NURSING: CHILDBEARING FAMILY

Question 1: Postpartum Mastitis

A postpartum client has been diagnosed with mastitis in her right breast. Given this diagnosis, which self-care measure should the nurse recommend to help alleviate discomfort while also improving drainage in the affected breast? NURSING: CHILDBEARING FAMILY

• Incorporate massage and hand expression in the right breast to relieve engorgement.
• Begin breastfeeding exclusively from the left breast until the infection resolves.
• Narcotics are contraindicated with breastfeeding so you will need to just take Tylenol for fever control.
• Apply cold compresses to the right breast before feedings.

Question 2: Preeclampsia and Hemorrhage

A postpartum patient has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia. It has been about 8 hours since her vaginal delivery and upon assessment the nurse finds the following: temperature 98.3°F, pulse rate 88 beats/min, respiratory rate 16 breaths/min, blood pressure (BP) 148/78 mmHg, 2+ deep tendon reflexes, 100cc of clear yellow urine over the past hour, heavy rubra lochia and a boggy fundus. What is the most appropriate action for the nurse to take?

• Administer additional magnesium sulfate to maintain therapeutic levels.
• Monitoring the patient’s blood pressure and reflexes.
• Administering a uterotonic medication to control bleeding.
• Call for a stat magnesium sulfate level.

Question 3: Rh Incompatibility

In this scenario, a nurse is caring for a client who delivered a healthy newborn 2 hours ago. Given that the client’s blood type is O negative and, simultaneously, the newborn’s blood type is A positive, which nursing action is most appropriate at this time?

• Withhold Rhogam because the mother has already delivered.
• Administer Rhogam only if the mother plans future pregnancies.
• Administer Rhogam within 72 hours postpartum.
• Withhold Rhogam because there is no indication for a second dose with the newborn’s blood type.

Question 4: Vitamin K Administration

A nurse is educating student nurses about Vitamin K administration in newborns. Which of the following fact is correct?

• It’s only beneficial for male infants actually undergoing a circumcision.
• It is required per state mandate for preterm infants.
• Primarily, it serves to aid in digestion while also facilitating effective nutrient absorption
• It prevents potentially life-threatening intracranial hemorrhage.

Question 5: Newborn Macrosomia

A macrosomic infant is born after a difficult forceps-assisted delivery. Furthermore, the APGAR scores are 7/9. After stabilization, the infant is measured. Moreover, the birth weight is 4550 grams (9 pounds, 6 ounces) and 21 inches long. What is the nurse’s most appropriate action is to:

• Prepare for immediate transfer to the neonatal intensive care unit (NICU).
• Encourage early breastfeeding to promote maternal-infant bonding.
• Monitor blood glucose levels per hospital policy and initiate feedings as soon as possible.
• Document the birth weight and continue routine care.

Question 6: Post-Cesarean Lochia

When caring for a mother who has had a cesarean birth, the nurse would expect the client’s lochia to be:

• about the same as after a vaginal delivery.
• saturated with clots and mucus.
• less than after a vaginal delivery.
• greater than after a vaginal delivery.

Question 7: Neonatal Abstinence Syndrome (NAS)

A nurse is caring for a 37w4d newborn admitted to the NICU today who is at risk for Neonatal Abstinence Syndrome (NAS) due to maternal substance use during pregnancy. Which medication and plan of care might the nurse anticipate for this newborn with severe NAS symptoms?

Medication (Select 2):

• Morphine
• Phenobarbital
• Amoxicillin
• Ibuprofen

Plan of Care (Select 2):

• Decrease environmental stimulation
• Apply barrier cream with each diaper change
• Place the infant on the abdomen to relieve congestion
• Delay feeding until symptoms subside

Question 8: Hyperbilirubinemia

A NICU nurse is providing discharge teaching to parents whose infant was born at 36 weeks 4 days. First, the nurse should explain that premature infants often have immature livers, which makes it harder to process bilirubin. Moreover, this buildup of bilirubin in the blood can lead to jaundice. Therefore, phototherapy is used to help break down bilirubin into a form that can be excreted more easily. Finally, the nurse should reassure the parents that phototherapy is a safe and effective treatment for managing hyperbilirubinemia in newborns. Which of the following explanation of the indication for treatment is correct?

• “Your baby received phototherapy helps improve his lung development.”
• “Your baby received phototherapy to reduce bilirubin levels and prevent kernicterus.”
• “Phototherapy is used for preterm infants to prevent cold stress of the newborn.”
• “Phototherapy is used in all preterm newborns as a prophylactic treatment due to their higher risk factors.”

