Deck 6: The Postpartum-Period

Question 1

A midwife is teaching a 14-year-old girl about contraceptives. The client gave birth to a healthy baby girl three days ago. The midwife is correct when she says that the most effective way to protect against conception is through:

A)Natural family planning.
B)Abstinence.
C)Oral contraception.
D)Surgical methods.

Answer 1

Abstinence.

Question 2

A female client visits the clinic to learn more about her contraceptive options. The client has a new partner and is a practicing Catholic. Which of the following contraceptive method is least likely to be appropriate for the client?

A)Basal body temperature method
B)Symptothermal method
C)Periodic abstinence
D)Spermicides

Answer 2

Spermicides

Question 3

An 18-year-old client is pregnant for the first time. A few weeks before her due date, the client informs the midwife that she has decided to breastfeed her baby after birth. As a part of the teaching plan, the midwife informs the client that she need to needs to add some calories to her current RDA to ensure sufficient milk production. If the pre-pregnancy RDA of the client is 2,200 calories per day and her pregnancy RDA is 2,500 calories per day, the client's RDA during the lactation period is:

A)2,800 calories per day.
B)3,000 calories per day.
C)2,200 calories per day.
D)2,700 calories per day.

Answer 3

3,000 calories per day.

Question 4

A midwife is monitoring a client who gave birth to a healthy baby girl 8 hours ago. No complications were noted during labor. The client has a temperature of 100.4 °F. Which of the following is the next action of the midwife?

A)Instruct the client to increase her oral fluid intake.
B)Assess the uterine tone.
C)Administer an antipyretic.
D)Assess the number of sanitary pads used for the past 8 hours.

Question 5

A midwife is managing the care of a client who gave birth to her first baby 12 hours ago. Analgesia was administered during labor. The midwife teaches the client to assume which of the following positions to encourage uterine involution?

A)Side-lying position
B)Trendelenburg position
C)Prone position
D)Knee-to-chest position

Question 6

A client who gave birth to a healthy baby girl 8 hours ago tells a midwife that she gets dizzy and lightheaded every time she attempts to ambulate. No complications were noted during labor. Which of the following is the most effective intervention for the client?

A)Assist the client to left side-lying position.
B)Instruct the client to sit on the edge of the bed and dangle her legs before getting up to ambulate.
C)Order for hemoglobin and hematocrit tests.
D)Instruct the client to use an assistive walking device when ambulating.

Question 7

A midwife is assessing four clients who recently gave birth through vaginal delivery. A part of the examination is measuring the fundal height. Which of the following clients needs further evaluation?

A)A client who gave birth 24 hours ago; the fundus is 1 fingerbreadth below the umbilicus.
B)A client who gave birth one hour ago; the fundus is at the level of the umbilicus.
C)A client who gave birth 72 hours ago; the fundus is 2 cm below the umbilicus.
D)A client who gave birth 10 days ago; the fundus is non-palpable.

Question 8

A midwife is assessing a postpartum client for signs of deep venous thrombosis. To elicit Homan's sign, the midwife:

A)Instructs the client to extend her legs flat on the bed, grasps the foot being tested and moves it downward.
B)Instructs the client to extend her legs flat on the bed, grasps the foot being tested and dorsiflexes it forward.
C)Instructs the client to lie flat on the bed with both legs extended and raises one leg at a time.
D)Instructs the client to lie flat on the bed and places both legs on two pillows for 15 minutes.

Question 9

A client gave birth to a baby girl 24 hours ago at 39 weeks' gestation. The child was delivered through cesarean section, and no complications were noted during labor. The client has three older kids, including a set of twins. The twins were born at 38 weeks' gestation, and the youngest child was born at 35 weeks' gestation. The client was pregnant 11 years ago but had a miscarriage on the 18th week of her pregnancy. About 5 years ago, she got pregnant, but the pregnancy was terminated at 25 weeks' gestation. Based on the client's history, she is accurately classified as:

A)G4 P4314
B)G5 P5214
C)G5 P5314
D)G4 P5313

Question 10

A midwife is managing the care of a postpartum client who has a history of thrombophlebitis. On assessment, the midwife suspects pulmonary embolus. Which of the following symptoms would not support this diagnosis?

