(Exam 2) PRN 1831 Principles of Maternal Child Health Nursing (NEW Update 2024-2025), Exams of Nursing

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Exam 2:

PRN 1831/ PRN

(NEW Update 2024/2025)

Principles of Maternal Child

Health Nursing

Review with Questions and

Verified Answers

100% Correct

A Grade –Rasmussen

PRN 1831 Exam 2

QUESTION

How does the bladder impact involution and bleeding Answer: A distended bladder pushes the uterus upward and usually to one side of the abdomen. The fundus may be boggy or firm. If not emptied, a distended bladder can result in uterine atony and hemorrhage because it interferes with the normal contraction of the uterus.

QUESTION

Postpartum blues, depression Baby blues Answer: resultant from hormonal shift after delivery First few postpartal days peak on the 5th day subside over the next several days.

QUESTION

Postpartum depression Answer: symptoms are persisting beyond 2 weeks postpartum Get adequate rest Take help from support person Know expected changes (baby blues), & when to report symptoms to provider

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Symptoms of endometritis

Answer: Temperature elevation o Tachycardia o Uterine tenderness, subinvolution o Malaise o Heavy, foul-smelling lochia

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Symptoms of magnesium toxicity Answer: Assess every hour respiratory status/respirations, deep tendon reflexes, and LOC o Antidote: Calcium gluconate

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Symptoms of mastitis Answer: Firm, red, swollen, tender breast w/ fever, myalgias, chills, malaise

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cause of mastitis Answer: common cause is the hemolytic staphylococcus aureus, introduced from the infant's mouth through a fissure in the nipple

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Rubin's phases "taking in"

Answer: Dependent First 24-48 hr Focus on meeting personal needs Rely on others for assistance Excited, talkative Need to review birth experience with others

QUESTION

Rubin's phases "taking hold" Answer: Begins on day 2 or 3 Lasts 10 days to several weeks Focus on baby care and improving caregiving competency Want to take charge but need acceptance from others Want to learn and practice, Dealing with physical and emotional discomforts, can experience "baby blues"

QUESTION

Rubin's phases "letting go" Answer: Focus on family as a unit Resumption of role (intimate partner, individual)

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BUBBLEHE assessment Answer: Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy, Homan's Sign, Emotional Status

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perineal assessment Answer: Manage inflammation/edema - cool/ice packs o After first 24 hrs - sitz bath (heat)

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Importance of folate in pregnancy what conditions does it prevent in the newborn? Answer: Started 3 months prior to becoming pregnant Spina bifida, anencephaly, myeolomenigocele

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Normal Newborn Vital Signs Answer: HR: 110-160 bpm o R: 30-60 breaths/min o T: 36.5-37.

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Which newborn blood glucose would require immediate intervention? Answer: Normal blood glucose: 40-60 mg/dL o Anything below or above normal range

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What is a code pink? Answer: Infant abduction/missing infant

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What is a code pink preventive measures Answer: ID band should be verified against the client's ID band Photo ID badges Newborn is not given to anyone who does not have a photo Locked maternal-newborn units Sensor device on the ID band or umbilical cord clamp that sounds an alarm

QUESTION

Recognize newborn rash - Milia Answer: small raised pearly or white spots on the nose, chin, and forehead.

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Recognize newborn rash - Telangiectatic Nevi "Stork Bite" Answer: flat pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of forehead.

QUESTION

umbilical cord care Answer: -keep clean, dry, clean stump with water, watch swelling/redness/purulent d/c

• fold diaper edge down to keep stump dry
• will fall of after 10-14 days

QUESTION

Newborn Reflexes: Rooting Answer: stroke cheek near corner of mouth (helps infant find nipple) Sucking - infant sucks finger (permits feeding)

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Newborn Reflexes: Moro (Startle) Answer: infant makes an "embracing" motion by arching back, extending legs, throwing arms outward, and the bringing arms in toward the body (may have helped infant cling to mother)

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Newborn Reflexes: sucking Answer: Stimulation: Place finger in infant's mouth Response: infant sucks finger rhythmically Age of disappearance: replaced by voluntary sucking after 4 months Function: permits feeding

