MATERNAL AND CHILD NURSING A

1. A client has given birth to a preterm male neonate. The client tells the nurse that she still wants to breast-feed her
neonate. The nurse should explain to the mother that:
a. Breast milk contains antibodies that help protect her neonate
b. Commercial formula will provide better nutrition for the neonate
c. Breast-feeding can be started when the neonate is read for discharge
d. The neonate will be less likel to develop an infection on commercial formula
!. "hich action best explains the main role of surfactant in the neonate#
a. Assists with ciliar bod maturation in the upper airwas
b. $elps maintain a rhthmic breathing pattern
c. %romotes clearing mucus from the respirator tract
d. $elps the lungs remain expanded after the initiation of breathing
&. "hile assessing a !-hour-old neonate' the nurse observes the neonate to have acrocanosis. "hich of the following
nursing actions should be performed initiall#
a. Activate the code blue or emergenc sstem
b. (o nothing because acrocanosis is normal in the neonate
c. )mmediatel take the neonate*s temperature according to hospital polic
d. +otif the phsician of the need for a cardiac consult
,. "hen teaching parents of a neonate the proper position for the neonate*s sleep' the nurse stresses the importance of
placing the neonate on his back to reduce the risk of which of the following#
a. Aspiration
b. -udden infant death sndrome .-)(-/
c. -uffocation
d. 0astroesophageal reflux .012/
3. The nurse is aware that a neonate if a mother with diabetes is at risk for which complication#
a. Anemia c. +itrogen loss
b. $poglcemia d. Thrombosis
4. "hich complication is common in neonates who receive prolonged mechanical ventilation at birth#
a. Bronchopulmonar dsplasia c. $drocephalus
b. 1sophageal atresia d. 2enal failure
5. "hen performing neonatal assessment' which is the best indication of ade6uate hdration#
a. -oft' smooth skin c. 7re6uent spitting up
b. A sunken fontanel d. +o urine output in the !, hours of life
8. "hen performing a neurologic assessment' which sign is considered a normal finding in a neonate#
a. (oll ees c. %ositive Babinski*s sign
b. 9-unset: ees d. %upils that don*t react to light
;. At what gestational age us a conceptus considered viable .able to live outside the womb/#
a. ; weeks c. !, weeks
b. 1, weeks d. &< weeks
1<. A client*s mother asks the nurse wh her newborn grandson is getting an in=ection of vitamin >. "hich best explains
wh this drug is given to neonates#
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a. ?itamin k assists with coagulation
b. ?itamin k assists the gut to mature
c. ?itamin k initiates the immuni@ation process
d. ?itamin k protects the brain from excess fluid production
11. +eonates born to women infected with hepatitis B should undergo which treatment regimen#
a. $epatitis B vaccine at birth and 1 month
b. $epatitis B immune globulin at birthA no hepatitis B vaccine
c. $epatitis B immune globulin within ,8 hours of birth and hepatitis B vaccine at 1 month
d. $epatitis B immune globulin within 1! hours of birth and hepatitis B vaccine at birth' 1 month' and 4 months
1!. "hen a neonate is delivered with meconium staining in the amnionic fluid' which se6uence of events will most
effectivel decrease the risk of meconium aspiration#
a. (eliver the thorax' then suction the nose
b. Clamp the umbilical cord' then suction the neonate*s mouth
c. (eliver the head' then suction the mouth and then the nose
d. (eliver the thorax' then suction the nose and then the mouth.
1&. 1rthromcin ointment is administered to the neonate*s ees shortl after birth to prevent which disorder#
a. Cataracts c. Bphthalmia neonatorum
b. (iabetic retinopath d. -trabismus
1,. A client with group AB blood whose husband has group B blood has =ust given birth. The ma=or sign of ABB blood
incompatibilit in the neonate is which complication or test result#
a. +egative Coombs* test c. Caundice after the first !, hours of life
b. Bleeding from nose or ear d. Caundice within the first !, hours of life
13. "hich circumstance of deliver would predispose a neonate to respirator distress sndrome .2(-/#
a. %remature birth c. 7irst born of twins
b. ?aginal deliver d. %ostdate pregnanc
14. Two das after circumcision' the nurse notes a ellow-white exudates around the head of the neonate*s penis. "hat
would be the most appropriate nursing intervention#
a. Deave the area alone as this is a normal finding
b. 2eport the findings to the phsician and document it
c. Take the neonate*s temperature because an infection is suspected
d. Tr to remove the exudates with a warm washcloth.
15. A client has =ust given birth at ,! weeks* gestation. "hen assessing the neonate' which phsical finding is expected#
a. A sleep' lethargic bab c. (es6uamation of the epidermis
b. Danugo covering the bab d. ?ernix caseosa covering the bod
18. The small-for-gestation neonate is at increased risk during the transitional period for which complication#
a. Anemia probabl due to chronic fetal hpoxia
b. $perthermia due to decreased glcogen stores
c. $perglcemia due to decreased glcogen stores
d. %olthermia probabl due to chronic fetal hpoxia
1;. "hich finding might be seen in a neonate suspected of having an infection#
a. 7lushed cheeks c. (ecreased temperature
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b. )ncreased temperature d. )ncreased activit level
!<. "hich smptom would indicate the neonate was adapting appropriatel to extrauterine life without difficult#
a. +asal flaring c. 2espirator rate ,< to 4< breathsEminute
b. Dight audible grunting d. 2espirator rate 4< to 8< breathsEminute
!1. After reviewing the client*s maternal histor of magnesium sulfate during labor' which condition would the nurse
anticipate as a potential problem in the neonate#
a. $poglcemia c. 2espirator depression
b. Citteriness d. Tachcardia
!!. "hich intervention is helpful for the neonate experiencing drug withdrawal#
a. %lace the isolette in a 6uiet area of the nurser
b. "ithhold all medication to improve the liver*s metaboli@ation of drugs
c. (ress the neonate in loose clothing so he won*t feel restricted
d. %lace the isolette near the nurses station for fre6uent contact with health care
!&. +eonates of mothers with diabetes are at risk for which complication following birth#
a. Atelectasis c. %neumothorax
b. Ficrocephal d. Facrosomia
!,. +eonates are given which medication to prevent hemorrhagic disease of the neonate#
a. ?itamin > c. )ron
b. $eparin d. "arfarin
!3. (uring the transition period' a neonate can lose heat in man different was. A neonate who isn*t completel dried
immediatel after birth or a bath loses heat through which of the following methods#
a. Conduction c. 1vaporation
b. Convection d. 2adiation
!4. B keeping the nurser temperature warm and wrapping the neonate in blankets' the nurse is preventing which tpe
of heat loss#
a. Conduction c. 1vaporation
b. Convection d. 2adiation
!5. "hich statement is the best explanation for phsiologic hperbilirubinemia#
a. The neonate usuall also has a medical problem
b. )n term neonates' it usuall appears after !, hours
c. )t*s caused b elevated con=ugated bilirubin levels
d. )t*s usuall progressive from the neonate*s feet to his head.
!8. A neonatal has been diagnosed with caput succedaneum. "hich statement is correct about caput succedaneum#
a. )t usuall resolves in & to 4 weeks
b. )t doesn*t cross the cranial suture line
c. )t*s a collection of blood between the skull and periosteum
d. )t involves swelling of the tissue over the presenting part of the fetal head.
