OB/GYN 4 Postpartum

1) A postpartum nurse is preparing to care for a woman who has just delivered a healthy newborn infant. In the immediate postpartum period the nurse plans to take the womans vital signs: 1. $. !. &. very !" minutes during the first hour and then every hour for the ne#t two hours. very 1% minutes during the first hour and then every !" minutes for the ne#t two hours. very hour for the first $ hours and then every & hours very % minutes for the first !" minutes and then every hour for the ne#t & hours.

/) *hen performing a 00 assessment on a client6 the nurse notes the presence of clots in the lochia. 'he nurse e#amines the clots and notes that they are larger than 1 cm. *hich of the following nursing actions is most appropriate+ 1. $. !. &. .ocument the findings -otify the physician ,eassess the client in $ hours ncourage increased intake of fluids.

$) A postpartum nurse is taking the vital signs of a woman who delivered a healthy newborn infant & hours ago. 'he nurse notes that the mothers temperature is 1"".$(). *hich of the following actions would be most appropriate+ 1. $. !. &. ,etake the temperature in 1% minutes -otify the physician .ocument the findings Increase hydration by encouraging oral fluids

7) A nurse in a 00 unit is instructing a mother regarding lochia and the amount of e#pected lochia drainage. 'he nurse instructs the mother that the normal amount of lochia may vary but should never e#ceed the need for: 1. $. !. &. 3ne peripad per day 'wo peripads per day 'hree peripads per day ight peripads per day

8) A 00 nurse is providing instructions to a woman after delivery of a healthy newborn infant. 'he nurse instructs the mother that she should e#pect normal bowel elimination to return: 1. 3ne the day of the delivery $. ! days 00 !. 7 days 00 &. within $ weeks 00 9) :elect all of the physiological maternal changes that occur during the 00 period. 1. $. !. &. %. ;ervical involution ceases immediately <aginal distention decreases slowly )undus begins to descend into the pelvis after $& hours ;ardiac output decreases with resultant tachycardia in the first $& hours .igestive processes slow immediately.

!) 'he nurse is assessing a client who is / hours 00 after delivering a full1term healthy infant. 'he client complains to the nurse of feelings of faintness and di22iness. *hich of the following nursing actions would be most appropriate+ 1. $. bed !. &. levate the mothers legs Inform the nursery room nurse to avoid bringing the newborn infant to the mother until the feelings of light1 headedness and di22iness have subsided. 3btain hemoglobin and hematocrit levels Instruct the mother to re4uest help when getting out of

&) A nurse is preparing to perform a fundal assessment on a postpartum client. 'he initial nursing action in performing this assessment is which of the following+ 1. $. !. &. Ask the client to turn on her side Ask the client to lie flat on her back with the knees and legs flat and straight. Ask the mother to urinate and empty her bladder 5assage the fundus gently before determining the level of the fundus.

1") A nurse is caring for a 00 woman who has received epidural anesthesia and is monitoring the woman for the presence of a vulva hematoma. *hich of the following assessment findings would best indicate the presence of a hematoma+ 1. $. !. &. ;omplaints of a tearing sensation ;omplaints of intense pain ;hanges in vital signs :igns of heavy bruising

%) 'he nurse is assessing the lochia on a 1 day 00 patient. 'he nurse notes that the lochia is red and has a foul1smelling odor. 'he nurse determines that this assessment finding is: 1. $. !. &. -ormal Indicates the presence of infection Indicates the need for increasing oral fluids Indicates the need for increasing ambulation

11) A nurse is developing a plan of care for a 00 woman with a small vulvar hematoma. 'he nurse includes which specific intervention in the plan during the first 1$ hours following the delivery of this client+ 1. $. !. &. Assess vital signs every & hours Inform health care provider of assessment findings 5easure fundal height every & hours 0repare an ice pack for application to the area.