Question 9: Newborn Thermoregulation

After the birth of a newborn which of the following would the nurse do first to assist in thermoregulation?

• Wrap the newborn in a blanket.
• Dry the newborn thoroughly.
• Put a hat on the newborn’s head.
• Check the newborn’s temperature.

Question 10: Umbilical Cord Care

Instructions and expected findings (pick 3):

• Sponge baths only
• Turns black in color
• Will fall off in 7-10 days

Notify the pediatrician (pick 3):

• Bleeding
• Foul odor
• Purulent drainage

Question 11: Small for Gestational Age (SGA)

The mother is concerned about the baby’s small size and asks for you to explain what small for gestational age means. Furthermore, you explain to her that the baby’s weight is below the 10th percentile for all babies born at 39 weeks gestation and puts the baby at risk for hypoglycemia.

Question 12: Failed Hearing Screening

Following the procedure, the newborn has failed the initial hearing screening conducted by the nurse as part of routine postnatal care. As a result, what should the nurse’s subsequent intervention be in response to this result?

• Initiate speech therapy services for the infant.
• Provide comfort to the parents and place a social services consult.
• Reassure the parents that this result is common in newborns and anticipate rescreening before discharge.
• Notify the provider and schedule a follow-up with an ENT within 24 hours.

Question 13: APGAR Priority

A newborn has an APGAR score of 6 at 5 minutes. Which of the following is the priority?

• Obtaining umbilical blood gases.
• Beginning resuscitative measures.
• Initiating IV fluid therapy.
• Promoting kangaroo care.

Question 14: Postpartum Assessment Investigation

During the postpartum assessment, when the nurse is evaluating a client approximately 6 hours after delivery, which of the following findings should prompt the nurse to conduct further assessment or investigation?

• Uterine cramping pain.
• Deep red, fleshy-smelling lochia.
• Heart rate of 108 beats/minute.
• Diaphoresis.

Question 15: Retinopathy of Prematurity (ROP)

A nurse is caring for a preterm infant in the neonatal intensive care unit (NICU) who is at risk for retinopathy of prematurity (ROP). Which statement by the parents indicates a need for further teaching?

• “We understand that our baby’s risk for ROP is related to their premature birth.”
• “This is happening because I declined the erythromycin when she was born.”
• “Regular eye exams will be needed to monitor for any signs of ROP.”
• “Treatment for ROP may involve laser therapy or injections into the eye.”

Question 16: Human Breast Milk

With regard to the special qualities and production of human breast milk, which of the following should nurses be aware about?

• Colostrum is an early, less concentrated, less rich version of mature milk.
• The milk of preterm mothers is the same as the milk of mothers who gave birth at term.
• The milk at the beginning of the feeding is the same as the milk at the end of the feeding.
• Frequent feedings during predictable growth spurts stimulate increased milk production.

Question 17: Formula Feeding Education

A nurse is providing discharge education to the parents of a formula-fed newborn. Which statement by the parents indicates a need for further clarification about formula feeding?

• “We’ll feed the baby on-demand and watch for hunger cues.”
• “The babies stool should change from black to green/brown color over the next few days.”
• “We can use tap water from our kitchen faucet to prepare the formula.”
• “We need to make sure to burp our baby during and after each feeding.”

Question 18: Subinvolution Finding

In a clinical setting, which of the following finding in a postpartum patient most strongly suggests subinvolution?

• Uterus nonpalpable by week 2.
• Lochia serosa on day 5.
• Uterus palpable above the umbilicus on day 7.
• Fundus firm and midline, 2 cm below the umbilicus on day.

Question 19: Recovery Room Test

While in the recovery room following a vaginal delivery, the nurse asks the patient if she can raise her legs off the bed. This action is most likely a test to assess whether she:

• If the patient is eligible to be discharged at the 24 hour mark from delivery.
• Has regained sensation in her legs after receiving her epidural or spinal anesthesia.
• Is experiencing any signs of deep vein thrombosis (DVT).
• Has hidden bleeding underneath her.

Question 20: Fluid Requirement Calculation

The daily fluid requirement for infants less than 10 kg is 100 mL/kg. Calculate how many milliliters an hour an infant weighing 2.5 pounds should receive. (Round to the nearest 10th place).

• Answer: 4.7

Question 21: Newborn Weight Loss

A nurse is caring for a newborn in the postpartum unit. The parents express concern about their baby’s weight loss of 5% since birth. Which of the following explanation by the nurse accurately describes the common reason for newborn weight loss in the first few days of life?

