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Examination Study Guide 2023
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CHAPTER 18: MATERNAL PHYSIOLOGIC CHANGES (2023)
- A woman gave birth to an infant boy 10 hour*s ago. Where would the nurse expect to locate this woman’s fundus?
a. (^) One centimeter above the umbilicus
ANS: A Within 12 hours after delivery fundus-approximately 1 cm above umbilicus. fundus descends about 1-2 cm every 24 hours. By 6th postpartum week-fundus normally halfway between symphysis pubis and umbilicus.
- Which woman is most likely to experience strong afterpains?
b. (^) A woman who is a gravida 4, para 4-0-0-
ANS: B Afterpains-more common in multiparous,with births in which uterus was greatly distended,in woman who experienced polyhydramnios or delivered large infant. Breastfeeding may cause afterpains to intensify.
- 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?
d. (^) Lochia serosa
ANS: D Lochia serosa-blood, serum, leukocytes,tissue debris,around day 3 or 4 after childbirth. Lochia rubra-blood,decidual,trophoblastic debris;3 to 4 days and pales, becoming pink or brown.Lochia alba-after day 10,continue up to 6 wks
- Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?
c. (^) Prolactin
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ANS: C Prolactin-increase progressively throughout pregnancy. In breastfeed-remain elevated into 6th week after birth. Estrogen,progesterone -decrease markedly after expulsion of placenta,reach their lowest levels 1 week into postpartum period. Human placental lactogen levels decrease dramatically after expulsion of placenta.
- 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:
c. (^) Loss of increased blood volume associated with pregnancy.
ANS: C Within 12 hours of birth women begin to lose excess tissue fluid.1st mechanism for reducing retained fluids-profuse diaphoresis-often occurs, especially at night, for 1st 2-3 days after childbirth. Postpartal diuresis -mechanism by which body rids itself of excess fluid. Diaphoresis,diuresis-referred to as reversal of water metabolism of pregnancy.Postpartal diuresis may be caused by removal of increased venous pressure in lower extremities.
- 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:
b. (^) Excessive uterine bleeding.
ANS: B Excessive bleeding-occur immediately after birth if bladder becomes distended because it pushes uterus up,to side,prevents it from contracting firmly.UTI- may result from overdistention of bladder,not most serious consequence.ruptured bladder may result from severely overdistended bladder.vaginal bleeding most likely would occur before bladder reaches this level of overdistention.Bladder distention may result from bladder wall atony.
- The nurse caring for the postpartum woman understands that breast engorgement is caused by:
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- The self-destruction of excess hypertrophied tissue in the uterus is called:
a. (^) Autolysis.
ANS: A Autolysis -caused by decrease in hormone levels. Subinvolution- failure of uterus to return to nonpregnant state. Afterpain -caused by uterine cramps 2-3 days after birth. Diastasis -separation of muscles.
- With regard to the postpartum uterus, nurses should be aware that:
b. (^) After 2 weeks postpartum it should not be palpable abdominally.
ANS: B After 2 wks postpartum-uterus should not be palpable abdominally; it has not yet returned to original size.At end of 3rd stage of labor,uterus weighs approximately 1000 g. It takes 6 full weeks for uterus to return to its original size.After 2 weeks postpartum uterus weighs about 350 g, not original size.Normal self-destruction of excess hypertrophied tissue accounts for slight increase in uterine size after each pregnancy.
- With regard to afterbirth pains, nurses should be aware that these pains are:
c. (^) More noticeable in births in which the uterus was overdistended.
ANS:C large baby or multiple babies overdistend uterus.cramping that causes after birth pains arises from periodic, vigorous contractions,relaxations, which persist through 1st part of postpartum period. Afterbirth pains-more common in multiparous women because 1st-time mothers have better uterine tone. Breastfeeding intensifies afterbirth pain because it stimulates contractions.
14. Postbirth uterine/vaginal discharge, called lochia:
d. (^) Should smell like normal menstrual flow unless an infection is present.
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ANS: D Offensive odor-indicates infection. Lochia flow should approximate heavy menstrual period for 1st 2 hrs,then steadily decrease. Less lochia-seen after cesarean births,increases with ambulation and breastfeeding.
- Which description of postpartum restoration or healing times is accurate?
b. (^) Vaginal rugae reappear by 3 weeks postpartum.
ANS: B Vaginal rugae reappear by 3 weeks postpartum;never as prominent as in nulliparous women.Cervix regains-form within days;cervical os may take longer.Most episiotomies take 2-3 weeks to heal. Hemorrhoids can take 6 wks to decrease in size.
- With regard to postpartum ovarian function, nurses should be aware that:
d. (^) The first menstrual flow after childbirth usually is heavier than normal.
ANS: D 1 st flow-heavier,within 3 or 4 cycles-back to normal.Ovulation can occur within 1st mth, but for 70% of nonlactating women,returns within 12 wks after birth.Breastfeeding take longer to resume ovulation.many women ovulate before1st postpartum menstrual period, contraceptive needed discussed early in puerperium.
- As relates to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that:
c. (^) Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.
ANS: C Excess fluid loss through other means occurs.Kidney function usually returns to normal in about 1mth.Diastasis recti abdominis-separation of muscles in abdominal wall; no effect on voiding reflex. Bladder tone-restored 5-7 days 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:
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a. (^) Nail brittleness
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ANS: A nails return to prepregnancy consistency,strength. Some women have permanent darker pigmentation of areolae,linea nigra.Striae gravidarum (stretch marks)-not completely disappear. For some women spider nevi persist indefinitely.