1/) A nurse is providing instructions to a mother who has been diagnosed with mastitis. *hich of the following statements if made by the mother indicates a need for further teaching+ 1. $. !. &. @I need to take antibiotics6 and I should begin to feel better in $&1&8 hours.A @I can use analgesics to assist in alleviating some of the discomfort.A @I need to wear a supportive bra to relieve the discomfort.A @I need to stop breastfeeding until this condition resolves.A

1$) A new mother received epidural anesthesia during labor and had a forceps delivery after pushing $ hours. At / hours 006 her systolic blood pressure has dropped $" points6 her diastolic =0 has dropped 1" points6 and her pulse is 1$" beats per minute. 'he client is an#ious and restless. 3n further assessment6 a vulvar hematoma is verified. After notifying the health care provider6 the nurse immediately plans to: 1. $. !. &. 5onitor fundal height Apply perineal pressure 0repare the client for surgery. ,eassure the client

17) A 00 client is being treated for .<'. 'he nurse understands that the clients response to treatment will be evaluated by regularly assessing the client for: 1. $. !. &. .ysuria6 ecchymosis6 and vertigo pista#is6 hematuria6 and dysuria ?ematuria6 ecchymosis6 and epista#is ?ematuria6 ecchymosis6 and vertigo

1!) A nurse is monitoring a new mother in the 00 period for signs of hemorrhage. *hich of the following signs6 if noted in the mother6 would be an early sign of e#cessive blood loss+ 1. $. !. &. A temperature of 1"".&() An increase in the pulse from 88 to 1"$ =05 An increase in the respiratory rate from 18 to $$ breaths per minute A blood pressure change from 1!">88 to 1$&>8" mm ?g

18) A nurse performs an assessment on a client who is & hours 00. 'he nurse notes that the client has cool6 clammy skin and is restless and e#cessively thirsty. 'he nurse prepares immediately to: 1. $. !. &. Assess for hypovolemia and notify the health care provider =egin hourly pad counts and reassure the client =egin fundal massage and start o#ygen by mask levate the head of the bed and assess vital signs

1&) A nurse is preparing to assess the uterine fundus of a client in the immediate postpartum period. *hen the nurse locates the fundus6 she notes that the uterus feels soft and boggy. *hich of the following nursing interventions would be most appropriate initially+ 1. $. !. &. 5assage the fundus until it is firm levate the mothers legs 0ush on the uterus to assist in e#pressing clots ncourage the mother to void

19) A nurse is assessing a client in the &th stage if labor and notes that the fundus is firm but that bleeding is e#cessive. 'he initial nursing action would be which of the following+ 1. 5assage the fundus $. 0lace the mother in the 'rendelenburgs position !. -otify the physician &. ,ecord the findings $") A nurse is caring for a 00 client with a diagnosis of .<' who is receiving a continuous intravenous infusion of heparin sodium. *hich of the following laboratory results will the nurse specifically review to determine if an effective and appropriate dose of the heparin is being delivered+ 1. $. !. &. 0rothrombin time Internationali2ed normali2ed ratio Activated partial thromboplastin time 0latelet count

1%) A 00 nurse is assessing a mother who delivered a healthy newborn infant by ;1section. 'he nurse is assessing for signs and symptoms of superficial venous thrombosis. *hich of the following signs or symptoms would the nurse note if superficial venous thrombosis were present+ 1. $. !. &. 0aleness of the calf area nlarged6 hardened veins ;oolness of the calf area 0alpable dorsalis pedis pulses

$1) A nurse is preparing a list of self1care instructions for a 00 client who was diagnosed with mastitis. :elect all instructions that would be included on the list. 1. 'ake the prescribed antibiotics until the soreness subsides. $. *ear supportive bra !. Avoid decompression of the breasts by breastfeeding or breast pump &. ,est during the acute phase %. ;ontinue to breastfeed if the breasts are not too sore. $$) 5ethergine or pitocin is prescribed for a woman to treat 00 hemorrhage. =efore administration of these medications6 the priority nursing assessment is to check the: 1. $. !. &. Amount of lochia =lood pressure .eep tendon refle#es Bterine tone

