Maternal-Newborn and Women's Health Nursing
- Exam 3 (ATI 17,18,19,20,21,22)
1. A nurse is performing a fundal assessment for a client who is 2 days
postpartum and observes the perineal pad for lochia. The pad is saturated
approximately 12cm with lochia that is bright red and contains small clots.
Which of the following findings should the nurse document?
A. moderate lochia rubra
B. excessive lochia serosa
C. light lochia rubra
D. scant lochia serosa: A. moderate lochia rubra
contains small clots which is expected finding for 2nd day post-partum
2. During ambulation to the bathroom a postpartum client experiences a gush
of dark red blood that soon stops. ON assessment, a nurse finds the uterus to
be firm, midline, and at the level of the umbilicus. Which of the following
findings should the nurse interpret this data as being?
A. evidence of a possible vaginal hematoma
B. an indication of a cervical or a perineal laceration
C. A normal postural discharge of lochia
D. abnormally excessive lochia rubra flow: C. A normal postural discharge of lochia
lochia typically trickles from vaginal opening but flows more steadily during uterine
contractions
3. A nurse is completing a postpartum discharge teaching to a client who had
no immunity to varicella and was given the varicella vaccine. Which of the
following statements by the client indicates understanding of the teaching?
A. I will need to use contraception for 3 months before considering pregnancy
, B. I need a second vaccination at my postpartum visit
C. I was given the vaccine because my baby is O-positive
D. I will be tested in 3 months to see if I have developed immunity: B. I need a second
vaccination at my postpartum visit
second varicella immunization needed at 4 to 8 weeks following delivery by clients who
had no hx of immunity
4. A nurse is assessing a postpartum client for fundal height, location,
consistency. The fundus is noted to be displaced laterally to the right, and
there is uterine atony. The nurse should identify which of the following
conditions as the cause of the uterine atony?
A. poor involution
B. urinary retention
C. hemorrhage
D. infection: B. urinary retention
can result in distention of bladder; distended bladder can cause uterine atony and lateral
displacement from midline
5. A nurse is providing education to a client who is 2 hr postpartum and has
perineal laceration. Which of the following info should the nurse include?
Select all that apply:
A. Use a perineal squeeze bottle to cleanse the perineum.
B.
Sit on the perineum while resting in bed
C.
Apply a topical anesthetic cream or spray to the perineum
D.
Wipe the perineum thoroughly with a back-and-forth motion
E.
Apply cold or ice packs to the perineum: A. Use a perineal squeeze bottle to cleanse
the perineum.
C. Apply a topical anesthetic cream or spray to the perineum
- Exam 3 (ATI 17,18,19,20,21,22)
1. A nurse is performing a fundal assessment for a client who is 2 days
postpartum and observes the perineal pad for lochia. The pad is saturated
approximately 12cm with lochia that is bright red and contains small clots.
Which of the following findings should the nurse document?
A. moderate lochia rubra
B. excessive lochia serosa
C. light lochia rubra
D. scant lochia serosa: A. moderate lochia rubra
contains small clots which is expected finding for 2nd day post-partum
2. During ambulation to the bathroom a postpartum client experiences a gush
of dark red blood that soon stops. ON assessment, a nurse finds the uterus to
be firm, midline, and at the level of the umbilicus. Which of the following
findings should the nurse interpret this data as being?
A. evidence of a possible vaginal hematoma
B. an indication of a cervical or a perineal laceration
C. A normal postural discharge of lochia
D. abnormally excessive lochia rubra flow: C. A normal postural discharge of lochia
lochia typically trickles from vaginal opening but flows more steadily during uterine
contractions
3. A nurse is completing a postpartum discharge teaching to a client who had
no immunity to varicella and was given the varicella vaccine. Which of the
following statements by the client indicates understanding of the teaching?
A. I will need to use contraception for 3 months before considering pregnancy
, B. I need a second vaccination at my postpartum visit
C. I was given the vaccine because my baby is O-positive
D. I will be tested in 3 months to see if I have developed immunity: B. I need a second
vaccination at my postpartum visit
second varicella immunization needed at 4 to 8 weeks following delivery by clients who
had no hx of immunity
4. A nurse is assessing a postpartum client for fundal height, location,
consistency. The fundus is noted to be displaced laterally to the right, and
there is uterine atony. The nurse should identify which of the following
conditions as the cause of the uterine atony?
A. poor involution
B. urinary retention
C. hemorrhage
D. infection: B. urinary retention
can result in distention of bladder; distended bladder can cause uterine atony and lateral
displacement from midline
5. A nurse is providing education to a client who is 2 hr postpartum and has
perineal laceration. Which of the following info should the nurse include?
Select all that apply:
A. Use a perineal squeeze bottle to cleanse the perineum.
B.
Sit on the perineum while resting in bed
C.
Apply a topical anesthetic cream or spray to the perineum
D.
Wipe the perineum thoroughly with a back-and-forth motion
E.
Apply cold or ice packs to the perineum: A. Use a perineal squeeze bottle to cleanse
the perineum.
C. Apply a topical anesthetic cream or spray to the perineum
