Nokea
The nurse is researching for evidence-based practice related to a mother's response during the postpartum period. Based on research by Rubin and Mercer, which finding will the nurse be able to easily implement to change the culture of the unit?
- A. Satisfaction questionnaires
- B. Alterations in terminology
- C. Decrease nurse/patient ratios
- D. Soliciting paternal expectations
Correct Answer: B
Rationale: The correct answer is B: Alterations in terminology. Rubin and Mercer's research emphasizes the importance of language in shaping postpartum experiences. By changing terminologies used in the unit to be more supportive and empowering, the nurse can easily implement this finding to positively change the culture. Satisfaction questionnaires (A) may not directly address cultural change. Decreasing nurse/patient ratios (C) may require significant resources and restructuring. Soliciting paternal expectations (D) focuses on a different aspect and may not directly impact unit culture.
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The nurse is observing a new mother interact with her baby and notices the mother holding the baby close to her body. However, the nurse also notices that the mother does not hold the baby in an enface position. Which question is most appropriate for the nurse to ask?
- A. Can I help you with a nice position in which to hold your baby?'
- B. What can you tell me about your family's beliefs with new babies?'
- C. Is there some reason that I have not seen you look into your baby's eyes?'
- D. Your baby is so expressive, have you looked into his eyes yet?'
Correct Answer: B
Rationale: The correct answer is B because it focuses on understanding the mother's cultural background and beliefs related to interacting with a new baby. This question allows the nurse to gain insight into the mother's perspective and approach to parenting, which can help tailor support and guidance effectively.
Choice A focuses on positioning, which is not the main concern in this scenario. Choice C assumes a negative reason for the mother's behavior without any evidence, potentially causing unnecessary worry. Choice D is too direct and may not be culturally sensitive, as some cultures have different norms regarding eye contact with infants.
A postpartum patient states, " am really in pain."For which sources of pain will the nurse not assess the patient?
- A. Uterine contractions
- B. Perineal trauma
- C. Breast engorgement
- D. General soreness
Correct Answer: D
Rationale: The correct answer is D: General soreness. Postpartum pain assessment typically focuses on specific sources such as uterine contractions, perineal trauma, and breast engorgement. General soreness is too vague and does not provide specific information for targeted intervention. By ruling out general soreness, the nurse can prioritize assessment and management of more specific sources of pain to provide appropriate care for the postpartum patient.
The nurse is providing care to a patient who is postpartum. Using anatomy and physiology knowledge, which expectation does the nurse relate to the cardiovascular system?
- A. Patient reporting of being cold related to blood loss
- B. WBC laboratory level of 30,000/mm a few hours after delivery
- C. Risk for hemorrhage due to decrease in circulating clotting factors
- D. A normal postpartum hemoglobin laboratory value of less than 11 g/dL
Correct Answer: B
Rationale: The correct answer is B: WBC laboratory level of 30,000/mm a few hours after delivery. Postpartum, a temporary increase in white blood cells (WBCs) is normal due to the body's response to delivery and potential inflammation. This increase is known as leukocytosis and helps the body combat potential infections. The other choices are incorrect because: A is more related to hypovolemia than to cardiovascular changes. C is incorrect as clotting factors increase postpartum to reduce the risk of hemorrhage. D is incorrect as a hemoglobin level less than 11 g/dL postpartum may indicate anemia, not normalcy.
The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis?
- A. To prevent uterine prolapse.
- B. To prevent uterine movement
- C. To prevent uterine hemorrhage
- D. To prevent uterine inversion
Correct Answer: D
Rationale: The correct answer is D: To prevent uterine inversion. Placing a hand just above the symphysis pubis helps support the uterus and prevent it from turning inside out. This is crucial postpartum to avoid complications such as hemorrhage and shock. Choices A, B, and C are incorrect as palpating the uterus in this manner is specifically aimed at preventing uterine inversion, not prolapse, movement, or hemorrhage.
The nurse is observing a new mother interact with her baby and notices the mother holding the baby close to her body. However, the nurse also notices that the mother does not hold the baby in an enface position. Which question is most appropriate for the nurse to ask?
- A. Can I help you with a nice position in which to hold your baby?'
- B. What can you tell me about your family's beliefs with new babies?'
- C. Is there some reason that I have not seen you look into your baby's eyes?'
- D. Your baby is so expressive, have you looked into his eyes yet?'
Correct Answer: B
Rationale: The correct answer is B: "What can you tell me about your family's beliefs with new babies?" This question allows the nurse to gather valuable cultural information that may explain the mother's behavior of not holding the baby in an enface position. Understanding the family's beliefs helps the nurse provide culturally sensitive care.
A: "Can I help you with a nice position in which to hold your baby?" - This question assumes the mother needs help with positioning, which may not be the case. It does not address the underlying reason for the mother's behavior.
C: "Is there some reason that I have not seen you look into your baby's eyes?" - This question is accusatory and may make the mother defensive. It does not consider cultural reasons for the behavior.
D: "Your baby is so expressive, have you looked into his eyes yet?" - This question assumes the mother has not looked into the baby's eyes, which may not be the case. It does not address the cultural