wash your hands
What type of bra should be worn if breast support is needed Correct Answer: well fitted, nonbinding bra
---do not use an underwire bra because it can cause clogged milk ducts
Allow the infant to nurse on demand which is how much Correct Answer: 8-12 times in a 24 hour period
An infant should feed until when Correct Answer: the breast softens and then offer the other breast
How do you relieve breast engorgement Correct Answer: -take a warm shower or apply warm compressed before feeding to promote letdown and milk flow
-empty each breast completely at feedings, use a pump if needed
-apply cool compresses after feeding
How to relieve cracked and irritated nipples Correct Answer: apply breast creams or wear breast shells in the bra to soften the nipples
How to relieve sore nipples Correct Answer: apply a small amount of breast milk to the nipple and let it air dry after feeding
If not planning to breast feed then wear your bra Correct Answer: -continuously for the first 72 hours
-avoid breast stimulation and running water over breasts for prolonged periods
-apply cold compresses 15 min on and 45 off if there is breast engorgement on the third or fifth day
What exercise is used to strengthen back muscles to relieve lower back strain Correct Answer: pelvic tilt exercises
-alternately arching and straightening back
Nonlactating women should consume how many calories Correct Answer: 1,800-2,200
Lactating women should add what to their diet Correct Answer: -additional 450-500 calories per day and calcium enriched foods
-eat high protein foods to aid in tissue repair
-continue taking prenatal vitamins until 6 weeks following birth
Do not take oral contraceptives if breast feeding until Correct Answer: milk production is well established (6 weeks)
Complications of postpartum include Correct Answer: -hemorrhage
-infection of breasts
-wounds
-incisions
-postpartum depression
Follow up visit for a vaginal delivery should be, following a cesarean birth it should be Correct Answer: 4-6 weeks
2 weeks
Signs & Symptoms of possible complications that need to be reported Correct Answer: -chills or fever greater than 100.4 after 24 hours
-change in vaginal discharge (large clots, lochia color, bright red bleeding, foul odor)
-episiotomy, laceration, or incisional pain that does not resolve with medication
-pain or tenderness in the abdominal or pelvic areas
-breasts with localized areas of pain and tenderness with firmness, heat, and swelling and/or nipples with cracks, redness, bruising, blisters or fissures
-calves with localized pain, tenderness, redness, and swelling
-urination with burning, pain, frequency, urgency
-indication of possible depression (apathy toward infant, not providing for self or infant, feeling of hurting)
Normal Lochial Flow Patterns Correct Answer: Rubra: dark red vaginal drainage for 1-3 days
Serosa: brownish red or pink vaginal drainage from 3-10 days
Alba: yellowish white vaginal discharge after day 10 to 8 weeks
A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact the provider for which of the following client findings?
1. scant, nonodorous white vaginal discharge
2. uterine cramping during breastfeeding
3. sore nipple with cracks and fissures
4. decreased response with sexual activity Correct Answer: 3
A nurse is providing discharge teaching for a nonlactating client. Which of the following instructions should the nurse include in the teaching?
1. wear a supportive bra continuously for the first 72 hours
2. pump your breast every 4 hours to relieve discomfort
3. use breast shells throughout the day to decrease milk supply
4. apply warm compresses until milk suppression occurs Correct Answer: 1
A nurse is providing care to four clients on the postpartum unit. Which of the following clients is at greatest risk for developing a postpartum infection?
1. a client who has an episiotomy that is erythematous and has extended into a third-degree laceration
2. a client who does not wash their hands between perineal care and breastfeeding
3. a client who is not breastfeeding and is using measures to suppress lactation
4. a client who has a cesarean incision that is well-approximated with no drainage Correct Answer: 2
- Correct Answer: -
CHAPTER 20 Correct Answer:
A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypovolemia caused by hemorrhage?
1. increasing pulse and decreasing blood pressure
2. dizziness and increasing respiratory rate
3. cool, clammy skin, and pale mucous membranes
4. altered mental status Correct Answer: 1
A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching? SATA
1. precipitous delivery
2. obesity
3. inversion of the uterus
4. oligohydramnios
5. retained placental fragments Correct Answer: 1, 3, 5
A nurse on the postpartum unit is assessing a client who i being admitted with a suspected DVT. Which of the following clinical findings should the nurse expect? SATA
1. calf tenderness to palpation
2. mottling of the affected extremity
3. elevated temperature
4. area of warmth
5. report of nausea Correct Answer: 1, 3, 4
A nurse is planning care for a client who is postpartum and has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care?
1. apply cold compresses to the affected extremity
2. massage the affected extremity
3. allow the client to ambulate
4. measure leg circumference Correct Answer: 4
A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for this condition?
