Deck 20: Postpartum Physiologic Changes

Question 1

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

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

Answer 1

Prolactin

Question 2

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

Answer 2

Autolysis

Question 3

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

Answer 3

Nail brittleness

Question 4

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 5

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 6

Which client is most likely to experience strong and uncomfortable 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 pounds,3 ounces

Question 7

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 changes 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 8

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 9

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

A) 1 centimeter above the umbilicus
B) 2 centimeters below the umbilicus
C) Midway between the umbilicus and the symphysis pubis
D) Nonpalpable abdominally

Question 10

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 11

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 48 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 12

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

Question 13

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 health care provider.
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 14

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 15

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

Question 16

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 17

Which explanation concerning postpartum ovary function 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 18

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 19

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

Question 20

What are the most common causes for subinvolution of the uterus?

A) Postpartum hemorrhage and infection
B) Multiple gestation and postpartum hemorrhage
C) Uterine tetany and overproduction of oxytocin
D) Retained placental fragments and infection

Question 21

The breast-feeding mother should be taught to expect which changes to the condition of the breasts? (Select all that apply. )

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