Deck 20: Postpartum Physiologic Changes

Question 1

Which 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 nonpalpable
D) Episiotomy slightly red and puffy

Answer 1

Fundus below the symphysis and nonpalpable

Question 2

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.Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is experiencing?

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

Answer 2

Loss of increased blood volume associated with pregnancy

Question 3

A woman gave birth to a healthy infant boy 5 days ago.What type of lochia does the nurse expect to find when evaluating this client?

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

Answer 3

Lochia serosa

Question 4

The nurse should be cognizant of which postpartum physiologic alteration?

A) Cardiac output, 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 childbirth.
C) Lowered white blood cell count after pregnancy can lead to false-positive results on tests for infections.
D) Hypercoagulable state protects the new mother from thromboembolism, especially after a cesarean birth.

Question 5

A woman gave birth to a 7-pound,6-ounce infant girl 1 hour ago.The birth was vaginal and the estimated blood loss (EBL)was 1500 ml.When evaluating the woman's vital signs,which finding would be of greatest concern to the nurse?

A) Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg
B) Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg
C) Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg
D) Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg

Question 6

The nurse is providing instruction to the newly delivered client regarding postbirth uterine and vaginal discharge,called lochia.Which statement is the most appropriate?

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

Question 7

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 8

Which description of postpartum restoration or healing times is accurate?

A) The cervix shortens, becomes firm, and returns to form within a month postpartum.
B) Vaginal rugae reappear by 3 weeks postpartum.
C) Most episiotomies heal within a week.
D) Hemorrhoids usually decrease in size within 2 weeks of childbirth.

Question 9

Which term best describes the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state?

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 10

A client asks the nurse when her ovaries will begin working again.Which explanation by the nurse is most accurate?

A) Almost 75% of women who do not breastfeed resume menstruating within 1 month after birth.
B) Ovulation occurs slightly earlier for breastfeeding women.
C) Because of menstruation and ovulation schedules, contraception considerations can be postponed until after the puerperium.
D) The first menstrual flow after childbirth usually is heavier than normal.

Question 11

Several delivery 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 12

Which statement,related to the reconditioning of the urinary system after childbirth,should the nurse understand?

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 is usually restored 2 to 3 weeks after childbirth.

Question 13

Which statement regarding the postpartum uterus is correct?

A) At the end of the third stage of labor, the postpartum uterus weighs approximately 500
B) After 2 weeks postpartum, it should be abdominally nonpalpable.
C) After 2 weeks postpartum, it weighs 100 g.
D) Postpartum uterus returns to its original (prepregnancy) size by 6 weeks postpartum.

Question 14

Which statement by a newly delivered woman indicates that she knows what to expect regarding 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 15

A client is concerned that her breasts are engorged and uncomfortable.What is the nurse's explanation for this physiologic change?

A) Overproduction of colostrum
B) Accumulation of milk in the lactiferous ducts and glands
C) Hyperplasia of mammary tissue
D) Congestion of veins and lymphatic vessels

Question 16

Pelvic floor exercises,also known as Kegel exercises,will help to strengthen the perineal muscles and encourage healing after childbirth.The nurse requests the client to repeat back instructions for this exercise.Which response by the client indicates successful learning?

A) "I contract my thighs, buttocks, and abdomen."
B) "I perform 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 in midstream."

Question 17

What should the nurse's next action be if the client's white blood cell (WBC)count is 25,000/mm³ on her second postpartum day?

A) Immediately inform the physician.
B) Have the laboratory draw blood for reanalysis.
C) Recognize that this count is an acceptable range at this point postpartum.
D) Immediately begin antibiotic therapy.

Question 18

After delivery,excess hypertrophied tissue in the uterus undergoes a period of self-destruction.What is the correct term for this process?

A) Autolysis
B) Subinvolution
C) Afterpains
D) Diastasis

Question 19

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

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

Question 20

The breast-feeding mother should be taught to expect which changes to the condition of the breasts?

A) Breast tenderness is likely to persist for approximately 1 week after the start of lactation.
B) As lactation is established, a mass may form that can be distinguished from cancer by its positional 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, then lactation ceases within a few days to a week.
E) Little change occurs to the breasts in the first 48 hours.

Question 21

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. Match the vital signs finding that the postpartum nurse may encounter with its probable cause.

Puerperal sepsis

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

Question 22

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. Match the vital signs finding that the postpartum nurse may encounter with its probable cause.

Hypovolemia resulting from hemorrhage

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

Question 23

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. Match the vital signs finding that the postpartum nurse may encounter with its 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 postpartum
D)Hypertension
E)Hypoventilation

Question 24

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. Match the vital signs finding that the postpartum nurse may encounter with its probable cause.

Excessive use of oxytocin

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

Question 25

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.What amount of blood loss does the postpartum nurse anticipate?

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

Question 26

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. Match the vital signs finding that the postpartum nurse may encounter with its probable cause.

Dehydrating effects of labor

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