A)Sharp chest pain
B)Confusion
C)Cyanosis
D)Bradycardia

Question 11

A postpartum client has type 1 diabetes. The client gave birth 24 hours ago. During the immediate postpartum perid, which of the following statements is the most accurate about her insulin needs?

A)The insulin needs of the client decrease.
B)The insulin needs of the client increase.
C)The insulin needs of the client are the same as her insulin needs during her pregnancy.
D)The insulin needs of the client are the same as her insulin needs before her pregnancy.

Question 12

A part of the placenta is left inside the client's uterus during the third stage of labor. Which of the following is the most common complication of this condition?

A)Postpartum depression
B)Subinvolution
C)Hemorrhage
D)Infection

Question 13

A client who gave birth to a healthy newborn experiences crying and expresses feelings of sadness and emptiness. The client delivered her baby 3 days ago. The midwife suspects that the client has:

A)Postpartum depression.
B)Postpartum blues.
C)Postpartum psychosis.
D)A normal behavior during the taking-hold phase.

Question 14

A midwife is managing the care of a postpartum client who gave birth to a baby girl two months ago. On assessment, the client informs the midwife that she is hearing voices and that she constantly feels empty. She has a history of clinical depression. Which of the following is the priority action of the midwife?

A)Offer compassion.
B)Protect the client and child from injury.
C)Consider counseling for the client.
D)Administer antidepressants.

Question 15

A client who is due to give birth any time asks the midwife what changes in the reproductive system she should expect after the delivery. Which of the following statements by the midwife is the most appropriate?

A)"After birth, your uterus will weigh about 1,000 grams. By the 6th week after birth, it will weigh around 500 grams."
B)"Your uterus will never completely return to its pre-pregnancy state."
C)"The rate of uterine involution greatly varies from person to person."
D)"By the third week after birth, your uterus can no longer be detected by abdominal palpation."

Question 16

Which of the following clients has the greatest risk for delayed uterine involution?

A)A client who gave birth to a 7-pound baby girl.
B)A multiparous client who completed the second stage of labor in 1 ½ hours.
C)A client who voids every 2 hours.
D)A client who gave birth to twins.

Question 17

A midwife is assessing the clients in the unit who gave birth 24 hours ago through vaginal delivery. Which of the following clients are at risk for puerperal infection?
I.A client who ruptured her membranes 12 hours before birth.
II.A client who had internal fetal monitoring during labor.
III.A client with low levels of hemoglobin and hematocrit.
IV.A client who is negative for vaginal infections.

A)I, II and III
B)I and III only
C)I and IV only
D)II, III and IV

Question 18

A midwife is assessing a postpartum client who gave birth through vaginal delivery 18 hours ago. On assessment, the midwife suspects that the client has cervical laceration. Which of the following findings is expected in this condition?

A)Uterine hyperactivity
B)Soft uterus
C)A gush of dark, red blood from the vagina
D)Continuous seepage of bright red blood from the vagina

Question 19

A client develops fever of 102.2 ºF on the third day postpartum. Assessment findings include abdominal tenderness and dark brown lochia. Endometritis is suspected. Which of the following interventions is the most appropriate for the client?

A)Obtain a culture from the perineal pad.
B)Administer an oxytocic agent.
C)Position the client in the side-lying position.
D)Instruct the client to remain in bed until the pain is resolved.

Question 20

A client had a cesarean delivery. The client informs the midwife that she intends to breastfeed her baby. Which of the following instructions is the most effective for a client who wants to breastfeed after a cesarean delivery?

A)"Use the football hold when breastfeeding."
B)"Choose the position that is most comfortable during breastfeeding."
C)"Breast feeding is withheld for the first 12 hours of life."
D)"Breastfeed the newborn every 4 to 8 hours."

Question 21

A midwife is teaching a group of pregnant women about the characteristics of the different types of lochia. Which of the following statements made by one of the women indicates that further teaching is necessary?

A)"Lochia rubra mainly consists of blood."
B)"The lochia consists of blood, mucus and some bacteria."
C)"Lochia serosa occurs 4 to 10 days after birth."
D)"Lochia alba is mainly composed of blood and leukocytes."

