Maternity-Post-Partum(with solved solutions)
A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is
prescribed to be administered before discharge. The nurse provides which information to the
client about the vaccine? Select all that apply.
Breast-feeding needs to be stopped for 3 months.
Pregnancy needs to be avoided for 1 to 3 months.
The vaccine is administered by the subcutaneous route.
Exposure to immunosuppressed individuals needs to be avoided.
A hypersensitivity reaction can occur if the client has an allergy to eggs.
The area of the injection needs to be covered with a sterile gauze for 1 week. correct answers 2,
3, 4, 5
Rubella vaccine is administered to women who have not had rubella or women who are not
serologically immune. The vaccine may be administered in the immediate postpartum period to
prevent the possibility of contracting rubella in future pregnancies.
-The live attenuated rubella virus is not communicable in breast milk; breast-feeding does not
need to be stopped.
-The client is counseled not to become pregnant for 1 to 3 months after immunization or as
specified by the obstetrician because of a possible risk to a fetus from the live virus vaccine; the
client must be using effective birth control at the time of the immunization.
-The client should avoid contact with immunosuppressed individuals because of their low
immunity toward live viruses and because the virus is shed in the urine and other body fluids.
-The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if
the client has an allergy to eggs because the vaccine is made from duck eggs. There is no useful
or necessary reason for covering the area of the injection with a sterile gauze.
The nurse is providing instructions to a pregnant client with human immunodeficiency virus
(HIV) infection regarding care to the newborn after delivery. The client asks the nurse about the
feeding options that are available. Which response should the nurse make to the client?
"You will need to bottle-feed your newborn."
"You will need to feed your newborn by nasogastric tube feeding."
"You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding."
"You will be able to breast-feed for 9 months and then will need to switch to bottle-feeding."
correct answers 1
Perinatal transmission of HIV can occur during the antepartum period, during labor and birth, or
in the postpartum period if the mother is breast-feeding. Clients who have HIV will most likely
be advised not to breast-feed; however, PHCPs recommendations regarding breast-feeding are
always followed. There is no physiological reason why the newborn needs to be fed by
nasogastric tube.
, A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the
family remained together, holding and touching the baby. Which statement by the nurse would
assist the family in their period of grief?
"What can I do for you?"
"Now you have an angel in heaven."
"Don't worry, there is nothing you could have done to prevent this from happening."
"We will see to it that you have an early discharge so that you don't have to be reminded of this
experience." correct answers 1
When a loss or death occurs, the nurse should ensure that parents have been honestly told about
the situation by their primary health care provider or others on the health care team. It is
important for the nurse to be with the parents at this time and to use therapeutic communication
techniques. The nurse must also consider cultural and religious/ spiritual practices and beliefs
The nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to
her newborn during postpartum hospitalization. Which maternal action best exemplifies the
mother's knowledge of potential disease transmission to the newborn?
The mother requests that the window be closed before feeding.
The mother holds the newborn properly during feeding and burping.
The mother tests the temperature of the formula before initiating feeding.
The mother washes and dries her hands before and after self-care of the perineum and asks for a
pair of gloves before feeding. correct answers 4
Hepatitis B virus is highly contagious and is transmitted by direct contact with blood and body
fluids of infected persons. The rationale for identifying childbearing clients with this disease is to
provide adequate protection of the fetus and the newborn, to minimize transmission to other
individuals, and to reduce maternal complications. The correct option provides the best
evaluation of maternal understanding of disease transmission
The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant
following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to
monitor the client for which risk associated with placenta previa?
Infection
Hemorrhage
Chronic hypertension
Disseminated intravascular coagulation correct answers 2
In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine
segment does not contain the same intertwining musculature as the fundus of the uterus, and this
site is more prone to bleeding.
A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is
prescribed to be administered before discharge. The nurse provides which information to the
client about the vaccine? Select all that apply.
Breast-feeding needs to be stopped for 3 months.
Pregnancy needs to be avoided for 1 to 3 months.
The vaccine is administered by the subcutaneous route.
Exposure to immunosuppressed individuals needs to be avoided.
A hypersensitivity reaction can occur if the client has an allergy to eggs.
The area of the injection needs to be covered with a sterile gauze for 1 week. correct answers 2,
3, 4, 5
Rubella vaccine is administered to women who have not had rubella or women who are not
serologically immune. The vaccine may be administered in the immediate postpartum period to
prevent the possibility of contracting rubella in future pregnancies.
-The live attenuated rubella virus is not communicable in breast milk; breast-feeding does not
need to be stopped.
-The client is counseled not to become pregnant for 1 to 3 months after immunization or as
specified by the obstetrician because of a possible risk to a fetus from the live virus vaccine; the
client must be using effective birth control at the time of the immunization.
-The client should avoid contact with immunosuppressed individuals because of their low
immunity toward live viruses and because the virus is shed in the urine and other body fluids.
-The vaccine is administered by the subcutaneous route. A hypersensitivity reaction can occur if
the client has an allergy to eggs because the vaccine is made from duck eggs. There is no useful
or necessary reason for covering the area of the injection with a sterile gauze.
The nurse is providing instructions to a pregnant client with human immunodeficiency virus
(HIV) infection regarding care to the newborn after delivery. The client asks the nurse about the
feeding options that are available. Which response should the nurse make to the client?
"You will need to bottle-feed your newborn."
"You will need to feed your newborn by nasogastric tube feeding."
"You will be able to breast-feed for 6 months and then will need to switch to bottle-feeding."
"You will be able to breast-feed for 9 months and then will need to switch to bottle-feeding."
correct answers 1
Perinatal transmission of HIV can occur during the antepartum period, during labor and birth, or
in the postpartum period if the mother is breast-feeding. Clients who have HIV will most likely
be advised not to breast-feed; however, PHCPs recommendations regarding breast-feeding are
always followed. There is no physiological reason why the newborn needs to be fed by
nasogastric tube.
, A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the
family remained together, holding and touching the baby. Which statement by the nurse would
assist the family in their period of grief?
"What can I do for you?"
"Now you have an angel in heaven."
"Don't worry, there is nothing you could have done to prevent this from happening."
"We will see to it that you have an early discharge so that you don't have to be reminded of this
experience." correct answers 1
When a loss or death occurs, the nurse should ensure that parents have been honestly told about
the situation by their primary health care provider or others on the health care team. It is
important for the nurse to be with the parents at this time and to use therapeutic communication
techniques. The nurse must also consider cultural and religious/ spiritual practices and beliefs
The nurse evaluates the ability of a hepatitis B-positive mother to provide safe bottle-feeding to
her newborn during postpartum hospitalization. Which maternal action best exemplifies the
mother's knowledge of potential disease transmission to the newborn?
The mother requests that the window be closed before feeding.
The mother holds the newborn properly during feeding and burping.
The mother tests the temperature of the formula before initiating feeding.
The mother washes and dries her hands before and after self-care of the perineum and asks for a
pair of gloves before feeding. correct answers 4
Hepatitis B virus is highly contagious and is transmitted by direct contact with blood and body
fluids of infected persons. The rationale for identifying childbearing clients with this disease is to
provide adequate protection of the fetus and the newborn, to minimize transmission to other
individuals, and to reduce maternal complications. The correct option provides the best
evaluation of maternal understanding of disease transmission
The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant
following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to
monitor the client for which risk associated with placenta previa?
Infection
Hemorrhage
Chronic hypertension
Disseminated intravascular coagulation correct answers 2
In placenta previa, the placenta is implanted in the lower uterine segment. The lower uterine
segment does not contain the same intertwining musculature as the fundus of the uterus, and this
site is more prone to bleeding.
