Obstetrical Nursing – Postpartum – NCLEX Quiz 4

1. Before giving a PP client the rubella vaccine. which of the following facts should the nurse include in client teaching?

The vaccine is safe in clients with egg allergies

Breastfeeding isn’t compatible with the vaccine

Transient arthralgia and rash are common adverse effects

The client should avoid getting pregnant for 3 months after the vaccine because the vaccine has teratogenic effects

The client must understand that she must not become pregnant for 3 months after the vaccination because of its potential teratogenic effects.Option A: The rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies.Option B: The virus is not transmitted into the breast milk. so clients may continue to breastfeed after the vaccination.Option C: Transient arthralgia and rash are common adverse effects of the vaccine.

Explanation

The client must understand that she must not become pregnant for 3 months after the vaccination because of its potential teratogenic effects.Option A: The rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies.Option B: The virus is not transmitted into the breast milk. so clients may continue to breastfeed after the vaccination.Option C: Transient arthralgia and rash are common adverse effects of the vaccine.

2. Which of the following responses is most appropriate for a mother with diabetes who wants to breastfeed her infant but is concerned about the effects of breastfeeding on her health?

Mothers with diabetes who breastfeed have a hard time controlling their insulin needs

Mothers with diabetes shouldn’t breastfeed because of potential complications

Mothers with diabetes shouldn’t breastfeed; insulin requirements are doubled.

Mothers with diabetes may breastfeed; insulin requirements may decrease from breastfeeding.

Breastfeeding has an antidiabetogenic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding mothers are at a higher risk of hypoglycemia in the first PP days after birth because the glucose levels are lower. Mothers with diabetes should be encouraged to breastfeed.

Explanation

Breastfeeding has an antidiabetogenic effect. Insulin needs are decreased because carbohydrates are used in milk production. Breastfeeding mothers are at a higher risk of hypoglycemia in the first PP days after birth because the glucose levels are lower. Mothers with diabetes should be encouraged to breastfeed.

3. Which of the following behaviors characterizes the PP mother in the taking in phase?

Passive and dependant

Striving for independence and autonomy

Curious and interested in care of the baby

Exhibiting maximum readiness for new learning

During the taking in phase. which usually lasts 1-3 days. the mother is passive and dependent and expresses her own needs rather than the neonate’s needs.Options B. C. and D: The taking hold phase usually lasts from days 3-10 PP. During this stage. the mother strives for independence and autonomy; she also becomes curious and interested in the care of the baby and is most ready to learn.

Explanation

During the taking in phase. which usually lasts 1-3 days. the mother is passive and dependent and expresses her own needs rather than the neonate’s needs.Options B. C. and D: The taking hold phase usually lasts from days 3-10 PP. During this stage. the mother strives for independence and autonomy; she also becomes curious and interested in the care of the baby and is most ready to learn.

4. Which of the following complications is most likely responsible for a delayed postpartum hemorrhage?

Cervical laceration

Clotting deficiency

Perineal laceration

Uterine subinvolution

Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution.Options A and C: Cervical or perineal lacerations can cause an immediate postpartum hemorrhage.Option B: A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn’t corrected at the time of delivery.

Explanation

Late postpartum bleeding is often the result of subinvolution of the uterus. Retained products of conception or infection often cause subinvolution.Options A and C: Cervical or perineal lacerations can cause an immediate postpartum hemorrhage.Option B: A client with a clotting deficiency may also have an immediate PP hemorrhage if the deficiency isn’t corrected at the time of delivery.

5. On the first PP night. a client requests that her baby be sent back to the nursery so she can get some sleep. The client is most likely in which of the following phases?

Depression phase

Letting-go phase

Taking-hold phase

Taking-in phase

The taking-in phase occurs in the first 24 hours after birth. The mother is concerned with her own needs and requires support from staff and relatives.Option B: The letting-go phase begins several weeks later when the mother incorporates the new infant into the family unit.Option C: The taking-hold phase occurs when the mother is ready to take responsibility for her care as well as the infant’s care.

Explanation

The taking-in phase occurs in the first 24 hours after birth. The mother is concerned with her own needs and requires support from staff and relatives.Option B: The letting-go phase begins several weeks later when the mother incorporates the new infant into the family unit.Option C: The taking-hold phase occurs when the mother is ready to take responsibility for her care as well as the infant’s care.

6. During the 3rd PP day. which of the following observations about the client would the nurse be most likely to make?

The client appears interested in learning about neonatal care

The client talks a lot about her birth experience

The client sleeps whenever the neonate isn’t present

The client requests help in choosing a name for the neonate.

The third to tenth days of PP care are the “taking-hold” phase. in which the new mother strives for independence and is eager for her neonate. The other options describe the phase in which the mother relives her birth experience.

Explanation

The third to tenth days of PP care are the “taking-hold” phase. in which the new mother strives for independence and is eager for her neonate. The other options describe the phase in which the mother relives her birth experience.

7. Which of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications?

Increase

Decrease

Remain the same as before pregnancy

Remain the same as during pregnancy

The placenta produces the hormone human placental lactogen. an insulin antagonist. After birth. the placenta. the major source of insulin resistance. is gone. Insulin needs decrease and women with type 1 diabetes may only need one-half to two-thirds of the prenatal insulin during the first few PP days.

Explanation

The placenta produces the hormone human placental lactogen. an insulin antagonist. After birth. the placenta. the major source of insulin resistance. is gone. Insulin needs decrease and women with type 1 diabetes may only need one-half to two-thirds of the prenatal insulin during the first few PP days.

8. What type of milk is present in the breasts 7 to 10 days PP?

Colostrum

Hind milk

Mature milk

Transitional milk

Transitional milk comes after colostrum and usually lasts until 2 weeks PP.

Explanation

Transitional milk comes after colostrum and usually lasts until 2 weeks PP.

9. Which of the following complications may be indicated by continuous seepage of blood from the vagina of a PP client. when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus?

Retained placental fragments

Urinary tract infection

Cervical laceration

Uterine atony

Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting.Options A and D: Retained placental fragments and uterine atony may cause subinvolution of the uterus. making it soft. boggy. and larger than expected.Option B: UTI won’t cause vaginal bleeding. although hematuria may be present.

Explanation

Continuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting.Options A and D: Retained placental fragments and uterine atony may cause subinvolution of the uterus. making it soft. boggy. and larger than expected.Option B: UTI won’t cause vaginal bleeding. although hematuria may be present.

10. Which of the following physiological responses is considered normal in the early postpartum period?

Urinary urgency and dysuria

Rapid diuresis

Decrease in blood pressure

Increase motility of the GI system

In the early PP period. there’s an increase in the glomerular filtration rate and a drop in the progesterone levels. which result in rapid diuresis.Options A: There should be no urinary urgency. though a woman may feel anxious about voiding.Options C and D: There’s a minimal change in blood pressure following childbirth. and a residual decrease in GI motility.

Explanation

In the early PP period. there’s an increase in the glomerular filtration rate and a drop in the progesterone levels. which result in rapid diuresis.Options A: There should be no urinary urgency. though a woman may feel anxious about voiding.Options C and D: There’s a minimal change in blood pressure following childbirth. and a residual decrease in GI motility.