The nurse would expect a postpartum woman to demonstrate lochia in which
sequence?
Rubra, alba, serosa
Rubra, serosa, alba
Serosa, alba, rubra
Alba, rubra, serosa
Give this one a try later!
Rubra, serosa, alba
30. A woman gave birth to a healthy term neonate today at 1330. It is now 1430 and
the nurse
has completed the client's assessment. At which time would the nurse next assess the
client?
A. 1445
,B. 1500
C. 1530
D. 1830
Give this one a try later!
Answer: B
Rationale: The woman is in her second hour postpartum. Typically, the
nurse would assess the
woman every 30 minutes. In this case, this would be 1500. During the first
hour, assessments are
usually completed every 15 minutes. After the second hour, assessments
would be made every 4
hours for the first 24 hours and then every 8 hours.
6. The nurse is discussing the insulin needs of a primiparous client with diabetes who
has been
using insulin for the past few years. The nurse informs the client that her insulin needs
will
increase during pregnancy based on the nurse's understanding that the placenta
produces:
A. hCG, which increases maternal glucose levels.
B. hPL, which deceases the effectiveness of insulin.
C. estriol, which interferes with insulin crossing the placenta.
D. relaxin, which decreases the amount of insulin produced.
Give this one a try later!
Answer: B
Rationale: Human placental lactogen (hPL) acts as an antagonist to insulin,
so the mother must
produce more insulin to overcome this resistance. If the mother has
diabetes, then her insulin
need would most likely increase to meet this demand. Human chorionic
gonadotropin (hCG)
does not affect insulin and glucose level. Estrogen, not estriol, is believed
to oppose insulin. In
, addition, insulin does not cross the placenta. Relaxin is not associated with
insulin resistance.
19. When assessing a newborn's reflexes, the nurse strokes the newborn's cheek, and
the
newborn turns toward the side that was stroked and begins sucking. The nurse
documents which
reflex as being positive?
A. palmar grasp reflex
B. tonic neck reflex
C. Moro reflex
D. rooting reflex
Give this one a try later!
Answer: D
Rationale: The rooting reflex is elicited by stroking the newborn's cheek.
The newborn should
turn toward the side that was stroked and should begin to make sucking
movements. The palmar
grasp reflex is elicited by placing a finger on the newborn's open palm. The
baby's hand will
close around the finger. Attempting to remove the finger causes the grip to
tighten. The tonic
neck reflex is elicited by having the newborn lie on the back and turning
the head to one side.
The arm toward which the baby is facing should extend straight away from
the body with the
hand partially open, whereas the arm on the side away from the face is
flexed and the fist is
clenched tightly. Reversing the direction to which the face is turned
reverses the position. The
Moro reflex is elicited by placing the newborn on his or her back,
supporting the upper body
weight of the supine newborn by the arms using a lifting motion without
lifting the newborn off
the surface. The arms are released suddenly, the newborn will throw the
arms outward and flex
, the knees, and then the arms return to the chest. The fingers also spread to
form a C.
9. After teaching a pregnant woman about the hormones produced by the placenta,
the nurse
determines that the teaching was successful when the woman identifies which
hormone produced
as being the basis for pregnancy tests?
A. human placental lactogen (hPL)
B. estrogen (estriol)
C. progesterone (progestin)
D. human chorionic gonadotropin (hCG)
Give this one a try later!
Answer: D
Rationale: The placenta produces hCG, which is the basis for pregnancy
tests. This hormone
preserves the corpus luteum and its progesterone production so that the
endometrial lining is
maintained. Human placental lactogen modulates fetal and maternal
metabolism and participates
in the development of the breasts for lactation. Estrogen causes
enlargement of the woman's
breasts, uterus, and external genitalia and stimulates myometrial
contractility. Progesterone
maintains the endometrium.
6. When the nurse is assessing a postpartum client approximately 6 hours after birth,
which
finding would warrant further investigation?
A. deep red, fleshy-smelling lochia
B. voiding of 350 cc
C. blood pressure 90/50 mm Hg
D. profuse sweating
sequence?
