Chapter 21: Nursing Care of the Family During the Postpartum Period Lowdermilk: Maternity & Women’s Health Care, 11th Edition

TEST BANK FOR MATERNITY & WOMEN’S HEALTH CARE 11TH EDITION BY LOWDERMILK Chapter 21: Nursing Care of the Family During the Postpartum Period Lowdermilk: Maternity & Women’s Health Care, 11th Edition MULTIPLE CHOICE 1. A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath three times daily, and a stool softener. Which information regarding the client‘s condition is most closely correlated with these orders? a. Woman is a gravida 2, para 2. b. Woman had a vacuum-assisted birth. c. Woman received epidural anesthesia. d. Woman has an episiotomy. CORRECT ANSWER: D These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids. A multiparous classification is not an indication for these orders. A vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate these interventions. The use of an epidural anesthesia has no correlation with these orders. DIF: Cognitive Level: Understand REF: p. 489 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 2. The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data? a. Rubella vaccine should be administered. b. Blood trCORRECT ANSWERfusion is necessary. c. Rh immune globulin is necessary within 72 hours of childbirth. d. Kleihauer-Betke test should be performed. CORRECT ANSWER: A This client‘s rubella titer indicates that she is not immune and needs to receive a vaccine. These data do not indicate that the client needs a blood trCORRECT ANSWERfusion. Rh immune globulin is indicated only if the client has an Rh-negative status and the infant has an Rh-positive status. A Kleihauer-Betke test should be performed if a large fetomaternal trCORRECT ANSWERfusion is suspected, especially if the mother is Rh negative. However, the data provided do not indicate a need forperforming this test. DIF: Cognitive Level: Understand REF: p. 493 TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance 3. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment, the nurse notices that both breasts are swollen, warm, and tender on palpation. Which guidance should the nurse provide to the client at this time? a. Run warm water on her breasts during a shower. b. Apply ice to the breasts for comfort. c. Express small amounts of milk from the breasts to relieve the pressure. d. Wearing a loose-fitting bra to prevent nipple irritation. CORRECT ANSWER: B Applying ice packs and cabbage leaves to the breasts for comfort is an appropriate intervention for treating engorgement in a mother who is bottle feeding. The ice packs should be applied for 15 minutes on and 45 minutes off to avoid rebound engorgement. A bottle-feeding mother should avoid any breast stimulation, including pumping or expressing milk. A bottle-feeding mother should continuously wear a well-fitted support bra or breast binder for at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation. DIF: Cognitive Level: Apply REF: p. 493 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 4. A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. What is the nurse‘s most appropriate response? a. ―Didn‘t you like your lunch?‖ b. ―Does your physician know that you are planning to eat that?‖ c. ―What is that anyway?‖ d. ―I‘ll warm the soup in the microwave for you.‖ CORRECT ANSWER: D Offering to warm the food shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response. Cultural dietary preferences must be respected. Women may request that family members bring favorite or culturally appropriate foods to the hospital. Asking the woman to identify her food does not show cultural sensitivity. DIF: Cognitive Level: Apply REF: p. 496 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 5. A primiparous woman is to be discharged from the hospital the following day with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? a. The woman is disinterested in learning about infant care. b. The woman continues to hold and cuddle her infant after she has fed her. c. The woman reads a magazine while her infant sleeps. d. The woman changes her infant‘s diaper and then shows the nurse the contents of the diaper. CORRECT ANSWER: A The client should be excited, happy, and interested or involved in infant care. A woman who is sad, tearful, or disinterested in caring for her infant may be exhibiting signs of depression or postpartum blues and may require further intervention. Holding and cuddling her infant after feeding is an appropriate parent-infant interaction. Taking time for herself while the infant is sleeping is an appropriate maternal action. Showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infant‘s elimination patterns. DIF: Cognitive Level: Understand REF: p. 486 TOP: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance 6. The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth. Which scenario is not a contributor to this model of care? a. Wellness orientation model of care rather than a sick-care model b. Desire to reduce health care costs c. Consumer demand for fewer medical interventions and more family-focused experiences d. Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information CORRECT ANSWER: D Nursing time and care are in demand as much as ever; the nurse simply has to do things more quickly. A wellness orientation model of care seems to focus on getting clients out the door sooner. In most cases, less hospitalization results in lower costs. People believe that the family gives more nurturing care than the institution. DIF: Cognitive Level: Understand REF: p. 481 TOP: Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment 7. Under the Newborns‘ and Mothers‘ Health Protection Act, all health plCORRECT ANSWER are required to allow new mothers and newborns to remain in the hospital for a minimum of hours after a normal vaginal birth and for hours after a cesarean birth. What is the correct interpretation of this legislation? a. 24; 72 b. 24; 96 c. 48; 96 d. 48; 120 CORRECT ANSWER: C The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge. A client may be discharged either 24 hours after a vaginal birth or 72 hours after a cesarean birth if she is stable and her provider is in agreement. A client is unlikely to remain in the hospital for 120 hours after a cesarean birth unless complications have developed.