!;. The nurse is teaching a postpartum client about the normal stooling pattern of a neonate. "hich color and
consistenc best describes the tpical appearance of meconium#
a. -oft' pale ellow c. -tick green' black
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b. $ard' pale brown d. Doose' golden ellow
&<. A &-da-old neonate needs phototherap for hperbilirubinemia. +urser care of a neonate receiving phototherap
would include which nursing intervention#
a. Tube feedings
b. 7eeding the neonate under phototherap lights
c. Fask over the ees to prevent retinal damage
d. Temperature monitored ever 4 hours during phototherap
&1. "hich of the following neonates would be most likel to develop hperbilirubinemia#
a. Blacks
b. +eonate of 2h-positive mother
c. +eonate with ABB incompatibilit
d. +eonate with Apgar scores ; and 1< at 1 and 3 minutes
&!. 0ram-positive cocci are responsible for causing 13G to !3G of the ma=or neonatal infections. "hich is an example of
a gram-positive bacteria#
a. Escherichia coli c. Klebsiella species
b. 0roup B streptococci d. Pseudomonas aeruginosa
&&. The most common neonatal sepsis and meningitis infection seen within !, hours after birth are caused b which
organism#
a. Candida albicans c. Escherichia coli
b. Chlamydia trachomatis d. 0roup B beta-hemoltic streptococci
&,. The nurse understands that erthromcin ointment is applied to a neonate*s ees immediatel after birth for what
purpose#
a. To eliminate the incidence of viral infections
b. To prevent Chlamdia infections
c. To prevent sphilis infection of the ees
d. To reduce the incidence of group B streptococcal con=unctivitis
&3. "hen attempting to interact with a neonate experiencing drug withdrawal' which behavior would indicate that the
neonate is willing to interact#
a. 0a@e aversion c. Huite alert state
b. $iccups d. Iawning
&4. "hen teaching umbilical cord care to a new mother' the nurse would include which information#
a. Appl peroxide to the cord with each diaper change
b. Cover the cord with petroleum =ell after bathing
c. >eep the cord dr and open to air
d. "as the cord with soap and water each da during a tub bath
&5. "hen caring for an infant of a mother with diabetes' which phsiological finding is most indicative of a hpoglcemic
episode#
a. $peralert state c. %ositive Babinski reflex
b. Citteriness d. -erum glucose level of 4< mgEdl
&8. A mother of a term neonate asks what the thick' white' chees coating is on his skin. "hich correctl describes this
finding#
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a. Danugo c. +evus flammeus
b. Filia d. ?ernix
&;. "hich drug is routinel given to the neonate within 1 hour of birth#
a. 1rthromcin ophthalmic ointment
b. 0entamcin
c. +statin
d. ?itamin A
,<. "hich condition or treatment best ensures lung maturit in a neonate#
a. Feconium in the amniotic fluid
b. 0lucocorticoid treatment =ust before deliver
c. Decithin to sphingomelin ration more than !:1
d. Absence of phosphatidlglcerol in amniotic fluid
,1. "hich assessment finding would be the most unlikel risk factor for respirator distress sndrome .2(-/#
a. -econd born of twins c. +eonate of a diabetic mother
b. +eonate born at &, weeks d. Chronic maternal hpertension
,!. A nurse is performing an assessment on a neonate. "hich of the following findings is considered common in the
health neonate#
a. -imian crease c. Cstic hgroma
b. Con=unctival hemorrhages d. Bulging fontanelle
,&. "hen performing nursing care for a neonate after a birth' which intervention has the highest nursing priorit#
a. Bbtain a (extrostix c. 0ive the vitamin > in=ection
b. 0ive the initial bath d. Cover the neonate*s head with a cap
,,. "hen assessing a neonate*s skin' the nurse observes small white papules surrounded b erthematous dermatitis.
This finding is characteristic of which condition#
a. Cutis marmorata c. 1rthema toxicum
b. 1pstein*s pearls d. Fongolian spots
,3. "hich nursing consideration is most important when giving a neonate his initial bath#
a. 0ive a tub bath c. 0ive it right after deliver
b. Jse water and mild soap d. Jse hexachlorophene soap
,4. The Centers for (isease Control and %revention .C(C/ recommends the hepatitis B vaccine be administered to which
neonates#
a. All neonates
b. 1xposed neonates onl
c. +eonates showing smptoms
d. +eonates of mothers with human immunodeficienc virus
,5. A male neonate has =ust been circumcised. "hich nursing intervention is part of the initial care of a circumcised
neonate#
a. Appl alcohol to the site
b. Change the diaper as needed
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c. >eep the neonate in the supine position
d. Appl petroleum gau@e to the site for !, hours
,8. "hen a performing an assessment on a neonate' which assessment finding is most suggestive of hpothermia#
a. Bradcardia c. Fetabolic alkalosis
b. $perglcemia d. -hivering
,;. "hich nursing intervention helps prevent evaporative heat loss in the neonate immediatel after birth#
a. Administering warm oxgen
b. Controlling the drafts in the room
c. )mmediatel dring the neonate
d. %lacing the neonate on a warm' dr towel
3<. "hich assessment finding in a neonate would indicate a metabolic response to cold stress#
a. Arrhthmias c. )ncrease in liver function
b. $poglcemia d. )ncrease in blood pressure
31. "hich would be the highest priorit in regulating the temperature of a neonate#
a. -uppl extra heat sources to the neonate
b. >eep the ambient room temperature less than 1<<K7 .&5.8KC/
c. Finimi@e the energ needed for the neonate to produce heat
d. Block radiant' convective' conductive and evaporative losses
3!. "hen maintaining thermoregulation' which neonatal characteristics negativel affect the establishment of a thermal
neutral @one#
a. 7lexed posture
b. Blood vessels that aren*t close to the skin
c. (ecreased subcutaneous fat and thin epidermis
d. )ncreased subcutaneous fat and thick epidermis
3&. "hich clinical finding is most suggestive of phsiologic hperbilirubinemia in a neonate#
a. Clinical =aundice before &4 hours of age
b. Clinical =aundice lasting beond 1, das
c. Bilirubin levels of 1! mgEdl b & das of life
d. -erum bilirubin level increasing b more than 3 mgEdlEda
3,. "hat*s the desired effect of %henobarbital used in neonates with hperbilirubinemia#
a. To sedate the neonate during treatment
b. To decrease the con=ugation of bilirubin
c. To increase the concentration of ligandin
d. To convert uncon=ugated bilirubin into water-soluble bilirubin
33. A neonate undergoing phototherap treatment needs to the monitored for which adverse effect#
a. $perglcemia c. -evere decrease in platelet count
b. )ncreased insensible water loss d. )ncreased 0) transit time
34. "hich assessment finding might be seen in a neonate suspected of having breast-milk =aundice#
a. $istor of being a poor feeder
b. (ecreased bilirubin level around da & of life
c. Clinical =aundice evident after !, hours
d. )nterruption of breast-feeding' resulting in decreased bilirubin levels between !, and 5! hours
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35. "hich sign is the earliest indication of respirator distress sndrome in a neonate#
a. Bilateral crackles
b. %ale gra color
c. Tachpnea more than 4< breathsEminute
d. %oor capillar filling time .& to , seconds/
38. "hich of the following disorders is a non respirator cause of respirator distress#
a. Choanal atresia c. %ulmonar hemorrhage
b. Feconium aspiration d. 2etained lung fluid sndrome
3;. A neonate is admitted to the neonatal intensive care unit with persistent pulmonar hpertension. "hich pulmonar
vasodilator is the drug of choice for this disorder#
a. (obutamine .(obutrex/ c. %rostaglandin 1!