$/) 3n completing a fundal assessment6 the nurse notes the fundus is situated on the clients left abdomen. *hich of the following actions is appropriate+ 1. $. !. &. Ask the client to empty her bladder :traight catheteri2e the client immediately ;all the clients health provider for direction :traight catheteri2e the client for half of her uterine volume

$7) 'he nurse is about the give a 'ype $ diabetic her insulin before breakfast on her first day postpartum. *hich of the following answers best describes insulin re4uirements immediately postpartum+ 1. Dower than during her pregnancy $. ?igher than during her pregnancy !. Dower than before she became pregnant &. ?igher than before she became pregnant $8) *hich of the following findings would be e#pected when assessing the postpartum client+ 1. $. !. &. )undus 1 cm above the umbilicus 1 hour postpartum )undus 1 cm above the umbilicus on postpartum day ! )undus palpable in the abdomen at $ weeks postpartum )undus slightly to the rightE $ cm above umbilicus on postpartum day $ $9) A client is complaining of painful contractions6 or afterpains6 on postpartum day $. *hich of the following conditions could increase the severity of afterpains+ 1. $. !. &. =ottle1feeding .iabetes 5ultiple gestation 0rimiparity

$!) 5ethergine or pitocin are prescribed for a client with 00 hemorrhage. =efore administering the medicationCs)6 the nurse contacts the health provider who prescribed the medicationCs) in which of the following conditions is documented in the clients medical history+ 1. $. !. &. 0eripheral vascular disease ?ypothyroidism ?ypotension 'ype 1 diabetes

$&) *hich of the following factors might result in a decreased supply of breast milk in a 00 mother+ 1. $. !. &. :upplemental feedings with formula 5aternal diet high in vitamin ; An alcoholic drink )re4uent feedings

!") 3n which of the postpartum days can the client e#pect lochia serosa+ 1. $. !. &. .ays ! and & 00 .ays ! to 1" 00 .ays 1"11& 00 .ays 1& to &$ 00

$%) *hich of the following interventions would be helpful to a breastfeeding mother who is e#periencing engorged breasts+ 1. $. !. &. Applying ice Applying a breast binder 'eaching how to e#press her breasts in a warm shower Administering bromocriptine C0arlodel)

!1) *hich of the following behaviors characteri2es the 00 mother in the taking inphase+ 1. 0assive and dependant $. :triving for independence and autonomy !. ;urious and interested in care of the baby &. #hibiting ma#imum readiness for new learning

!$) *hich of the following complications may be indicated by continuous seepage of blood from the vagina of a 00 client6 when palpation of the uterus reveals a firm uterus 1 cm below the umbilicus+ 1. $. !. &. ,etained placental fragments Brinary tract infection ;ervical laceration Bterine atony

!8) 3n the first 00 night6 a client re4uests that her baby be sent back to the nursery so she can get some sleep. 'he client is most likely in which of the following phases+ 1. $. !. &. .epression phase Detting1go phase 'aking1hold phase 'aking1in phase

!!) *hat type of milk is present in the breasts 7 to 1" days 00+ 1. $. !. &. ;olostrum ?ind milk 5ature milk 'ransitional milk

!9) *hich of the following physiological responses is considered normal in the early postpartum period+ 1. $. !. &. Brinary urgency and dysuria ,apid diuresis .ecrease in blood pressure Increase motility of the FI system

!&) *hich of the following complications is most likely responsible for a delayed postpartum hemorrhage+ 1. ;ervical laceration $. ;lotting deficiency !. 0erineal laceration &. Bterine subinvolution !%) =efore giving a 00 client the rubella vaccine6 which of the following facts should the nurse include in client teaching+ 1. $. !. &. 'he vaccine is safe in clients with egg allergies =reast1feeding isnt compatible with the vaccine 'ransient arthralgia and rash are common adverse effects 'he client should avoid getting pregnant for ! months after the vaccine because the vaccine has teratogenic effects

