Chapter 20: Postpartum Physiology My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 20: Postpartum Physiology

Test Bank

MULTIPLE CHOICE

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

a.

At the level of the umbilicus

b.

Two centimeters below the umbilicus

c.

Midway between the umbilicus and the symphysis pubis

d.

Nonpalpable abdominally

ANS: A

Within 12 hours after delivery the fundus rises to approximately the level of the umbilicus.

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.

By the sixth postpartum week the fundus normally is halfway between the symphysis pubis and the umbilicus.

The fundus should be easily palpated using the maternal umbilicus as a reference point.

DIF: Cognitive Level: Comprehension REF: 478

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. To provide optimum care for the postpartum woman, the nurse understands that the most common causes of subinvolution are:

a.

Postpartum hemorrhage and infection

b.

Multiple gestation and postpartum hemorrhage

c.

Uterine tetany and overproduction of oxytocin

d.

Retained placental fragments and infection

ANS: D

Subinvolution is failure of the uterus to return to a nonpregnant state. The most common causes of subinvolution are retained placental fragments and infection.

Subinvolution may be caused by infection and result in hemorrhage.

Multiple gestation may cause uterine atony, resulting in postpartum hemorrhage.

Uterine tetany and overproduction of oxytocin do not cause subinvolution.

DIF: Cognitive Level: Comprehension REF: 478

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. 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 lb, 3 oz

ANS: B

Afterpains are more common in multiparous women.

In a woman who experienced polyhydramnios, afterpains are more noticeable because the uterus was greatly distended.

Breastfeeding may cause afterpains to intensify.

In a woman who delivered a large infant, afterpains are more noticeable because the uterus was greatly distended.

DIF: Cognitive Level: Comprehension REF: 479

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

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

a.

Lochia rubra

b.

Lochia sangra

c.

Lochia alba

d.

Lochia serosa

ANS: D

Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth.

Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown.

Lochia sangra is not a real term.

Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.

DIF: Cognitive Level: Comprehension REF: 479

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

5. 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

Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth.

Estrogen levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period.

Progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period.

Human placental lactogen levels dramatically decrease after expulsion of the placenta.

DIF: Cognitive Level: Comprehension REF: 481

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

6. 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

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.

An elevated temperature causes chills and possibly dehydration, not diaphoresis and diuresis.

Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate.

Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.

DIF: Cognitive Level: Comprehension REF: 482

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

7. A nurse caring for a postpartum woman understands that breast engorgement is caused by:

a.

Overproduction of colostrum

b.

Accumulation of milk in the lactiferous ducts and glands

c.

Hyperplasia of mammary tissue

d.

Congestion of veins and lymphatics

ANS: D

Breast engorgement is caused by the temporary congestion of veins and lymphatics.

Breast engorgement is not the result of overproduction of colostrum.

Accumulation of milk in the lactiferous ducts and glands does not cause breast engorgement.

Hyperplasia of mammary tissue does not cause breast engorgement.

DIF: Cognitive Level: Knowledge REF: 482

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

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

a.

Temperature 37.9 C, heart rate 120, respirations 20, blood pressure 90/50

b.

Temperature 37.4 C, heart rate 88, respirations 36, blood pressure 126/68

c.

Temperature 38 C, heart rate 80, respirations 16, blood pressure 110/80

d.

Temperature 36.8 C, heart rate 60, respirations 18, blood pressure 140/90

ANS: A

An EBL of 1500 ml with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss.

Temperature 37.4 C, heart rate 88, respirations 36, blood pressure 126/68 are normal vital signs except for an increased respiratory rate, which may be secondary to pain from the birth.

Temperature 38 C, heart rate 80, respirations 16, blood pressure 110/80 are normal vital signs 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.

Temperature 36.8 C, heart rate 60, respirations 18, blood pressure 140/90 are normal vital signs, although the blood pressure is slightly elevated, which may be due to the use of oxytocic medications.

DIF: Cognitive Level: Comprehension REF: 483

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment, Diagnosis

9. 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

The puerperium, also called the fourth trimester or the postpartum period of pregnancy, lasts about 3 to 6 weeks.