b. )soproterenol .)suprel/ d. Tola@oline .%riscoline/
4<. "hich neonatal respirator disorder is usuall mild and runs a self-limited course#
a. %neumonia
b. Feconium aspiration sndrome
c. Transient tachpnea of neonate
d. %ersistent pulmonar hpertension
41. "hich procedure should be avoided in a neonate born with diaphragmatic hernia#
a. Chest L-ra c. %lacement of orogastric tube
b. Fask ventilation d. )mmediate endotracheal intubation
4!. "hich immunoglobulin .)g/ provides immunit against bacterial and viral pathogens through passive immunit#
a. )gA c. )g0
b. )g1 d. )gF
4&. "hich cranio-facial change is most characteristic in a neonate with fetal alcohol sndrome .7A-/#
a. Facrocephal c. "ide palbebral fissures
b. Ficroophthalmia d. "ell-developed philtrum
4,. A &4 week neonate born weighing 1'8<< g has microcephal and microophthalmia. Based on these findings' which
risk factor might be expected in the maternal histor#
a. Jse of alcohol c. 0estational diabetes
b. Jse of mari=uana d. %ositive group B streptococci
43. "hich neonatal behavior is most commonl associated with fetal alcohol sndrome .7A-/#
a. $poactivit c. %oor wake and sleep patterns
b. $igh birth weight d. $igh threshold of stimulation
44. "hich 0) disorder is most suggestive of cstic fibrosis#
a. (uodenal obstruction c. Falrotation
b. Ce=unal atresia d. Feconium ileus
45. "hich orthopedic disorder of the neonate results in multiple fractures and skeletal deformities#
a. >lippel-7eil sndrome c. Congenital hip dislocation
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b. Bsteogenesis imperfecta d. Arthrogrposis multiplex congenital
48. A neonate has an imperforate anus' tracheoesophageal fistula' and a single umbilical arter. A nurse suspects that the
neonate might have which congenital disorder#
a. Beckwith-"iedemann sndrome
b. Trisom 1&
c. Turner*s sndrome
d. ?AT12 association
4;. An initial assessment of a female neonate shows pink-streaked vaginal discharge. "hich factor is the probable
cause#
a. Cstitis c. +eonatal candidiasis
b. Birth trauma d. "ithdrawal of maternal hormones
5<. "hen assessing for congenital anomalies in a neonate' which smptom is seen first with tracheoesophageal atresia#
a. Torticollis c. Bligohdramnios
b. +asal stuffiness d. 1xcessive oral secretions
51. The neonate is vulnerable to heat loss because of which anatomic characteristic#
a. )mmature liver
b. )mmature brain
c. Darge skin surface area to bod weight ration
d. Fore brown fat .adipose tissue/ than an adult
5!. Faintaining thermoregulation in the neonate is an important nursing intervention because cold stress in the neonate
can lead to which condition#
a. Anemia c. Fetabolic alkalosis
b. $perglcemia d. )ncreased oxgen consumption
5&. "hich initial nursing intervention best addresses the needs of a term neonate with ade6uate respirator and heart
rates but who has central canosis#
a. %rovide tactile stimulation
b. 0ive supplemental free-flow oxgen
c. Assist ventilation with bag and mask
d. )ntubate and suction the lower airwa
5,. A woman delivers a &'!3< g neonate at ,! week*s gestation. "hich phsical finding is expected during an
examination of this neonate#
a. Abundant lanugo c. Breast bud of 1 to ! mm in diameter
b. Absence of sole creases d. Deather' cracked and wrinkled skin
53. "hich performing an initial assessment on a term neonate with an Asian mother' a bluish marking is observed across
the neonate*s lower back. "hat is the significance of this finding#
a. )t*s probabl a sign of birth trauma
b. )t*s probabl a telangiectatic hemangioma
c. )t*s probabl a tpical marking in dark-skinned races
d. )t probabl indicates that hperbilirubinemia ma follow
54. A nurse in the neonate nurser is serving as preceptor for a student nurse. The student asks the nurse wh the
neonate*s head is cone-shaped. "hich response is accurate#
a. 9)t results from caput succendum. The difficult labor caused bruising and swelling of the neonate*s head:
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b. 9)t results from molding. Bverriding of the cranial sutures allows the neonate*s head to pass though the birth
canal:
c. 9)t results from cephalohematoma. -ome blood has collected between the skull bone and periosteum:
d. 9)t results from hdrocephalus. 1ither too much cerebrospinal fluid is being formed or too little is being
absorbed:
55. A neonate receiving formula feedings is discharged from the neonate nurser. Twent-four hours later' the mother
calls the hospital' stating that the neonate is vomiting most of this feedings. "hich statement b the mother indicates
that she needs further discharge instructions#
a. 91ver time ) feed him' he spits up a about a teaspoonful of formula onto his bib:
b. 9)*m using prepared formula' and he takes M o@ to 1 o@ ever & to , hours:
c. 9) feed him ever time he cries. -ometimes he eats , o@ at a time ever couple of hours:
d. 9) burp him after each M o@ of formula:
58. A health term neonate born b cesarean deliver was admitted to the transitional nurser &< minutes ago and placed
under a radiant warmer. The neonate has an axillar temperature of ;;.3K 7 .&5.3K C/' a respirator rate of 8<
breathsEminute' and a heelstick glucose value of 4< mgEdl. "hich action should the nurse take#
a. "rap the neonate warml and place her in an open crib.
b. Administer an oral glucose feeding of dextrose 1<G in water
c. )ncrease the temperature setting on the radiant warmer
d. Bbtain an order for ).?. fluid administration
5;. A home health nurse assesses a neonate who is ,8 hours old and was discharged from the hospital !, hours ago.
"hich assessment finding indicates a potential problem#
a. The neonate cries but no tears appear
b. -mall papules appear all over the neonate*s skin
c. The neonate doesn*t turn his head in the direction that his cheek is stroked
d. The neonate produces a greenish' tarr stool
8<. A mother tells the nurse that her !!-month-old child sas' 9+o: to everthing. "hen the toddler scolded becomes
angr and starts cring loudl but then immediatel wants to be held. "hat is the best interpretation of this behavior#
a. The toddler isn*t effectivel coping with the stress
b. The toddler*s need for affection isn*t being met
c. This is normal behavior for a ! ear old child
d. This behavior suggests the need for counseling
81. The mother of a 1!-month-old infant expresses concern about the effect of fre6uent thumb sucking on her child*s
teeth. After the nurse teaches her about this matter' which response b the mother indicates that the teaching has
been effective#
a. 9Thumb sucking should be discouraged at 1! months:
b. 9)*ll give the bab a pacifier instead:
c. 9-ucking is important to the bab:
d. 9)*ll wrap the thumb in a bandage:
8!. An adolescent client has =ust had surger and has a dressing on the abdomen. "hich of the following 6uestions would
the nurse expect the client to ask initiall#
a. 9(id the surger go oka#: c. 9"hat complications can ) expect#:
b. 9"ill ) have a large scar#: d. 9"hen can ) return to school#:
8&. 7or an 8-month-old infant' the nurse should plan to provide which of the following tos to promote the child*s cognitive
development#
a. 7inger-paints c. -mall rubber ball
b. Cack-in-the-box d. %la gm strung across the crib
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8,. Before a routine checkup in the pediatrician*s office' an 8-month-old infant is sitting contentedl on his mother*s lap'
chewing on a to. "hen preparing to examine this infant' which of the following actions should the nurse do first#
a. Feasure the head circumference
b. Auscultate heart and lung sounds
c. 1licit papillar reaction
d. Bbtain bod weight
83. "hich comment b a 5-ear-old bo to his friend best tpifies his developmental stage#
a. 90irl are so uck:
b. 9F momm and ) are alwas together:
c. 9) can*t decide if ) like Am or $eather better:
d. 9) can turn into Batman when ) come out of m closet:
84. The nurse should expect a &-ear-old child to be able to perform which of the following actions#
a. 2ide a triccle c. 2oller skate
b. Tie shoelaces d. Cump rope
85. A 4-month-old infant is admitted to the pediatric unit for a !-week course of antibiotics. $is parents can visit onl on
weekends. "hich action indicates that the nurse understands the infant*s emotional needs#
a. The nurse places the infant in a four-bed unit
b. The nurse places the infant in a room awa from other children
c. The nurse assigns the infant to a different nurse each da
d. The nurse assign the infant to the same nurse as often as possible
88. A term neonate weighs 5 M pounds at birth. "hen he*s 1 ear old' approximatel how much should he weight#
a. 14 lb .5.& kg/ c. !8 lb .1!.5 kg/
b. !! lb .1< kg/ d. &! lb .1,.3 kg/
8;. "hich behavior b a preschool child indicates that the child is in the proper stage of growth and development#
a. $e cries in protest when his mother leaves
b. $e asks for a bandage after having blood drawn
c. $e*s upset about having a scar after surger
d. $e wants to know wh his friends don*t visit
;<. The nurse observes parents plaing with their 1<-month-old daughter. "hich behavior indicates that the infant is
developing ob=ect permanence#
a. -he looks for the to that her parents hid under the blanket
b. -he returns the pla blocks to the same spot on the table
c. -he recogni@es that a ball of cla is the same ob=ect even when it*s flattened out.
