Nokea
Which vaccinations are indicated for the postpartum patient if she does not have immunity? (Select all that apply.)
- A. Pertussis
- B. Rubella
- C. Diphtheria, tetanus (Tdap)
- D. RhoGAM
Correct Answer: A
Rationale: Rationale:
1. Pertussis vaccine is recommended in the postpartum period to protect the newborn from whooping cough.
2. Rubella vaccine is usually given preconception or postpartum if the mother is not immune.
3. Tdap vaccine (Diphtheria, Tetanus, Pertussis) is recommended during pregnancy, not specifically postpartum.
4. RhoGAM is given to Rh-negative mothers to prevent hemolytic disease in the newborn, not for general immunity.
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A mother, G4 P4004, is 15 minutes postpartum. Her baby weighed 4,595 grams at birth. For which of the following complications should the nurse monitor this client?
- A. Seizures.
- B. Hemorrhage.
- C. Infection.
- D. Thrombosis.
Correct Answer: B
Rationale: Macrosomic babies increase the risk of postpartum hemorrhage.
To facilitate adequate urinary elimination during the postpartum period, the nurse should incorporate which intervention into the plan of care?
- A. Have the patient drink carbonated beverages to promote urinary excretion.
- B. Tell the patient that because of postpartum diuresis there is less risk to develop dehydration.
- C. Limit fluid intake to prevent polyuri
- D. Teach the patient to perform pelvic floor exercises to combat potential stress
Correct Answer: D
Rationale: The correct answer is D, teaching the patient to perform pelvic floor exercises to combat potential stress incontinence. This intervention strengthens pelvic floor muscles, aiding in bladder control postpartum. Choice A is incorrect as carbonated beverages can irritate the bladder. Choice B is incorrect as postpartum diuresis increases fluid loss, increasing the risk of dehydration. Choice C is incorrect as limiting fluid intake can lead to dehydration and hinder urinary elimination.
A mother asks whether or not she should be concerned that her baby never opens his mouth to breathe when his nose is so small. Which of the following is the nurse's best response?
- A. The baby does rarely open his mouth but you can see that he isn't in any distress.
- B. Babies usually breathe in and out through their noses so they can feed without choking.
- C. Everything about babies is small. It truly is amazing how everything works so well.
- D. You are right. I will report the baby's small nasal openings to the pediatrician right away.
Correct Answer: B
Rationale: Nasal breathing is normal in newborns to allow simultaneous feeding and breathing.
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: The correct answer is A: Maternal Role Attainment. Mercer's theory emphasizes the process through which a woman acquires the maternal role, including changes in behavior, attitudes, and values. Choice B, Postpartum Adapting, is vague and doesn't specifically address the process of becoming a mother. Choice C, Postpartum Maternal Change, is too general and lacks the focus on role attainment. Choice D, Maternal Encouragement, is not a theory developed by Ramona Mercer and does not capture the essence of the maternal role attainment process.
A client has just received Hemabate (carboprost) because of uterine atony not controlled by IV oxytocin. For which of the following side effects of the medication will the nurse monitor this patient? Select one that doesn't apply.
- A. Hyperthermia.
- B. Diarrhea.
- C. Hypotension.
- D. Palpitations.
Correct Answer: B
Rationale: Hemabate can cause hyperthermia, hypotension, and palpitations.