Question 1

The process in which the uterus returns to a non-pregnant state after birth is known as ____________________.

Accepted Answer

Involution
The process of involution begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle.

Question 2

Which woman is most likely to experience strong afterpains?

Accepted Answer

A woman who is a gravida 4, para 4-0-0-4 (meaning she has had four pregnancies, given birth four times, and has had no miscarriages or stillbirths) is more likely to experience strong afterpains due to the increased sensitivity of the uterus. Afterpains are contractions that occur after the birth of the baby as the uterus returns to its pre-pregnancy size. The more times a woman has given birth, the more sensitive her uterus is likely to be to these contractions.

Question 3

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

Accepted Answer

However,the uterus does not return to its original size.At the end of the third stage of labor,the uterus weighs approximately 1000 g.It does not return to its original size.After 2 weeks postpartum the uterus weighs about 350 g.It does not return to its original size.The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

Question 4

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

Accepted Answer

Congestion of veins and lymphatics causes breast engorgement by preventing the flow of milk out of the breast.

Question 5

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.However,the nails return to their prepregnancy consistency and strength.Striae gravidarum (stretch marks)usually do not completely disappear.However,the nails return to their prepregnancy consistency and strength.For some women,spider nevi persist indefinitely.However,the nails return to their prepregnancy consistency and strength.

Question 6

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

Accepted Answer

The fundus is typically at the level of the umbilicus or slightly above it within the first 12 hours postpartum.

Question 7

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

Accepted Answer

Prolactin is the hormone responsible for milk production and remains elevated in the immediate postpartum period in breastfeeding women. Estrogen and progesterone levels drop sharply after delivery, while human placental lactogen levels return to normal within a few days after birth.

Question 8

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 is the type of lochia typically present 3-10 days postpartum. It is reddish-brown or pink in color, contains some old blood, and may have a slight odor. Lochia rubra is present immediately after birth and lasts 3-5 days, while Lochia sangra is present from day 10 until around week 3 postpartum. Lochia alba is the final stage and is present from weeks 3-6 postpartum.

Question 9

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 woman understands the correct process for completing these conditioning exercises when she reports:

Accepted Answer

The correct process for completing Kegel exercises is to contract the pelvic floor muscles, which are the muscles used to stop the flow of urine midstream. Option A focuses on the wrong muscles, while option B only mentions the frequency of the exercises and option C is not necessarily appropriate or helpful.

Question 10

Clotting factors and fibrinogen levels normally are decreased during pregnancy and remain low in the immediate puerperium. This hypocoagulable state increases the risk of thromboembolism, especially after cesarean birth.

Accepted Answer

This statement is false. Clotting factors and fibrinogen normally are increased during pregnancy and remain elevated in the immediate puerperium. This hypercoagulable state increases the risk of thromboembolism, especially after cesarean birth.

Question 11

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

Accepted Answer

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

Question 12

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 interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the puerperium or fourth trimester of pregnancy. This period typically lasts for about six weeks but can extend up to 12 weeks in some cases. During this time, the body goes through various physiological changes to recover from pregnancy and childbirth, including involution of the uterus and the shedding of the uterine lining (lochia).

Question 13

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 of the following statements except:

Accepted Answer

Breast tenderness is likely to persist for more than just a week after the start of lactation, as it can continue for several weeks or even months.

Question 14

With regard to the postpartum 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,which can obscure the diagnosis of acute infections (false-negative results).The hypercoagulable state increases the risk of thromboembolism,especially after a cesarean birth.

Question 15

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

Accepted Answer

Fluid loss through perspiration and increased urinary output is common after childbirth and can lead to a weight loss of over 2 kg during the puerperium.

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 postpartum period is:

Accepted Answer

During pregnancy, the body produces additional blood volume to support the growth and development of the fetus. After giving birth, the body rapidly eliminates this excess fluid, which can result in diaphoresis (excessive sweating) and diuresis (frequent urination). This process is known as diuresis of pregnancy and is a normal physiological process in the early postpartum period.

Question 17

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 approximately 1500 ml. When assessing the woman's vital signs, the nurse would be concerned to see:

Accepted Answer

The vital signs in option A indicate that the woman may be experiencing hypovolemic shock due to the significant blood loss during delivery. The low BP, tachycardia, and low respiratory rate along with the elevated temperature suggest that the body may be compensating to maintain perfusion. Immediate interventions such as fluid resuscitation and close monitoring are necessary to prevent further deterioration. The vital signs in the other options are within the normal range or only slightly elevated and do not indicate an urgent concern.

Question 18

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

Accepted Answer

Headaches in the postpartum period can be a sign of a serious condition such as preeclampsia or postpartum eclampsia. Close medical monitoring and assessment is necessary to ensure proper treatment if needed. While the other conditions mentioned may cause discomfort, they are not as likely to require urgent medical attention during the puerperium.

Question 19

With regard to postpartum 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 in about 3 months.Breastfeeding women take longer to resume ovulation.Because many women ovulate before their first postpartum menstrual period,contraceptive options need to be discussed early in the puerperium.

Quiz 13: Maternal Physiologic Changes