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Worksheets2205 Exam 3 pt.4
Total questions: 97
Worksheet time: 49mins
A nurse is assessing a client during the fourth stage of labor. Which time frame defines this stage?
Delivery of the newborn through delivery of the placenta
Delivery of the placenta through at least the first 2 hr after birth
First 24 hr after birth through discharge
Birth through return of menses
A nurse is planning care for a client in the immediate postpartum period. What is the primary goal?
Prevent postpartum infection
Promote parent-newborn bonding
Prevent postpartum hemorrhage
Promote early ambulation
A nurse is prioritizing postpartum nursing goals. Which goal is included in addition to preventing postpartum hemorrhage?
Restrict oral fluids for 24 hr
Identify deviations in the expected recovery process
Delay breastfeeding until discharge teaching is complete
Encourage sleep and limit assessments
The nurse explains that the postpartum period is also called the puerperium. Which statement best describes the puerperium?
The interval from implantation to birth
The interval between birth and return of reproductive organs to a nonpregnant state
The first 2 hr after delivery of the placenta
The time from birth until lactation ends
A nurse teaches a client about postpartum physiologic changes. Which change is included in the text?
Increased cervical mucus production
Uterine involution and lochia flow
Increased vaginal distention
Increased progesterone levels after placental delivery
Which postpartum risks are identified as the greatest risks during the postpartum period?
Hypertension, seizures, and edema
Hemorrhage, shock, and infection
Thrombosis, anemia, and hypoglycemia
Depression, fatigue, and constipation
A nurse explains why breastfeeding can increase uterine cramping. Which hormone release causes this effect?
Prolactin
Estrogen
Oxytocin
Progesterone
A postpartum client is prescribed exogenous oxytocin. Which outcome explains the purpose of this medication postpartum?
Reduce breast engorgement
Improve uterine contractions to prevent hemorrhage
Increase cervical mucus production
Promote diuresis of extracellular fluid
A client reports uncomfortable uterine cramping while breastfeeding. The nurse should identify this as which term?
Lochia
Afterpains
Involution
Diaphoresis
A nurse reviews hormonal changes after delivery of the placenta. Which change is expected?
Increased estrogen and progesterone
Increased placental insulinase
Decreased estrogen, progesterone, and placental insulinase
Increased hCG for 6 weeks postpartum
Decreased estrogen postpartum is associated with which manifestations in the text?
Increased appetite and constipation
Breast engorgement, diaphoresis, and diuresis
Vaginal lubrication and muscle relaxation
Hypertension and fever
A nurse teaches that decreased estrogen postpartum can affect sexual comfort. Which statement reflects the text?
“Intercourse discomfort resolves once lochia rubra ends.”
“Vaginal dryness can persist until ovarian function returns and menstruation resumes.”
“Lubrication increases with breastfeeding.”
“Vaginal lubrication is unrelated to estrogen levels.”
Decreased progesterone postpartum results in which change?
Decreased muscle tone throughout the body
Increased muscle tone throughout the body
Increased placental insulinase effects
Increased vaginal lubrication
The nurse explains why blood glucose levels drop immediately postpartum. Which factor from the text causes this?
Increased placental insulinase
Decreased placental insulinase reversing diabetogenic effects
Increased estrogen production
Increased hCG levels
A postpartum client asks how long pregnancy hormone (hCG) may remain detectable. Which response aligns with the text?
“It disappears immediately after delivery.”
“It can be detected for up to 4 weeks postpartum.”
“It persists for at least 12 weeks postpartum.”
“It remains detectable until menstruation resumes.”
A lactating client asks why ovulation is delayed. Which explanation is correct?
Prolactin remains elevated and suppresses ovulation
Estrogen remains elevated and suppresses ovulation
Progesterone increases and blocks ovulation
hCG stimulates continued ovulation suppression for 12 weeks
Which factor influences return of ovulation in lactating clients according to the text?
Maternal temperature
Breastfeeding frequency, length of feeding, and supplementation
Amount of postpartum bleeding
Route of birth (vaginal vs cesarean)
The nurse teaches a lactating client about timing of first postpartum ovulation per the text. Which is correct?
Approximately 3 weeks
Approximately 6 months
7 to 9 weeks
By 12 weeks
A nonlactating client asks when prolactin returns to prepregnant levels. Which response matches the text?
Within 72 hr
By 3 weeks postpartum
By 6 months postpartum
By 12 weeks postpartum
For a nonlactating client, when does ovulation occur according to the text?
1 to 3 days after birth
2 to 3 weeks after birth
7 to 9 weeks after birth
6 months after birth
For a nonlactating client, when do menses typically resume according to the text?
By 4 weeks postpartum
By 6 weeks postpartum
By 8 weeks postpartum
By 12 weeks postpartum
Immediately following birth, which assessments are included per the text?
