Uworld maternity -Maternal Newborn Nursing

Uworld maternity Maternal Newborn Nursing Postpartum 1. Prior to hospital discharge, the nurse discussessexuality after childbirth with a client who had an uncomplicated vaginal birth with no perineal laceration. Which client statement requires further teaching? “I will begin using condoms to prevent pregnancy once mensesreturns”. Rationale: - many postpartum clients resume sexual activity before their postpartum checkups (4-6 weeks after birth). Encouraging the use of barrier contraceptive (e.g. Condoms) to prevent pregnancy is important because ovulation may occur as daily as 4 weeks after birth and before resumption of menses. 2. the graduate nurse (GN) receives report on a postpartum client with a Rh-negative blood type. Which statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide further teaching? “if the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health care provider”. Rationale: -Rh alloimmunization occurs when a pregnant client with an Rh-negative blood type is exposed to Rh-positive fetal RBcs. Postpartum, the nurse should verify that the client is not Rh sensitized by checking for a negative screen and then proceeding with administration of Rh immune globulin if the newborn is Rh positive. 3. A nurse is caring for postpartum client who is breastfeeding and has been diagnosed with mastitis of the right breast. Which of the following instructions should the nurse include in client teaching? SATA Apply warm compressesto breast; increase oral fluid intake; take ibuprofen as needed for pain. Rationale: - treatment of lactational mastitis includes antibiotic therapy, continued breastfeeding, breastfeeding support(e.g. Proper latch technique), warm compresses, massage, adequate nutrition and hydration, and appropriate analgesics(e.g. Ibuprofen, acetaminophen). 4. A nurse is caring for a client who had a vaginal birth 2 hours ago. The client has saturated a perineal pad in 20 minutes. During assessment, the nurse notices that the client has a boggy fundusthat is deviated to the right and slightly above the umbilicus. Which intervention should the nurse performs first? Assist client to use the bedpan to void. Rationale:- excessive postpartum bleeding is most commonly caused by uterine atony.The nursing priority for uterine atony associated with bladder distension id to assist the client with voiding and then perform fundal massage and other intervention as needed to control excessive bleeding. 5. the pediatric nurse is performing an assessment on a 4 week old client in the clinic. During the assessment, the newborn’s mother starts to cry and states, “ I am the worst mother in the world’. What should the nurse do next? “Have you felt depressed or hopeless over the last 2 weeks?’ lOMoAR cPSD| Rationale: PPD is a perinatal mood disorder characterized by crying, irritability, sleep disturbances, anxiety, or feeling of guilt. Nurses should assess for PPD by asking specific questions about the feeling of depression and hopelessness as well as thoughts about selfharm. 6. the nurse provides a follow-up phone call to a client who gave birth at a birthing center 5 days ago. Which statement by the client should the nurse be most concerned about? “my bleeding is like a really heavy period with some blood clots.” Rationale: - secondary or delayed PPH occurs 24 hrs but 6 weeks postpartum. Reports of increased vaginal bleeding, soaking a pad in 1-2 hrs, reverting from lochia serosa back to lochia rubra, or passing several/large clots are concerning findings associated with secondary PPH. 7. The nurse receivesreport on several postpartum clients who gave birth a term gestation. Which client should the nurse assess first? Client G5P5, who is 12 hrs postvaginal birth and saturating perineal pads every hr for 2 hrs with lochia rubra. Rationale:_ The nurse should prioritize assessment of clients with signs of immediately life threatening postpartum, complications( eg. Hemorrhage, pulmonary embolism). A perineal pad that is saturated in  1 hr indicates excessive bleeding and requires immediate assessment to prevent hemodynamic compromise.