After birth, the nurse quickly dries and wraps the newborn in a blanket. How does this action prevent heat loss?
- A. Conduction
- B. Radiation
- C. Evaporation
- D. Convection
Correct Answer: C
Rationale: Newborns lose heat quickly after birth as fluid evaporates from their bodies.
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Although the nurse has massaged the uterus every 15 minutes, it remains flaccid, and the patient continues to pass large clots. What does the nurse recognize these signs indicate?
- A. Uterine atony
- B. Uterine dystocia
- C. Uterine hypoplasia
- D. Uterine dysfunction
Correct Answer: A
Rationale: Atony describes a lack of normal muscle tone. If the uterus is atonic, then muscle fibers are flaccid and will not compress bleeding vessels.
What instruction should the nurse teach the postpartum woman about perineal self-care?
- A. Perform perineal self-care at least twice a day.
- 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.
Correct Answer: B
Rationale: Cleansing from front to back prevents contamination from the rectal area.
Below what blood glucose level is the newborn considered hypoglycemic?
- A. Below 70 mg/dL
- B. Below 60 mg/dL
- C. Below 50 mg/dL
- D. Below 40 mg/dL
Correct Answer: D
Rationale: A blood glucose level of less than 40 mg/dL is considered hypoglycemic. If the screening sample is below 40 mg/dL, a venous sample will be drawn. After the blood has been drawn, the infant should be fed to prevent a further drop.
A new mother states her preference to formula feed her newborn. What will the nurse planning discharge instructions tell her to help suppress lactation and promote comfort?
- A. Wear a well-fitting bra continuously for several days.
- B. Stand in a warm shower, letting the water spray over the breasts.
- C. Express small amounts of milk from the breasts several times a day.
- D. Massage the breasts when they ache.
Correct Answer: A
Rationale: When a mother does not wish to breastfeed, a snug bra worn around the clock can help alleviate discomfort from engorgement.
The nurse is giving a shower to a patient who had a cesarean section 2 days previously. What interventions should be included before, during, and after the shower? (Select all that apply.)
- A. Leave abdominal dressing open to air.
- B. Position patient with back to water stream.
- C. Cover infusion site with rubber glove.
- D. Provide a shower chair.
- E. Confirm ambulation ability.
Correct Answer: B,C,D,E
Rationale: The patient should be evaluated for ambulatory ability, and the abdominal dressing and infusion site should be covered with a waterproof cover. The patient should be provided a shower chair and positioned with her back to the water stream.
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