Lung sounds, capillary refill, reflexes, and pupils
Vital signs, uterine firmness/location, midline position, and amount of vaginal bleeding
Deep tendon reflexes and clonus
Fetal heart rate and contraction pattern
Based on AAP/ACOG recommendations in the text, how often should BP and pulse be assessed for the first 2 hr after birth?
Every 5 min
Every 15 min
Every 30 min
Every 2 hr
Based on the text, temperature should be assessed every 4 hr for the first:
2 hr
4 hr
8 hr
24 hr
A nurse performs a focused postpartum assessment. Which set matches the BUBBLE-HE items listed in the text?
Breasts, urine, blood pressure, bonding, lungs, episiotomy
Breasts, uterus, bowel/GI, bladder, lochia, episiotomy, vital signs/pain, teaching needs
Breasts, uterus, bonding, bladder, legs, emotions, heart sounds
Breasts, uterus, bowel, bladder, lochia only
The nurse assesses lochia using the “COCA” framework. Which component is included?
Contractions, odor, cervical dilation, amount
Color, odor, consistency, amount
Color, oxygenation, circulation, appetite
Consistency, output, contractions, appearance
Which labs may be included postpartum per the text?
BMP, ABG, troponin
Urinalysis and CBC monitoring Hgb, Hct, WBC, platelets
INR only
LFTs and amylase
A nurse explains uterine involution. Which statement reflects the text?
The uterus grows larger for 2 weeks postpartum
The uterus returns to prepregnant state through contractions of uterine smooth muscle
Involution occurs due to cervical dilation
Uterine involution stops if the client breastfeeds
The nurse teaches expected uterine weight change. Which matches the text?
60–80 g immediately after birth
1,000 g at 6 weeks postpartum
About 1,000 g after third stage decreasing to 60–80 g at 6 weeks
About 500 g after delivery decreasing to 200 g at 2 weeks
A postpartum client asks how quickly the fundus should descend after the recovery period. Which response is correct per the text?
3 to 4 cm per day
1 to 2 cm per day
5 cm per day
It remains at the umbilicus for 2 weeks
Immediately following birth, where should the fundus be per the text?
Boggy, 2 cm above umbilicus
Firm, midline, about 2 cm below umbilicus
Firm, displaced to the right, at symphysis pubis
Not palpable in the pelvis
One hour following birth, which fundal position is expected per the text?
2 cm below umbilicus
At the level of the umbilicus
2 cm above umbilicus
Halfway between symphysis pubis and umbilicus
Twelve hours postpartum, the fundus can be palpated:
At the symphysis pubis
1 cm above the umbilicus
4 cm below the umbilicus
Not palpable
By about 2 weeks postpartum, the uterus should:
Be palpable above the umbilicus
Lie within the true pelvis and not be palpable
Be halfway between symphysis pubis and umbilicus
Remain enlarged due to breastfeeding
When assessing the fundus, why should the client be positioned supine with knees slightly flexed?
To increase abdominal muscle tone for accuracy
To ensure fundal height is not influenced by positioning
To prevent lochia from flowing
To promote uterine displacement for palpation
Which action is required when palpating the fundus per the text?
Palpate fundus without support to assess tone
Cup one hand just above symphysis pubis to support the lower uterine segment
Use deep, sharp pressure directly over the fundus
Massage vigorously before locating the fundus
A nurse documents fundal height by:
Measuring inches from xiphoid to umbilicus
Counting fingerbreadths between fundus and umbilicus
Estimating based on abdominal distention only
Measuring from iliac crest to symphysis pubis
The nurse notes the fundus is displaced laterally. What is the cause listed in the text?
Postpartum leukocytosis
Full bladder
Decreased progesterone
Breast engorgement
The nurse finds the fundus boggy. What is the correct nursing action per the text?
Apply ice pack to the abdomen and reassess in 1 hr
Lightly massage the fundus in a circular motion
Place the client in Trendelenburg position
Immediately administer antibiotics
The uterus does not firm after massaging. What does the text direct next?
Stop massaging to prevent inversion
Keep massaging and notify the provider
Offer oral fluids only
Encourage sleep and recheck later
A nurse documents the fundus 1 cm above the umbilicus. Which notation matches the text?
U-1
1/U
U+1
Which action occurs postpartum after the placenta is delivered to prevent hemorrhage per the text?
Administer oxytocics IM or IV
Administer anticoagulants
Delay breastfeeding for 24 hr
Restrict voiding for 6 hr
Which medication listed is an oxytocic in the text?
Terbutaline
Methylergonovine
Ondansetron
Cefazolin
Which adverse effect is associated with oxytocin and misoprostol per the text?
Hypertension
Hypotension
Hyperglycemia
Fever after 48 hr
Which medications can cause hypertension per the text?