d. -he bangs two cubes in her hands and throws them to the floor
;1. "hen completing the morning postpartum assessment the nurse notices the clients perineal pad is completel
saturated with lochia rubra. "hich of the following actions should be the nurse*s first response#
a. vigorousl massage the fundus
b. immediatel call the primar care provider
c. have the charge nurse review the assessment
d. Ask the client when she last changed her perineal pad.
;!. "hich of the following factors might result in a decreased suppl of breast milk in a post partum mother#
a. supplemental feedings with formula
b. maternal diet high in vitamin C
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c. an alcoholic drink
d. fre6uent feedings
;&. "hich of the following interventions would be helpful to a breast-feeding mother who is experiencing engorged
breasts#
a. appling ice
b. appling a breast hinder
c. teaching how to express her breasts in a warm shower
d. administering Bromocroptine .parlodel/
;, "hich of the following assessments should be performed routinel in the postpartum client#
a. Antibod screen c. $oman*s reflex
b. Babinski*s reflex d. %atellar reflex
;3. "hich of the following reasons explains wh >egel exercises are advantageous to woman after the deliver a child#
a. The assist with lochia removal
b. The promote the return of normal bowel function
c. The promote blood flow' allowing for healing and strengthening the musculature.
d. The assist the woman in burning calories for rapid postpartum weight loss.
;4. "hen the nurse is performing a pschosocial assessment on a postpartum client' the nurse is aware that what
percentage of women experience 9postpartum blues:#
a. !< to 3<G c. &< to ,3G
b. 3< to 8<G d. ;3 to 1<<G
;5. "hich of the following practices would the nurse recommend to a client who has a cesarean deliver#
a. fre6uent douching after she*s discharged
b. coughing and deep-breathing exercises
c. sit-ups at ! weeks postoperativel
d. side-rolling exercises
;8 "hich of the following reasons explains wh client might express disappointment after having a cesarean deliver
instead of a vaginal deliver#
a. cesarean deliveries cost more
b. depression is more common after a cesarean deliver
c. the client is usuall more fatigued after cesarean deliver
d. the client ma feel a loss for not having experienced a 9normal: birth
;;. "hich of the following findings is normal during the postpartum period of a client who has experienced a vaginal birth#
a. redness or swelling in the calves
b. a palpable uterine fundus beond 4 weeks postpartum
c. vaginal drness after the lochia flow has ended
d. dark red lochia for approximatel 4 weeks after the birth
1<<. Bn completing a fundal assessment' the nurse notes the fundus is situated on the client*s left abdomen. "hich of the
the following actions is appropriate#
a. Ask the client to empt her bladder
b. -traight catheteri@e the client immediatel
c. Call the client*s primar health care provider for direction
d. -traight catheteri@e the client for half of her urine volume.
1<1. The nurse should inform the client with mastitis that the disorder is most commonl caused b which of the following
organisms#
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a. E. coli
b. group A beta-hemoltic streptococci .0B-/
c. Staphylococcus aureus
d. Streptococcus pyogenes
1<!. A client had a spontaneous vaginal deliver after 18 hours of labor. $er excessive vaginal bleeding has now become
a postpartum hemorrhage. )mmediatel nursing care of this should include which of the following preventions#
a. Avoiding massaging the uterus
b. Fonitoring vital signs ever hour
c. placing the client in Trendelenburg*s position
d. elevating the head of the bed to increase blood flow
1<&. "hich of the following complications should the nurse assess for in a client with tpe ) (iabetes Fellitus whose
deliver was complicated b polhdramios and macrosomia#
a. %ostpartum mastitis
b. )ncreased insulin needs
c. %ostpartum hemorrhage
d. pregnanc-induced hpertension .%)$/
1<,. )nfections in mothers with diabetes tend to the more severe and can 6uickl lead to which of the following
complications#
a. Anemia c. 2espirator acidosis
b. >etoacidosis d. 2espirator alkalosis
1<3. "hich of the following statements regarding mastitis is correct#
a. The most common pathogen is 0roup A beta-hemoltic streptococci.
b. A breast abscess is a common complications of mastitis
c. Fastitis usuall develops in both breasts of a breast feeding woman.
d. -mptoms include fever' chills' malaise' and locali@ed breast tenderness.
1<4. "hich of he following measurements best describes delaed postpartum hemorrhage#
a. Blood loss exceed of &<< ml' occurring !, hours to 4 weeks after deliver
b. Blood loss exceed to 3<< ml' occurring !, hours o 4 weeks after deliver
c. Blood loss exceed to 8<< ml' occurring !, hours o 4 weeks after deliver
d. Blood loss exceed to 1<<< ml' occurring !, hours o 4 weeks after deliver
1<5. "hich of the following assessments of the mother should made in the immediate post partum period .first ! hours/
a. Blood glucose level c. $eight of fundus
b. 1lectrocardiogram .1C0/ d. -tool test for occult blood
1<8. )s performing an assessment of a postpartum client ! hours after deliver' the nurse notices heav bleeding with
large clots. "hich of the following response is mops appropriate initiall#
a. Fassaging the fundus firml
b. %erforming bimanual compressions
c. Administering ergonivine
d. +otifing he primar health care provider
1<;. The nurse is about to give a class B diabetic .age of onset greater than !< ears duration less than 1< ears/ her
insulin before breakfast on her first da postpartum. "hich of the following answers best describes insulin
re6uirements immediatel postpartum#
a. Dower than during her pregnanc
12
b. higher than during her pregnanc
c. Dower than before she became pregnant
d. higher than before she became pregnant
11<. "hich of the following findings would be expected when assessing the postpartum client#
a. fundus 1 cm above the umbilicus 1 hour postpartum
b. fundus 1 cm above the umbilicus on post postpartum da &
c. fundus palpable in the abdomen at ! weeks postpartum
d. fundus slightl to right: ! cm above umbilicus on postpartum da !
111. A client is complaining of painful contractions' or afterpains' on postpartum da !. "hich of the following conditions
could increase the severit of afterpains#
a. Bottle-feeding c. Fultiple gestations
b. (iabetes d. %rimiparit
11!. "hen giving a postpartum client self-care instructions' the nurse instructs her to report heav or excessive bleeding.
