Chapter 13: Maternal Physiologic Changes My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 13: Maternal Physiologic Changes

Test Bank 

MULTIPLE CHOICE

1. A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this womans fundus?

a. One centimeter above the umbilicus
b. Two centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally

ANS: A

Feedback
A Within 12 hours after delivery, the fundus may be approximately 1 cm above the umbilicus.
B The fundus descends about 1 to 2 cm every 24 hours. Within 12 hours after delivery, the fundus may be approximately 1 cm above the umbilicus.
C By the sixth postpartum week, the fundus normally is halfway between the symphysis pubis and the umbilicus.
D The fundus should be easily palpated using the maternal umbilicus as a reference point.

DIF:Cognitive Level: ComprehensionREF:384

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

2. Which woman is most likely to experience strong afterpains?

a. A woman who experienced oligohydramnios
b. A woman who is a gravida 4, para 4-0-0-4
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 5 pounds, 3 ounces

ANS: B

Feedback
A Afterpains are more noticeable with births in which the uterus was greatly distended, as in a woman who experienced polyhydramnios.
B Afterpains are more common in multiparous women.
C Breastfeeding may cause afterpains to intensify.
D Afterpains are more noticeable with births in which the uterus was greatly distended, as in a woman who delivered a large infant.

DIF:Cognitive Level: ComprehensionREF:384

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

3. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman?

a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa

ANS: D

Feedback
A Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown.
B There is no such term.
C Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.
D Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth.

DIF:Cognitive Level: ComprehensionREF:385

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

4. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?

a. Estrogen
b. Progesterone
c. Prolactin
d. Human placental lactogen

ANS: C

Feedback
A Estrogen levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period.
B Progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period.
C Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth.
D Human placental lactogen levels decrease dramatically after expulsion of the placenta.

DIF:Cognitive Level: ComprehensionREF:387

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

5. Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. One mechanism for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period is:

a. Elevated temperature caused by postpartum infection.
b. Increased basal metabolic rate after giving birth.
c. Loss of increased blood volume associated with pregnancy.
d. Increased venous pressure in the lower extremities.

ANS: C

Feedback
A An elevated temperature would cause chills and may cause dehydration, not diaphoresis and diuresis.
B Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate.
C Within 12 hours of birth, women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid.
D Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.

DIF:Cognitive Level: ComprehensionREF:388

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

6. The nurse caring for the postpartum woman understands that breast engorgement is caused by:

a. Overproduction of colostrum.
b. Accumulation of milk in the lactiferous ducts.
c. Hyperplasia of mammary tissue.
d. Congestion of veins and lymphatics.

ANS: D

Feedback
A Breast engorgement is caused by the temporary congestion of veins and lymphatics, not by overproduction of colostrum.
B Breast engorgement is caused by the temporary congestion of veins and lymphatics, not by overproduction of milk.
C Breast engorgement is caused by the temporary congestion of veins and lymphatics, not by hyperplasia of mammary tissue.
D Breast engorgement is caused by the temporary congestion of veins and lymphatics.

DIF:Cognitive Level: KnowledgeREF:388

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

7. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 ml. When assessing the womans vital signs, the nurse would be concerned to see:

a. Temperature 37.9 C, heart rate 120, respirations 20, blood pressure (BP) 90/50.
b. Temperature 37.4 C, heart rate 88, respirations 36, BP 126/68.
c. Temperature 38 C, heart rate 80, respirations 16, BP 110/80.
d. Temperature 36.8 C, heart rate 60, respirations 18, BP 140/90.

ANS: A

Feedback
A An EBL of 1500 ml with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss.
B The vital signs are normal except for an increased respiratory rate, which may be secondary to pain from the birth.
C The vital signs are normal except for the temperature. However, temperature may increase to 38 C during the first 24 hours as a result of the dehydrating effects of labor.
D The vital signs are normal, although the BP is slightly elevated, which may be caused by the use of oxytocic medications.

