Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 33 The Postpartum Family: Needs and Care

1. The nurse assesses the postpartum client to have moderate lochia rubra with clots. Which nursing intervention would be appropriate?
2. Assess fundus and bladder status.
3. Catheterize the client.
4. Administer Methergine I M per order.
5. Contact the physician immediately.

Page Ref: 888

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 7. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is providing education to the new family. Which question by the nurse is best?
2. "Do you know how to give the baby a bath?"
3. "You have diapers and supplies at home, right?"
4. "How have your breastfeedings been going?"
5. "How much formal education do you have?"

Page Ref: 888

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care; Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Identify patient teaching topics for promoting postpartum family wellness.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is preparing to administer postpartum neuraxial morphine to a client who is morbidly obese. For which side effect related to morbid obesity should the nurse monitor?
2. Respiratory depression
3. Confusion
4. Constipation
5. Hypotension

Page Ref: 905

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Identify critical physiologic, psychosocial, and safety needs related to the care of obese and morbidly obese postpartum women.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A postpartum client has just received a rubella vaccination. The client demonstrates understanding of the teaching associated with administration of this vaccine when she states which of the following?
2. "I will need another vaccination in 3 months."
3. "I must avoid getting pregnant for 1 month."
4. "This will prevent me from getting chickenpox."
5. "This will protect my newborn from getting the measles."

Page Ref: 895

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Delineate nursing responsibilities for patient teaching during the early postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The incidence of complications and discomforts in the first year postpartum is common and women may experience which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Pain
2. Excess energy
3. Urinary incontinence
4. Changes in mental health status
5. Sleep deprivation

Page Ref: 884

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A variety of drugs are used either alone or in combination to provide relief of postpartum pain. Which of the following would be an option for pain relief?
2. Nonsteroidal anti-inflammatory agents
3. Proquad
4. Methergine
5. Intravenous oxytocin

Page Ref: 897

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. A. 3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. On the 3rd day postpartum, a client who is not breastfeeding experiences engorgement. To relieve her discomfort, the nurse should encourage the client to do which of the following?
2. Remove her bra
3. Apply heat to the breasts
4. Apply cold packs to the breasts
5. Use a breast pump to release the milk

Page Ref: 894

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is caring for a client who had a cesarean birth 4 hours ago. Which interventions would the nurse implement at this time?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Administer analgesics as needed.
2. Encourage the client to ambulate to the bathroom to void.
3. Encourage leg exercises every 2 hours.
4. Encourage the client to cough and deep-breathe every 2 to 4 hours.
5. Encourage the use of breathing, relaxation, and distraction.

Page Ref: 904

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Compare the nursing needs of a woman who experienced a cesarean birth with the needs of a woman who gave birth vaginally.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A client who delivered 2 hours ago tells the nurse that she is exhausted and feels guilty because her friends told her how euphoric they felt after giving birth. How should the nurse respond?
2. "Everyone is different, and both responses are normal."
3. "Most mothers do feel euphoria; I don't know why you don't."
4. "It's good for me to know that because it might indicate a problem."
5. "Let me bring your baby to the nursery so that you can rest."

Page Ref: 898

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Delineate nursing responsibilities for patient teaching during the early postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The breastfeeding client asks the nurse about appropriate contraception. What is the nurse's best response?
2. "Breastfeeding has many effects on sexual intercourse."
3. "I U Ds are easy to use and easy to insert prior to sexual intercourse."
4. "It's possible to get pregnant before your menstrual period returns. Let's talk about some different options for contraception."
5. "Breastfeeding hampers ovulation, so no contraception is needed."

Page Ref: 902

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Delineate nursing responsibilities for patient teaching during the early postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The postpartum client expresses concern about getting back to her prepregnant shape, and asks the nurse when she will be able to run again. Which statement by the client indicates that teaching was effective?
2. "I can start running in 2 weeks, and can breastfeed as soon as I am done."
3. "I should see how my energy level is at home, and increase my activity slowly."
4. "Running is not recommended for breastfeeding women."
5. "If I am getting 8 hours of sleep per day, I can start running."

Page Ref: 899

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Describe the nurse's role in promoting maternal rest and helping the mother to gradually resume an appropriate level of activity.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The hospital is developing a new maternity unit. What aspects should be included in the planning of the new unit to best promote family wellness?
2. Normal newborn nursery centrally located to all client rooms
3. A kitchen with a refrigerator stocked with juice and sandwiches
4. Small, cozy rooms with a client bed and rocking chair
5. A nursing care model based on providing couplet care

Page Ref: 900

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Teamwork: Contributions of other individuals and groups in helping patient/family achieve health goals. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Identify patient teaching topics for promoting postpartum family wellness.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. Which statement by a nursing student preparing to care for a postpartum lesbian mother would indicate that the student is prepared for the teaching?
2. "I can't let the client know I've never worked with lesbian mothers."
3. "I will have to adjust some of my discharge instruction for this mother."
4. "I don't need to include the partner when I provide care and instruction."
5. "Discharge teaching is exactly the same for lesbian mothers as for all others."