"hich of the following would indicate heav bleeding#
a. -aturating a pad in 13 minutes c. -aturating a pad in , to 4 hours
b. -aturating a pad in 1 hour d. -aturating a pad in 8 hours
11&. Bn which of the following postpartum das the client except lochia serosa .old blood' serum' leukoctes and tissue
debris/#
a. (as & and , postpartum c. (as 1< to 1, postpartum
b. (as & to 1< postpartum d. (as 1, to ,! postpartum
11,. A client and her neonate have a blood incompatibilit' and the nurse has had a positive direct Comb*s test. "hich of
the following nursing interventions is appropriate#
a. Because the woman has been sensiti@ed give 2h< immune globulin .2ho0AF/
b. Because the woman hasn*t been sensiti@ed' give 2ho0AF
c. Because the woman has been sensiti@ed' don*t give 2ho0AF
d. Because the woman hasn*t been sensiti@ed' don*t give 2ho0AF
113. "hich of the following definitions best describes a puerperal infections#
a. An infections in the uterus of a postpartum woman
b. An infection in the bladder of a postpartum woman
c. An infection in the perineum of a postpartum woman
d. An infection in the genital tract of a postpartum woman
114. "hich of the following behaviors characteri@es the postpartum mother in the taking in phase#
a. %assive and dependent
b. -triving for independence and autonom
c. Curious and interested in care of the bab
d. 1xhibiting maximum readiness for new learning
115. "hich of the following verbali@ations should be cause to the nurse treating a postpartum client within a few das of
deliver#
a. The client is nervous about taking the bab home
b. The client feels empt since she delivered the bab
c. The client would like to watch the nurse give the bab her first bath
d. The client would like the nurse to take her bab to the nurser so she can sleep.
13
118. "hich of the following complications ma be indicated b continous seepage of blood from the vagina of a
postpartum client' when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus#
a. 2etained placental fragments c. Cervical laceration
b. Jrinar tract infection .JT)/ d. Jterine aton
11;. (ischarge teaching of the postpartum client who is receiving anticoagulant therap for a deep venous
thrombophlebitis includes which of the following instructions#
a. Avoid iron replacement therap
b. Avoid over the counter saliclates
c. "ear girdles and knee high stockings when possible
d. -hortness of breath is a common adverse effect of the medication
1!<. TB2C$ is an acronm for maternal infections associated with an increase in congenital malformations and disorders.
"hich of the following disorders does the H represent#
a. $emophilia c. $erpes simplex virus
b. $epatitis B virus d. $uman immunodeficienc virus
1!1. "hich of the following signs of grieving is dsfunctional in a client & das after a prenatal loss#
a. Dack of appetite c. Blaming herself
b. (enial of the death d. 7re6uent cring spells
1!!. "hich of the following conditions in a postpartum client ma cause fever not caused b infection#
a. Breast engorgement c. Fastitis
b. 1ndometritis d. Jterine involution
1!&. An 2$ positive client delivers a 4 lb.' 1< o@ neonate vaginall after 15 hours of labor. "hich of the following
conditions puts this client at risk for infection#
a. Dength of labor c. Fethod of deliver
b. Faternal 2h status d. -i@e of the bab
1!,. "hich of the management strategies should be implemented regarding breast feeding after cesarean deliver#
a. (ela breast feeding until !, hours after deliver
b. Breast feed fre6uentl during the da and ever , to 4 hours at night
c. Jse the cradle hold position to avoid incisional discomfort
d. Jse the football hold position to avoid incisional discomfort
1!3. "hat tpe of milk is present in the breasts 5 to 1< das postpartum#
a. Colostrums c. Fature milk
b. $ind milk d. Transitional milk
1!4. "hich of the following recommendations should be given to a client with mastitis who is concerned about breast
feeding her neonate#
a. -he should stop breast feeding until completing the antibiotic
b. -he should supplement feeding with formula until the infection resolve
c. -he shouldn*t use analgesics because the aren*t compatible with breast feeding
d. -he should continue to breast feedA mastitis won*t infect the infant
1!5. "hich of the following terms is used to describe maladaption to the stress and conflicts of the postpartum period'
characteri@ed b disabling feelings of inade6uac and an inabilit to cope#
a. %ostpartum blues c. %ostpartum neurosis
14
b. %ostpartum depression d. %ostpartum pschosis
1!8. )n which of the following time periods is it most likel for a client who has delivered twins to experience late
postpartum hemorrhage#
a. !, to ,8 hours after deliver
b. !, hours to 4 weeks after deliver
c. 4 weeks to & months after deliver
d. 4 weeks to 4 months after deliver
1!;. "hich of the following complications is most likel responsible for a delaed postpartum hemorrhage#
a. Cervical lacerations c. %erineal laceration
b. Clotting deficienc d. Jterine subinvolution
1&<. A client needs to void & hours after a vaginal deliver. "hich of the following risk factors necessitates assisting her
out of bed#
a. Chest pain c. Brthostatic hpotension
b. Breast engorgement d. -eparation of episiotom incision
1&1. Before giving a postpartum client the rubella vaccine' which of the following facts should the nurse include in client
teaching#
a. The vaccine is safe in clients with egg allergies
b. Breast feeding isn*t compatible with the vaccine
c. Transient arthalgia and rash are uncommon adverse effects
d. The client should avoid getting pregnant for & months after the vaccination because the vaccine has
teratogenic effects
1&!. "hich of the following medications is most commonl used to treat preeclampsia during the prenatal and postpartum
periods#
a. (ia@epam .?alium/ c. Fagnesium sulfate
b. $drala@ine .Apresoline/ d. +itedipine .procardia/
1&&. "hich of the following complications is associated with magnesium sulfate therap#
a. $potension c. %ostpartum hemorrhage
b. %ostpartum depression d. Jterine infection
1&,. "hich of the following changes best describes the insulin needs of a client with tpe 1 diabetes mellitus who has =ust
delivered an infant vaginall without complications#
a. )ncrease
b. (egrease
c. 2emain the same as before pregnanc
d. 2emain the same as during pregnanc
1&3. "hich of the following response is most appropriate for a mother with diabetes who wants to breast feed but is
concerned about the effects of breast feeding on her health#
a. Fothers with diabetes who breast feed have a hard time controlling their insulin needs
b. Fothers with diabetes shouldn*t breast feed because of potential complications
c. Fothers with diabetes shouldn*t breast feed: insulin re6uirements are doubled
d. Fothers with diabetes ma breast feed insulin re6uirements ma decrease from breast feeding
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1&4. A multiparous client vaginall delivered an infant at &8 weeks without complications. -he has three other children at
home' two of whom were full term and one a preterm. "hich of the following classifications would accuratel describe
this client#
a. gravida & para ,1<, c. 0ravida , para !1<&
b. gravida & para &11& d. 0ravida , para &1<,
1&5. "hich of the following factors puts a multiparous client on her first postpartum da at risk for developing
hemorrhage#
a. $emoglobin level of 1!gEdl c. Trombophlebitis
b. Jterine aton d. Foderate amount of lochia rubra
1&8. Bn the first postpartum night' a client re6uests that her bab be sent back to the nurser so she can get some sleep.
