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The nurse is caring for a postpartum patient who delivered by the vaginal route 12 hours ago. Which assessment finding should the nurse report to the health care provider?
- A. Pulse rate of 50
- B. Temperature of 38C (100.4F)
- C. Firm fundus, but excessive lochia
- D. Lightheaded when moving from a lying to standing position
Correct Answer: A
Rationale: Correct Answer: A - Pulse rate of 50
Rationale:
1. A normal postpartum pulse rate is 60-100 bpm.
2. A pulse rate of 50 is below normal range, indicating potential bradycardia.
3. Bradycardia can be a sign of postpartum hemorrhage or other complications.
4. Reporting this finding promptly can help in early intervention.
Summary:
B: A temperature of 38C (100.4F) could indicate infection but is within normal postpartum range.
C: A firm fundus with excessive lochia may indicate uterine atony, but is not as urgent as bradycardia.
D: Feeling lightheaded when changing positions is common postpartum but not as concerning as a low pulse rate.
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Which should the nurse do to provide support to a patient who must return to full-time employment 6 weeks after a vaginal birth?
- A. Discuss child care arrangements with her.
- B. Allow her to solve the problem on her own.
- C. Reassure her that she’ll get used to leaving her baby.
- D. Allow her to express her positive and negative feelings freely.
Correct Answer: A
Rationale: The correct answer is A because discussing child care arrangements with the patient is essential for addressing her concerns and ensuring a smooth transition back to full-time employment. By discussing child care options, the nurse can help the patient make informed decisions and feel more confident about returning to work. This step shows support and helps the patient plan ahead for her baby's care while she's at work.
Choices B, C, and D are incorrect because they do not actively address the patient's needs or provide practical support. Allowing the patient to solve the problem on her own (B) may leave her feeling overwhelmed and unsupported. Reassuring her that she'll get used to leaving her baby (C) minimizes her feelings and does not offer concrete assistance. Allowing her to express feelings (D) is important but may not directly address the practical aspect of arranging child care, which is crucial for her successful return to work.
Which anticipatory guidance action by the nurse makes role transition to parenthood easier?
- A. Helps the new parents identify resources.
- B. Recommends employing babysitters frequently.
- C. Tells the parents about the realities of parenthoo
- D. Offers a home phone number and tells parents to call if they have a question.
Correct Answer: A
Rationale: The correct answer is A because helping new parents identify resources promotes a smoother role transition by providing support and guidance. This action empowers parents to access necessary services and assistance. Choice B is incorrect as frequent babysitting does not address the parents' transition needs. Choice C is incorrect because focusing on the negatives may increase anxiety. Choice D is incorrect as it lacks proactive support and guidance.
The nurse should expect to observe which behavior in a 3-week-multigravid postpartum client with postpartum depression?
- A. Feelings of infanticide.
- B. Difficulty with breastfeeding latch.
- C. Feelings of failure as a mother.
- D. Concerns about sibling jealousy.
Correct Answer: C
Rationale: Postpartum depression often manifests as feelings of inadequacy.
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
A nurse is teaching a mother how to care for her 3-day-old son's circumcised penis. Which of the following actions demonstrates that the mother has learned the information?
- A. The mother cleanses the glans with a cotton swab dipped in hydrogen peroxide.
- B. The mother covers the glans with antifungal ointment after rinsing off any discharge.
- C. The mother squeezes soapy water from the wash cloth over the glans.
- D. The mother replaces the dry sterile dressing before putting on the diaper.
Correct Answer: D
Rationale: Proper care involves keeping the area clean and dry, with a sterile dressing if necessary.