Page Ref: 908

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 8 Describe possible approaches to sensitive, holistic nursing care for targeted populations of childbearing patients: Lesbian birth mothers and co-mothers, women with special needs, women who have experienced abuse, and women relinquishing their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A new grandmother comments that when her children were born, they stayed in the nursery. The grandmother asks the nurse why her daughter's baby stays mostly in the room instead of the nursery. How should the nurse respond?
2. "Babies like to be with their mothers more than they like to be in the nursery."
3. "Contact between parents and babies increases attachment."
4. "Budget cuts have decreased the number of nurses in the nursery."
5. "Why do you ask? Do you have concerns about your daughter's parenting?"

Page Ref: 900

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Family Dynamics

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. What is the advantage of a client using a patient-controlled analgesia (P C A) following a cesarean birth?
2. The client receives a bolus of the analgesia when pressing the button.
3. The client experiences pain relief within 30 minutes.
4. The client feels a greater sense of control, and is less dependent on the nursing staff.
5. The client can deliver as many doses of the medication as needed.

Page Ref: 904

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. C. 9. Recognize that patient expectations influence outcomes in management of pain or suffering. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Compare the nursing needs of a woman who experienced a cesarean birth with the needs of a woman who gave birth vaginally.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The client having her second child is scheduled for a cesarean birth because the baby is in a breech presentation. The client states, "I'm wondering what will be different this time compared with my first birth, which was vaginal." What response is best?
2. "We'll take good care of you and your baby. You'll be home before you know it."
3. "You'll be wearing a sequential compression device until you start walking."
4. "You will have a lot of pain, but there are medications that we give when it gets really bad."
5. "You won't be able to nurse until the baby is 12 hours old, because of your epidural."

Page Ref: 906

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Compare the nursing needs of a woman who experienced a cesarean birth with the needs of a woman who gave birth vaginally.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is caring for a client who delivered by cesarean birth. The client received a general anesthetic. To prevent or minimize abdominal distention, which of the following would the nurse encourage?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Increased intake of cold beverages
2. Leg exercises every 2 hours
3. Abdominal tightening
4. Ambulation
5. Using a straw when drinking fluids

Page Ref: 903

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Compare the nursing needs of a woman who experienced a cesarean birth with the needs of a woman who gave birth vaginally.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A multiparous client delivered her first child vaginally 2 years ago, and delivered an infant by cesarean yesterday due to breech presentation. Which statement would the nurse expect the client to make?
2. "I can't believe how much more tired I was with the first baby."
3. "I'm having significantly more pain this time than with my last birth."
4. "It is disappointing that I can't breastfeed because of the cesarean."
5. "Getting in and out of bed feels more comfortable than last time."

Page Ref: 904

Cognitive Level: Understanding

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. A. 3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Compare the nursing needs of a woman who experienced a cesarean birth with the needs of a woman who gave birth vaginally.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is supervising a student nurse who is working with a 14-year-old client who delivered her first child yesterday. Which statement indicates that the nursing student understands the particular needs of an adolescent client?
2. "This client will need less teaching, because she will have gotten the right information in school."
3. "Because of her age, this client will require less frequent fundal checks to assess for postpartal hemorrhage."
4. "Because of her age, this client will probably need extra teaching about the terminology for her anatomy."
5. "This client will need to have her grandmother provide day care and help raise the baby."

Page Ref: 907

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Summarize the nursing needs of the childbearing adolescent during the postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is caring for a 15-year-old client who gave birth to her first child yesterday. What action is the best indicator that the nurse understands the parenting adolescent?
2. The client's mother is included in all discussions and demonstrations.
3. The father of the baby is encouraged to change a diaper and give a bottle.
4. The nurse explains the characteristics and cues of the baby when assessing him.
5. A discussion on contraceptive methods is the first topic of teaching.

Page Ref: 907

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Therapeutic Communication

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Summarize the nursing needs of the childbearing adolescent during the postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is planning care for three newly delivered adolescents and their babies. What should the nurse keep in mind when planning their care?
2. The baby's father should be encouraged to participate when the nurse is providing instruction.
3. A class for all the adolescents would decrease teaching effectiveness.
4. The schools that the adolescents attend will provide teaching on bathing.
5. Adolescents understand the danger signals in newborns.

Page Ref: 907

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Summarize the nursing needs of the childbearing adolescent during the postpartum period.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is preparing to receive a newly delivered client. The client is a young single mother who is relinquishing custody of her newborn through an open adoption. What action is most important?
2. Assign the client a room on the G Y N surgical floor instead of on the postpartum floor.
3. Prepare to complete teaching in time for discharge at 24 hours post-delivery.
4. Make an effort not to bring up the topic of the baby, and discuss the mother's health instead.
5. Ask the client how much contact she would like with the baby, and whether she wants to feed it.