The client is most likel in which of the following phases#
a. (epression phase c. Taking hold phase
b. Detting go phase d. Taking in place
1&;. 7our clients each gave birth 1! hours ago. "hich one would most likel suffer complications after birth#
a. 0ravida ! para !<<!' cesarean birth' incisional site intact' hemoglobin level ;.8 gEdl
b. 0ravida ! para 1<11' cesarean birth' incisional site intact' pulse 8, beats per minute
c. 0ravida 1 para 1<<1' vaginal deliver' midline episiotom' temperature ;;.8 7 .&5.5 C/
d. 0ravida 1 para 1<<1' vaginal deliver' ruptured membranes 1< hours before deliver
1,<. "hich of the following groups of smptoms is most commonl associated with preeclampsia#
a. 1dema' hporeflexia' and glcosuria
b. $potension' hporeflexia' and protenuria
c. $pertension' hperreflexia and protienuria
d. $perglcemia' hperreflexia and glcosuria
1,1. A client has delivered twins. "hich of the following interventions would be most important for the nurse to perform#
a. Assess fundal tone and lochia flow
b. Appl a clod pack to the perineal area
c. Administer analgesics as ordered
d. 1ncourage voiding b offering the bedpan
1,!. "hich of the following phsiological response is considered normal in the earl postpartum period#
a. Jrinar urgenc and dsuria
b. 2apid diuresis
c. (ecrease in blood pressure
d. )ncreased motilit of the 0) sstem
1,&. (uring the third postpartum da' which of the following observations about the client would the nurse be most likel to
make#
a. The client appears interested in learning more about neonatal care
b. The client talks a lot about her birth experience
c. The client sleeps whenever the neonate isn*t present
d. The client re6uest helps in choosing a name for the neonate
1,,. "hich of the following circumstances is most likel to cause uterine aton and lead to postpartum hemorrhage#
a. $pertension c. Jrine retention
b. Cervical and vaginal tears d. 1ndometritis
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1,3. "hich tpe of lochia should the nurse except to find a client ! das postpartum#
a. 7oul smelling c. Dochia alba
b. lochia serosa d. Dochia rubra
1,4. "hich percentage of postpartum clients experiences 9postpartum blues:#
a. !<G to !3G c. &<G to ,3G
b. 3<G to 8<G d. 1<<G
1,5. "hen performing a comprehensive fundal check during a postpartum assessment' the nurse evaluates which fundal
state#
a. fundal consistenc' location and height
b. fundal consistenc and height
c. fundal location and potential fundal distention
d. fundal location and height
1,8. (uring the postpartum period' which situation does a firm fundus indicate#
a. A firm tumor at the top of the uterus
b. Contraction of the uterus
c. Continuing labor contractions
d. Bladder distention
1,;. To encourage uterine involution in a primigravida client on the first postpartum da' the nurse should instruct her
assume which position#
a. %rone c. -upine
b. >nee to chest d. -ide ling
13<. A postpartum client is receiving anticoagulant therap for deep vein thromboplebitis. (ischarge teaching should
include which instruction#
a. Avoid iron replacement therap
b. "ear a girdle and knee high stockings whenever possible
c. Avoid over the counter saliclates
d. be aware that shortness of breath is a common adverse effect of anticoagulants
131. 7or a breast feeding client on the fourth postpartum da' which breast examination findings are normal#
a. -mmetrical breast shape and si@e
b. 1ngorged breasts with inflamed' radiating areas that are sore to the touch
c. -lightl tender' crackled nipples' slightl firm' nontender breasts' transitional milk
d. Tender intact nipplesA firm' nontender breastsA transitional milk
13!. $ow man additional calories should a breast feeding primiparous client consume to ensure high 6ualit breast milk#
a. 3<< caloriesEda c. ,<< caloriesEda
b. &<< caloriesEda d. 1'<<< caloriesEda
13&. The nurse is teaching a breast feeding primiparous client how to prevent sore nipple. "hich client statement
indicates the need for further instructions#
a. 9) should breast feed for onl & to , minutes at a time until m flow is established
b. 9) should position the bab properl during feedings
c. 9) should pull the bab gentl awa from m nipple after the feedings:
d. 9) should prevent the bab from feeding after m breast has been emptied:
13,. "hich of the following statements best describes lochia rubra#
17
a. )t contains a mixture of mucus' tissue debris' and blood
b. )t contains placental fragments and blood
c. )t contains mucus' placental fragments and blood
d. )t contains tissue debris and blood
133. Bn the second postpartum da a client complains that she*s urinating more than when she was pregnant. "hich is
the primar cause of increased urinar output after deliver#
a. %ostpartum diuresis
b. %ostpartum renal malfunctioning
c. increased postpartum fluid intake
d. %ostpartum breast feeding
134. Dochia Alba follows lochia serosa and usuall lasts from the first to third week postpartum. "hich of the following
statements best describes lochia Alba#
a. )ts cream white to brown and ma have a stale odor.
b. )ts cream to brown' contains decidual cells and ma have a stale odor
c. its brown to red' contains tissue fragments' and ma have an odor
d. its brown to red and contains decidual vells and leukoctes
135. "hat*s the most common ma=or complications of retained placental fragments#
a. %uerperal infection c. %ostpartum hemorrhage
b. %ostpartum depression d. %ostpartum subinvolution
138. %ostpartum involution refers to which of the following descriptions#
a. +ormal postpartum pschiatric developmental stages of the mother
b. +ormal postpartum coping stages of the mother
c. +ormal postpartum uterine contractions that force the uterus to shrink
d. Abnormal postpartum uterine activit
18
BJDD1T- )+ FC+ A
-tudies have proven that breast milk provides preterm neonates with better protection from infection such as
necroti@ing enterocolitis because of the antibodies contained in breast milk.
-urfactant works b reducing surface tension in the lung. -urfactant allows the lung to remain slightl expanded'
decreasing the amount of work re6uired for inspiration.
Acrocanosis' or bluish discoloration of the hands and feet in the neonate .also called peripheral canosis/' is a
normal finding and shouldn*t last more than !, hours after birth.
-upine positioning is recommended to reduce the risk of -)(- in infanc.
+eonates of mothers with diabetes are at risk for hpoglcemia due to increased insulin levels. (uring gestation'
an increased amount of glucose is transferred to the fetus through the placenta. The neonate*s liver can*t initiall
ad=ust to the changing glucose levels after birth.
Bronchopulmonar dsplasia commonl results from the high pressures that must sometimes be used to maintain
ade6uate oxgenation.
-oft' smooth skin is a sign of ade6uate hdration.
%ositive Babinski*s sign is present in infants until approximatel age 1. A positive Babinski*s reflex is normal in
neonates but abnormal in adults.
At approximatel !& to !, week*s gestation' the lungs are developed enough to sometimes maintain extrauterine
life. The lungs are the most immature sstem during the gestational period.
?itamin > deficient in the neonate is needed to activate clotting factors ))' ?))' )L' and L. )n the event of trauma'
the neonate would be at risk for excessive bleeding.
$epatitis B immune globulin should be given as soon as possible after birth but within 1! hours. +eonates should
also receive hepatitis B vaccine at regularl scheduled intervals.
To minimi@e the risk of aspiration of meconium after deliver' the neonate*s mouth then nose should be suctioned
after deliver of the head.
1e prophlaxis is administered to the neonate immediatel or soon after birth to prevent ophthalmia neonatorum.
The neonate with an ABB blood incompatibilit with its mother will have =aundice within the first !, hours of life.
%rematurit is the single most important risk factor for developing 2(-.
The ellow-white exudates is part of the granulation process and a normal finding for a healing penis after
circumcision. Therefore notifing the phsician isn*t necessar.
%ostdate fetuses lose the vernix caseosa' and the epidermis ma become des6uamated.
The small-for-gestation neonate is at risk for developing polcthemia during the transitional period in an attempt
to decrease hpoxia.
Temperature instabilit' especiall when it results in a low temperature in the neonate' ma be a sign of infection.
The neonate*s color often changes with an infection process but generall becomes ashen or mottled.
A respirator rate ,< to 4< breathsEminute is normal for a neonate during the transitional period.
Fagnesium sulfate crosses the placenta and adverse neonatal effects are respirator depression' hpotonia' and
bradcardia.
+eonates experiencing drug withdrawal often have sleep disturbance. The neonate should be moved to a 6uiet
area of the nurser to minimi@e environmental stimuli.
+eonates of mothers with diabetes are at increased risk for macrosomia .excessive fetal growth/ as a result of the
combination of the increased suppl of maternal glucose and an increase in fetal insulin. Along with macrosomia'
neonates of diabetic mothers are at risk for respirator distress sndrome' hpoglcemia' hpocalcemia'
hperbilirubinemia and congenital anomalies.
