Question 1

Which of the following is true about lochia?
A) It is similar to a light menstrual period for the first 6 to 12 hours.
B) It is usually greater after Caesarean births.
C) It will usually decrease with ambulation and breastfeeding.
D) It should smell like normal menstrual flow, unless an infection is present.

Accepted Answer

An offensive odour usually indicates an infection.Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease.Less lochia usually is seen after Caesarean births and usually increases with ambulation and breastfeeding.

Question 2

What should the nurse be aware of with regard to postpartum ovarian function?
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.

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.

Question 3

A woman gave birth to a 3100 g infant girl 1 hour ago.The birth was vaginal,and the estimated blood loss (EBL)was approximately 1500 mL.Which of the following would the nurse be concerned about?
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

Accepted Answer

An EBL of 1500 mL with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss.An increased respiratory rate of 36 may be secondary to pain from the birth.Temperature may increase to 38°C during the first 24 hours as a result of the dehydrating effects of labour.A BP of 140/90 is slightly elevated,which may be caused by the use of oxytocic medications.

Question 4

Which woman is most likely to experience strong afterpains?
A) A woman who experienced oligohydramnios
B) A woman who gave birth to twins
C) A woman who is bottle-feeding her infant
D) A woman whose infant weighed 5 pounds, 3 ounces

Accepted Answer

Afterpains are more noticeable after births in which the uterus was overdistended (e.g.,large baby,multifetal gestation,polyhydramnios).Breastfeeding may cause afterpains to intensify,not bottle feeding.An average-weight baby does not intensify afterpains.

Question 5

Approximately how long is engorgement expected to last?
A) 12 hours
B) 48 hours
C) 72 hours
D) 1 week

Accepted Answer

Engorgement typically lasts 24 to 48 hours.

Question 6

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.What is responsible for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period?
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

Accepted Answer

Within 12 hours of birth women begin to lose the excess tissue fluid that accumulated during pregnancy.One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs,especially at night,for the first 2 or 3 days after childbirth.Postpartal diuresis is another mechanism by which the body rids itself of excess fluid.An elevated temperature would cause chills and may cause dehydration,not diaphoresis and diuresis.Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy,not as the basal metabolic rate.Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.

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

Accepted Answer

Headaches in the postpartum period can have a number of causes,some of which deserve medical attention.Total or nearly total regression of varicosities is expected after childbirth.Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is lessened.Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition.

Question 8

The nurse caring for the postpartum woman understands that breast engorgement is caused by which of the following?
A) Overproduction of colostrum
B) Accumulation of milk in the lactiferous ducts
C) Hyperplasia of mammary tissue
D) Congestion of veins and lymphatics

Accepted Answer

Breast engorgement is caused by the temporary congestion of veins and lymphatics,not by overproduction of colostrum,overproduction of milk,or hyperplasia of mammary tissue.

Question 9

The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is referred to as which of the following?
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

Accepted Answer

The puerperium,also called the fourth trimester or the postpartum period of pregnancy,was traditionally thought to be 6 weeks,but it varies from woman to woman.Involution marks the end of the puerperium,or the fourth trimester of pregnancy.Lochia refers to the various vaginal discharges during the puerperium.

Question 10

Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
A) Estrogen
B) Progesterone
C) Prolactin
D) Human placental lactogen

Accepted Answer

Prolactin levels in the blood increase progressively throughout pregnancy.In women who breastfeed,prolactin levels remain elevated into the sixth week after birth.Estrogen and progesterone levels decrease markedly after expulsion of the placenta,reaching their lowest levels 1 week into the postpartum period.Human placental lactogen levels decrease dramatically after expulsion of the placenta.

Question 11

Which of the following is accurate with regard to afterbirth pains?
A) They are caused by mild, continuous contractions for the duration of the postpartum period.
B) They are more common in first-time mothers.
C) They are more noticeable in births in which the uterus was overdistended.
D) They are alleviated somewhat when the mother breastfeeds.

Accepted Answer

A large baby or multiple babies overdistend the uterus.The cramping that causes afterbirth pains arises from periodic,vigorous contractions and relaxations,which persist through the first part of the postpartum period.Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone.Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Question 12

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) The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth.
C) Most episiotomies heal within a week.
D) Hemorrhoids usually decrease in size within 2 weeks of childbirth.

Accepted Answer

The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth; however,lubrication may take longer.The cervix regains its form within days; the cervical os may take longer.Most episiotomies take 2 to 3 weeks to heal.Hemorrhoids can take 6 weeks to decrease in size.