• “It’s primarily due to the baby’s inability to digest breast milk or formula initially.”
• “Weight loss can be normal but 5% is too much and may indicate an underlying health problem.”
• “Weight loss occurs as a result of normal physiological processes such as fluid loss and adjusting to a new feeding pattern.”
• “Newborns lose weight because they have a higher metabolism than adults.”

Question 22: Artificial Surfactant

A newborn with respiratory distress syndrome (RDS) is prescribed artificial surfactant therapy. First, the nurse should explain that surfactant is a substance normally produced in the lungs to help keep the air sacs open. Moreover, infants with RDS lack sufficient natural surfactant, which makes breathing difficult. Therefore, giving artificial surfactant helps reduce the effort needed to breathe and improves oxygen exchange. How should the nurse best explain the use of artificial surfactant in the management of RDS to the parents?

• “Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon dioxide.”
• “Surfactant is used to reduce episodes of periodic apnea.”
• “Your baby needs this medication to reduce fever and inflammation in the lungs.”
• “It prevents your baby from experiencing discomfort during breathing.”

Question 23: Displaced Fundus

During a routine assessment, the nurse is evaluating a postpartum woman. Specifically, the fundus is palpated on the right side of the abdomen and is also found to be above the expected level. In light of these findings, what is the most appropriate first action for the nurse to take?

• Instruct her to change position since she has probably been lying on her right side too long.
• Have the woman empty her bladder and then reassess.
• Contact the health care provider.
• Recognize this finding is associated with a hematoma and draw a stat CBC.

Question 24: Medication Calculation (True/False)

“Order: Ampicillin 35 mg IVPB three times a day for an infant weighing 5.5 lbs. Furthermore, the infant dosage range is 20–40 mg/kg/day in 3 equal doses. The order is appropriate.

• True
• False

Question 25: DVT and Contraception

During a postpartum follow-up, a woman with a history of deep vein thrombosis (DVT) asks about starting birth control pills. What is the nurse’s best response?

• “You can safely use any oral contraceptive.”
• “Birth control pills will actually lower your risk of another blood clot.”
• “The barrier method such as condoms is the only safe option with your history.”
• “Estrogen-containing contraceptives are contraindicated due to your history of blood clots.”

Question 26: Breastfeeding Success

After teaching a postpartum woman about breastfeeding, the nurse determines that the teaching was successful when the woman states which of the following?

• “It’s normal for my baby to feed every 4-6 hours during the day and have longer stretches of sleep during the night due to their natural circadian rhythm.”
• “Keeping the baby swaddled during the feeding will help prevent him from getting cold.”
• “I’ll switch to formula feeding if my baby seems fussy or unsatisfied after breastfeeding.”
• “I’ll breastfeed my baby whenever they show signs of hunger, even if it’s more frequently than every few hours.”

Question 27: Postpartum Psychological Assessment

A postpartum nurse is providing care to a new mother who delivered her baby two days ago. Initially, she scored a 3 on her Edinburgh Postnatal Depression Scale (EPDS) upon admission to the unit; however, the mother now appears tearful and anxious. Furthermore, she expresses persistent feelings of inadequacy in her new role. Which action by the nurse is most appropriate when addressing the mother’s condition?

• Reassure the mother that these feelings are normal and part of the “baby blues.”
• Realize she is probably afraid to go home and advocate to the provider that she stays an extra day.
• Administer an anti-anxiety medication to alleviate her symptoms.
• Immediately, refer the mother to a social services specialist for postpartum depression.

Question 28: APGAR Scoring

Which physiological indicators should the nurse monitoring the newborn utilize to assess the APGAR scores during birth?

• Heart rate, respiratory effort, muscle tone, reflex irritability, and color
• Reflex irritability, heart rate, cap refill, blood pressure, and respiratory rate
• Color, O2 saturation, heart rate, respiratory rate, and alertness
• Movement, heart rate, cry, tone, and temperature

Question 29: Newborn Stool Patterns

The nurse is on the mother baby unit teaching a new mother about changing the diaper of her 20-hour-old newborn. The mother is alarmed and asks why the stool is black and sticky. Which of the following response by the nurse would be most appropriate?

• “You probably took iron during your pregnancy.”
• “This is often associated with blood in the stool caused by a dairy allergy. Let’s switch the babies formula to the sensitive type.”
• “This is meconium stool, normal for a newborn.”
• “Black stool is a sign of dehydration; has the lactation specialist been by to see you?”

Question 30: Postpartum Complications (Triage)

A postpartum mother with a BMI of 35 is day 2 status post cesarean section. You received in report she has had minimal ambulation since her surgery yesterday. The patient uses her call light to ask if the nurse “could come to her room.” She complains of sudden shortness of breath and chest pain. VS are as follows: HR: 119, RR: 22, BP: 148/84, Temp: 98.7F, pain is 8/10. Which of the following nursing action is most appropriate in response to these findings?

