NURS 4403 Chapter 18: Maternal Physiologic Changes
MULTIPLE CHOICE
1. A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus?
a. One centimeter above the umb
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NURS 4403 Chapter 18: Maternal Physiologic Changes
MULTIPLE CHOICE
1. A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus?
a. One centimeter above the umbilicus
b. Two centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
2. Which woman is most likely to experience strong 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
3. 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 c. Lochia alba
b. Lochia sangra d. Lochia serosa
4. Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
a. Estrogen c. Prolactin
b. Progesterone d. Human placental lactogen
5. 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:
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.
6. A woman gave birth to a 7-pound, 3-ounce 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, the most serious consequence likely to occur from bladder distention is:
a. Urinary tract infection. c. A ruptured bladder.
b. Excessive uterine bleeding. d. Bladder wall atony.
7. The nurse caring for the postpartum woman understands that breast engorgement is caused by:
a. Overproduction of colostrum.
b. Accumulation of milk in the lactiferous ducts.
c. Hyperplasia of mammary tissue.
d. Congestion of veins and lymphatics.
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 approximately 1500 mL. When assessing the woman’s vital signs, the nurse would be concerned to see:
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.
9. Which 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.”
10. The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:
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.
11. The self-destruction of excess hypertrophied tissue in the uterus is called:
a. Autolysis. c. Afterpain.
b. Subinvolution. d. Diastasis.
12. With regard to the postpartum uterus, nurses should be aware that:
a. At the end of the third stage of labor it weighs approximately 500 g.
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.
13. With regard to afterbirth pains, nurses should be aware that these pains are:
a. Caused by mild, continuous contractions for the duration of the postpartum period.
b. More common in first-time mothers.
c. More noticeable in births in which the uterus was overdistended.
d. Alleviated somewhat when the mother breastfeeds.
14. Postbirth uterine/vaginal discharge, called lochia:
a. Is similar to a light menstrual period for the first 6 to 12 hours.
b. Is usually greater after cesarean births.
c. Will usually decrease with ambulation and breastfeeding.
d. Should smell like normal menstrual flow unless an infection is present.
15. 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.
16. With regard to postpartum ovarian function, nurses should be aware that:
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.
17. As relates to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:
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 usually is restored 2 to 3 weeks after childbirth.
18. 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 clients all the following statements except:
a. Breast tenderness is likely to persist for about a week after the start of lactation.
b. As lactation is established, a mass may form that can be distinguished from cancer by its position 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), lactation ceases within a few days to a week.
19. With regard to the postpartum changes and developments in a woman’s cardiovascular system, nurses should be aware that:
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 cesarean birth.
20. 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
21. 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?
a. Nail brittleness
b. Darker pigmentation of the areolae and linea nigra
c. Striae gravidarum on the breasts, abdomen, and thighs
d. Spider nevi
22. 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 client understands the correct process for completing these conditioning exercises when she reports:
a. “I contract my thighs, buttocks, and abdomen.”
b. “I do 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 midstream.”
23. Which maternal event is abnormal in the early postpartum period?
a. Diuresis and diaphoresis
b. Flatulence and constipation
c. Extreme hunger and thirst
d. Lochial color changes from rubra to alba
24. Which finding 12 hours after birth requires further assessment?
a. The fundus is palpable two fingerbreadths above the umbilicus.
b. The fundus is palpable at the level of the umbilicus.
c. The fundus is palpable one fingerbreadth below the umbilicus.
d. The fundus is palpable two fingerbreadths below the umbilicus.
25. If the patient’s white blood cell (WBC) count is 25,000/mm on her second postpartum day, the nurse should:
a. Tell the physician immediately.
b. Have the laboratory draw blood for reanalysis.
c. Recognize that this is an acceptable range at this point postpartum.
d. Begin antibiotic therapy immediately.
26. A postpartum patient asks, “Will these stretch marks go away?” The nurse’s best response is:
a. “They will continue to fade and should be gone by your 6-week checkup.”
b. “No, never.”
c. “Yes, eventually.”
d. “They will fade to silvery lines but won`t disappear completely.”