Rubra, alba, serosa
Rubra, serosa, alba
Serosa, alba, rubra
Alba, rubra, serosa
Give this one a try later!
Rubra, serosa, alba
30. A woman gave birth to a healthy term neonate today at 1330. It is now 1430 and
the nurse
has completed the client's assessment. At which time would the nurse next assess the
client?
A. 1445
,B. 1500
C. 1530
D. 1830
Give this one a try later!
Answer: B
Rationale: The woman is in her second hour postpartum. Typically, the
nurse would assess the
woman every 30 minutes. In this case, this would be 1500. During the first
hour, assessments are
usually completed every 15 minutes. After the second hour, assessments
would be made every 4
hours for the first 24 hours and then every 8 hours.
6. The nurse is discussing the insulin needs of a primiparous client with diabetes who
has been
using insulin for the past few years. The nurse informs the client that her insulin needs
will
increase during pregnancy based on the nurse's understanding that the placenta
produces:
A. hCG, which increases maternal glucose levels.
B. hPL, which deceases the effectiveness of insulin.
C. estriol, which interferes with insulin crossing the placenta.
D. relaxin, which decreases the amount of insulin produced.
Give this one a try later!
Answer: B
Rationale: Human placental lactogen (hPL) acts as an antagonist to insulin,
so the mother must
produce more insulin to overcome this resistance. If the mother has
diabetes, then her insulin
need would most likely increase to meet this demand. Human chorionic
gonadotropin (hCG)
does not affect insulin and glucose level. Estrogen, not estriol, is believed
to oppose insulin. In
, addition, insulin does not cross the placenta. Relaxin is not associated with
insulin resistance.
19. When assessing a newborn's reflexes, the nurse strokes the newborn's cheek, and
the
newborn turns toward the side that was stroked and begins sucking. The nurse
documents which
reflex as being positive?
A. palmar grasp reflex
B. tonic neck reflex
C. Moro reflex
D. rooting reflex
Give this one a try later!
Answer: D
Rationale: The rooting reflex is elicited by stroking the newborn's cheek.
The newborn should
turn toward the side that was stroked and should begin to make sucking
movements. The palmar
grasp reflex is elicited by placing a finger on the newborn's open palm. The
baby's hand will
close around the finger. Attempting to remove the finger causes the grip to
tighten. The tonic
neck reflex is elicited by having the newborn lie on the back and turning
the head to one side.
The arm toward which the baby is facing should extend straight away from
the body with the
hand partially open, whereas the arm on the side away from the face is
flexed and the fist is
clenched tightly. Reversing the direction to which the face is turned
reverses the position. The
Moro reflex is elicited by placing the newborn on his or her back,
supporting the upper body
weight of the supine newborn by the arms using a lifting motion without
lifting the newborn off
the surface. The arms are released suddenly, the newborn will throw the
arms outward and flex
, the knees, and then the arms return to the chest. The fingers also spread to
form a C.
9. After teaching a pregnant woman about the hormones produced by the placenta,
the nurse
determines that the teaching was successful when the woman identifies which
hormone produced
as being the basis for pregnancy tests?
A. human placental lactogen (hPL)
B. estrogen (estriol)
C. progesterone (progestin)
D. human chorionic gonadotropin (hCG)
Give this one a try later!
Answer: D
Rationale: The placenta produces hCG, which is the basis for pregnancy
tests. This hormone
preserves the corpus luteum and its progesterone production so that the
endometrial lining is
maintained. Human placental lactogen modulates fetal and maternal
metabolism and participates
in the development of the breasts for lactation. Estrogen causes
enlargement of the woman's
breasts, uterus, and external genitalia and stimulates myometrial
contractility. Progesterone
maintains the endometrium.
6. When the nurse is assessing a postpartum client approximately 6 hours after birth,
which
finding would warrant further investigation?
A. deep red, fleshy-smelling lochia
B. voiding of 350 cc
C. blood pressure 90/50 mm Hg
D. profuse sweating