&") .uring the !rd 00 day6 which of the following observations about the client would the nurse be most likely to make+ 1. 'he client appears interested in learning about neonatal care $. 'he client talks a lot about her birth e#perience !. 'he client sleeps whenever the neonate isnt present &. 'he client re4uests help in choosing a name for the neonate. &1) *hich of the following circumstances is most likely to cause uterine atony and lead to 00 hemorrhage+ 1. ?ypertension $. ;ervical and vaginal tears !. Brine retention &. ndometritis &$) *hich type of lochia s hould the nurse e#pect to find in a client $ days 00+ 1. $. !. &. )oul1smelling Dochia serosa Dochia alba Dochia rubra

!/) *hich of the following changes best described the insulin needs of a client with type 1 diabetes who has just delivered an infant vaginally without complications+ 1. $. !. &. Increase .ecrease ,emain the same as before pregnancy ,emain the same as during pregnancy

!7) *hich of the following responses is most appropriate for a mother with diabetes who wants to breastfeed her infant but is concerned about the effects of breastfeeding on her health+ 1. $. !. &. 5others with diabetes who breast1feed have a hard time controlling their insulin needs 5others with diabetes shouldnt breastfeed because of potential complications 5others with diabetes shouldnt breastfeedE insulin re4uirements are doubled. 5others with diabetes may breastfeedE insulin re4uirements may decrease from breastfeeding.

&!) After e#pulsion of the placenta in a client who has si# living children6 an infusion of lactated ringers solution with 1" units of pitocin is ordered. 'he nurse understands that this is indicated for this client because: 1. $. !. &. :he had a precipitate birth 'his was an e#tramural birth ,etained placental fragments must be e#pelled 5ultigravidas are at increased risk for uterine atony.

&&) As part of the postpartum assessment6 the nurse e#amines the breasts of a primiparous breastfeeding woman who is one day postpartum. An e#pected finding would be: 1. $. !. &. :oft6 non1tenderE colostrum is present Deakage of milk at let down :wollen6 warm6 and tender upon palpation A few blisters and a bruise on each areola

&8) *hen performing a postpartum check6 the nurse should: 1. $. Assist the woman into a lateral position with upper leg fle#ed forward to facilitate the e#amination of her perineum Assist the woman into a supine position with her arms above her head and her legs e#tended for the e#amination of her abdomen Instruct the woman to avoid urinating just before the e#amination since a full bladder will facilitate fundal palpation *ash hands and put on sterile gloves before beginning the check

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&%) )ollowing the birth of her baby6 a woman e#presses concern about the weight she gained during pregnancy and how 4uickly she can lose it now that the baby is born. 'he nurse6 in describing the e#pected pattern of weight loss6 should begin by telling this woman that: 1. $. !. &. ,eturn to prepregnant weight is usually achieved by the end of the postpartum period )luid loss from diuresis6 diaphoresis6 and bleeding accounts for about a ! pound weight loss 'he e#pected weight loss immediately after birth averages about 11 to 1! pounds Dactation will inhibit weight loss since caloric intake must increase to support milk production

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&9) 0erineal care is an important infection control measure. *hen evaluating a postpartum womans perineal care techni4ue6 the nurse would recogni2e the need for further instruction if the woman: 1. $. !. &. Bses soap and warm water to wash the vulva and perineum *ashes from symphysis pubis back to episiotomy ;hanges her perineal pad every $ I ! hours Bses the peribottle to rinse upward into her vagina

&/) *hich of the following findings would be a source of concern if noted during the assessment of a woman who is 1$ hours postpartum+ 1. $. !. &. 0ostural hypotension 'emperature of 1"".&G) =radycardia H pulse rate of %% =05 0ain in left calf with dorsifle#ion of left foot

%") *hich measure would be least effective in preventing postpartum hemorrhage+ 1. $. !. &. Administer 5ethergine ".$ mg every / hours for & doses as ordered ncourage the woman to void every $ hours 5assage the fundus every hour for the first $& hours following birth 'each the woman the importance of rest and nutrition to enhance healing

&7) 'he nurse e#amines a woman one hour after birth. 'he womans fundus is boggy6 midline6 and 1 cm below the umbilicus. ?er lochial flow is profuse6 with two plum1si2ed clots. 'he nurses initial action would be to: 1. $. !. &. 0lace her on a bedpan to empty her bladder 5assage her fundus ;all the physician Administer 5ethergine ".$ mg I5 which has been ordered prn