Question 22

A client delivered a healthy infant through cesarean section. The midwife encourages the client to eat which food item to promote wound healing?

A)Banana
B)Wheat bread
C)Orange
D)Milk

Question 23

A female client asks a midwife why a newborn is not immunized with MMR immediately after birth. The client was immunized with MMR about 5 months ago and is planning to get pregnant. Which of the following possible responses is the most appropriate?

A)"IgM maternal antibodies cross the placenta into the fetus during the third trimester, giving the newborn temporary passive immunity during the first months of life."
B)"If the mother has been immunized within five months before the pregnancy, the newborn is temporarily protected from German measles during the first months of life. This is an example of active immunity."
C)"IgG maternal antibodies cross the placenta into the fetus during the third trimester, so temporary active immunity is attained during the newborn's first months of life."
D)"IgG maternal antibodies cross the placenta during the third trimester, giving the newborn temporary passive immunity during the first months of life."

Question 24

A mother who gave birth a week ago comes to the facility complaining of a cracked and fissured nipple on her right breast. The mother is diagnosed with mastitis. Which of the following teachings is the most effective when managing a client with mastitis?

A)Instruct the client to discontinue breastfeeding until antibiotic therapy is completed.
B)Instruct the client to start breastfeeding on the left breast.
C)Offer formula milk if the breasts are too painful when breastfeeding.
D)Instruct the client to avoid wearing bras until the pain is tolerable.

Question 25

The placenta is an organ located in the gravid uterus, and it connects the fetus to the uterine wall (and enables nutrient uptake by the fetus). When there is an accessory lobe of placenta connected by an artery or vein to the main placenta, what is this called?

A)Retained placenta
B)Placenta accreta
C)Placenta succenturiata
D)Circumvallate placenta

Question 26

A woman who delivered two hours previously at home is diagnosed with a retained placenta. She presents via ambulance with severe vaginal bleeding. Of the following which is the possible management of her complication?

A)Catheterization of bladder
B)Manual removal of placenta
C)Blood transfusion
D)All of the above

Question 27

A 26 years old female in the third trimester has developed a condition in which the placenta and its blood vessels are attached too deeply to the uterine wall. Of the following, which is the term for this condition?

A)Retained placenta
B)Placenta improper
C)Placenta accreta
D)Circumvallate placenta

Question 28

The amnion and chorion are fetal membranes that surround and protect the developing fetus. Which of the following statements is false in regard to the fetal membranes?

A)Chorion is the outer layer
B)Chorion is much thicker than amnion
C)Amnion is the outer layer
D)Amnion has no blood supply

Question 29

Amniotic fluids have both fetal and maternal origin. Which of the following statements is true in regard to amniotic fluid?

A)Amniotic fluid is acidic
B)Amniotic fluid is highly hypertonic
C)Amniotic fluid is mainly composed of water and solid materials
D)None of the above

Question 30

Amniotic fluid is alkaline. It is mainly composed of water and sustances such as proteins. Of the following, which is a function of amniotic fluid?

A)Acts as shock absorber
B)Maintains temperature (warmth)
C)Forms a hydrostatic wedge (which helps in dilation of the cervix)
D)All of the above

Question 31

Abnormal colors of the amniotic fluid have their own significance. Which of the following statement is true about the color of amniotic fluid?

A)Yellow to amber color found in postmaturity
B)Greenish color found in Rh incompatibility
C)Greenish color found in concealed accidental hemorrhage
D)Yellow to amber color found in Rh incompatibility

Question 32

A 25 years old female (at 36 weeks of pregnancy) complains of undue enlargement of the abdomen. Of the following, which is a possible management for her condition?

A)Hospitalization
B)Bed rest
C)Treatment of preeclampsia
D)All of the above

Question 33

Amniocentesis is the sampling of amniotic fluid to screen for developmental abnormalities in a fetus. Of the following, which maternal complication of amniocentesis occurs most frequently?

A)Hemorrhage
B)Trauma
C)Respiratory distress
D)None of the above

Question 34

A 30 years old pregnant female had developed a condition in which the amniotic fluid is less than 200 ml at term. Of the following, which is the most likely cause of this condition?