Page Ref: 908

Cognitive Level: Analyzing

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: Q S E N Competencies: Ⅰ. C. 10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 8 Describe possible approaches to sensitive, holistic nursing care for targeted populations of childbearing patients: Lesbian birth mothers and co-mothers, women with special needs, women who have experienced abuse, and women relinquishing their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is caring for a client who plans to relinquish her baby for adoption. The nurse would implement which approach to care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Encourage the client to see and hold her infant.
2. Encourage the client to express her emotions.
3. Respect any special requests for the birth.
4. Acknowledge the grieving process in the client.
5. Allow access to the infant, if the client requests it.

Page Ref: 908

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Grief and Loss

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Describe possible approaches to sensitive, holistic nursing care for targeted populations of childbearing patients: Lesbian birth mothers and co-mothers, women with special needs, women who have experienced abuse, and women relinquishing their newborns.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is planning discharge teaching for a postpartum woman. What recommendations should the woman receive before being discharged?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. To abstain from sexual intercourse for 6 months
2. To avoid showers for 4 weeks
3. To avoid overexertion
4. To practice postpartum exercises
5. To obtain adequate rest

Page Ref: 910

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Identify patient teaching topics for promoting postpartum family wellness.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is preparing a teaching brochure for Spanish-speaking postpartum clients. Which topics are critical for this population?
2. Baby baths and birth certificates
3. Hygiene practices
4. When and how to contact their healthcare provider
5. Pain-relief options in labor and after birth

Page Ref: 899

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Describe the nurse's role related to promoting safety for the postpartum patient and family.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. To actively involve the postpartal client during discharge teaching, the postpartum nurse applies which learning principle?
2. Reprints of magazine articles
3. Classroom lectures
4. Audiotapes
5. Interactive nurse-patient relationships

Page Ref: 911

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Identify patient teaching topics for promoting postpartum family wellness.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is performing discharge teaching for a newly delivered first-time mother and her infant on the 2nd postpartum day. Which statement by the mother indicates that teaching has been successful?
2. "Taking baths will help my perineum feel less sore each day."
3. "If I develop heavy bleeding, I should take my temperature."
4. "My bowel movements should resume in a week."
5. "I will go back to the doctor in 4 days for my R h o G A M shot."

Page Ref: 891

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Identify patient teaching topics for promoting postpartum family wellness.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is assessing clients after delivery. For which client is early discharge at 24 hours after delivery appropriate?
2. Woman and baby who have had two successful breastfeedings
3. Woman who is bottle-feeding her infant and has not voided since delivery
4. Twins delivered at 35 weeks, bottle-feeding
5. Cesarean birth performed for fetal distress

Page Ref: 882

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Delineate the nurse's responsibilities related to early postpartum discharge.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is preparing teaching material for a new mother. What should the nurse include when instructing on areas to include when observing the infant?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Touch
2. Vision
3. Hearing
4. Diaper care
5. General appearance

Page Ref: 886

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 4 Identify patient teaching topics for promoting postpartum family wellness.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is monitoring a postpartum patient receiving methylergonovine maleate (Methergine). Which assessment findings should the nurse identify as being expected adverse effects of this medication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Nausea
2. Leg pain
3. Headache
4. Hypertension
5. Uterine cramping

Page Ref: 889

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | N L N Competencies: Context and Environment: Practice: conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Evaluation: Nursing Process.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. The nurse is preparing to administer a sitz bath to a postpartum patient. In which order should the nurse perform the steps of this procedure?
2. Open the clamp on the tubing
3. Anchor the infusion bag to the sitz bath basin, with the tube facing upward
4. Fill the drainage bag with warm or cool water up to the top line as indicated on the bag
5. Close the clamp on the tubing, dry perineum with a clean towel, and apply new peri-pad
6. Secure the drainage bag from a hook over the toilet or from the handle used to flush the toilet

Page Ref: 892

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A new mother is planning to bottle feed her infant and wants helps with suppressing lactation. What should the nurse suggest to help this new mother?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Wear a 24-hour support bra
2. Apply cabbage leaves to the breast tissue
3. Apply warm compresses every 4 to 6 hours
4. Massage lotion on the breasts 3 times a day
5. Avoid all nipple stimulation for 7 to 10 days

Page Ref: 894

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.

1. A postpartum patient who received epidural morphine prior to a cesarean birth is concerned about a severe headache that has persisted for several days. What should the nurse suggest to this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Ingest fluids with caffeine
2. Engage in moderate exercise
3. Increase the intake of all fluids
4. Lie in bed in a quiet dark room
5. Restrict the intake of warm fluids

Page Ref: 905

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 2 Discuss appropriate nursing interventions to promote maternal comfort and well-being.

M N L L O: Demonstrate use of the nursing process in the care of the postpartum family.