Deck 20: Postpartum Adaptations

Question 1

A pregnant patient asks when the dark line on her abdomen (linea nigra)will go away.The nurse knows the pigmentation will decrease after delivery because of

A) increased estrogen.
B) increased progesterone.
C) decreased melanocyte-stimulating hormone.
D) decreased human placental lactogen.

Answer 1

decreased melanocyte-stimulating hormone.

Question 2

Rh? immune globulin will be ordered postpartum if which situation occurs?

A) Mother Rh-, baby Rh+
B) Mother Rh-, baby Rh-
C) Mother Rh+, baby Rh+
D) Mother Rh+, baby Rh-

Answer 2

Mother Rh-, baby Rh+

Question 3

If the fundus is palpated on the right side of the abdomen above the expected level,the nurse should suspect that the patient has

A) been lying on her right side too long.
B) a distended bladder.
C) stretched ligaments that are unable to support the uterus.
D) a normal involution.

Answer 3

a distended bladder.

Question 4

A postpartum patient asks,"Will these stretch marks go away?" The nurse's best response is

A) "They will fade and be gone by your 6-week checkup."
B) "No, unfortunately they will never fade away."
C) "Yes, eventually they will totally disappear."
D) "They will fade to silvery lines but won't disappear completely."

Question 5

What documentation on a woman's chart on postpartum day 14 indicates a normal involution process?

A) Moderate bright red lochial flow
B) Breasts firm and tender
C) Fundus below the symphysis and not palpable
D) Episiotomy slightly red and puffy

Question 6

If rubella vaccine is indicated for a postpartum patient,instructions to the patient should include

A) drinking plenty of fluids to prevent fever.
B) no specific instructions.
C) recommending that she stop breastfeeding for 24 hours after injection.
D) explaining the risks of becoming pregnant within 1 month after injection.

Question 7

Postpartal overdistention of the bladder and urinary retention can lead to which complication?

A) Postpartum hemorrhage and eclampsia
B) Fever and increased blood pressure
C) Postpartum hemorrhage and urinary tract infection
D) Urinary tract infection and uterine rupture

Question 8

Which finding 12 hours after birth requires further assessment?

A) The fundus is palpable two fingerbreadths above the umbilicus.
B) The fundus is palpable at the level of the umbilicus.
C) The fundus is palpable one fingerbreadth below the umbilicus.
D) The fundus is palpable two fingerbreadths below the umbilicus.

Question 9

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

A) Notify the provider of an impending hemorrhage.
B) Assess the blood pressure and pulse.
C) Evaluate the lochia.
D) Assist the patient in emptying her bladder.

Question 10

A woman gave birth vaginally to a 9-pound,12-ounce girl yesterday.Her primary health care provider has written orders for perineal ice packs,use of a sitz bath tid,and a stool softener.What information is most closely correlated with these orders?

A) The woman is a gravida 2, para 2.
B) The woman had a vacuum-assisted birth.
C) The woman received epidural anesthesia.
D) The woman has an episiotomy.

Question 11

To assess fundal contraction 6 hours after cesarean delivery,the nurse should

A) palpate forcefully through the abdominal dressing.
B) gently palpate, applying the same technique used for vaginal deliveries.
C) place hands on both sides of the abdomen and press downward.
D) rely on assessment of lochial flow rather than palpating the fundus.

Question 12

During which stage of role attainment do the parents become acquainted with their baby and combine parenting activities with cues from the infant?

A) Anticipatory
B) Formal
C) Informal
D) Personal

Question 13

If the patient's white blood cell (WBC)count is 25,000/mm³ on her second postpartum day,the nurse should

A) tell the physician immediately.
B) have the laboratory draw blood for reanalysis.
C) recognize that this is an acceptable range at this point.
D) begin antibiotic therapy immediately.

Question 14

Which maternal event is abnormal in the early postpartum period?

A) Diuresis and diaphoresis
B) Flatulence and constipation
C) Extreme hunger and thirst
D) Lochial color changes from rubra to alba

Question 15

When caring for a newly delivered woman,the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is

A) rectal suppositories.
B) early and frequent ambulation.
C) tightening and relaxing abdominal muscles.
D) providing carbonated beverages.

Question 16

A nurse observes a mother on her first postpartum day sitting in bed while her newborn lies awake in the bassinet.What action by the nurse is best?

A) Realize that this situation is perfectly acceptable.
B) Offer to hand the baby to the woman.
C) Hand the baby to the woman.
D) Explain "taking in" to the woman.

Question 17

A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means.The nurse's best response is

A) "You have pitting edema in your ankles."
B) "You have deep tendon reflexes rated 2+."
C) "You have calf pain when I flexed your foot."
D) "You have a 'fleshy' odor to your vaginal drainage."

Question 18

The mother-baby nurse is able to recognize reciprocal attachment behavior.What does this refer to?

A) The positive feedback an infant exhibits toward parents during the attachment process
B) Behavior during the sensitive period when the infant is in the quiet alert stage
C) Unidirectional behavior exhibited by the infant, initiated and enhanced by eye contact
D) Behavior by the infant during the sensitive period to elicit feelings of "falling in love" from the parents

Question 19

Which woman is most likely to have severe afterbirth pains and request a narcotic analgesic?

A) Gravida 5, para 5
B) Woman who is bottle-feeding her first child
C) Primipara who delivered a 7-lb boy
D) Woman who has started to breastfeed

Question 20

The postpartum woman who continually repeats the story of her labor,delivery,and recovery experiences is

A) providing others with her knowledge of events.
B) making the birth experience "real."
C) taking hold of the events leading to her labor and delivery.
D) accepting her response to labor and delivery.