1. preeclampsia
2. thrombophlebitis
3. placenta previa
4. hyperemesis gravidarum Correct Answer: 1
CHAPTER 21 Correct Answer:
Postpartum infections can occur up to how many days following childbirth or abortion Correct Answer: 28 days
Where can infections be present in a postpartum patient Correct Answer: bladder, uterus, wound, or breast
What is the major complication of a puerperal infection Correct Answer: septicemia
Endometritis Correct Answer: Uterine Infection
-most frequently occurring puerperal infection
-infection of the uterine lining or endometrium
-usually begins on the second to fifth postpartum day, generally starting as a localized infection at the placental attachment site and spreading to include the entire uterine endometrium
Mastitis Correct Answer: -infection of the breast involving the interlobular connective tissue and is usually unilateral
-Staphylococcus aureus is usually the infection organism
-can progress to an abscess is untreated
-can occur as early as the seventh postpartum day
-usually occurs during the first 6 weeks of breastfeeding
Risk Factors of Mastitis Correct Answer: -milk stasis, can be cause by a blocked duct, engorgement, or a bra with an underwire
-nipple trauma and cracked or fissured nipples
-poor breastfeeding technique with improper latching of the infant onto the breast
-decrease in breastfeeding frequency due to supplementation with bottle feeding
-contamination of breasts due to poor hygiene
Symptoms of Puerperal Infections Correct Answer: -flu-like manifestations: (body aches, chills, fever, malaise)
-anorexia
-nausea
-elevated temperature of at least 100.4 for 2 or more consecutive days
-tachycardia
Symptoms of Endometritis Correct Answer: -pelvic pain
-chills
-fatigue
-loss of appetite
-uterine tenderness and enlargement
-dark, profuse lochia
-lochia that is either malodorous or purulent
-temperature greater than 100.4
-tachycardia
Symptoms of Mastitis Correct Answer: -painful or tender localized hard mass and reddened area, usually on one breast
-Influenza-like manifestations: (chills, fever, headache, body ache)
-fatigue
-axillary adenopathy in the affected side with an area of inflammation that can be red, swollen, warm, and tender
Symptoms of a Wound Infection Correct Answer: -warmth, erythema, tenderness, pain, edema, seropurulent drainage, and wound dehiscence or evisceration
-temperature greater than 100.4 for 2 or more consecutive days
What labs tests would be used to catch these infections? Correct Answer: -Blood, intracervical, or intrauterine bacterial cultures to reveal the offending organism
-WBC Count: leukocytosis
-RBS Sedimentation Rate: distinctly increased
-RBC Count: anemia
Nursing Care for Puerperal Infections Correct Answer: -use aseptic technique for appropriate procedures; don gloves for labor, birth, and postpartum care
-maintain or initiate IV access
-administer IV broad spectrum antibiotics therapy (Penicillin, Cephalosporins, Clindamycin, Gentamicin)
-provide comfort measures
-educate to have a diet high in protein to promote tissue healing
-educate to include good perineal hygiene
Nursing Care for Endometritis Correct Answer: -collect vaginal and blood cultures
-administer IV antibiotics
-administer analgesics
-maintain interaction with the infant to facilitate bonding
Nursing Care for Wound Infections Correct Answer: -perform wound care
-administer IV antibiotics
-provide or encourage comfort measures (sitz baths, perineal care, warm or cold compresses)
-change perineal pads from front to back
Nursing Care and Education for Mastitis Correct Answer: -administer antibiotics
-breast hygiene can prevent and manage mastitis
-maintain cleanliness of breasts by frequent changes of breast pads and hand hygiene
-allow nipples to air-dry
-continue breastfeeding frequently, every 2 to 4 hours, especially on the affected side
-rest, take analgesics, and maintain fluid intake of at least 3,000 mL/day
-wear a well-fitting bra for support with no underwire
Medications used for Endometritis Correct Answer: Clindamycin
Cephalosporins
Penicillin
Gentamicin
-treatment of bacterial infections
-notify the provider of the development of watery bloody diarrhea
-notify the provider if breastfeeding
Urinary Tract Infections Correct Answer: -common postpartum infections secondary to bladder trauma incurred during the delivery or a break in aseptic technique during catherization
-can progress to pyelonephritis with permanent kidney damage leading to kidney failure
Risk Factors of a UTI Correct Answer: -postpartal hypotonic bladder or urethra (urinary stasis and retention)
-epidural anesthesia
-urinary bladder catherization
-frequent pelvic examinations
-genital tract injuries
-history of a UTI
-Cesarean birth
Symptoms of a UTI Correct Answer: -urgency
-frequency
-dysuria
-retention
-discomfort in the pelvic area
-fever
-chills
-malaise
-elevated temperature
-cloudy, blood-tinges, malodorous, or visible sediment urine
-pain in the suprapubic area
-pain at the costovertebral angle (pyelonephritis)
Diagnostic Procedures for a UTI Correct Answer: -urinalysis for WBC, RBC, protein, and bacteria
-clean catch urine sample
Nursing Care for a UTI Correct Answer: -administer antibiotics
-administer acetaminophen to reduce discomfort and pain associated with a UTI
-educate proper perineal hygiene
-educate to increase their fluid intake to 3,000 mL/day to dilute the bacteria and flush the bladder
A nurse is teaching a client who is breastfeeding and has mastitis. Which of the following responses should the nurse make?
1. limit the amount of time the infant nurses on each breast
2. nurse the infant only on the unaffected breast until resolved
3. completely empty each breast at each feeding or use a pump
4. wear a tight fitting bra until lactation has ceased Correct Answer: 3
A nurse is reviewing discharge teaching with a client who has a UTI. Which of the following statements by the client indicates understanding of the teaching? SATA
1. i will perform perineal care and apply a perineal pad in a back to front direction
2. i will drink grape juice to make my urine more acidic
3. i will drink large amounts of fluids to flush the bacteria form my urinary tract
4. i will go back to breastfeeding after i have finished taking the antibiotic
5. i will take Tylenol for any discomfort Correct Answer: 3, 5
A nurse on the postpartum unit is caring for four cli [Show Less]