Deck 13: Maternal Physiologic Changes

Question 1

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

Answer 1

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

Question 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

Answer 2

A woman who is a gravida 4, para 4-0-0-4

Question 3

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.

Answer 3

After 2 weeks postpartum, it should not be palpable abdominally.

Question 4

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.

Question 5

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

Question 6

A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman's 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

Question 7

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

A) Estrogen
B) Progesterone
C) Prolactin
D) Human placental lactogen

Question 8

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

Question 9

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."

Question 10

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.

Question 11

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

A) Autolysis.
B) Subinvolution.
C) Afterpain.
D) Diastasis.

Question 12

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.

Question 13

Knowing that the condition of the new mother's 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.

Question 14

With regard to the postpartum changes and developments in a woman's 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.

Question 15

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.

Question 16

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.

Question 17

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 woman's 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.

Question 18

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

Question 19

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.