A)Hypertensive disorders
B)Postmaturity
C)Dehydration
D)Uteroplacental insufficiency

Question 35

A primigravida at 36 weeks of pregnancy has abdominal pain and blood-stained vaginal discharge? Of the following, which are indications of maternal distress in this period?

A)Increased anxiety
B)Increased dehydration
C)Increasing pulse rate
D)All of the above

Question 36

A third gravida at 38 weeks of pregnancy complains of intermittent abdominal pain. Examination reveals that the uterus is contracting and retracting. Which of the following is the recommended management for her?

A)Reassurance and encouragement
B)Sedative drug prescription
C)Proper rest and ambulation
D)None of the above

Question 37

The third stage of labor begins after expulsion of the fetus, and ends with expulsion of the placenta and placental membranes. Which of the following is associated with the third stage of labor?

A)Placental separation
B)Delivery of the "afterbirth
C)Expulsion of the placenta
D)All of the above

Question 38

Malpresentation refers to other fetal presentations than the normal vertex presentation. Of the following, which is considered a maternal risk for fetal malpresentation in delivery? (Choose all that apply)

A)Short stature
B)Abnormal uterine shape
C)Congenital anomalies
D)Prematurity

Question 39

Malpresentation refers to other fetal presentations than the normal vertex presentation. Which of the following is a fetal (as opposed to maternal) cause of malpresentation of the fetus at delivery?

A)Pelvic neoplasms
B)Large baby (macrosomia)
C)Placenta previa
D)Short stature

Question 40

Of the following options, what is the desciptive term (applicable to the vertex presentation) used to express that the occiput is posteriorly placed over the sacroiliac joint or directly over the sacrum?

A)Face presentation
B)Breech presentation
C)Occipito-posterior position
D)None of the above

Question 41

A primigravida has experienced labor pain for 18 hours, and examination reveals that the fetal head is at the level of the ischial spine. Which of the following is possible cause?

A)Faulty pelvic architecture
B)Deflexion of the head
C)Weak uterine contractions
D)All of the above

Question 42

A woman (second gravida) presents with labor pain. Examination reveals that her cervix is fully dilated, and the fetal sagittal suture is transversely placed. Of the following, which may be the recommended management of this woman?

A)Ventouse delivery
B)Manual rotation
C)Cesarean section
D)All of the above

Question 43

In a breech presentation, the lie is longitudinal and the podalic pole presents at the pelvic brim. How many methods are used to perform vaginal breech delivery?

A)2
B)3
C)4
D)5

Question 44

A breech extraction refers to a delivery of a baby in malpresentation in the birth canal. Which of the following can be a complication of vaginal breech delivery?

A)Arrest of labor in the first stage of labor
B)Fetal distress
C)Umbilical cord prolapse
D)All of the above

Question 45

When the long axis of the fetus lies perpendicular to the maternal spine, it is called transverse lie. In a full-term delivery scenario, which of the following statements is true about the management of transverse lie? (Choose all that apply)

A)Perform external cephalic version
B)If external cephalic version fails, then deliver by cesarean section
C)Do nothing to assist with the delivery
D)None of the above

Question 46

A 2nd gravida at 38 weeks of pregnancy developed a condition whereby the fetal presentation was continuously in transition instead of stabilized. Which of the following is the probable reason?

A)Transverse lie
B)Unstable lie
C)Ruptured uterus
D)None of the above

Question 47

A multigravida woman is determined to have obstetric abnormalities. Examination reveals a case of unstable lie. Which of the following is a possible management for her?

A)Existence of placenta previa should be determined
B)Vaginal delivery if condition is stable
C)Cesarean section if any complicating factors are present
D)All of the above

Question 48

The cord lying inside the vagina (or outside the vulva) following rupture of the placental membranes is called______.

A)Occult prolapse
B)Cord presentation
C)Cord prolapse
D)None of the above

Question 49

A pregnant woman is in labor. If the umbilical cord is placed by the side of the presenting fetal part (and is not felt by the fingers on internal examination), this complication is called______.

A)Cord presentation
B)Occult prolapse
C)Cord prolapse
D)Placenta previa

Question 50

A pregnant woman is in labor. When the cord is slipped down below the presenting fetal part (and is felt lying in the intact bag of membranes), this complication is called______.