Involution marks the end of the puerperium, or the fourth trimester of pregnancy.

Lochia refers to the various vaginal discharges during the puerperium, or fourth trimester of pregnancy.

The final period of pregnancy lasts 3 to 6 weeks, but it is called the puerperium, or fourth trimester of pregnancy.

DIF: Cognitive Level: Knowledge REF: 478

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

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

a.

Autolysis

b.

Subinvolution

c.

Afterpain

d.

Diastasis

ANS: A

Autolysis is caused by a decrease in hormone levels.

Subinvolution is failure of the uterus to return to a nonpregnant state.

Afterpain is caused by uterine cramps 2 to 3 days after birth.

Diastasis refers to the separation of muscles.

DIF: Cognitive Level: Knowledge REF: 478

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

11. 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

However, the uterus does not return to its original size.

At the end of the third stage of labor, the uterus weighs approximately 1000 g. It does not return to its original size.

After 2 weeks postpartum the uterus weighs about 350 g. It does not return to its original size.

The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

DIF: Cognitive Level: Comprehension REF: 478

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

12. 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

The first flow is heavier, but within three or four cycles it is back to normal.

Ovulation can occur within the first month, but for 70% of nonlactating women, it returns in about 3 months.

Breastfeeding women take longer to resume ovulation.

Because many women ovulate before their first postpartum menstrual period, contraceptive options need to be discussed early in the puerperium.

DIF: Cognitive Level: Comprehension REF: 481

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 clients all of these 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

Breasts become fuller and heavier as colostrum transitions to milk. This should last 72 to 96 hours.

The movable, noncancerous mass is a filled milk sac.

Colostrum is present for a few days whether the mother breastfeeds or not.

A mother who does not want to breastfeed should also avoid stimulating her nipples.

DIF: Cognitive Level: Comprehension REF: 482

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

Respirations should decrease to within the womans normal prepregnancy range by 6 to 8 weeks after birth.

Stroke volume increases and cardiac output remains high for a couple of days. However, the heart rate and blood pressure return to normal quickly.

Leukocytosis increases 10 to 12 days after childbirth, which can obscure the diagnosis of acute infections (false-negative results).

The hypercoagulable state increases the risk of thromboembolism, especially after a cesarean birth.

DIF: Cognitive Level: Comprehension REF: 483

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

Headaches in the postpartum period can have a number of causes, some of which deserve medical attention.

Total or nearly total regression of varicosities is expected after childbirth. However, headaches might deserve attention.

Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened. Headaches, however, might deserve attention.

Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition. Headaches, however, might deserve attention.

DIF: Cognitive Level: Comprehension REF: 484

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

The nails return to their prepregnancy consistency and strength.

Some women have permanent darker pigmentation of the areolae and linea nigra. However, the nails return to their prepregnancy consistency and strength.

Striae gravidarum (stretch marks) usually do not completely disappear. However, the nails return to their prepregnancy consistency and strength.

For some women, spider nevi persist indefinitely. However, the nails return to their prepregnancy consistency and strength.

DIF: Cognitive Level: Comprehension REF: 484

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 client 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

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.

Each contraction should be as intense as possible without contracting the abdomen, buttocks, or thighs.

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.

The best position to learn Kegel exercises is to lie supine with knees bent. A secondary position is on the hands and knees.

DIF: Cognitive Level: Analysis REF: 481

OBJ: Client Needs: Health Promotion and Maintenance: Self-Care

TOP: Nursing Process: Evaluation

COMPLETION

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

ANS:

Involution

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

DIF: Cognitive Level: Comprehension REF: 478

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. Is this statement true or false?

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: Comprehension REF: 483

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

2. Although all other joints return to their normal prepregnancy state, those in the parous womans feet do not. The new mother may notice a permanent increase in her shoe size.

ANS: T

This is an accurate statement.

DIF: Cognitive Level: Comprehension REF: 484

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

3. Changes in the maternal immune system during the postpartum period account for the profuse diaphoresis that new mothers experience.

ANS: F

No significant changes in the maternal immune system occur during the postpartum period.

DIF: Cognitive Level: Knowledge REF: 484

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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