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What is the nursing intervention for unilateral edema in a lower extremity and a hot, red area on the leg?
- A. Contact the health-care provider.
- B. Explain this is a normal finding.
- C. Massage calf.
- D. Offer pain medication.
Correct Answer: A
Rationale: Unilateral edema and redness in the leg may indicate a deep vein thrombosis (DVT) a condition that requires medical attention.
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Which of the following laboratory values would the nurse expect to see in a normal postpartum woman?
- A. Hematocrit, 39%.
- B. White blood cell count, 16,000 cells/mm3.
- C. Red blood cell count, 5 million cells/mm3.
- D. Hemoglobin, 15 grams/dL.
Correct Answer: B
Rationale: A slightly elevated white blood cell count is common postpartum due to the physiological stress of delivery and recovery.
A bottle-feeding woman, 11 1/2 weeks postpartum from a vaginal delivery, calls the obstetric office to state that she has saturated 2 pads in the past 1 hour. Which of the following responses by the nurse is appropriate?
- A. You must be doing too much. Lie down for a few hours and call back if the bleeding has not subsided.
- B. You are probably getting your period back. You will bleed like that for a day or two and then it will lighten up.
- C. It is not unusual to bleed heavily every once in a while after a baby is born. It should subside shortly.
- D. It is important for you to be examined by the doctor today. Let me check to see when you can come in.
Correct Answer: D
Rationale: Saturating 2 pads in 1 hour could indicate abnormal bleeding or a complication. Immediate evaluation by a healthcare provider is necessary.
When teaching the postpartum woman about peripads, the nurse should tell her that:
- A. She can change to tampons when the initial perineal soreness goes away.
- B. Pads having cold packs within them usually hold more lochia than regular pads.
- C. Blood-soaked pads must be returned in a plastic bag to the hospital after discharge.
- D. The pads should be applied and removed in a front to back direction.
Correct Answer: D
Rationale: The pads should be applied and removed in a front-to-back direction to reduce the risk of infection.
What theory developed by Ramona Mercer focused on the process of becoming a mother?
- A. Maternal Role Attainment
- B. Postpartum Adapting
- C. Postpartum Maternal Change
- D. Maternal Encouragement
Correct Answer: A
Rationale: Ramona Mercer's theory of Maternal Role Attainment focuses on how women adapt and assume the maternal role following childbirth.
The nurse evaluates a postpartum couplet for parent-infant attachment. What finding would be concerning?
- A. The postpartum person is sleepy.
- B. Parents are both caring for the infant.
- C. The parent is disinterested in the infant.
- D. The family is involved.
Correct Answer: C
Rationale: A lack of interest or emotional engagement with the infant is a concerning sign that may indicate attachment issues.