A)Cord presentation
B)Cord prolapse
C)Unstable lie
D)Occult prolapse

Question 51

A 25 year old pregnant female is in the 2nd stage of labor. Examination reveals that it is a case of umbilical cord prolapse. Which of the following can be proper management for her?

A)Oxygen inhalation
B)I.V. fluids
C)Bladder attention (filling)
D)All of the above

Question 52

The disparity in the relation between the head and the pelvis is called cephalopelvic disproportion (CPD). Which of the following is the recommended management of CPD? (Choose all that apply)

A)Induction of labor and delivery
B)Trial labor
C)Elective c-section at full-term
D)None of the above

Question 53

Trial labor in an institution under supervision (with watchful expectancy) may be attempted in a patient with cephalopelvic disproportion. Which of the following statements is true about the conduction of trial labor?

A)Labor should ideally be spontaneous in onset
B)Prevention of rupture is crucial
C)Progressive dilation of the cervix is entailed
D)All of the above

Question 54

In terms of moderate cephalopelvic disproportion (CPD), which of the following is a disadvantage in deciding upon a trial labor for a patient with this condition?

A)Eliminates unnecessary c-section
B)Test of disproportion remains unproven
C)Eliminates injudicious use of premature induction of labor
D)Ensures the woman is in good obstetrical condition for surgery

Question 55

Contracted pelvis is considered when the essential diameters of one or more planes are shortened by 0.5 cm. Which of the following is a maternal complication of contracted pelvis? (Choose all that apply)

A)Trauma
B)Umbilical cord prolapse
C)Obstructed labor
D)Perinatal mortality in the first trimester

Question 56

Puerperium is the approximately six-week period following childbirth, during which the mother's reproductive organs revert back to the pre-pregnant state. Which of the following statements is true about normal puerperium?

A)Abdomen remains tremendously distended
B)Pulse returns to normal
C)Temperature is at least 100 degrees F. (37.7 degrees C.)
D)Uterus becomes prolapsed

Question 57

Puerperium is the approximately six-week period following childbirth, during which the mother's reproductive organs revert back to the pre-pregnant state. Which of the following statement is true about the management of puerperium?

A)Care of the bladder
B)Care of the bowel
C)Rest and ambulation
D)All of the above

Question 58

Lochia is the vaginal discharge that occurs after giving birth, and this discharge can continue for 4-6 weeks following delivery.Which of the following statements is false about lochia?

A)Lochia is composed of MRSA
B)Lochia smells like rotten eggs
C)Lochia from the uterus is alkaline
D)Duration: May extend upto 3 weeks

Question 59

Immediately after delivery, the breast milk (called colostrum) is yellowish-or a cream color-and sticky. Which of the following statements is true about colostrum?

A)Protein content of colostrum is low
B)Fat content in colostrum is low
C)There are immunoglobulins in colustrum
D)Mineral content of colostrum is low

Question 60

Immediately after delivery, the breast milk (called colustrum) is yellowish-or a cream color-and sticky. Which of the following is an advantage for the newborn of colostrum? (Choose all that apply)

A)Colostrum enables the baby's passive immunity due to immunoglobulins
B)Colustrum is low in protein
C)Helps in preventing jaundice
D)None of the above

Question 61

Giving baby only breast milk (and no other liquid) until 6 months of age is called exclusive breast feeding. Of the following, which are the advantages of breast feeding over formula feeding?

A)Breast milk is easily digested and well absorbed
B)Breast milk protects against infection
C)Breast milk promotes bonding between infant and mother
D)All of the above

Question 62

In breast-feeding, which of the following statements is a sign of poor attachment for suckling?

A)Baby's chin is touching the breast
B)Baby's mouth is opened widely
C)Baby's lower lip is turned outward
D)More areola is seen above than below

Question 63

Postnatal care includes systemic examination of the mother and baby, and appropriate advice given to the mother during the postpartum period. Which of the following is a recommendation to the mother regarding her infant?

A)Puerperal pyrexia
B)Puerperal sepsis
C)Immunization
D)Involution of the uterus

Question 64

A primigravida had a vaginal delivery 2 days ago. What is your advice to her?