%1) *hen making a visit to the home of a postpartum woman one week after birth6 the nurse should recogni2e that the woman would characteristically: 1. $. !. #press a strong need to review events and her behavior during the process of labor and birth #hibit a reduced attention span6 limiting readiness to learn <acillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn ?ave reestablished her role as a spouse>partner

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%$) )our hours after a difficult labor and birth6 a primiparous woman refuses to feed her baby6 stating that she is too tired and just wants to sleep. 'he nurse should: 1. $. !. &. 'ell the woman she can rest after she feeds her baby ,ecogni2e this as a behavior of the taking1hold stage ,ecord the behavior as ineffective maternal1newborn attachment 'ake the baby back to the nursery6 reassuring the woman that her rest is a priority at this time

%!) 0arents can facilitate the adjustment of their other children to a new baby by: 1. $. !. &. ?aving the children choose or make a gift to give to the new baby upon its arrival home mphasi2ing activities that keep the new baby and other children together ?aving the mother carry the new baby into the home so she can show the other children the new baby ,educing stress on other children by limiting their involvement in the care of the new baby

%&) A primiparous woman is in the taking1in stage of psychosocial recovery and adjustment following birth. 'he nurse6 recogni2ing the needs of women during this stage6 should: 1. $. !. )oster an active role in the babys care 0rovide time for the mother to reflect on the events of and her behavior during childbirth ,ecogni2e the womans limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now 0romote maternal independence by encouraging her to meet her own hygiene and comfort needs

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%. A-:* ,: 1. $. $. -ot providing a rationale Jcause you all should know this crap. &. 'he mothers temperature may be taken every & hours while she is awake. 'emperatures up to 1"".& C!8 ;) in the first $& hours after birth are often related to the dehydrating effects of labor. 'he most appropriate action is to increase hydration by encouraging oral fluids6 which should bring the temperature to a normal reading. Although the nurse would document the findings6 the most appropriate action would be to increase the hydration. $. 3rthostatic hypotension may be evident during the first 8 hours after birth. )eelings of faintness or di22iness are signs that should caution the nurse to be aware of the clients safety. 'he nurse should advise the mother to get help the first few times the mother gets out of bed. 3btaining an ?>? re4uires a physicians order. !. =efore starting the fundal assessment6 the nurse should ask the mother to empty her bladder so that an accurate assessment can be done. *hen the nurse is performing fundal assessment6 the nurse asks the woman to lie flat on her back with the knees fle#ed. 5assaging the fundus is not appropriate unless the fundus is boggy and soft6 and then it should be massaged gently until firm. $. Dochia6 the discharge present after birth6 is red for the first 1 to ! days and gradually decreases in amount. -ormal lochia has a fleshy odor. )oul smelling or purulent lochia usually indicates infection6 and these findings are not normal. ncouraging the woman to drink fluids or increase ambulation is not an accurate nursing intervention. $. -ormally6 one may find a few small clots in the first 1 to $ days after birth from pooling of blood in the vajayjay. ;lots larger than 1 cm are considered abnormal. 'he cause of these clots6 such as uterine atony or retained placental fragments6 needs to be determined and treated to prevent further blood loss. Although the findings would be documented6 the most appropriate action is to notify the physician. &. 'he normal amount of lochia may vary with the individual but should never e#ceed & to 8 peripads per day. 'he average number of peripads is / per day. $. After birth6 the nurse should auscultate the womans abdomen in all four 4uadrants to determine the return of bowel sounds. -ormal bowel elimination usually returns $ to ! days 00. :urgery6 anesthesia6 and the use of narcotics and pain control agents also contribute to the longer period of altered bowel function. 1 and !. In the 00 period6 cervical healing occurs rapidly and cervical involution occurs. After 1 week the muscle begins to regenerate and the cervi# feels firm and the e#ternal os is the width of a pencil. Although the vaginal mucosa heals and vaginal distention decreases6 it takes the entire 00 period for complete involution to occur and muscle tone is never restored to the pregravid state. 'he fundus begins to descent

