Question 1

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

Accepted Answer

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.

Question 2

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

Accepted Answer

Within 12 hours after delivery the fundus may be approximately 1 cm above 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 after birth 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.

Question 3

The nurse caring for the after birth woman understands that breast engorgement is caused by:

Accepted Answer

Breast engorgement is caused by the temporary congestion of veins and lymphatics,not by overproduction of colostrum,overproduction of milk,or hyperplasia of mammary tissue.

Question 4

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?

Accepted Answer

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.There is no such term as lochia sangra.Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.

Question 5

Which woman is most likely to experience strong afterpains?

Accepted Answer

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

Question 6

A woman gave birth to a 7-lb,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:

Accepted Answer

An EBL of 1500 mL with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss.An increased respiratory rate of 36 may be secondary to pain from the birth.Temperature may increase to 38° C during the first 24 hours as a result of the dehydrating effects of labor.A BP of 140/90 is slightly elevated,which may be caused by the use of oxytocic medications.

Question 7

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 the following statements except:

Accepted Answer

Breast tenderness should persist for 24 to 48 hours after lactation begins.That 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.

Question 8

Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?

Accepted Answer

"My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles" is an accurate statement and indicates her understanding of her expected menstrual activity.She can expect her first menstrual cycle to be heavier than normal (which occurs by 3 months after childbirth),and the volume of her subsequent cycles will return to prepregnant levels within three or four cycles.

Question 9

With regard to the after birth uterus,nurses should be aware that:

Accepted Answer

After 2 weeks after birth,the uterus should not be palpable abdominally; however,it has not yet returned to its original size.At the end of the third stage of labor,the uterus weighs approximately 1000 g.It takes 6 full weeks for the uterus to return to its original size.After 2 weeks after birth the uterus weighs about 350 g,not its original size.The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

Question 10

A woman gave birth to a 7-lb,3-ounce infant boy 2 hours ago.The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline.In the immediate after birth period,the most serious consequence likely to occur from bladder distention is:

Accepted Answer

Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly.A urinary tract infection may result from overdistention of the bladder,but it is not the most serious consequence.A ruptured bladder may result from a severely overdistended bladder.However,vaginal bleeding most likely would occur before the bladder reaches this level of overdistention.Bladder distention may result from bladder wall atony.The most serious concern associated with bladder distention is excessive uterine bleeding.

Question 11

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

Accepted Answer

The puerperium,also called the fourth trimester or the after birth 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.

Question 12

With regard to the after birth changes and developments in a woman's cardiovascular system,nurses should be aware that:

Accepted Answer

Respirations should decrease to within the woman's 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 and can obscure the diagnosis of acute infections (false-negative results).The hypercoagulable state increases the risk of thromboembolism,especially after a cesarean birth.

Question 13

Post birth uterine/vaginal discharge,called lochia:

Accepted Answer

An offensive odor usually indicates an infection.Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease.Less lochia usually is seen after cesarean births and usually increases with ambulation and breastfeeding.

Question 14

With regard to after birth pains,nurses should be aware that these pains are:

Accepted Answer

A large baby or multiple babies overdistend the uterus.The cramping that causes after birth pains arises from periodic,vigorous contractions and relaxations,which persist through the first part of the after birth period.After birth pains are more common in multiparous women because first-time mothers have better uterine tone.Breastfeeding intensifies after birth pain because it stimulates contractions.

Question 15

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

Accepted Answer

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

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 after birth period is:

Accepted Answer

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 would cause chills and may cause 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.

Question 17

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?

Accepted Answer

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

Question 18

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

Accepted Answer

Prolactin levels in the blood increase progressively throughout pregnancy.In women who breastfeed,prolactin levels remain elevated into the sixth week after birth.Estrogen and progesterone levels decrease markedly after expulsion of the placenta and reach their lowest levels 1 week into the after birth period.Human placental lactogen levels decrease dramatically after expulsion of the placenta.

Question 19

As relates to the condition and reconditioning of the urinary system after childbirth,nurses should be aware that:

Accepted Answer

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

Question 20

With regard to after birth ovarian function,nurses should be aware that:

Accepted Answer

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 within 12 weeks after birth.Breastfeeding women take longer to resume ovulation.Because many women ovulate before their first after birth menstrual period,contraceptive options need to be discussed early in the puerperium.

Quiz 18: Postpartum Physiologic Changes