Deck 29: Postpartum Visit

Question 1

What is the shrinking process undergone by the uterus after childbirth?

A) Prolapse
B) Inclusion
C) Involution
D) Shedding
E) Inversion

Answer 1

C

Question 2

How long is the postpartum period after childbirth?

A) 24-72 hours
B) 1-2 weeks
C) 3-4 weeks
D) 4-5 weeks
E) 6-8 weeks

Answer 2

E

Question 3

Which of the following feelings and experiences are common in the postpartum role transition?

A) Changes in self-perception
B) Disequilibrium
C) Vulnerability
D) Uncertainty
E) All of the above

Answer 3

E

Question 4

When are postpartum surgical wound infections most likely to present?

A) Before hospital discharge
B) 1-3 days
C) 3-8 days
D) 1-3 weeks
E) 4-6 weeks

Question 5

During a prenatal visit a woman at risk for postpartum depression asks what dietary and lifestyle changes she can implement to prevent perinatal complications. Which of the following is an evidence-based recommendation with efficacy in reducing the incidence and/or severity of postpartum mood and anxiety disorders?

A) Bed rest
B) Calcium supplementation
C) Daily multivitamin
D) Increased consumption of essential fatty acids
E) Low carbohydrate diet

Question 6

What might you consider in the postpartum care for a woman at risk for postpartum depression

A) A contraceptive implant in the immediate postpartum period
B) Postpartum visit 1-2 weeks after childbirth
C) Psychiatrist visit at 6 weeks postpartum
D) All of the above
E) None of the above

Question 7

If Kegel exercises do not improve urinary or fecal incontinence within 1-2 months postpartum, which of the following treatment options may be required?

A) Pelvic floor muscle training
B) Pessary fitting
C) Surgical intervention
D) All of the above

Question 8

A breastfeeding woman wants to lose the weight she gained during pregnancy. Which of the following would not be included in your nutritional counseling for this woman?

A) Milk production usually requires approximately 500 calories per day.
B) Minimal daily caloric intake required for the average breastfeeding woman is 1,800.
C) Weight loss of 2 pounds per month does not typically affect lactation.
D) Women who are breastfeeding should not exercise to lose weight.

Question 9

Delusions and hallucinations are an aspect of which perinatal mood and anxiety disorder?

A) Bipolar disorder
B) Depression
C) Obsessive compulsive disorder
D) Panic disorder
E) Psychosis

Question 10

You are conducting a postpartum visit with a 19-year-old woman who gave birth by cesarean 4 weeks ago, following induction of labor at term for gestational hypertension. During your visit today she reports scant lochia, exclusive breastfeeding, and some pain on the outer aspect of her left breast. She wants to review her experience of labor and birth with you, and asks whether it is true that, "once a cesarean, always a cesarean."
Chart review reveals BMI of 39, gestational diabetes with diet control, laboratory tests normal, no history of Pap screening.
During your visit you note that her blood pressure is 148/92, with a pulse of 88 and 14 respirations per minute. Your physical exam reveals the following:
$\bullet$ Breasts: Soft and nontender, no palpable masses, and intact everted nipples
$\bullet$ Abdominal exam: No guarding, fundus firm and central halfway between the umbilicus and symphysis pubis. Nontender except at palpation of surgical incision where no erythema or exudates was observed.
$\bullet$ Pelvic exam: No cervical motion tenderness on bimanual exam, which confirmed uterine size estimated by abdominal exam. Moderate pelvic muscle tone, lochia alba noted.
Which of the following health screening, promotion, and education activities are not recommended in this case?

A) A baseline Pap smear
B) Advice that a vaginal birth after cesarean is recommended in most circumstances
C) Encouragement to achieve and maintain a normal body mass index
D) Screening for posttraumatic stress disorde
E) Two-hour, 75-gram oral glucose tolerance test

Question 11

You are conducting a postpartum visit with a 19-year-old woman who gave birth by cesarean 4 weeks ago, following induction of labor at term for gestational hypertension. During your visit today she reports scant lochia, exclusive breastfeeding, and some pain on the outer aspect of her left breast. She wants to review her experience of labor and birth with you, and asks whether it is true that, "once a cesarean, always a cesarean."
Chart review reveals BMI of 39, gestational diabetes with diet control, laboratory tests normal, no history of Pap screening.
During your visit you note that her blood pressure is 148/92, with a pulse of 88 and 14 respirations per minute. Your physical exam reveals the following:
$\bullet$ Breasts: Soft and nontender, no palpable masses, and intact everted nipples
$\bullet$ Abdominal exam: No guarding, fundus firm and central halfway between the umbilicus and symphysis pubis. Nontender except at palpation of surgical incision where no erythema or exudates was observed.
$\bullet$ Pelvic exam: No cervical motion tenderness on bimanual exam, which confirmed uterine size estimated by abdominal exam. Moderate pelvic muscle tone, lochia alba noted.
Which of the following conditions may be present in this case and warrant consultation, collaboration, or referral if outside your scope of practice?

A) Endometritis
B) Hypertension
C) Infection of surgical site
D) Mastitis
E) Prolonged vaginal bleeding

Question 12

You are conducting a postpartum visit with a 19-year-old woman who gave birth by cesarean 4 weeks ago, following induction of labor at term for gestational hypertension. During your visit today she reports scant lochia, exclusive breastfeeding, and some pain on the outer aspect of her left breast. She wants to review her experience of labor and birth with you, and asks whether it is true that, "once a cesarean, always a cesarean."
Chart review reveals BMI of 39, gestational diabetes with diet control, laboratory tests normal, no history of Pap screening.
During your visit you note that her blood pressure is 148/92, with a pulse of 88 and 14 respirations per minute. Your physical exam reveals the following:
$\bullet$ Breasts: Soft and nontender, no palpable masses, and intact everted nipples
$\bullet$ Abdominal exam: No guarding, fundus firm and central halfway between the umbilicus and symphysis pubis. Nontender except at palpation of surgical incision where no erythema or exudates was observed.
$\bullet$ Pelvic exam: No cervical motion tenderness on bimanual exam, which confirmed uterine size estimated by abdominal exam. Moderate pelvic muscle tone, lochia alba noted.In this case the uterus is enlarged and medical treatment is indicated.