+eonates have coagulation deficiencies because of a lack of vitamin > in the intestines' which helps the liver
snthesi@e clotting factors ))' ?))' )L' and L.
1vaporation is the loss of heat that occurs when a li6uid is converted to a vapor. )n the neonate' heat loss b
evaporation occurs as a result of vapori@ation of moisture from the skin.
Convection heat loss is the flow of heat from the bod surface to cooler air.
%hsiologic =aundice in term neonates first appears after !, hours.
Caput succedaneum is the swelling of tissue over the presenting part of the fetal scalp due to sustained pressure.
This bogg edematous swelling is present at birth' crosses the suture line' and most commonl occurs in the
occipital area.
Feconium collects in the 0) tract during gestation and is initiall sterile. Feconium is greenish black because of
occult blood and is viscous.
19
The neonate*s ees must be covered with ee patches to prevent damage. The mouth of the neonate doesn*t
need to be covered during phototherap.
The mother*s blood tpe which is different from the neonate*s has an impact on the neonate*s bilirubin level due to
the antigen-antibod reaction.
0roup B streptococci are gram-positive cocci that the neonate is exposed to if these bacteria are coloni@ed in the
vaginal tract.
Transmission of group B beta-hemoltic streptococci to the fetus results in respirator distress that can rapidl
lead to septic shock.
Both Chlamdia and gonorrhea are common cause of neonatal con=unctival infections' and erthromcin
effectivel treats these infections.
"hen caring for a neonate experiencing drug withdrawal' the nurse needs to be alert for distress signals from the
neonate. -timuli should be introduced one at a time when the neonate is in a 6uite alert state.
>eeping the cord dr and open to air helps reduce infection and hastens dring.
$poglcemia in a neonate is expressed as =itteriness' letharg' diaphoresis and a serum glucose level below ,<
mgEdl
?ernix is a white' chees material present on the neonate*s skin at birth.
1rthromcin ophthalmic ointment is given for prophlactic treatment of ophthalmic neonatorum.
Decithin and sphingomelin are phospholipids that help compose surfactant in the lungsA lecithin peaks at &4
weeks' and sphingomelin concentrations remain stable.
Chronic maternal hpertension is an unlikel factor because chronic fetal stress tends to increase lung maturit.
Con=unctival hemorrhages are commonl seen in neonates secondar to the cranial pressure applied during the
birth process.
Covering the neonate*s head with a cap helps prevent cold stress due to excessive evaporative heat loss from a
neonate*s wet head.
1rthema toxicum has lesions that come and go on the face' trunk and limbs. The*re small white or ellow
papules or vesicles with erthematous dermatitis.
Jse onl water and mild soap on a neonate to prevent dring out the skin. The mild bath is given when the
neonate*s temperature is stable.
The C(C recommends hepatitis B vaccine be given to all neonates' including those born to hepatitis B surface
antigen-negative mothers.
%etroleum gau@e is applied to the site for the first !, hours to prevent the skin edges from sticking to the diaper.
$pothermic neonates become bradcardic proportional to the degree of core temperature.
)mmediatel dring the neonate decreases evaporative heat loss from his moist bod from birth.
$poglcemia occurs as the consumption of glucose increases with the increase in metabolic rate.
%revention of heat loss is alwas the first goal in thermoregulation to avoid hpothermia. The second goal is to
minimi@e the energ necessar for neonates to produce heat.
(ecreased subcutaneous fat and a thin epidermis affect the establishment of a thermal neutral @one.
)ncreased bilirubin levels in the liver usuall cause bilirubin levels of 1! mgEdl b the &
rd
da of life. This is from the
impaired con=ugation and excretion of bilirubin and difficult clearing bilirubin from plasma.
%henobarbital increases the concentration of ligandin' which transports bilirubin for con=ugation.
)ncreased insensible water loss is due to absorbed photon energ from the lights.
The exact cause of breast-milk =aundice is unknown. )f bilirubin levels don*t decreased after & das' human milk is
eliminated as a cause. These babies are tpicall good eaters will good weight gain. Bilirubin levels increase'
rather than decrease at &. Caundice in the !, hours of life is characteristic of hemoltic disease.
Tachpnea and expirator grunting occur earl in respirator distress sndrome to help improve oxgenation.
Choanal atresia is caused b protrusion of bone or membrane into nasal passages' causing blockage or
narrowing.
Tola@oline dilates pulmonar arteries and decreases pulmonar vascular resistance.
Transient tachpnea has an invariabl favorable outcome after several hours to several das.
Fask ventilation should be avoided to prevent air from being introduced into the 0) tract b his techni6ue.
)g0 is a ma=or )g of serum and interstitial fluid that crosses the placenta.
(istinctive facial dsmorpholog of children with 7A- most commonl involves the ees .microophthalmia/.
The most common sign of the effects of alcohol on fetal development is retarded grow in weight' length and head
circumference.
Altered sleep patterns are caused b disturbances in the central nervous sstem from alcohol exposure in utero.
20
Feconium ileus is a luminal obstruction of the distal small intestine b abnormal meconium seen in neonates with
cstic fibrosis.
Bsteogenesis imperfecta is a connective tissue disorder with the primar defect involving the collagen structure.
?AT12 association clinicall presents with three or more defects' including the three mentioned.
"ithdrawal of maternal estrogen can produce pseudo menstruation
Accumulated secretions are copious because the neonate can*t swallow.
The neonate has proportionall more surface area through which heat can dissipate.
The neonate*s metabolic rate increases as a result of cold stress' which leads to an increased oxgen
re6uirement. Cold stress doesn*t increase erthrocte destruction.
2oom air is currentl insufficient' seen b the central canosis. Tactile stimulation is onl needed if the neonate is
apneic or gasping. )ntubation is onl indicated in special circumstances' such as prematurit or a diaphragmatic
hernia. Bag and mask ventilation is onl indicated if the heart rate is less than 1<< beatsEminute.
+eonatal skin thickens with maturit and is often peeling b postterm.
This is Fongolian spot' commonl found over the lumbosacral area in neonates of Black' Asian' Datin American'
or +ative American origin.
Folding refers to overlapping of the cranial sutures' which causes the neonate*s head to appear cone-shaped
7eeding the neonate ever time he cries results in overfeeding. A neonate*s cring doesn*t alwas signal hunger'
sometimes it means his diaper is wet' he needs to suck or he wants to be held. 7or the first few das' the
neonate*s normal stomach capacit is 13 ml so he should be fed ever & to , hours.
Assessment findings indicate that the neonate is in respirator distress N most likel from transient tachpnea'
which is common after cesarean deliver. The normal respirator rate is &< to 4< breathsEminuteA a neonate with a
rate of 8< breathsEminute shouldn*t be fed but should receive ).?. fluids until the respirator rate returns to normal.
A normal health neonate turns in the direction that the cheek is stroked. 7ailure to do so ma indicate a
neurologic problem which the nurse should report to the phsician.
Toddlers are confronted with the conflict of achieving autonom' et relin6uishing the much en=oed dependence
on N and affection of N others.
-ucking is the infant*s chief pleasure. $owever thumb sucking can cause malocclusion if it persists after age ,.
Fan fetuses begin sucking their fingers in utero and as infants' refuse a pacifier as a substitute.
Adolescents are deepl concerned about their bod image and how the appear to others. An adolescent wouldn*t
ask how the surger went or what complications to expect' although an adult probabl would.
According to %iaget*s theor of cognitive development' an 8 month old child will look for an ob=ect after it
disappears from sight to develop the cognitive skill of ob=ect permanence.
$eart and lung auscultation shouldn*t distress the infant' so it should be done earl in the assessment.
(uring the school-age ears' the most important social interactions tpicall are those with peers. %eer-to-peer
interactions lead to the formation of intimate friendships between same sex children.