Question 13

What is the term that refers to the self-destruction of excess hypertrophied tissue in the uterus?
A) Autolysis
B) Subinvolution
C) Afterpain
D) Diastasis

Accepted Answer

Autolysis is caused by a decrease in hormone levels.Subinvolution is failure of the uterus to return to a nonpregnant state.Afterpain is caused by uterine cramps 2 to 3 days after birth.Diastasis refers to the separation of muscles.

Question 14

A woman gave birth to an infant boy 12 hours ago.Where would the nurse expect to locate this woman's fundus?
A) One centimetre above the umbilicus
B) Two centimetres below the umbilicus
C) Midway between the umbilicus and the symphysis pubis
D) Nonpalpable abdominally

Accepted Answer

Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus.The fundus descends about 1 to 2 cm every 24 hours.Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus.By the sixth postpartum week the fundus normally is halfway between the symphysis pubis and the umbilicus.The fundus should be easily palpated using the maternal umbilicus as a reference point.

Question 15

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

Accepted Answer

Lochia serosa,which consists of blood,serum,leukocytes,and tissue debris,generally occurs around day 3 or 4 after childbirth.Lochia rubra consists of blood and decidual and trophoblastic debris.The flow generally lasts 3 to 4 days and pales,becoming pink or brown.There is no such term as lochia sangra.Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.

Question 16

With regard to the postpartum changes and developments in a woman's cardiovascular system,nurses should be aware of which of the following?
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 Caesarean birth.

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 Caesarean birth.

Question 17

What 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."

Accepted Answer

She can expect her first menstrual cycle to be heavier than normal (which occurs by 3 months after childbirth),and the volume of her subsequent cycles will return to prepregnant levels within three or four cycles.

Question 18

A woman gave birth to a 2850 g 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 postpartum period,what is the most serious consequence likely to occur from bladder distension?
A) Urinary tract infection
B) Excessive uterine bleeding
C) A ruptured bladder
D) Bladder wall atony

Accepted Answer

Excessive bleeding can occur immediately after birth if the bladder becomes distended,because it pushes the uterus up and to the side and prevents it from contracting firmly.A urinary tract infection may result from overdistension of the bladder,but it is not the most serious consequence.A ruptured bladder may result from a severely overdistended bladder.However,vaginal bleeding most likely would occur before the bladder reaches this level of overdistension.Bladder distension may result from bladder wall atony.The most serious concern associated with bladder distension is excessive uterine bleeding.

Question 19

What should the nurse be aware of with regard to the postpartum uterus?
A) At the end of the third stage of labour it weighs approximately 500
B) After 2 weeks postpartum it should not be palpable abdominally.
C) After 2 weeks postpartum it weighs 100 g.
D) It returns to its original (prepregnancy) size by 6 weeks, postpartum.

Accepted Answer

After 2 weeks postpartum,the uterus should not be palpable abdominally; however,it does not return to its original size.At the end of the third stage of labour,the uterus weighs approximately 1000 g.After 2 weeks postpartum the uterus weighs about 350 g.The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.

Question 20

With regard to the condition and reconditioning of the urinary system after childbirth,nurses should be aware of which of the following?
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 over 2 kg during the puerperium.
D) With adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

Accepted Answer

Fluid loss through perspiration and increased urinary output accounts for a weight loss of 2.25 kg during the puerperium.Excess fluid loss through other meAnswer occurs as well.Kidney function usually returns to normal in about a month.Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex.Bladder tone usually is restored 5 to 7 days after childbirth.

Quiz 20: Maternal Physiological Changes

Which of the following is true about lochia?

What should the nurse be aware of with regard to postpartum ovarian function?

A woman gave birth to a 3100 g infant girl 1 hour ago.The birth was vaginal,and the estimated blood loss (EBL) was approximately 1500 mL.Which of the following would the nurse be concerned about?

Which woman is most likely to experience strong afterpains?

Approximately how long is engorgement expected to last?

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.What is responsible for the diaphoresis and diuresis that this woman is experiencing during the early postpartum period?

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

The nurse caring for the postpartum woman understands that breast engorgement is caused by which of the following?

The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is referred to as which of the following?

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

Which of the following is accurate with regard to afterbirth pains?

Which description of postpartum restoration or healing times is accurate?

What is the term that refers to the self-destruction of excess hypertrophied tissue in the uterus?

A woman gave birth to an infant boy 12 hours ago.Where would the nurse expect to locate this woman's fundus?

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?

With regard to the postpartum changes and developments in a woman's cardiovascular system,nurses should be aware of which of the following?

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

What should the nurse be aware of with regard to the postpartum uterus?

With regard to the condition and reconditioning of the urinary system after childbirth,nurses should be aware of which of the following?