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into the pelvic cavity after $& hours6 a process known as involution. .espite blood loss that occurs during delivery of the baby6 a transient increase in cardiac output occurs. 'he increase in cardiac output6 which persists about &8 hours after childbirth6 is probably caused by an increase in stroke volume because =radycardia is often noted during the 00 period. :oon after childbirth6 digestion begins to begin to be active and the new mother is usually hungry because of the energy e#pended during labor. 1". !. =ecause the woman has had epidural anesthesia and is anestheti2ed6 she cannot feel pain6 pressure6 or a tearing sensation. ;hanges in vitals indicate hypovolemia in the anestheti2ed 00 woman with vulvar hematoma. ?eavy bruising may be visuali2ed6 but vital sign changes indicate hematoma caused by blood collection in the perineal tissues. 11. &. Application of ice will reduce swelling caused by hematoma formation in the vulvar area. 'he other options are not interventions that are specific to the plan of care for a client with a small vulvar hematoma. 1$. !. 'he use of an epidural6 prolonged second stage labor and forceps delivery are predisposing factors for hematoma formation6 and a collection of up to %"" ml of blood can occur in the vaginal area. Although the other options may be implemented6 the immediate action would be to prepare the client for surgery to stop the bleeding.

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$. .uring the &th stage of labor6 the maternal blood

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pressure6 pulse6 and respiration should be checked every 1% minutes during the first hour. A rising pulse is an early sign of e#cessive blood loss because the heart pumps faster to compensate for reduced blood volume. 'he blood pressure will fall as the blood volume diminishes6 but a decreased blood pressure would not be the earliest sign of hemorrhage. A slight rise in temperature is normal. 'he respiratory rate is increased slightly. 1&. 1. If the uterus is not contracted firmly6 the first intervention is to massage the fundus until it is firm and to e#press clots that may have accumulated in the uterus. 0ushing on an uncontracted uterus can invert the uterus and cause massive hemorrhage. levating the clients legs and encouraging the client to void will not assist in managing uterine atony. If the uterus does not remain contracted as a result of the uterine massage6 the problem may be distended bladder and the nurse should assist the mother to urinate6 but this would not be the initial action.

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accompanied by signs and symptoms of inflammation. 'hese include swelling of the involved e#tremity and redness6 tenderness6 and warmth. 1/. &. In most cases6 the mother can continue to breast feed with both breasts. If the affected breast is too sore6 the mother can pump the breast gently. ,egular emptying of the breast is important to prevent abscess formation. Antibiotic therapy assists in resolving the mastitis within $&1&8 hours. Additional supportive measures include ice packs6 breast supports6 and analgesics.

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!. 'he treatment for .<' is anticoagulant therapy. 'he nurse assesses for bleeding6 which is an adverse effect of anticoagulants. 'his includes hematuria6 ecchymosis6 and epista#is. .ysuria and vertigo are not associated specifically with bleeding. 1. :ymptoms of hypovolemia include cool6 clammy6 pale skin6 sensations of an#iety or impending doom6 restlessness6 and thirst. *hen these symptoms are present6 the nurse should further assess for hypovolemia and notify the health care provider. !. If the bleeding is e#cessive6 the cause may be laceration of the cervi# or birth canal. 5assaging the fundus if it is firm will not assist in controlling the bleeding. 'rendelenburgs position is to be avoided because it may interfere with cardiac function. !. Anticoagulation therapy may be used to prevent the e#tension of thrombus by delaying the clotting time of the blood. Activated partial thromboplastin time should be monitored6 and a heparin dose should be adjusted to maintain a therapeutic level of 1.% to $.% times the control. 'he prothrombin time and the I-, are used to monitor coagulation time when warfarin C;oumadin) is used. $6 &6 and %. 5astitis are an infection of the lactating breast. ;lient instructions include resting during the acute phase6 maintaining a fluid intake of at least ! D a day6 and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. 'hey are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. ;ontinued decompression of the breast by breastfeeding or pumping is important to empty the breast and prevent formation of an abscess. $. 5ethergine and pitocin are agents that are used to prevent or control postpartum hemorrhage by contracting the uterus. 'hey cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. 'he physician should be notified if hypertension is present. 1. 'hese medications are avoided in clients with significant cardiovascular disease6 peripheral disease6 hypertension6 eclampsia6 or preeclampsia. 'hese conditions are worsened by the vasoconstriction effects of these medications. 1. ,outine formula supplementation may interfere with establishing an ade4uate milk volume because decreased stimulation to the mothers nipples affects hormonal levels and milk production. !. 'eaching the client how to e#press her breasts in a warm shower aids with let1down and will give temporary relief. Ice can promote comfort by vasoconstriction6 numbing6 and discouraging further letdown of milk. 1. A full bladder may displace the uterine fundus to the left or right side of the abdomen. ;atheteri2ation is unnecessary invasive if the woman can void on her own.