Oxytocin and misoprostol
Methylergonovine, ergonovine, and carboprost
Docusate and ibuprofen
Acetaminophen and codeine
Which postpartum action helps prevent uterine displacement and atony per the text?
Encourage the client to delay voiding for rest
Encourage emptying of the bladder
Apply antiembolism stockings to all clients
Restrict oral fluids
Lochia is defined in the text as discharge containing:
Only mucus and leukocytes
Blood, mucus, and uterine tissue
Amniotic fluid and vernix
Cervical mucus only
Which lochia stage is described as dark red, bloody, fleshy odor, lasting 1–3 days?
Alba
Serosa
Rubra
Purulent
Lochia serosa typically lasts:
1–3 days
Day 4 to day 10 after birth
10 days to 6 weeks
6 weeks to 12 weeks
A nurse instructs a postpartum client about a gush of dark red lochia after rising. The uterus is firm, midline, at the umbilicus, and the gush stops. How should the nurse interpret this finding per the text?
Evidence of possible vaginal hematoma
Indication of cervical or perineal laceration
Normal postural discharge of lochia
Abnormally excessive lochia rubra flow
A client is 12 hours postpartum and repeatedly recounts every detail of the labor experience while avoiding discussion about the newborn. Which nursing action is most appropriate?
Redirect the conversation to infant care education
Allow the client to verbalize the birth experience while completing assessments
Ask the client to focus on feeding the newborn
Limit interaction to allow the client to rest
A nurse observes a postpartum client holding the newborn face-to-face, smiling, and speaking softly. Which behavior does this best demonstrate?
Physical restoration
En face bonding
Dependent-independent role transition
Co-parent adaptation
Which postpartum client requires priority nursing intervention related to bonding?
Client who frequently asks questions about newborn care
Client who expresses fear of hurting the newborn
Client who turns away when the newborn cries
Client who requests assistance with breastfeeding
A client is 2 days postpartum and states, “I want to take care of my baby, but I’m afraid I’m doing everything wrong.” Which maternal role phase is the client experiencing?
Letting-go
Taking-in
Taking-hold
Interdependent
Which nursing intervention most directly supports baby-friendly care?
Completing newborn assessments immediately after birth
Delaying routine procedures during the first hour after birth
Encouraging the newborn to sleep in the nursery
Scheduling breastfeeding after maternal rest
A nurse is assessing parent-newborn bonding. Which behavior most strongly suggests impaired bonding?
Requests reassurance about newborn care
Avoids eye contact with the newborn
Describes the newborn’s physical features
Holds the newborn close during feeding
A client expresses disappointment that the newborn “doesn’t look like anyone in the family.” How should the nurse interpret this finding?
Normal adjustment during the letting-go phase
Expected behavior during physical restoration
A potential indicator of impaired bonding
A sign of postpartum depression
A postpartum nurse plans care for a client with a history of depression and a preterm newborn. Which concern is most appropriate?
Delayed physical recovery
Impaired bonding with the newborn
Excess milk production
Hyperactivity in the newborn
A client is in the first 24 hours postpartum and focuses on hunger, pain relief, and sleep while relying on family for newborn care. Which phase is this?
Letting-go
Taking-hold
Taking-in
Interdependent
Which nursing action best promotes bonding when a parent appears anxious about handling the newborn?
Encourage immediate independent newborn care
Provide step-by-step education while present
Tell the parent anxiety is normal
Limit contact until confidence improves
A nurse observes a client referring to the newborn as “it” and not using the baby’s name. This finding suggests:
Normal early postpartum behavior
Cultural variation in bonding
Lack of parent-newborn bonding
Delayed physical restoration
Which behavior most clearly reflects positive parent-newborn bonding?
Expressing fear of diapering
Viewing newborn behavior as uncooperative
Responding promptly to newborn cries
Requesting the nurse feed the newborn
A postpartum client is emotionally labile, crying frequently, and expressing self-doubt on day 3. Which interpretation is most accurate?
Normal taking-hold phase with baby blues
Postpartum depression
Impaired maternal role attainment
Letting-go phase disruption
A nurse plans to promote bonding immediately after delivery. Which action is the priority?
Encourage verbal interaction
Place the newborn skin-to-skin
Assist with newborn measurements
Initiate teaching about infant care
A co-parent states, “I feel pushed aside since the baby arrived.” Which phase of co-parent transition is this?
Reaping rewards
Creating the involved role
Expectations and intentions
Confronting reality
Which nursing action best supports co-parent adaptation?
Assigning newborn care to one parent
Encouraging equal participation in care
Limiting co-parent contact during hospitalization
Focusing teaching only on the primary caregiver
A nurse assesses sibling adaptation after the birth of a newborn. Which finding indicates a negative response?
Increased independence
Interest in helping with care
Regression in toileting habits
Curiosity about the newborn
A client states, “My older child keeps whining and demanding attention.” How should the nurse respond?
