Question 1

A client who is due to give birth any time asks the nurse midwife what changes in the reproductive system she should expect after the delivery. Which of the following statements by the nurse midwife is the most appropriate?

Accepted Answer

The uterus never completely returns to its pre-pregnancy state. Involution is the process by which the reproductive organs return to their pre-pregnancy state. Although the uterus returns to its pre-pregnant size, its cavity becomes larger, its vessels become more convoluted, the external orifice is more marked, fissures are observed on its edges and the muscles are more defined. After birth, the uterus will weigh about 1,000 grams, but on the 6th week, it will weigh about 50 grams. The rate of uterine involution follows a usual pattern and rate. An hour after delivery, the fundus is palpated at the level of the umbilicus. In the next 24 hours, the fundus is expected to go down by 1 fingerbreadth. On the second day, it is palpated 2 fingerbreadths from the uterus. On the 10th day the fundus is non palpable.

Question 2

Which of the following clients has the greatest risk for delayed uterine involution?

Accepted Answer

Multiple gestation increases the risk for delayed uterine involution. Other risk factors include hydramnios, exhaustion, prolonged labor, retained placental fragments, full bladder, difficult birth, multiparity and excessive administration of analgesia.

Question 3

A nurse midwife is assessing the clients in the unit who gave birth 24 hours ago through vaginal delivery. Which of the following clients are at risk for puerperal infection?
I.A client who ruptured her membranes 12 hours before birth.
II.A client who had internal fetal monitoring during labor.
III.A client with low levels of hemoglobin and hematocrit.
IV.A client who is negative for vaginal infections.

Accepted Answer

Clients with internal fetal monitoring during labor and clients with low levels of hemoglobin and hematrocrit are at risk for puerperal infection. The other risk factors for puerperal infection are: rupture of membranes 24 hours before birth, retained placental fragments, difficult labor, vaginal infections and postpartum hemorrhage.

Question 4

A nurse midwife is assessing a postpartum client who gave birth through vaginal delivery 18 hours ago. On assessment, the nurse midwife suspects that the client has cervical laceration. Which of the following findings is expected in this condition?

Accepted Answer

Continuous seepage of bright red blood from the vagina with a firm uterus suggests cervical laceration. The bleeding usually occurs minutes after the delivery of placenta.

Question 5

A client develops fever of 102.2 ºF on the third day postpartum. Assessment findings include abdominal tenderness and dark brown lochia. Endometritis is suspected. Which of the following interventions is the most appropriate for the client?

Accepted Answer

The most appropriate action is to administer an oxytocic agent to encourage uterine contractions. The client is recommended to increase her fluid intake to control fever and dehydration. An antibiotic may be administered. The sample must be obtained from the vagina by a sterile swab. The client should be placed in Fowler's position or encouraged to ambulate to drain infected secretions.

Question 6

A client had a cesarean delivery. The client informs the nurse midwife that she intends to breastfeed her baby. Which of the following instructions is the most effective for a client who wants to breastfeed after a cesarean delivery?

Accepted Answer

The most appropriate action of the nurse midwife is to instruct the client to use the football hold when breastfeeding. This position alleviates or avoids incisional discomfort. Breastfeeding may be started immediately after birth, and the newborn must be breastfed every 2 to 4 hours.

Question 7

A nurse midwife is teaching a group of pregnant women about the characteristics of the different types of lochia. Which of the following statements made by one of the women indicates that further teaching is necessary?

Accepted Answer

Lochia alba is mainly composed of mucus and leukocytes; it has fewer blood cells than other types of lochia. It is white or yellowish white in color. Lochia serosa, on the other hand, consists of blood, mucus and invading leukocytes. The other options are all correct statements about types of lochia.

Question 8

A nurse midwife is receiving a client who gave birth an hour ago. Which of the following nursing interventions is the priority action of the nurse during the immediate postpartum period?

Accepted Answer

The priority action of the nurse during the immediate postpartum period is to palpate for the height of fundus. Hemoglobin and hematocrit may be ordered, but this is not the priority action of the nurse midwife. Oxygen administration is not indicated at this time.

Quiz 5: Postpartum