• Document the findings and continue routine care.
• Administer a hydrocodone as ordered for pain to alleviate chest discomfort.
• Encourage the mother to rest and practice deep breathing exercises.
• Notify the healthcare provider after focused respiratory assessment and prepare for further evaluation.

Question 31: Thermoregulation

A nursing student is preparing a presentation on minimizing heat loss in the newborn. Which of the following would the student include as a measure to prevent heat loss through conduction?

• Keeping the isolette side rails up as much as possible
• Placing the newborn skin-to-skin with the mother
• Keep the bassinet away from windows or doors in winter
• Drying the newborn with a clean towel immediately after birth

Question 32: Matching Head Assessment Findings

Match the following correctly, the newborn facial and head assessment finding with the definition and typical causes.

• Cephalohematoma: Collection of blood on the fetal scalp that does not cross the sagittal suture line.
• Caput succedaneum: Localized swelling of the tissue caused by pressure of the head during labor (crosses suture lines).
• Depressed anterior fontanel: Indication of dehydration of the newborn.
• Hydrocephalus: Excessive cerebral fluid.
• Molding: Elongated head with irregular shape.

Question 33: Breastfeeding Complications

If a woman develops cracked and bleeding nipples after breastfeeding for 8 days, the nurse would be correct in determining the most likely cause is:

• inadequate breastfeeding positioning and latch.
• normal irritation from initiation of breastfeeding.
• an early sign of mastitis.
• infrequent breastfeeding sessions throughout the day.

Question 34: Return of Menses

A postpartum client who plans on feeding formula to newborn asks, “When should my period return?” Which response by the nurse would be most appropriate?

• “It varies, but you can estimate it returning in about 7 to 9 weeks.”
• “You won’t have to worry about it returning for at least 6 months.”
• “It’s difficult to say but it will probably return in about 2 to 3 weeks.”
• “You don’t have to worry about that now. It’ll be quite a while.”

Question 35: Postpartum Hemorrhage (PPH) Risks

Which factors in a client’s history exist that would consequently alert the nurse to an increased risk for postpartum hemorrhage?

• Premature birth, infection and length of labor
• Uterine atony, placenta previa, operative procedures
• Multiparity, age of mother, operative delivery
• Primigravida, small baby, operative delivery

Question 36: CCHD Screening

A nurse is preparing to perform a congenital heart screening procedure on a newborn. Therefore, which equipment should the nurse ensure is readily available to complete the task?

• A pulse oximeter and ECG machine.
• A syringe and needle for blood sampling.
• A thermometer and warming blanket.
• A stethoscope and blood pressure cuff.

Question 37: Postpartum Diuresis

A nurse is caring for a client who is 12 hours postpartum. Moreover, the client is voiding large amounts of urine. Therefore, which response by the nurse is correct regarding the cause of this diuresis? NURSING: CHILDBEARING FAMILY

• “Your kidneys are working harder to filter the anesthesia used during delivery.”
• “This is a result of the increased pressure the baby had on your bladder.”
• “Your body is losing extra fluid that was needed during pregnancy due to a decrease in estrogen and progesterone levels.”
• “This happens because your blood volume is rapidly increasing after delivery.”

Question 38: Infant Nutrition Guidelines

Per the guidelines set forth by the American Academy of Pediatrics (AAP) regarding infant nutrition, which of the following statements is accurate?

• Infants fed on formula should be started on solid food sooner than breastfed infants.
• If infants are weaned from breast milk before 12 months they should receive cow’s milk, not formula.
• Infants should be given only human milk for the first 6 months of life.
• After 6 months mothers should shift from breast milk to cow’s milk.

Question 39: Caloric Dosage Calculation

Given that the recommended caloric intake for a newborn is 110 Kcal/kg/day, how many Kcal per day should your 7.9 pound baby consequently receive?

• Answer: 395

Question 40: Kangaroo Care

A nurse is providing education to a new mother about kangaroo care in the NICU. Following this education, which statement by the mother demonstrates a good understanding?

• “Kangaroo care is only beneficial for full-term infants, so I don’t think it’s necessary for my preemie.”
• “I should place my baby on my chest skin-to-skin for at least 30 minutes each day.”
• “I should ensure my baby is fully clothed and wrapped in a blanket during kangaroo care to keep them warm.”
• “Kangaroo care is primarily for breastfeeding promotion and has no other benefits for my baby.”

