Immediately after birth, the father of the newborn holds the baby close, stares into his eyes, and seems captivated by him. The nurse recognizes this as the normal process of:

The nurse is aware that fibrinogen levels are increased in pregnancy. Which measure can be taken to prevent postpartum complications that result because of this increase? Have the client:

Calculate the gravity rate for gentamycin 100 mg/100ml with secondary tubing (20gtts/mL) over 60 minutes.

A client is ordered 325mL of packed red blood cells over 3 hours. What is the rate to be set on the infusion pump? Round to a whole number

A nurse is caring for a client who has their newborn placed skin to skin immediately following birth with a temperature of 37° C (98.6" F). Which of the following interventions by the nurse would place the newborn at higher risk for hypothermia?

A nurse on a postpartum unit is caring for a client.

Click to highlight the findings that require follow-up.

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Nurses' Notes

2hr postpartum:

Client is 2 hr postpartum following vaginal delivery. Client alert and oriented. Lungs clear to auscultation bilaterally. S1 S2 auscultated, no murmur. Abdomen soft, nontender. Uterus firm and midline, 1 cm below the umbilicus. Moderate amount of lochia rubra present on perineal pad.

24 hr postpartum:

Client alert and oriented. Lungs clear to auscultation bilaterally. S1,S2 auscultated, no murmur. Abdomen soft, nontender. Uterus boggy and midline, 2 cm below the umbilicus. Moderate amount of lochia rubra present on perineal pad, foul odor present.

Vital signs:

1 hr postpartum:

Temperature 37.5° C (99.5° F)

Heart rate 88/min

Respiratory rate 16/min

Blood pressure 118/78 mm Hg

24 hr postpartum:

Temperature 38.3° C (100.9° F)

Heart rate 105/min

Respiratory rate 18/min

Blood pressure 115/78 mm Hg

A nurse is caring for a newborn immediately following birth.

Click to highlight the newborn's assessment findings that require follow-up by the nurse.

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A nurse is caring for a newborn immediately following birth.

Nurses' Notes

2100:

Newborn has strong, steady cry. Skin tone consistent with genetic background. Acrocyanosis noted on bilateral extremities and hands.

Respirations are even and unlabored. Lung fields clear. Brachial pulse regular. Apical heart rate regular. Moves all extremities actively.

2200:

Newborn has occasional strong cries. Skin tone consistent with genetic background. Acrocyanosis noted on bilateral extremities and hands.

Lanugo noted on the posterior back. Respirations are even and unlabored. Sternal retractions noted. Lung fields with coarse rhonchi

noted in bilateral lung fields. Brachial pulse regular. Apical heart rate regular. Moves all extremities actively

Vital signs

2100:

Temperature 36.5° C (97.7° F) Axillary

Heart rate 152/min

Respiratory rate 54/min

2200:

Temperature 35.7° C (96.3° F) Axillary

Heart rate 140/min

Respiratory rate 68/min

When assessing a newborn shortly after birth, the nurse finds flat, irregular pinkish marks the forehead, the nape of the neck and the eyelids. The areas blanch when pressed with a finger. The nurse would document this finding as:

A client is ordered ampicillin 0.5 g po every 6 hours. On hand are ampicillin capsules labeled 250mg. How many capsules will the nurse administer for single dose?

The nurse is obtaining an obstetrical history on a currently pregnant woman. The client has an 18-month-old daughter who was delivered 2 days after estimated due date and a 3-year-old son who was born at 35 weeks' gestation. Before her son was born, she lost two pregnancies: one at 10 weeks and the other at 22 weeks. Using the GTPAL method, how would the nurse record this history?

A nurse in a hospital is caring for a client who is 4 hour postpartum. Which of the following interventions should the nurse first perform after finding that the client's uterus is not firm? (Select All that Apply.)