Chapter 29 The Postpartum Family: Early Care Needs and Home Care

Chapter 29   The Postpartum Family: Early Care Needs and Home Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse had completed a postpartum assessment on a client who gave birth to her first child 12 hours ago. She is nauseated, but has not vomited in the last 2 hours. Her fundus was boggy, and firmed with massage to 1 FB ↓ U, moderately heavy lochia rubra, perineum ecchymosis and edematous, and pain rating 6 on scale of 1 to 10. Her partner is present and supportive. Breastfeeding has been successful three times. Which nursing diagnosis has the highest priority for this client?

1. Acute pain related to perineal trauma
2. Risk for deficient fluid volume related to uterine bleeding and nausea
3. Readiness for enhanced family coping
4. Knowledge deficit related to newborn care

Answer:  2

Explanation:  1. Although this nursing diagnosis is applicable, pain is a lower priority than is risk for fluid volume deficit.

2. Adequate fluid volume is a critical physiological need; therefore, this is the highest-priority nursing diagnosis.
3. Although this nursing diagnosis may be applicable, family coping is a lower priority than is risk for fluid volume deficit.
4. Although this nursing diagnosis may be applicable, a knowledge deficit is a psychosocial issue, and therefore a lower priority than is the physiological need for adequate fluid volume.

Page Ref: 644

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Diagnosis/Coordination of care

Learning Outcome:  LO 29.1-Formulate nursing diagnoses and nursing care based on the findings of the “normal” postpartum assessment.

MNL LO:  Examine the normal physiologic changes expected in the postpartum client.

 

2) During a home care visit, the new mother complains of breast engorgement. Which intervention is most appropriate for recommendation by the home care nurse?

1. “Apply an ice compress to your breast before nursing.”
2. “Encourage your baby to suckle for an average of 5 minutes per feeding.”
3. “Apply warm compresses to your breast after you finish feeding your baby.”
4. “When you aren’t nursing, wear a well-fitted nursing bra at all times, even when you sleep.”

Answer:  4

Explanation:  1. Warm compresses before nursing stimulate let-down and soften the breast so that the infant can grasp the areola more easily. Cool compresses after nursing can help slow refilling of the breasts and provide comfort to the mother.

2. For women with breast engorgement, the infant should suckle for an average of 15 minutes per feeding and should feed at least 8 to 12 times in 24 hours.
3. Warm compresses before nursing stimulate let-down and soften the breast so that the infant can grasp the areola more easily. Cool compresses after nursing can help slow refilling of the breasts and provide comfort to the mother.
4. The mother should wear a well-fitted nursing bra 24 hours a day to support the breasts and prevent discomfort from tension.

Page Ref: 645

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 29.11-Delineate interventions to address the common concerns of breastfeeding mothers following discharge.

MNL LO:  Recognize the assessment, care, and teaching required for the postpartum woman during a home visit.

 

3) The postpartum client delivered 4 hours ago. She has a mediolateral episiotomy and large hemorrhoids. She is rating her pain at 7 on a scale of 1 to 10. She has a history of anaphylactic reaction to Tylenol (acetaminophen). Which nursing action would be best?

1. Offer the client 800 mg ibuprofen orally with food.
2. Provide 2 Percocet (oxycodone with acetaminophen) by mouth.
3. Encourage use of a topical anesthetic spray.
4. Run very warm water into the tub and assist her into the bath.

Answer:  1

Explanation:  1. This is the best option, because the client is experiencing moderately severe pain with inflammation. Ibuprofen is a nonsteroidal anti-inflammatory drug that both reduces inflammation and provides pain relief.

2. This medication is contraindicated because of the client’s allergic reaction to acetaminophen.
3. Topical anesthetic sprays can be a helpful adjunct in pain relief, but are not sufficient when a client has moderately severe pain.
4. Ice packs would be better at this stage because they will cause vasoconstriction to reduce edema and pain relief.

Page Ref: 647-648

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 29.2-Discuss nursing interventions to promote postpartum maternal comfort, rest, and well-being.

MNL LO:  Determine nursing interventions that promote health maintenance in the postpartum client.

 

 

4) On the second day postpartum, the client experiences engorgement. To relieve her discomfort, the nurse should encourage the client to:

1. Remove her bra.
2. Apply heat to her breasts.
3. Apply ice packs to her breasts.
4. Limit breastfeeding to twice daily.

Answer:  3

Explanation:  1. Removing her bra will only serve to increase breast milk production.

2. Applying heat will promote breast milk production.
3. Applying ice packs to the breasts relieves discomfort through the numbing effect of ice.
4. Limiting breastfeeding to twice daily actually would decrease the flow of breast milk eventually, but would not serve to decrease the discomfort of mother or infant.

Page Ref: 648-649

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 29.2-Discuss nursing interventions to promote postpartum maternal comfort, rest, and well-being.

MNL LO:  Determine nursing interventions that promote maternal comfort during the postpartum period.