“This behavior is abnormal and concerning.”
“This is a common response to a new sibling.”
“Your child may need counseling.”
“Limit your older child’s involvement with the baby.”
Which nursing intervention best supports sibling adaptation?
Limiting sibling contact initially
Encouraging siblings to help care for the newborn
Avoiding discussion of the newborn
Enforcing strict behavioral expectations
A nurse notes a parent handles the newborn roughly during feeding. What is the priority nursing response?
Document the behavior only
Provide immediate support and guidance
Remove the newborn from the parent
Delay further bonding attempts
Which behavior best demonstrates maternal identity achievement?
Reliance on others for newborn care
Anxiety about newborn handling
Integration of parenting with other life roles
Frequent review of birth experience
Which maternal behavior requires nursing intervention?
Naming the newborn
Interpreting cries as communication
Expressing disgust when the newborn spits up
Talking and singing to the newborn
Which factor can delay bonding according to the chapter?
Early rooming-in
Congenital anomalies
Frequent breastfeeding
Adequate support systems
Which client statement most reflects the letting-go phase?
“I’m still exhausted and need help.”
“Tell me if I’m doing this right.”
“Our family routine is changing, but we’re adjusting.”
“I can’t stop thinking about the delivery.”
Which nursing intervention best supports parents moving toward independence?
Limiting hands-on practice
Providing praise and reassurance
Completing care for the parents
Correcting mistakes immediately
A nurse observes a parent who perceives the newborn’s behavior as “bad.” This finding suggests:
Effective adaptation
Impaired bonding
Normal frustration
Cultural difference
Which assessment finding suggests adequate emotional readiness for newborn care?
Flat affect
Avoidance of newborn
Comfort with feeding and holding
Withdrawal from interaction
Which nursing action best facilitates bonding during hospitalization?
Separating mother and newborn at night
Promoting rooming-in
Scheduling infant care
Limiting parental involvement
Which behavior reflects the taking-in phase?
Focus on infant care mastery
Reliance on others for self-care
Integration of family roles
Independence in caregiving
A parent avoids discussing the newborn’s appearance. This behavior may indicate:
Normal cultural practice
Positive bonding
Difficulty with attachment
Letting-go phase
Which nursing action promotes bonding for an adolescent parent?
Limiting parental involvement
Providing education and support
Encouraging separation
Assigning newborn care to staff
Which finding indicates the nurse should assess further for mood disturbance?
Smiling while holding newborn
Expressing feelings of inadequacy
Naming the newborn
Maintaining eye contact
Which nursing intervention best addresses impaired bonding?
Completing care tasks for the parent
Encouraging expression of fears
Limiting parent-newborn interaction
Ignoring emotional cues
Which behavior indicates effective co-parent bonding?
Avoids newborn contact
Compares newborn features to self
Expresses resentment
A sibling regresses in sleep habits after the newborn’s arrival. How should the nurse interpret this?
Behavioral disorder
Normal adjustment response
Parenting failure
Need for immediate referral
Which action best supports sibling adaptation?
Prevent sibling visits
Allow sibling to help with care
Discourage discussion of newborn
Enforce strict discipline
Which nursing assessment best evaluates bonding?
Measuring maternal vital signs
Observing interaction behaviors
Assessing fundal height
Monitoring intake and output
Which finding suggests lack of bonding?
Naming the newborn
Holding the newborn close
Ignoring newborn cries
Talking to the newborn
Which nursing action best supports family integration?
Limiting family involvement
Encouraging grandparents’ support
Discouraging discussion of concerns
Assigning care to staff
Which behavior requires immediate nursing intervention?
Requesting reassurance
Rough handling of the newborn
Asking questions
Expressing uncertainty
Which factor most strongly affects bonding?
Maternal age alone
Socioeconomic status alone
Combined maternal and newborn conditions
Route of delivery
Which nursing strategy best promotes confidence in parenting?
Critiquing technique
Hands-on teaching
Limiting involvement
Correcting errors immediately
Which behavior indicates the need for further psychosocial assessment?
Smiling at the newborn
Flat affect and withdrawal
Holding newborn skin-to-skin
Talking to the newborn
Which nursing action promotes parent-newborn bonding most effectively?
Limiting interruptions
Delaying newborn care education
Separating the newborn
Scheduling contact times
Which finding suggests successful adaptation to the parental role?
Dependence on staff
Confidence in newborn care
Avoidance of newborn
Emotional withdrawal
Which nursing response best supports a parent experiencing anxiety with newborn care?
“You’ll get used to it.”
“Why are you so nervous?”
“Let me show you how.”
“I’ll do it for you.”
Which outcome best indicates effective nursing interventions for bonding?
Parent requests staff perform all care
Parent avoids newborn interaction
Parent participates in newborn care
Parent verbalizes fear consistently