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Understand newborn weight loss and when they regain Answer: Loss of 5% - 10% after birth is normal o Infants should regain weight and return to normal birth weight by 10-14 days after birth o Gain 110-200 g/week for first 3 mos

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Indications of dehydration or poor feeding Answer: o dry mucous membranes o dry sunken eyes o depressed or sunken fontanelle

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Understand impaired thermoregulation in the newborn- why? Answer: o Newborn has an unstable heat-regulating system o Newborn cannot adapt to changes in temp Little subcutaneous fat High body water content

QUESTION

Circumcision care Answer: Keep area clean o Apply diaper loosely o Apply petroleum jelly w/each diaper change for at least 24 hrs after the circumcision to keep the diaper from adhering to the penis o Do not give tub bath *trickle warm water gently over penis o Notify the provider: redness, discharge, swelling, strong odor, tenderness, decrease in urination, or excessive crying from newborn

QUESTION

Newborn immunity Answer: Temporary immunity is passed from mom and lasts the first 3 mos of life

o Infant gradually produces his/her own immunoglobulin, until adult levels are reached by puberty o IgA is an immunoglobulin produced after the neonatal period (about 1 mos of age) that is contained in breast milk and provides some resistance to respiratory and GI infections

QUESTION

SIDS & prevention Answer: o Teaching: teach the parent about the importance of the "back-to-sleep" concept to prevent SIDS o Infants should be positioned for sleep on their backs on a firm, flat mattress in a crib, both for their safety

QUESTION

Newborn Identification and Security Answer: o Nurse should verify the match each time she brings the baby to mom o Apply matching identification bands on the infant and the mother as well as the father or other designated birth support person. Infants ID band are placed snugly enough so that when the initial weight loss occurs, the ID band does not fall of

QUESTION

measuring adequacy of feeds for the nursing infant Answer: adequacy of breastfeeds is eval via weight gain and the number of wet diapers: 6/day

QUESTION

Newborn Output Answer: o Stools: meconium first 24- o Breastfed infants: transition to yellow, liquid, seedy stools o If dry diapers for 8hrs or more notify provider

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newborn vision Answer: intermittent eye crossing is normal

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Ophthalmic Ointment Answer: The application is delayed sometimes to facilitate bonding

QUESTION

Priority nursing interventions for the 4th stage of labor? Answer: Assessing VS, fundus, and bleeding every 15 min for 1-2 hr

QUESTION

Medications given as opioid antagonist: what medication? Why is it given?

Answer: Naloxone Given to women in labor or postpartum to counteract the effects of narcotic/opioid medications. To counteract the side effects (respiratory depression)

QUESTION

Provide teaching and planning for a postpartum woman who is not immune to rubella Answer: Should be administer a dose of MMR following delivery, before discharge Teaching: client should not get pregnant for 28 days following the immunization

QUESTION

Be able to provide instruction re: breastfeeding and maternal pain medications Answer: Offer pain medication immediately after feed so that it has ample time to be metabolized prior to next feed.

QUESTION

Which breastfeeding position would be best for a mom after c/s Answer: Football hold

QUESTION

Who gets Rhogam and why? Answer:

All Rh-negative clients who have newborns who are Rh-positive (administered IM) o Why: to suppress antibody formation in the mother

QUESTION

What should you do if a fundus is boggy on assessment? Why? Answer: Have the mom try to empty her bladder/massage o Why: full bladder can impede the uterus ability to stay firmly contracted and result in increased bleeding/hemorrhage

QUESTION

Identify types of lochia and when to expect them Answer: Lochia rubra: (through day 3) dark red menstrual period like discharge fleshy odor o Lochia serosa: (4-10 days) pinkish brown and serosanguineous consistency o Lochia alba: (10 days - 8 weeks) yellowish white creamy color, fleshy odor

QUESTION

Bathing and pericare after c/s Answer: Ensure stability during ambulation o Keep stream of water on back away from incision o Keep incision covered with an occlusive dressing o Provide shower chair if needed

QUESTION

Provide teaching on pericare (understand the rationales

Answer: After vaginal: Use warm water in squeeze bottle after every void (front to back) Pat dry, front to back Use optional topical anesthetic (dermaplast) if episiotomy or laceration Apply ice packs (first 24 hrs) Optional: use sitz bath (first 24 hrs)

