Deck 18: Postpartum Physiologic Changes

Question 1

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

A) autolysis.
B) subinvolution.
C) afterpain.
D) diastasis.

Answer 1

autolysis.

Question 2

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

Answer 2

One centimeter above the umbilicus

Question 3

The nurse caring for the after birth 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.

Answer 3

congestion of veins and lymphatics.

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?

A) Lochia rubra
B) Lochia sangra
C) Lochia alba
D) Lochia serosa

Question 5

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 lbs, 3 ounces

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:

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 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:

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 8

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

A) "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter."
B) "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles."
C) "I will not have a menstrual cycle for 6 months after childbirth."
D) "My first menstrual cycle will be heavier than normal and then will be light for several months after."

Question 9

With regard to the after birth 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 after birth it should not be palpable abdominally.
C) after 2 weeks after birth it weighs 100 g.
D) it returns to its original (prepregnancy) size by 6 weeks after birth.

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:

A) urinary tract infection.
B) excessive uterine bleeding.
C) a ruptured bladder.
D) bladder wall atony.

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:

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 12

With regard to the after birth 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 13

Post birth uterine/vaginal discharge,called lochia:

A) is similar to a light menstrual period for the first 6 to 12 hours.
B) is usually greater after cesarean births.
C) will usually decrease with ambulation and breastfeeding.
D) should smell like normal menstrual flow unless an infection is present.

Question 14

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

A) caused by mild, continuous contractions for the duration of the after birth period.
B) more common in first-time mothers.
C) more noticeable in births in which the uterus was overdistended.
D) alleviated somewhat when the mother breastfeeds.

Question 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

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:

A) elevated temperature caused by after birth 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

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 18

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

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

Question 19

As relates 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 more than 2 kg during the puerperium.
D) with adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

Question 20

With regard to after birth 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.

Question 21

MATCHING
The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Please match the vital signs finding that the after birth nurse may encounter with the probable cause:

Dehydrating effects of labor

A)Elevated temperature within the first 24 hours
B)Rapid pulse
C)Elevated temperature at 36 hours after birth
D)Hypertension
E)Hypoventilation

Question 22

Changes in blood volume after childbirth depend on several factors such as blood loss during childbirth and the amount of extravascular water (physiologic edema)mobilized and excreted.A after birth nurse anticipates blood loss of: (Select all that apply.)

A) 100 mL.
B) 250 mL or less.
C) 300 to 500 mL.
D) 500 to 1000 mL.
E) 1500 mL or greater.

Question 23

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 24

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 patient 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 25

MATCHING
The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Please match the vital signs finding that the after birth nurse may encounter with the probable cause:

Puerperal sepsis

A)Elevated temperature within the first 24 hours
B)Rapid pulse
C)Elevated temperature at 36 hours after birth
D)Hypertension
E)Hypoventilation

Question 26

Which maternal event is abnormal in the early after birth period?

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

Question 27

MATCHING
The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Please match the vital signs finding that the after birth nurse may encounter with the probable cause:

Excessive use of oxytocin

A)Elevated temperature within the first 24 hours
B)Rapid pulse
C)Elevated temperature at 36 hours after birth
D)Hypertension
E)Hypoventilation

Question 28

MATCHING
The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Please match the vital signs finding that the after birth nurse may encounter with the probable cause:

Hypovolemia resulting from hemorrhage

A)Elevated temperature within the first 24 hours
B)Rapid pulse
C)Elevated temperature at 36 hours after birth
D)Hypertension
E)Hypoventilation

Question 29

Which documentation on a woman's chart on after birth 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 30

If the patient's white blood cell (WBC)count is 25,000/mm on her second after birth 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 after birth.
D) begin antibiotic therapy immediately.

Question 31

MATCHING
The physiologic changes that occur during the reversal of the processes of pregnancy are distinctive; however, they are normal. To provide care during this recovery period the nurse must synthesize knowledge regarding anticipated maternal changes and deviations from normal. Please match the vital signs finding that the after birth nurse may encounter with the probable cause:

Unusually high epidural or spinal block

A)Elevated temperature within the first 24 hours
B)Rapid pulse
C)Elevated temperature at 36 hours after birth
D)Hypertension
E)Hypoventilation