Postpartum assessment: You are the oncoming day shift nurse and receive report on the couplet assigned to you.
Maternal Report: A G3 T2 P0 A1 L2 patient delivered vaginally 48 hours ago.
Estimated blood loss (EBL): 345 milliliters, second-degree laceration repaired.
The patient is ambulating and voiding well, pain is well controlled with Ibuprofen 600 milligrams as needed.
She is breastfeeding and bonding well with the infant.
Newborn Report: Female, 39 weeks 0 days gestation.
Exclusive breastfeeding.
Birth weight: 2380 grams (small for gestational age or SGA). She has had 2 wet and 3 dirty diapers for the previous shift.
Car seat test and hearing screening are pending before discharge.
The mother is concerned about the baby's small size and asks you to explain what small for gestational age means.
You explain to her that the baby's weight is choose your answer for all babies born at 39 weeks gestation and puts the baby at risk for choose your answer.
Below the 10th percentile for all babies born at 39 weeks gestation and puts the baby at risk for hypoglycemia.
Below the 5th percentile for all babies born at 39 weeks gestation and puts the baby at risk for hyperbilirubinemia.
Above the 90th percentile for all babies born at 39 weeks gestation and puts the baby at risk for polycythemia.
At the 50th percentile for all babies born at 39 weeks gestation and puts the baby at risk for meconium aspiration.
The Correct Answer is A
Choice A rationale
Small for gestational age (SGA) is scientifically defined as a newborn whose birth weight is below the 10th percentile for their specific gestational age, indicating restricted fetal growth. These infants have lower glycogen stores, a critical energy source, and decreased gluconeogenesis capacity, leading to rapid depletion of glucose reserves postpartum. This deficiency significantly increases the newborn's risk for hypoglycemia (blood glucose <40 to 45 mg/dL), requiring frequent monitoring and early feeding interventions.
Choice B rationale
A weight below the 5th percentile is a more severe classification, sometimes called severe SGA or fetal growth restriction (FGR), but the general definition of SGA remains the 10th percentile cutoff. While SGA infants may have a higher hematocrit (polycythemia), which is a risk factor for hyperbilirubinemia due to increased red blood cell breakdown, hypoglycemia is the most immediate and common metabolic risk due to low energy stores.
Choice C rationale
A birth weight above the 90th percentile for gestational age defines a large for gestational age (LGA) or macrosomic infant, the complete opposite of SGA. These infants, often born to diabetic mothers, are at a higher risk for birth trauma, shoulder dystocia, and hypoglycemia, but are not defined as SGA. Polycythemia (central hematocrit >65%) is a risk for SGA infants, but SGA is not defined by weight above the 90th percentile.
Choice D rationale
The 50th percentile represents the average or median weight for that gestational age, classifying the infant as appropriate for gestational age (AGA), not SGA. Meconium aspiration syndrome is primarily a risk associated with post-term infants (born ≥42 weeks) or term/SGA infants experiencing fetal distress and asphyxia, which triggers meconium passage in utero, not a direct or defining metabolic risk of SGA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Uterine cramping pain, often called afterpains, is a normal physiological process, especially in multiparous women or those who are breastfeeding. This pain is caused by oxytocin-mediated uterine contractions that help the uterus involute and compress blood vessels, which reduces the risk of hemorrhage.
Choice B rationale
A heart rate of 108 beats/minute (tachycardia) is a finding that warrants further investigation. The normal postpartum heart rate is typically 60-100 beats/minute (although mild, transient bradycardia may occur). Persistent tachycardia can be an early sign of hypovolemia due to hemorrhage, infection (sepsis), or pain.
Choice C rationale
Deep red, fleshy-smelling lochia (Lochia rubra) is the expected discharge for the first 3-4 days postpartum. The fleshy odor is normal, originating from the sloughing decidua, and indicates normal uterine healing and cleansing. An offensive odor would suggest an infection.
Choice D rationale
Diaphoresis (profuse sweating) is a normal physiological mechanism in the postpartum period. It is the body's way of eliminating the increased fluid volume accumulated during pregnancy and the excess fluid retained during labor. This is a normal process of diuresis and fluid balance restoration.
Correct Answer is D
Explanation
Choice A rationale
Testing the ability to raise legs is not a specific or reliable method for assessing Deep Vein Thrombosis (DVT). DVT assessment primarily involves checking for unilateral leg swelling, warmth, redness, and pain, sometimes elicited by Homan's sign (pain on dorsiflexion of the foot), although this sign is less reliable and discouraged by some guidelines due to the risk of embolization. Venous Doppler ultrasound is the definitive diagnostic tool.
Choice B rationale
Assessing hidden bleeding, particularly postpartum hemorrhage (PPH), involves checking the fundus for firmness and location (normal is firm, near the umbilicus initially), assessing the amount and characteristics of lochia (normal is rubra, scant to moderate), and monitoring vital signs for signs of shock (e.g., tachycardia, hypotension). The leg-raising test is irrelevant to PPH assessment.
Choice C rationale
Discharge eligibility after vaginal delivery is typically based on factors such as stable vital signs, appropriate uterine involution, controlled pain, adequate voiding, successful newborn feeding, and completion of necessary teaching and screenings. The ability to raise legs only relates to motor function post-anesthesia, not the global criteria for discharge.
Choice D rationale
Epidural or spinal anesthesia temporarily blocks nerve impulses, causing sensory and motor paralysis in the lower extremities. The ability to flex or raise the legs is a direct test of motor function return. Full motor function must be regained before a patient can safely ambulate, which is crucial for preventing falls and is part of the recovery room discharge criteria. —.
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