27. 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 not palpable
d. Episiotomy slightly red and puffy
MULTIPLE RESPONSE
28. 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. A postpartum nurse anticipates blood loss of (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
MATCHING
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. Please match the vital signs finding that the postpartum nurse may encounter with the probable cause:
a. Elevated temperature within the first 24 hours
b. Rapid pulse
c. Elevated temperature at 36 hours postpartum
d. Hypertension
e. Hypoventilation
29. Puerperal sepsis
30. Unusually high epidural or spinal block
31. Dehydrating effects of labor
32. Hypovolemia resulting from hemorrhage
33. Excessive use of oxytocin
29. ANS: C PTS: 1 DIF: Cognitive Level: Comprehension
REF: 488 OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic integrity
NOT: During the first 24 hours postpartum, temperature may increase to 38¦ C as a result of the dehydrating effects of labor. After 24 hours the woman should be afebrile. Other causes of fever include mastitis, endometritis, urinary tract infection, and other systemic infections. Pulse, along with stroke volume and cardiac output, remains elevated for the first hour or so after childbirth. A rapid pulse, or one that is increasing, may indicate hypovolemia as a result of hemorrhage. Hypoventilation may occur after an unusually high subarachnoid block or epidural narcotic after a cesarean birth. An increased reading in blood pressure may result from the excessive use of the vasopressor or oxytocic medication. Because gestational hypertension can persist into or occur first in the postpartum period, routine evaluation of blood pressure is necessary.
30. ANS: E PTS: 1 DIF: Cognitive Level: Comprehension REF: 488 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic integrity
NOT: During the first 24 hours postpartum, temperature may increase to 38¦ C as a result of the dehydrating effects of labor. After 24 hours the woman should be afebrile. Other causes of fever include mastitis, endometritis, urinary tract infection, and other systemic infections. Pulse, along with stroke volume and cardiac output, remains elevated for the first hour or so after childbirth. A rapid pulse, or one that is increasing, may indicate hypovolemia as a result of hemorrhage. Hypoventilation may occur after an unusually high subarachnoid block or epidural narcotic after a cesarean birth. An increased reading in blood pressure may result from the excessive use of the vasopressor or oxytocic medication. Because gestational hypertension can persist into or occur first in the postpartum period, routine evaluation of blood pressure is necessary.
31. ANS: A PTS: 1 DIF: Cognitive Level: Comprehension REF: 488 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic integrity
NOT: During the first 24 hours postpartum, temperature may increase to 38¦ C as a result of the dehydrating effects of labor. After 24 hours the woman should be afebrile. Other causes of fever include mastitis, endometritis, urinary tract infection, and other systemic infections. Pulse, along with stroke volume and cardiac output, remains elevated for the first hour or so after childbirth. A rapid pulse, or one that is increasing, may indicate hypovolemia as a result of hemorrhage. Hypoventilation may occur after an unusually high subarachnoid block or epidural narcotic after a cesarean birth. An increased reading in blood pressure may result from the excessive use of the vasopressor or oxytocic medication. Because gestational hypertension can persist into or occur first in the postpartum period, routine evaluation of blood pressure is necessary.
32. ANS: B PTS: 1 DIF: Cognitive Level: Comprehension REF: 488 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic integrity
NOT: During the first 24 hours postpartum, temperature may increase to 38¦ C as a result of the dehydrating effects of labor. After 24 hours the woman should be afebrile. Other causes of fever include mastitis, endometritis, urinary tract infection, and other systemic infections. Pulse, along with stroke volume and cardiac output, remains elevated for the first hour or so after childbirth. A rapid pulse, or one that is increasing, may indicate hypovolemia as a result of hemorrhage. Hypoventilation may occur after an unusually high subarachnoid block or epidural narcotic after a cesarean birth. An increased reading in blood pressure may result from the excessive use of the vasopressor or oxytocic medication. Because gestational hypertension can persist into or occur first in the postpartum period, routine evaluation of blood pressure is necessary.
33. ANS: D PTS: 1 DIF: Cognitive Level: Comprehension REF: 488 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic integrity
NOT: During the first 24 hours postpartum, temperature may increase to 38¦ C as a result of the dehydrating effects of labor. After 24 hours the woman should be afebrile. Other causes of fever include mastitis, endometritis, urinary tract infection, and other systemic infections. Pulse, along with
stroke volume and cardiac output, remains elevated for the first hour or so after childbirth. A rapid pulse, or one that is increasing, may indicate hypovolemia as a result of hemorrhage. Hypoventilation may occur after an unusually high subarachnoid block or epidural narcotic after a cesarean birth. An increased reading in blood pressure may result from the excessive use of the vasopressor or oxytocic medication. Because gestational hypertension can persist into or occur first in the postpartum period, routine evaluation of blood pressure is necessary.
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