DIF:Cognitive Level: ComprehensionREF:389

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Assessment, Diagnosis

8. The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:

a. Involutionary period because of what happens to the uterus.
b. Lochia period because of the nature of the vaginal discharge.
c. Mini-tri period because it lasts only 3 to 6 weeks.
d. Puerperium, or fourth trimester of pregnancy.

ANS: D

Feedback
A Involution marks the end of the puerperium, or the fourth trimester of pregnancy.
B Lochia refers to the various vaginal discharges during the puerperium, or fourth trimester of pregnancy.
C The final period of pregnancy lasts 3 to 6 weeks, but it is called the puerperium, or fourth trimester of pregnancy.
D The puerperium, also called the fourth trimester or the postpartum period of pregnancy, lasts about 3 to 6 weeks.

DIF:Cognitive Level: KnowledgeREF:384

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

9. The self-destruction of excess hypertrophied tissue in the uterus is called:

a. Autolysis.
b. Subinvolution.
c. Afterpain.
d. Diastasis.

ANS: A

Feedback
A Autolysis is caused by a decrease in hormone levels.
B Subinvolution is failure of the uterus to return to a nonpregnant state.
C Afterpain is caused by uterine cramps 2 to 3 days after birth.
D Diastasis refers to the separation of muscles.

DIF:Cognitive Level: KnowledgeREF:384

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

10. With regard to the postpartum uterus, nurses should be aware that:

a. At the end of the third stage of labor, it weighs approximately 500 g.
b. After 2 weeks postpartum, it should not be palpable abdominally.
c. After 2 weeks postpartum, it weighs 100 g.
d. It returns to its original (prepregnancy) size by 6 weeks postpartum.

ANS: B

Feedback
A At the end of the third stage of labor, the uterus weighs approximately 1000 g. It does not return to its original size.
B However, the uterus does not return to its original size.
C After 2 weeks postpartum, the uterus weighs about 350 g. It does not return to its original size.
D The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

DIF:Cognitive Level: ComprehensionREF:384

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

11. With regard to postpartum ovarian function, nurses should be aware that:

a. Almost 75% of women who do not breastfeed resume menstruating within a month after birth.
b. Ovulation occurs slightly earlier for breastfeeding women.
c. Because of menstruation/ovulation schedules, contraception considerations can be postponed until after the puerperium.
d. The first menstrual flow after childbirth usually is heavier than normal.

ANS: D

Feedback
A Ovulation can occur within the first month, but for 70% of nonlactating women, it returns in about 3 months.
B Breastfeeding women take longer to resume ovulation.
C Because many women ovulate before their first postpartum menstrual period, contraceptive options need to be discussed early in the puerperium.
D The first flow is heavier, but within three or four cycles, it is back to normal.

DIF:Cognitive Level: ComprehensionREF:387

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

12. With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:

a. Kidney function returns to normal a few days after birth.
b. Diastasis recti abdominis is a common condition that alters the voiding reflex.
c. Fluid loss through perspiration and increased urinary output accounts for a weight loss of over 2 kg during the puerperium.
d. With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

ANS: C

Feedback
A Kidney function usually returns to normal in about a month.
B Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex.
C Excess fluid loss through other means occurs as well.
D Bladder tone usually is restored 5 to 7 days after childbirth.

DIF:Cognitive Level: ComprehensionREF:388

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

13. Knowing that the condition of the new mothers breasts will be affected by whether she is breastfeeding, nurses should be able to tell their patients all of the following statements except:

a. Breast tenderness is likely to persist for about a week after the start of lactation.
b. As lactation is established, a mass may form that can be distinguished from cancer by its position shift from day to day.
c. In nonlactating mothers, colostrum is present for the first few days after childbirth.
d. If suckling is never begun (or is discontinued), lactation ceases within a few days to a week.

ANS: A

Feedback
A Breast tenderness should persist only about 48 hours after lactation begins.
B That movable, noncancerous mass is a filled milk sac.
C Colostrum is present for a few days whether the mother breastfeeds or not.
D A mother who does not want to breastfeed should also avoid stimulating her nipples.