Question 41: Cold Stress Rationale

Preterm infants are highly vulnerable to temperature fluctuations; consequently, what is the primary rationale for safeguarding them from the adverse effects of cold stress? NURSING: CHILDBEARING FAMILY

• To encourage bonding between the infant and parents.
• Excessive shivering of the newborn to generate heat may result in excessive calorie expenditure.
• It has the potential to exacerbate respiratory distress syndrome.
• To prevent unnecessary discomfort for the infant.

Question 42: Postpartum Depression Assessment

A postpartum mother presents to the healthcare clinic for her 6 week postnatal check-up. During the assessment, she expresses feelings of overwhelming sadness, hopelessness, and guilt. She also mentions a loss of interest in activities she once enjoyed and difficulty bonding with her newborn. Which nursing action is most appropriate for the nurse to take in this situation?

• Conduct a comprehensive assessment of the mother’s mental health and refer her for further evaluation and support.
• Reassure the mother that these feelings will resolve on their own as she adjusts to motherhood.
• Provide education on the normal and expected emotional changes experienced during the postpartum period.
• Ensure she is not left alone in the room with the baby while you prepare to transfer her to inpatient psychiatric care.

Question 43: Newborn Metabolic Screening

A nurse is discussing newborn metabolic screening with parents who state, “Our baby looks perfectly healthy. Why does she need this?” Which of the following is the nurse’s best response?

• “Some genetic disorders are not visible at birth but can cause serious problems if untreated.”
• “The metabolic screening is primarily used for state research purposes and is voluntary.”
• “The test ensures your baby’s immune system is developing normally.”
• “This is to test the newborn’s jaundice level at 24 hours of life so we can treat hyperbilirubinemia if your newborn develops it.”

Question 44: Postpartum Complications (Hematoma)

At 3 hours postpartum, a gravida 2, para 2 complains of rectal pressure and increasing perineal pain. She is unable to void. This woman had a low forceps delivery with a midline episiotomy and a third-degree laceration. The fundus is firm and one fingerbreadth below the umbilicus. Lochia is moderate, bright red and without clots. The nurse is correct to assess further for: NURSING: CHILDBEARING FAMILY

• uterine atony.
• a vaginal laceration or hematoma.
• a bladder infection.
• a hemorrhoid.

Question 45: Perineal Laceration Care

The nurse understands that a 4th degree laceration tore through the rectal wall and anal sphincter and as a result,that the patient will need to ____. NURSING: CHILDBEARING FAMILY

• apply pressure to the perineum during voiding.
• take a stool softener to help ease her first bowel movement.
• see a pelvic floor specialist before discharge.
• schedule a follow up for reconstructive surgery.

Question 46 (Categorization): Risk Factors & Peri Care

Based on the case study (9\lb 2 \ oz baby, 4th degree laceration, G1forceps), categorize the following:

Risk Factors (4 in total):

1. Macrosomic infant
2. Operative vaginal delivery
3. Primigravida
4. Prolonged pressure of fetal head on vaginal mucosa

Peri Care (4 in total):

1. Assess/treat pain
2. Intermittent ice pack use
3. Sitz Bath
4. Heat packs

Question 47: Postpartum Hemorrhage

The nurse enters the room to complete her afternoon assessment of the patient. Her fundus is boggy, 2 cm above the umbilicus, displaced to the right. Her bleeding is heavy with large clots expelled. The nurse recognizes this bleeding is likely because of:

• a hematoma
• the 4th degree laceration
• an undiagnosed bleeding disorder
• uterine atony

Question 48 (Categorization): Phases of Lochia

Match each phase of lochia to the correct description:

Lochia Rubra:

• Lasts from day 1-3 postpartum
• Fleshy odor

Lochia Serosa:

• Lasts from day 4-10 postpartum
• Pinkish/brown color

Lochia Alba:

• Yellowish/white color
• Consists of mucus and leukocytes

Question 49: Breastfeeding Adequacy

A nurse is assessing a newborn who is exclusively breastfed. The mother is concerned about whether her baby is getting enough breast milk. Which assessment findings would indicate to the nurse the baby has adequate intake of breast milk?

• The infant last stool was yellow and seedy.
• A good latch with active feeding for 3-5 minutes on each breast.
• Satisfaction cues from the baby.
• Sleeping for 6 hours without feeding.

Question 50: Gentamicin Dosage Calculation

The doctor has ordered Gentamicin IM 1.3 mg/kg q 12 hours. Infant weighs 3.7 pounds. Based on this order, how many mg of Gentamicin would this infant receive? Enter numeric value only. Round to the nearest 100th place. NURSING: CHILDBEARING FAMILY

• Answer: 2.19