At age &' gross motor development and refinement in hand-ee coordination enable a child to ride a triccle.
Building a sense of trust is crucial with an infant at this stage of growth and development. %lacing him in a , bed
unit isn*t the best choice because a 4 month old child doesn*t pla with other children.
A term neonate who weighs 5 M pounds at birth should triple his birth weight b age 1 ear' therefore he should
weigh approximatel !! to !& pounds.
A preschooler tpicall asks for a bandage after having blood drawn because he as poorl defined bod
boundaries and believes he will lose all of his blood from the hole the needle has made.
Bb=ect permanence is exhibited b the infant looking for ob=ects that have been hidden from sight.
)f the morning assessment is done relativel earl' it*s possible that the client hasn*t et been to the bathroom' in
which case her perineal pad ma have been in place all night.
2outine formula supplementation ma interfere with establishing an ade6uate milk volume because decreased
stimulation to the mother*s nipple affects hormonal levels and milk production.
Teaching the client how to express her breasts in a warm shower aids with let down reflex and will give temporar
relief.
$oman*s sign or pain on dorsiflexion of the foot ma indicate deep vein thrombosis .(?T/.
1xercising the pubococcgeal muscle increase blood flow to the area. The increased blood flow brings oxgen
and other nutrients to the perineal area to aid in healing.
The 9postpartum blues: are a transient mood alteration that arise within the first & postpartum weeks and are
tpicall self-limiting' occurring in 3< N 8< G of clients.
21
As for an postoperative client' coughing and deep-breathing exercises sgould be taught to keep the alveoli open
and prevent infection.
Clients occasionall feel a loss after a cesarean deliver. The ma feel the are inade6uate because the
couldn*t deliver their infant vaginall.
?aginal drness is a normal finding during the postpartum period due to hormonal changes.
A full bladder ma displace the uterine fundus to the left or right side of the abdomen.
The most common cause of mastitis is S. aureus' transmitted from the bab*s mouth.
The client should be placed in Trendelenburg*s position to prevent or control hpovolemic shock.
The client is at risk for a postpartum hemorrhage from the overdistention of the uterus because of the extra
amniotic fluid and the large bab.
"omen with diabetes who become pregnant tend to become sicker and develop illnesses 6uicker than pregnant
woman without diabetes.
Fastitis is an infection of the breast characteri@ed b flulike smptoms' along with redness and tenderness in the
breast.
%ostpartum hemorrhage involves blood loss in excess of 3<< ml.
A complete phsical assessment should be performed ever 13 minutes for the forst 1 to ! hours postpartum'
including assessment of the fundus' lochia' perineum' blood pressure' pulse' and bladder function.
)nitial management of excessive postpartum bleeding is firm massage of the fundus along with a rapid infusion of
oxtocin or lactated 2inger*s solution.
%ostpartum insulin re6uirements are usuall significantl lower than prepregnanc re6iuremens.
"ithin the first 1! hours postpartum' the fundus usuall is approximatel 1 cm above the umbilicus.
Fultiple gestation' breast feeding' multiparit' and conditions hat cause overdistention of the uterus will increase
he intensit of afterpain.
Bleeding is considered heav when a woman saturates a sanitar pad in 1 hour.
Bn the third and fourth postpartum das' the lochia becomes a pale pink or brown and contains old blood' serum'
leukoctes and tissue debris.
A positive Coomb*s test means that the 2h- negative woman is now producing antibodies o he 2h N positive blood
of the neonate.
A puerperal infection is an infection of the genial tract' after deliver through the first 4 weeks postpartum.
(uring the taking-in phase' which usuall lasts ! o & das' the mother is passive and dependent and expresses
her own needs rather than neonate*s needs.
A mother experiencing postpartum blues ma sa she feels empt now ha the infant is no longer in her uterus.
Continuous seepage of blood ma be due to cervical or vaginal lacerations if the uterus is firm and contracting.
(ischarge teaching should include informing the client to avoid saliclates' which ma potentiate the effects of
anticoagulants therap.
TB2C$ N Toxoplasmosis' Bthers such as gonorrhea' sphilis' varicella' 2ubella' Comegalovirus and $erpes
simplex virus.
(enial of the perinatal loss is dsfunctional grieving in the client.
Breast engorgement and dehdration are noninfectious causes of postpartum fevers.
A prolonged length of labor places the mother at increased risk for developing an infection.
"hen breast feeding after a cesarean deliver' the client should be encourage to use the football hold to avoid
incisional discomfort.
Transitional milk comes after colostrums and usuall lass until ! weeks postpartum.
The client with mastitis should be encouraged to continue breast feeding while taking antibiotics for the infection.
%ostpartum depression occurs in approximatel 1<G to 13 G of all postpartum women.
Date or secondar postpartum hemorrhages occur more than !, hours but less than 4 weeks postpartum.
Date postpartum bleeding is often the result of subinvolution of the uterus.
The rapid decrease in intra-abdominal pressure occurring after birth causes splanchnic engorgement. The client is
at risk for orthostatic.
The client must understand that she must not become pregnant for ! to & months after the vaccination because of
its potential teratogenic effects.
Fagnesium sulfate is commonl used in the treatment of preeclampsia to prevent sei@ures.
Because magnesium sulfate produces a smooth muscle depressive effect' the uterus should be assessed for
uterine aton' which would increase the risk of postpartum hemorrhage.
The placenta produces the hormone human placental lactogen' an insulin antagonist.
22
Breast feeding has an anidiabetogenic effects.
0ravida is the number of times a woman has been pregnant. %arit is he number of pregnancies that have
reached viabilit.
Fultiparous women often experience a loss of uterine tone due to fre6uent distention*s of the uterus from past
pregnancies.
The taking- in phase occurs in the first !, hours after birth.
"omen who are anemic in pregnanc ma experience more complications' such as poor wound healing and
inabilit to tolerate activit.
The hallmark signs and smptoms of preeclamsia include hpertension' hperreflexia' and proteinuria.
"omen who deliver twins are a higher risk for postpartum hemorrhage due to overdistention of the uterus' which
causes uterine aton.
)n the earl postpartum period' there*s an increase in he glomerular filtration rate and a drop in progesterone
levels' which result in rapid diuresis.
The third o tenth das of postpartum care are he 9taking-hold: phase' in which the new mother strives for
independence and is eager for her neonate.
Jterine reunion causes a distended bladder o displace the uterus above the umbilicus and to the side' which
prevents the uterus from contracting.
lochia rubra lasts about , das.
9%ostpartum blues: N a transient mood alteration that arises during the first & weeks postpartum and is tpicall
self N limiting N affects 3< N 8<G of postpartum clients.
A comprehensive fundal check includes evaluation of fundal consistenc' height' and location.
A firm postpartum fundus means that the uterus has contracted and is constricting blood vessels' thereb
decreasing lochia flow.
A prone position supports the abdominal muscles and aids uterine involution.
(ischarge teaching should include an instruction o avoid saliclates' which ma magnif the effects of
anticoagulant therap.
Tender' intact nipples' firm' nontender breasts' and transitional milk are normal in a breast feeding client on the
fourth postpartum da.
A breast feeding client should consume an additional 3<< caloriesE da to ensure that she produces high-6ualit
breast milk.
)n some cases' it takes 5 minutes for the let down reflex to cause milk to fill the breast.
lochia rubra contains a mixture of mucus' tissue debris' and blood.
%ostpartum diuresis occurs as the bod starts to reduce the extracellular fluid volume.
lochia alba is cream white to brown' contains decidual cells' and ma have a stale odor.
2etained placental fragments' which prevent the uterus from contracting properl' increase postpartum blood loss.
Jterine involution is the normal contraction of the uterus during the immediate and prolonged postpartum periods.
23
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24
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25