INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING 8TH EDITION LEIFER TEST BANK
Test Bank - Introduction to Maternity and Pediatric Nursing 8e (by Leifer) 79
Chapter 09: The Family After Birth
MULTIPLE CHOICE
1. The nurse is assessing a newborn. What sign of hypoglycemia does the nurse record?
a. Increased nasal mucus
b. Increased temperature
c. Active muscle movements
d. High-pitched cry
ANS: D
There are many signs of hypoglycemia in the newborn. One is a high-pitched cry.
DIF: Cognitive Level: Comprehension REF: Page 228
TOP: Signs of Hypoglycemia KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk
2. What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery?
a. Well-contracted with its upper border at or just below the umbilicus
b. Well-contracted with its upper border three or four fingerbreadths above the umbilicus
c. Relaxed with its upper border level with the umbilicus
d. Relaxed with its upper border two or three fingerbreadths below the umbilicus
ANS: A
Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a
grapefruit, at the level of the umbilicus.
DIF: Cognitive Level: Comprehension REF: Page 209
TOP: Fundus Assessment KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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3. What statement made by a new mother indicates she needs additional information about breastfeeding?
a. I let the baby nurse 10 to 15 minutes on the first breast and then switch to the other breast.
b. The baby needs to nurse at least 5 minutes on the breast to get the hindmilk.
c. The baby has been nursing every 2 to 3 hours.
d. If the baby gets fussy between feedings, I give her a bottle of water.
ANS: D
Supplemental feedings of formula or water should not be offered to a healthy newborn who is breastfeeding.
DIF: Cognitive Level: Comprehension REF: Page 232
OBJ: 14 TOP: BreastfeedingSupplemental Feedings
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. After delivery, the nurses assessment reveals a soft, boggy uterus located above the level of the umbilicus.
What is the most appropriate nursing intervention?
a. Notify the physician.
b. Massage the fundus.
c. Initiate measures that encourage voiding.
d. Position the patient flat.
ANS: B
A poorly contracted uterus should be massaged until firm to prevent hemorrhage.
DIF: Cognitive Level: Application REF: Page 211
TOP: Boggy Uterus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
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, INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING 8TH EDITION LEIFER TEST BANK
Test Bank - Introduction to Maternity and Pediatric Nursing 8e (by Leifer) 80
5. What type of lochia will the nurse assess initially after delivery?
a. Serosa
b. Rubra
c. Alba
d. Vaginalis
ANS: B
The initial vaginal discharge after delivery is called lochia rubra. It is red and moderately heavy. Lochia rubra
lasts for up to 3 days postpartum.
DIF: Cognitive Level: Knowledge REF: Page 211
TOP: Lochia Rubra KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A woman will be discharged 48 hours after a vaginal delivery. When planning discharge teaching, the nurse
would include what information about lochia?
a. Lochia should disappear 2 to 4 weeks postpartum.
b. It is normal for the lochia to have a slightly foul odor.
c. A change in lochia from pink to bright red should be reported.
d. A decrease in flow will be noticed with ambulation and activity.
ANS: C
A return to bright red lochia rubra may indicate a late postpartum hemorrhage and must be reported.
DIF: Cognitive Level: Application REF: Page 212
TOP: Hemorrhage KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
7. What instruction should the nurse teach the postpartum woman about perineal self-care?
a. Perform perineal self-care at least twice a day.
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b. Cleanse with warm water in a squeeze bottle from front to back.
c. Remove perineal pads from the rectal area toward the vagina.
d. Use cool water to decrease edema of the perineum.
ANS: B
Cleansing from front to back prevents contamination from the rectal area.
DIF: Cognitive Level: Application REF: Page 213
TOP: Perineal Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. A postpartum woman is not immune to rubella. What will the nurse expect?
a. The rubella virus vaccine should be administered before discharge.
b. The woman should receive the rubella virus vaccine at her 6-week postpartum checkup.
c. The woman should be instructed not to get pregnant until she receives the rubella vaccine.
d. No intervention is indicated at this time because the woman is not at risk for rubella.
ANS: A
The woman who is not immune to rubella is immunized in the immediate postpartum period because there is
no danger of her being pregnant.
DIF: Cognitive Level: Comprehension REF: Page 218
TOP: Rubella KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. Which statement indicates the new mother is breastfeeding correctly?
a. I will alternate breasts when feeding the baby.
b. I keep the baby on a 4-hour feeding schedule.
c. I let the baby stay on the first breast only 5 minutes.
This study source was downloaded by 100000840946462 from CourseHero.com on 04-16-2022 10:06:56 GMT -05:00
https://www.coursehero.com/file/59641926/TB-Chapter-09-The-Family-After-Birth1pdf/
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Test Bank - Introduction to Maternity and Pediatric Nursing 8e (by Leifer) 79
Chapter 09: The Family After Birth
MULTIPLE CHOICE
1. The nurse is assessing a newborn. What sign of hypoglycemia does the nurse record?
a. Increased nasal mucus
b. Increased temperature
c. Active muscle movements
d. High-pitched cry
ANS: D
There are many signs of hypoglycemia in the newborn. One is a high-pitched cry.