A)Should maintain a high nutrition diet
B)Should not bear heavy weight
C)Should plan birth spacing of at least 2 years apart
D)All of the above

Question 65

Any deviation from normal parameters of puerperium is called abnormal puerperium. Of the following, which are commonly associated with abnormal puerperium? (Choose all that apply)

A)Puerperal pyrexia
B)Renal failure
C)Retention of urine
D)Antenatal hemorrhage

Question 66

A woman came in her sixth day of puerperium complains of foul-smelling vaginal discharge and a rise in temperature above normal. How will you manage her?

A)Adequate fluid and calorie intake
B)Antibiotic administration
C)Reduction of temperature
D)All of the above

Question 67

A 30 year-old, postpartum female had a home delivery seven days ago. Since delivery, she has developed not only a high fever and foul-smelling vaginal discharge, but also a rapid pulse, low blood pressure, and generalized abdominal pain. Which of the following is the probable diagnosis?

A)Puerperal pyrexia
B)Puerperal sepsis
C)Urinary tract infection
D)Renal failure

Question 68

A 26 years old had a normal vaginal delivery some days ago. She reports high fever and foul smelling vaginal discharge. Of the following, which is the probable be cause?

A)Preterm labor
B)Anxiety
C)Puerperal sepsis
D)All of the above

Question 69

A 23 years old female was diagnosed with peurpeural sepsis, but she is noncompliant with her antibiotic regimen. Of the following, which is a possible complication? (Choose all that apply)

A)Pancreatitis
B)Pelvic cellulitis
C)General peritonitis
D)Hemorrhage

Question 70

Puerperal sespsis is a systemic infection of the genital tract that occurs as a complication of delivery. Of the following, which is proper management for puerperal sepsis? (Choose all that apply)

A)Fluid and electrolyte balance
B)Respiratory support
C)Do nothing and wait
D)None of the above

Question 71

Which of the following is a breast complication that commonly occurs during puerperium in an otherwise healthy mother? (Choose all that apply)

A)Malignancy
B)Breast engorgement
C)Breast sepsis
D)Mastalgia

Question 72

A patient who had a vaginal delivery 4 days ago (and has been unable to drain her breasts due to distraction) has now developed breast pain. Which of the following is the most likely diagnosis?

A)Breast engorgement
B)Vaginal discharge
C)Silicon implants in the breast
D)Breast abscess

Question 73

A postpartum woman is experiencing engorged breasts. Of the following, which is a possible management for her?

A)Supporting the breasts with brassiere
B)Analgesics
C)Breast pump use
D)All of the above

Question 74

When the involution of the uterus is impaired, it is called uterine subinvolution. Of the following, which is a probable delivery cause of uterine subinvolution?

A)Cesarean section
B)Weakness of ligament
C)Placenta previa
D)Puerperal pyrexia

Question 75

When the involution of the uterus is impaired, it is called uterine subinvolution. Which of the following is a possible management of subinvolution?

A)Improved nutrition
B)Treatment of anemia
C)Antibiotics (in endometritis)
D)All of the above

Question 76

A 30 year old female delivered a baby a few days ago, and has developed malaise, fever and breast pain. Of the following, which is the probable management?

A)Breast support
B)Analgesics
C)Oxygen inhalation
D)None of this above

Question 77

The inappropriate secretion of milk (unrelated to the normal milk production of breast-feeding) is called _________.

A)Breast engorgement
B)Milk fever
C)Galactorrhea
D)Cracked nipple

Question 78

A 28 years old female delivered normally but has failed to feed her baby, and now fails to produce milk. Which of the following can be a probable cause?

A)Infrequent suckling
B)Disinterest in breast-feeding the infant
C)Painful breasts
D)All of the above

Question 79

A 20 year old woman with amenorrhea for 10 weeks presents with excessive nausea and vomiting in the morning. What is your probable diagnosis?

A)Preeclampsia
B)Hyperemesis gravidarum
C)Psychiatric illness
D)None of the above

Question 80

Preeclampsia is a systemic disorder of unknown etiology. Which of the following is a maternal complication of preeclampsia?

A)Eclampsia
B)Oliguria
C)Heart failure
D)All of the above