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!. 00 insulin re4uirements are usually significantly lower than prepregnancy re4uirements. 3ccasionally6 clients may re4uire little to no insulin during the first $& to &8 hours postpartum. 1. *ithin the first 1$ hours postpartum6 the fundus usually is appro#imately 1 cm above the umbilicus. 'he fundus should be below the umbilicus by 00 day !. 'he fundus shouldnt be palpated in the abdomen after day 1". !. 5ultiple gestation6 breastfeeding6 multiparity6 and conditions that cause overdistention of the uterus will increase the intensity of after1pains. =ottle1feeding and diabetes arent directly associated with increasing severity of afterpains unless the client has delivered a macrosomic infant. $. 3n the third and fourth 00 days6 the lochia becomes a pale pink or brown and contains old blood6 serum6 leukocytes6 and tissue debris. 'his type of lochia usually lasts until 00 day 1". Dochia rubra usually last for the first ! to & days 00. Dochia alba6 which contain leukocytes6 decidua6 epithelial cells6 mucus6 and bacteria6 may continue for $ to / weeks 00. 1. .uring the taking in phase6 which usually lasts 11! days6 the mother is passive and dependent and e#presses her own needs rather than the neonates needs. 'he taking hold phase usually lasts from days !11" 00. .uring this stage6 the mother strives for independence and autonomyE she also becomes curious and interested in the care of the baby and is most ready to learn. !. ;ontinuous seepage of blood may be due to cervical or vaginal lacerations if the uterus is firm and contracting. ,etained placental fragments and uterine atony may cause subinvolution of the uterus6 making it soft6 boggy6 and larger than e#pected. B'I wont cause vaginal bleeding6 although hematuria may be present. &. 'ransitional milk comes after colostrum and usually lasts until $ weeks 00. &. Date postpartum bleeding is often the result of subinvolution of the uterus. ,etained products of conception or infection often cause subinvolution. ;ervical or perineal lacerations can cause an immediate postpartum hemorrhage. A client with a clotting deficiency may also have an immediate 00 hemorrhage if the deficiency isnt corrected at the time of delivery. &. 'he client must understand that she must not become pregnant for ! months after the vaccination because of its potential teratogenic effects. 'he rubella vaccine is made from duck eggs so an allergic reaction may occur in clients with egg allergies. 'he virus is not transmitted into the breast milk6 so clients may continue to breastfeed after the vaccination. 'ransient arthralgia and rash are common adverse effects of the vaccine. $. 'he placenta produces the hormone human placental lactogen6 an insulin antagonist. After birth6 the placenta6 the major source of insulin resistance6 is gone. Insulin needs decrease and women with type 1 diabetes may only need one1 half to two1thirds of the prenatal insulin during the first few 00 days.