DIF: Cognitive Level: Comprehension REF: Page 228
TOP: Signs of Hypoglycemia KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Reduction of Risk
2. What would the nurse expect to find when assessing the fundus of the uterus immediately after delivery?
a. Well-contracted with its upper border at or just below the umbilicus
b. Well-contracted with its upper border three or four fingerbreadths above the umbilicus
c. Relaxed with its upper border level with the umbilicus
d. Relaxed with its upper border two or three fingerbreadths below the umbilicus
ANS: A
Immediately after the placenta is expelled, the uterine fundus can be felt as a firm mass, about the size of a
grapefruit, at the level of the umbilicus.
DIF: Cognitive Level: Comprehension REF: Page 209
TOP: Fundus Assessment KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
NURSINGTB.COM
3. What statement made by a new mother indicates she needs additional information about breastfeeding?
a. I let the baby nurse 10 to 15 minutes on the first breast and then switch to the other breast.
b. The baby needs to nurse at least 5 minutes on the breast to get the hindmilk.
c. The baby has been nursing every 2 to 3 hours.
d. If the baby gets fussy between feedings, I give her a bottle of water.
ANS: D
Supplemental feedings of formula or water should not be offered to a healthy newborn who is breastfeeding.
DIF: Cognitive Level: Comprehension REF: Page 232
OBJ: 14 TOP: BreastfeedingSupplemental Feedings
KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. After delivery, the nurses assessment reveals a soft, boggy uterus located above the level of the umbilicus.
What is the most appropriate nursing intervention?
a. Notify the physician.
b. Massage the fundus.
c. Initiate measures that encourage voiding.
d. Position the patient flat.
ANS: B
A poorly contracted uterus should be massaged until firm to prevent hemorrhage.
DIF: Cognitive Level: Application REF: Page 211
TOP: Boggy Uterus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
This study source was downloaded by 100000840946462 from CourseHero.com on 04-16-2022 10:06:56 GMT -05:00
https://www.coursehero.com/file/59641926/TB-Chapter-09-The-Family-After-Birth1pdf/
NURSINGTB.COM
, INTRODUCTION TO MATERNITY AND PEDIATRIC NURSING 8TH EDITION LEIFER TEST BANK
Test Bank - Introduction to Maternity and Pediatric Nursing 8e (by Leifer) 80
5. What type of lochia will the nurse assess initially after delivery?
a. Serosa
b. Rubra
c. Alba
d. Vaginalis
ANS: B
The initial vaginal discharge after delivery is called lochia rubra. It is red and moderately heavy. Lochia rubra
lasts for up to 3 days postpartum.
DIF: Cognitive Level: Knowledge REF: Page 211
TOP: Lochia Rubra KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
6. A woman will be discharged 48 hours after a vaginal delivery. When planning discharge teaching, the nurse
would include what information about lochia?
a. Lochia should disappear 2 to 4 weeks postpartum.
b. It is normal for the lochia to have a slightly foul odor.
c. A change in lochia from pink to bright red should be reported.
d. A decrease in flow will be noticed with ambulation and activity.
ANS: C
A return to bright red lochia rubra may indicate a late postpartum hemorrhage and must be reported.
DIF: Cognitive Level: Application REF: Page 212
TOP: Hemorrhage KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
7. What instruction should the nurse teach the postpartum woman about perineal self-care?
a. Perform perineal self-care at least twice a day.
NURSINGTB.COM
b. Cleanse with warm water in a squeeze bottle from front to back.
c. Remove perineal pads from the rectal area toward the vagina.
d. Use cool water to decrease edema of the perineum.
ANS: B
Cleansing from front to back prevents contamination from the rectal area.
DIF: Cognitive Level: Application REF: Page 213
TOP: Perineal Care KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
8. A postpartum woman is not immune to rubella. What will the nurse expect?
a. The rubella virus vaccine should be administered before discharge.
b. The woman should receive the rubella virus vaccine at her 6-week postpartum checkup.
c. The woman should be instructed not to get pregnant until she receives the rubella vaccine.
d. No intervention is indicated at this time because the woman is not at risk for rubella.
ANS: A
The woman who is not immune to rubella is immunized in the immediate postpartum period because there is
no danger of her being pregnant.
DIF: Cognitive Level: Comprehension REF: Page 218
TOP: Rubella KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
9. Which statement indicates the new mother is breastfeeding correctly?
a. I will alternate breasts when feeding the baby.
b. I keep the baby on a 4-hour feeding schedule.
c. I let the baby stay on the first breast only 5 minutes.
This study source was downloaded by 100000840946462 from CourseHero.com on 04-16-2022 10:06:56 GMT -05:00
https://www.coursehero.com/file/59641926/TB-Chapter-09-The-Family-After-Birth1pdf/
NURSINGTB.COM
