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The person with a cesarean birth has additional nursing concerns beyond those of a person with a vaginal birth. What concern should the nurse anticipate for the cesarean birth?
- A. increased risk for DVT
- B. faster recovery
- C. less use of pain medication
- D. less risk for infection
Correct Answer: A
Rationale: The correct answer is A: increased risk for DVT. Cesarean birth increases the risk of Deep Vein Thrombosis (DVT) due to reduced mobility and potential blood clot formation. This is a critical concern as DVT can lead to serious complications like pulmonary embolism. Choices B and C are incorrect as cesarean birth typically results in longer recovery time and increased need for pain medication compared to vaginal birth. Choice D is incorrect as cesarean birth poses a higher risk of infection due to the surgical incision.
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The nurse observes a patient on her first postpartum day sitting in bed while her newborn lies awake in the bassinet. Which action is most appropriate for the nurse to take at this time?
- A. Hand the baby to the woman.
- B. Explain “taking-in” to the woman.
- C. Offer to hand the baby to the woman.
- D. No action, because this situation is perfectly acceptabl
Correct Answer: B
Rationale: The correct answer is B: Explain "taking-in" to the woman. This action allows the nurse to educate the woman on the normal postpartum adjustment period. By explaining "taking-in," the nurse helps the woman understand her current need for rest and reflection without feeling guilty about not immediately attending to her newborn. This approach promotes bonding by reducing anxiety and enhancing the mother's confidence in her abilities.
Summary of other choices:
A: Hand the baby to the woman - This choice may not address the woman's emotional needs and understanding of her current state.
C: Offer to hand the baby to the woman - While offering is a good gesture, it may not address the underlying need for education and reassurance.
D: No action, because this situation is perfectly acceptable - Ignoring the opportunity to provide guidance and support may lead to confusion and insecurity for the woman.
What is the term for the separation found in the midline of the abdomen after birth?
- A. uterine subinvolution
- B. umbilical hernia
- C. striae
- D. diastasis recti abdominus
Correct Answer: D
Rationale: The correct answer is D: diastasis recti abdominus. This term refers to the separation of the rectus abdominis muscles along the midline of the abdomen. This condition commonly occurs after pregnancy due to the stretching of the abdominal muscles. It is important to differentiate diastasis recti from other conditions such as uterine subinvolution, which is the delayed return of the uterus to its normal size postpartum; umbilical hernia, which is a protrusion of abdominal contents through the umbilical ring; and striae, which are stretch marks caused by rapid stretching of the skin. Diastasis recti is characterized by a visible gap between the muscles, often causing a bulge in the midline of the abdomen. Treatment usually involves specific exercises to strengthen the abdominal muscles and improve the condition.
The nurse is providing care to a patient who delivered a 3525-g infant 14 hours ago. The nurse palpates the fundus of the uterus as firm and at the umbilicus. What is the nurse’s priority action related to this finding?
- A. Inform the health care provider.
- B. Encourage the patient to urinat
- C. Massage the uterus to expel clots.
- D. Document the finding in the patient’s chart.
Correct Answer: D
Rationale: The correct answer is D: Document the finding in the patient’s chart. The fundus being firm and at the umbilicus indicates normal involution after delivery. Documenting this finding is essential for accurate assessment and continuity of care. Informing the health care provider (choice A) is not necessary as the finding is normal. Encouraging the patient to urinate (choice B) is important for postpartum care but not the priority in this situation. Massaging the uterus to expel clots (choice C) is not indicated as the fundus is already firm, indicating proper contraction.
An example of binding in during the postpartum period is a
- A. new mother telling her friends all about her labor and birth experienc
- B. father looking at his newborn and stating that he “looks like I did when I was a baby.”
- C. mother reporting increasing anxiety during the postpartum period because she feels like she is without support.
- D. mother wanting some time alone so that she can catch up on needed sleep.
Correct Answer: A
Rationale: The correct answer is A because it demonstrates the concept of binding, which refers to the process of forming a strong emotional attachment between a parent and their newborn. In this scenario, the new mother is sharing personal details about her labor and birth experience with her friends, showcasing her emotional connection and bonding with her baby. This act of sharing personal experiences and feelings with others reflects the deep emotional bond that the mother is forming with her child.
Choices B, C, and D are incorrect because they do not directly demonstrate the concept of binding. Choice B focuses on the father's observation of the baby's physical resemblance to himself, which is not directly related to the emotional bonding process. Choice C discusses the mother's anxiety due to lack of support, which is a common issue during the postpartum period but does not specifically illustrate the concept of binding. Choice D mentions the mother's need for alone time to catch up on sleep, which is a practical aspect of postpartum care but does not address the
The nursery charge nurse is assessing a 1-day-old female on morning rounds. Which of the following findings should be reported to the neonatologist as soon as possible? Select all that apply.
- A. Blood in the diaper.
- B. Grunting during expiration.
- C. Deep red coloring on one side of the body with pale pink on the other side.
- D. Lacy and mottled appearance over the entire chest and abdomen.
Correct Answer: B
Rationale: Grunting indicates respiratory distress, and harlequin coloring suggests vascular compromise.