QUESTION

Preventing breast engorgement in the bottle feeding mom Answer: Supportive sports bra/ace wrap breasts o Ice packs to the breasts o Apply cabbage leaves to draw out milk

QUESTION

Dietary sources of calcium Answer: -milk and milk products -soy milk -broccoli -fortified orange juice -fish with bones (sardines)

QUESTION

symptoms of preeclampsia Answer: Headache o Visual disturbances o Epigastric pain o Edema o Proteinuria o Brisk DTRs o Clonus o Seizure (Eclampsia)

QUESTION

Expected findings in the postpartum period (fundal assessment) Answer: At about an hour after childbirth, your fundus should be around your belly button (where it was at 20 weeks). After that, it should steadily decrease 1 centimeter every 24 hours. At about one week postpartum, your fundus should be at your pubic bone (where it was at 12 weeks)

QUESTION

What do apgar scores indicate? At 1 min, at 5 min? Answer: At 1 min: How the baby tolerated the delivery process At 5 min: How the baby is adjusting to life outside the uterus

QUESTION

APGAR Scoring: A = Appearance Answer: Appearance (skin color) 0 Points: blue;pale 1 Point: pink body; blue extremities 2 points: pink

QUESTION

APGAR Scoring: P = Pulse Answer: Absent - 0 points Below 100 bpm - 1 point Over 100 bpm - 2 points

QUESTION

APGAR Scoring: G - Grimace Answer: (reflex irritability) Floppy - 0 points Minimal response to stimulation - 1 point Prompt response to stimulation - 2 points

QUESTION

APGAR Scoring: A - Activity Answer: (muscle tone) Absent - 0 points Flexed arms and legs - 1 point Active - 2 points

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APGAR Scoring: R - Respirations Answer: Absent - 0 points Slow & Irregular - 1 point Vigorous Cry - 2 points

QUESTION

caput succedaneum Answer: diffuse edema of the fetal scalp that crosses the suture lines. reabsorbs within 1 to 3 days

QUESTION

Cephalohematoma

Answer: Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.

QUESTION

Congenital Hip Dysplasia Answer: o Assess posterior legs for symmetry of gluteal asymmetry possible dysplasia o Assess bilateral leg length for symmetry asymmetric length possible hip dysplasia o Perform Ortolani and Barlow test positive indicators possible HD

QUESTION

Immediate actions in the care of the newborn and why Answer: o Dry the infant thoroughly to prevent heat loss/cold stress o Application of ID bands to mom and baby Matching serial numbers that will be verified each time baby is brought to mom to ensure right mom/right baby

QUESTION

hyperbilirubinemia Answer: Caused by the rapid destruction of excess RBC, which the infant does not need now because he/she is in an atmosphere that contains more oxygen than was available during prenatal life

QUESTION

hyperbilirubinemia s/s

Answer: Appearance: yellow skin and mucous membranes, scleral icteris (yellow discoloration) Testing: indirect and direct bilirubin mainly

QUESTION

hyperbilirubinemia risks? Answer: If levels too high kernicterus (brain damage)

QUESTION

hyperbilirubinemia nursing care Answer: Shield the eyes and genitals Encourage feeds q2-3 hr Monitor temp Monitor I&O

QUESTION

Vitamin K Answer: o Administer 0.5 to 1 mg IM into the vastus lateralis (where muscle development is adequate) within 1 hr after birth

QUESTION

Gestational Age Assessment:

Answer: o Ballard Scale

QUESTION

Maternal hydration Answer: 2-3 L of water daily

QUESTION

Caloric Intake Answer: Mom will burn an + 500 calories daily above her basal rate while breastfeeding

QUESTION

Stimulation of the breasts to produce Answer: Frequent stim of breasts via nursing or pumping (at least q 2 hrs) o Alternate breasts

QUESTION

Avoid combination contraceptives Answer: Estrogen will inhibit milk production

QUESTION

Breastfeeding Assessment o Education: Answer: Feed on demand Advise mom to alternate breasts when feeding baby Express a small amount of breastmilk/colostrum, apply to the nipple and allow to air dry