Question 21

To promote bonding and attachment immediately after delivery,what action by the nurse is most important?

A) Allow the mother quiet time with her infant.
B) Assist the mother in assuming an en face position with her newborn.
C) Teach the mother about the concepts of bonding and attachment.
D) Assist the mother in feeding her baby.

Question 22

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge.As the nurse prepares her for discharge,she begins to cry.What action should the nurse take first?

A) Assess her for pain.
B) Point out how lucky she is to have a healthy baby.
C) Explain that she is experiencing postpartum blues.
D) Allow her time to express her feelings.

Question 23

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 and glands.
C) hyperplasia of mammary tissue.
D) congestion of veins and lymphatics.

Question 24

A postpartum woman is unable to empty her bladder.What intervention would the nurse try last?

A) Pouring water from a squeeze bottle over the woman's perineum
B) Providing hot tea
C) Asking the physician to prescribe analgesics
D) Inserting a sterile catheter

Question 25

A nurse has taught a woman how to do Kegel exercises.What statement by the patient shows good understanding?

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 26

A nurse is observing a family.The mother is holding the baby she delivered less than 24 hours ago.Her husband is watching his wife and asking questions about newborn care.The 4-year-old brother is punching his mother on the back.What action by the nurse is best?

A) Report the incident to the social services department.
B) Advise the parents that the toddler needs to be reprimanded.
C) Report to oncoming staff that the mother is not a good disciplinarian.
D) Realize that this is a normal family adjusting to family change.

Question 27

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago.Today her husband brings a large container of brown seaweed soup to the hospital.When the nurse enters the room,the husband asks for help with warming the soup so that his wife can eat it.The nurse's most appropriate response is to ask the woman

A) "Didn't you like your lunch?"
B) "Does your doctor know that you are planning to eat that?"
C) "What is that anyway?"
D) "I'll warm the soup in the microwave for you."

Question 28

A new father states,"I know nothing about babies," but he seems to be interested in learning.What action by the nurse is best?

A) Continue to observe his interaction with the newborn.
B) Tell him when he does something wrong.
C) Show no concern, as he will learn on his own.
D) Include him in teaching sessions.

Question 29

The nurse explains to the nursing student that one mechanism for the diaphoresis and diuresis experienced during the early postpartum period is which of the following?

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 30

In providing support to a new mother who must return to full-time employment 6 weeks after a vaginal delivery,which action by the nurse is best?

A) Allow her to express her positive and negative feelings freely.
B) Reassure her that she'll get used to leaving her baby.
C) Discuss child care arrangements with her.
D) Allow her to solve the problem on her own.

Question 31

A nurse has taught a woman and partner about measures to improve sexuality after childbirth.Which statement by the partner demonstrates a need for further teaching?

A) "We will use water-soluble lubricant before intercourse."
B) "We can try having sex in the morning when we are rested."
C) "Breastfeeding before sex will increase vaginal lubrication."
D) "My wife will be more comfortable if she is on top."

Question 32

Which condition seen in the postpartum period is likely to require careful medical assessment?

A) Varicosities of the legs
B) Carpal tunnel syndrome
C) Periodic numbness and tingling of the fingers
D) Headaches

Question 33

Nurses must be aware of the conditions that increase the risk of hemorrhage,one of the most common complications of the puerperium.What are these conditions? (Select all that apply.)

A) Primipara
B) Rapid or prolonged labor
C) Overdistention of the uterus
D) Uterine fibroids
E) Preeclampsia

Question 34

A nurse is examining a woman 2 months after delivery.The woman has lost 25 pounds.What action by the nurse is best?

A) Counsel her on other weight loss measures.
B) Ask her for a dietary recall for 3 days.
C) Instruct her on exercises for faster loss.
D) Explain that her weight loss is affecting her breast milk.

Question 35

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

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

Question 36

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby?

A) Letting go
B) Taking hold
C) Taking in
D) Taking on

Question 37

What is the best way for the nurse to promote and support the maternal-infant bonding process?

A) Help the mother identify her positive feelings toward the newborn.
B) Encourage the mother to provide all newborn care.
C) Assist the family with rooming-in.
D) Return the newborn to the nursery during sleep periods.

Question 38

A man calls the nurse's station stating that his wife,who delivered 2 days ago,is happy one minute and crying the next.The man says,"She was never like this before the baby was born." What response by the nurse is best?

A) Tell him to ignore the mood swings, as they will go away.
B) Reassure him that this behavior is normal.
C) Advise him to get immediate psychological help for her.
D) Instruct him in the signs, symptoms, and duration of postpartum blues.

Question 39

Many women given up smoking during pregnancy to protect the health of the fetus.The majority of women resumed smoking within the first 6 months postpartum.Factors that increase the likelihood of relapse include (Select all that apply.)

A) living with a smoker.
B) returning to work.
C) weight concerns.
D) successful breastfeeding.
E) failure to breastfeed.

Question 40

The nurse assesses a woman's episiotomy or perineal laceration using the acronym REEDA.What factors does this include? (Select all that apply.)

A) Redness
B) Edema
C) Approximation
D) Depth
E) Discharge

Question 41

A woman's chart indicates she has a second-degree laceration.When assessing this patient,the nurse plans to observe which of the following structures? (Select all that apply.)

A) Vaginal mucosa
B) Perineal skin
C) Peritoneal muscle
D) Anus
E) Rectum