DIF:Cognitive Level: ComprehensionREF:389

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Planning, Implementation

14. With regard to the postpartum changes and developments in a womans cardiovascular system, nurses should be aware that:

a. Cardiac output, the pulse rate, and stroke volume all return to prepregnancy normal values within a few hours of childbirth.
b. Respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth.
c. The lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections.
d. A hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth.

ANS: B

Feedback
A Stroke volume increases, and cardiac output remains high for a couple of days. However, the heart rate and blood pressure return to normal quickly.
B Respirations should decrease to within the womans normal prepregnancy range by 6 to 8 weeks after birth.
C Leukocytosis increases 10 to 12 days after childbirth, which can obscure the diagnosis of acute infections (false-negative results).
D The hypercoagulable state increases the risk of thromboembolism, especially after a cesarean birth.

DIF:Cognitive Level: ComprehensionREF:389

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

15. Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium?

a. Varicosities of the legs
b. Carpal tunnel syndrome
c. Periodic numbness and tingling of the fingers
d. Headaches

ANS: D

Feedback
A Total or nearly total regression of varicosities is expected after childbirth. However, headaches might deserve attention.
B Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. However, headaches might deserve attention.
C Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition. However, headaches might deserve attention.
D Headaches in the postpartum period can have a number of causes, some of which deserve medical attention.

DIF:Cognitive Level: ComprehensionREF:390

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation

16. Several changes in the integumentary system that appear during pregnancy disappear after birth, although not always completely. What change is almost certain to be completely reversed?

a. Nail brittleness
b. Darker pigmentation of the areolae and linea nigra
c. Striae gravidarum on the breasts, abdomen, and thighs
d. Spider nevi

ANS: A

Feedback
A The nails return to their prepregnancy consistency and strength.
B Some women have permanent darker pigmentation of the areolae and linea nigra. However, the nails return to their prepregnancy consistency and strength.
C Striae gravidarum (stretch marks) usually do not completely disappear. However, the nails return to their prepregnancy consistency and strength.
D For some women, spider nevi persist indefinitely. However, the nails return to their prepregnancy consistency and strength.

DIF:Cognitive Level: ComprehensionREF:391

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

17. Childbirth may result in injuries to the vagina and uterus. Pelvic floor exercises also known as Kegel exercises will help to strengthen the perineal muscles and encourage healing. The nurse knows that the woman understands the correct process for completing these conditioning exercises when she reports:

a. I contract my thighs, buttocks, and abdomen.
b. I do 10 of these exercises every day.
c. I stand while practicing this new exercise routine.
d. I pretend that I am trying to stop the flow of urine midstream.

ANS: D

Feedback
A Each contraction should be as intense as possible without contracting the abdomen, buttocks, or thighs.
B Guidelines suggest that these exercises should be done 24 to 100 times per day. Positive results are shown with a minimum of 24 to 45 repetitions per day.
C The best position to learn Kegel exercises is to lie supine with knees bent. A secondary position is on the hands and knees.
D The woman can pretend that she is attempting to stop the passing of gas or the flow of urine midstream. This will replicate the sensation of the muscles drawing upward and inward.

DIF:Cognitive Level: AnalysisREF:387

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

COMPLETION

1. The process in which the uterus returns to a non-pregnant state after birth is known as ____________________.

ANS:

Involution

The process of involution begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle.

DIF:Cognitive Level: ComprehensionREF:384

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation

TRUE/FALSE

1. Clotting factors and fibrinogen levels normally are decreased during pregnancy and remain low in the immediate puerperium. This hypocoagulable state increases the risk of thromboembolism, especially after cesarean birth.

ANS: F

This statement is false. Clotting factors and fibrinogen normally are increased during pregnancy and remain elevated in the immediate puerperium. This hypercoagulable state increases the risk of thromboembolism, especially after cesarean birth.

DIF:Cognitive Level: ComprehensionREF:389

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

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