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&. =reastfeeding has an antidiabetogenic effect. Insulin needs are decreased because carbohydrates are used in milk production. =reastfeeding mothers are at a higher risk of hypoglycemia in the first 00 days after birth because the glucose levels are lower. 5others with diabetes should be encouraged to breastfeed. &. 'he taking1in phase occurs in the first $& hours after birth. 'he mother is concerned with her own needs and re4uires support from staff and relatives. 'he taking1hold phase occurs when the mother is ready to take responsibility for her care as well as the infants care. 'he letting1go phase begins several weeks later6 when the mother incorporates the new infant into the family unit. $. In the early 00 period6 theres an increase in the glomerular filtration rate and a drop in the progesterone levels6 which result in rapid diuresis. 'here should be no urinary urgency6 though a woman may feel an#ious about voiding. 'heres a minimal change in blood pressure following childbirth6 and a residual decrease in FI motility. 1. 'he third to tenth days of 00 care are the @taking1holdA phase6 in which the new mother strives for independence and is eager for her neonate. 'he other options describe the phase in which the mother relives her birth e#perience. !. Brine retention causes a distended bladder to displace the uterus above the umbilicus and to the side6 which prevents the uterus from contracting. 'he uterus needs to remain contracted if bleeding is to stay within normal limits. ;ervical and vaginal tears can cause 00 hemorrhage but are less common occurrences in the 00 period. &. &. 5ultiple full1term pregnancies and deliveries result in overstretched uterine muscles that do not contract efficiently and bleeding may ensue. 1. =reasts are essentially unchanged for the first two to three days after birth. ;olostrum is present and may leak from the nipples. !. 0repregnant weight is usually achieved by $ to ! months after birth6 not within the /1week postpartum period. *eight loss from diuresis6 diaphoresis6 and bleeding is about 9 pounds. *eight loss continues during breastfeeding since fat stores developed during pregnancy and e#tra calories consumed are used as part of the lactation process &. ,esponses 1 and ! are e#pected related to circulatory changes after birth. A temperature of 1"".&G) in the first $& hours is most likely indicative of dehydration which is easily corrected by increasing oral fluid intake. 'he findings in response & indicate a positive ?oman sign and are suggestive of thrombophlebitis and should be investigated further. $. A boggy or soft fundus indicates that uterine atony is present. 'his is confirmed by the profuse lochia and passage of clots. 'he first action would be to massage the fundus until firm6 followed by ! and &6 especially if the fundus does not become or remain firm with massage. 'here is no indication of a distended bladder since the fundus is midline and below the umbilicus.

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1. *hile the supine position is best for e#amining the abdomen6 the woman should keep her arms at her sides and slightly fle# her knees in order to rela# abdominal muscles and facilitate palpation of the fundus. 'he bladder should be emptied before the check. A full bladder alters the position of the fundus and makes the findings inaccurate. Although hands are washed before starting the check6 clean Cnot sterile) gloves are put on just before the perineum and pad are assessed to protect from contact with blood and secretions. &. ,esponses 16 $6 and ! are all appropriate measures. 'he peribottle should be used in a backward direction over the perineum. 'he flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still1open cervi#. !. 'he fundus should be massaged only when boggy or soft. 5assaging a firm fundus could cause it to rela#. ,esponses 16 $6 and & are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing. !. 3ne week after birth the woman should e#hibit behaviors characteristic of the taking1hold stage as described in response !. 'his stage lasts for as long as & to % weeks after birth. ,esponses 1 and $ are characteristic of the taking1in stage6 which lasts for the first few days after birth. ,esponse & reflects the letting1go stage6 which indicates that psychosocial recovery is complete. &. ,esponse 1 does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking1in stage. 'he behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. 5others need to reestablish their own well1being in order to effectively care for their baby. 1. :pecial time should be set aside just for the other children without interruption from the newborn. :omeone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. ;hildren should be actively involved in the care of the baby according to their ability without overwhelming them. $. 'he focus of the taking1in stage is nurturing the new mother by meeting her dependency needs for rest6 comfort6 hygiene6 and nutrition. 3nce they are met6 she is more able to take an active role6 not only in her own care but also the care of her newborn. *omen e#press a need to review their childbirth e#perience and evaluate their performance. :hort teaching sessions6 using written materials to reinforce the content presented6 are a more effective approach.