QUESTION

Understand patterns of growth: Answer: Doubles by age 5-6 months and triples by age 1 yr

QUESTION

patterns of growth: Birth-1 mo Answer: Height/length: 19-21 inches Weight: 7.5lbs Head circumference: 13-14 inches Chest Circumference: 12-13 inches

QUESTION

patterns of growth: 1-2 mo Answer: Weight: increases 1.5lb per month Height: increases 1 inch per month Head circumference: increases 0.5 in per month

QUESTION

patterns of growth: 3-6 mo Answer: Weight: double the birth weight by 6 months Height: increases by 1 inch per month

QUESTION

patterns of growth: 9-12 mo Answer: Weight: triple the birth weight Height: increases 1 inch per month Head & Chest circumference: same at 12 months of age

QUESTION

Adolescence should increase what? Answer: Increase in caloric intake and rest

QUESTION

Adolescence growth spurt girl vs. boy Answer: Females have growth spurts approximately 2 years earlier than males

QUESTION

Erikson's stages of development Infancy

Answer: Infancy (birth to 18 months)Trust vs. Mistrust - Feeding

QUESTION

Erikson's stages of development Early Childhood Answer: Early Childhood (2 to 3 years)Autonomy vs. Shame and DoubtToilet Training

QUESTION

Erikson's stages of development Preschool Answer: (3 to 5 years)Initiative vs. GuiltExploration

QUESTION

Erikson's stages of development Nursing care Answer: developmental stages are assessed to determine if the client is at the expected level of growth and development, to plan care that is age and developmentally appropriate and to modify care as based on the age related characteristics and needs

QUESTION

What is cephalocaudal development? Answer: Development proceeds from head to toe.

QUESTION

Cephalocaudal development example Answer: The infant is able to raise his/her head before being able to sit, and he/she gains control of the trunk before walking.

QUESTION

What is stranger anxiety? When does it occur? Answer: Results from the ability to discriminate between familiar and unfamiliar faces

QUESTION

When does stranger anxiety occur? Answer: Between 6-8 months, peaks at 8 months.

QUESTION

appropriate toys according to the developmental stage: birth to 2 months Answer: Mobiles 8-10in from the face

QUESTION

appropriate toys according to the developmental stage: 2-4 Months

Answer: Rattle and cradle Gym

QUESTION

appropriate toys according to the developmental stage: 4-6 Months Answer: Bright-colored toys

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appropriate toys according to the developmental stage: 6-9 months Answer: large toys with bright colors w/- movable parts- noise makers

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appropriate toys according to the developmental stage: 9-12 months Answer: Books with large pictures Large push-pull toys Teddy Bears

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appropriate toys according to the developmental stage: Toddlers Answer: Toddlers Push-pull toy Low Rocking Horses, Dolls, Stuffed Animals

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appropriate toys according to developmental stage Pre-school aged Answer: Play-ground Materials Housekeeping toys Coloring Books Tricycles

QUESTION

Immunizations: what vaccines should a child have when starting kindergarten Answer: Require a second MMR & a DTaP booster

QUESTION

Normal development in infancy: Fine motor Answer: 1 month: Has a strong grasp reflex 4 months: Grasps objects with both hands 6 months: Holds bottle 12 months: Tries to build a two-block tower w/out success Can turn pages in a book

QUESTION

Normal development in infancy: Gross motor Answer: 2 months: Lifts head off mattress when prone 7 months: Bears full weight on feet Sits, leaning forward on both hands 8 months: Sits unsupported 11 months: Cruises or walks while holding onto something 12 months: Sits down from a standing position w/out assistance Walks with one handheld

QUESTION

Adolescents and body image Answer: o Peer interactions are highly valued o Developing a sense of self.. figuring out who they are

QUESTION

Adolescents and body image concerns Answer: related to scars, having body parts shaved for surgery, use of assistive devices that make them "different"

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School-aged children: Social Answer: o Prefers to interact with same-sex peer groups

QUESTION

School-aged children Task oriented focus Answer: Mastery of tasks & skills provides a sense of ability