- 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:
d. (^) “I pretend that I am trying to stop the flow of urine midstream.”
ANS: D Pretend attempting to stop passing of gas or flow of urine midstream-will replicate sensation of muscles drawing upward,inward.Each contraction-as intense as possible without contracting abdomen,buttocks,thighs.Guidelines-exercises should be done 24-100xday.Positive results- min of 24-45 repetitions/day. Best position to learn Kegel exercises-lie supine with knees bent;2nd position-on hands and knees.
- Which maternal event is abnormal in the early postpartum period?
d. (^) Lochial color changes from rubra to alba
ANS: D 1 st 3 days lochia- rubra. Lochia serosa follows,then at about 11 days,discharge becomes clear, colorless, or white. Diuresis,diaphoresis-methods by which body rids itself of increased plasma volume. Urine output-3000 mL/day=1st few days,facilitated by hormonal changes.Bowel tone remains sluggish for days. Many women anticipate pain during defecation,unwilling to exert pressure on perineum. new mother hungry because of energy used in labor,thirsty because of fluid restrictions during labor.
- Which finding 12 hours after birth requires further assessment?
a. (^) The fundus is palpable two fingerbreadths above the umbilicus.
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c. (^) 300 to 500 mL
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d. (^) 500 to 1000 mL
ANS: C, D average blood loss vaginal birth of single fetus from 300-500 mL (10% of blood volume).cesarean -500-1000 mL(15% to 30% of blood volume). During 1st few days after birth plasma volume decreases further as result diuresis.Pregnancy-induced hypervolemia (increase in blood volume of at least 35%) allows most women to tolerate considerable blood loss during childbirth.
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:
- Puerperal sepsis - Elevated temperature at 36 hours postpartum (C)
- Unusually high epidural or spinal block - Hypoventilation (E)
- Dehydrating effects of labor - Elevated temperature within the first 24 hours (A)
- Hypovolemia resulting from hemorrhage - Rapid pulse (B)
- Excessive use of oxytocin- Hypertension (D)
Chapter 19: Nursing Care of the Family during the Postpartum Period
- A 25 - year-old gravida 2, para 2 - 0 - 0 - 2 gave birth 4 hours ago to a 9 - pound, 7 - ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, “I’m bleeding a lot.” The most likely cause of postpartum hemorrhage in this woman is:
c. (^) Uterine atony.
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ANS: A rubella titer indicates-not immune,needs to receive a vaccine.
- A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle- feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by:
b. (^) Applying ice to the breasts for comfort.
ANS: B Applying ice(cabbage leaves)to breasts for comfort treating engorgement in mother who is bottle-feeding, avoid any breast stimulation, including pumping or expressing milk;should wear well-fitted support bra or breast binder continuously for at least 1st 72 hours after giving birth.
- A 25 - year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse’s most appropriate response is to ask the woman:
d. (^) “I’ll warm the soup in the microwave for you.”
ANS: D
- A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?
a. (^) The woman leaves the infant on her bed while she takes a shower.
ANS: A Leaving infant on bed unattended-never acceptable.Holding,cuddling after feeding,reading magazine while infant sleeps-appropriate.
- In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:
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a. (^) Is inconsistent with the Baby Friendly Hospital Initiative.
ANS: A
- A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means. The nurse’s best response is:
c. (^) “You have calf pain when the nurse flexes your foot.”
ANS: C Discomfort in calf with sharp dorsiflexion of foot may indicate deep vein thrombosis. Deep tendon reflexes should be 1+ to 2+.
- In the recovery room, if a woman is asked either to raise her legs (knees extended) off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:
a. (^) Has recovered from epidural or spinal anesthesia.
ANS: A
- Under the Newborns’ and Mothers’ Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of hours after a normal vaginal birth and for hours after a cesarean birth.
c. (^) 48, 96
ANS: C
- In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:
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ANS: D In couplet care mother shares room with newborn,care with nurse educated in maternity and infant care.
- Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to:
d. (^) Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood.
ANS: D “Mothering the mother” is more process of encouraging,supporting woman in her new role.
- Excessive blood loss after childbirth can have several causes; the most common is:
c. (^) Failure of the uterine muscle to contract firmly.
ANS: C Uterine atony can best be thwarted by maintaining good uterine tone,preventing bladder distention.vaginal or vulvar hematomas, unpaired lacerations of vagina or cervix,retained placental fragments-possible causes of excessive blood loss,uterine muscle failure (uterine atony)-most common cause.
- A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:
a. (^) Improve the accuracy of blood loss estimation, which usually is a subjective assessment.
ANS: A
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- Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse could try is:
d. (^) Inserting a sterile catheter.
ANS: D Invasive procedures usually-last to be tried, especially with so many other simple.easy methods available (water, peppermint vapors, pain medication).
17. If a woman is at risk for thrombus and is not ready to ambulate, nurses may intervene by performing a number of interventions. Which intervention should the nurse avoid?
c. (^) Having the patient sit in a chair.
ANS: C Sitting immobile in chair-not help.Bed exercise,prophylactic footwear may. TED hose,SCD boots-recommended.Bed exercises-flexing, extending,rotating feet, ankles,legs-useful.Positive Homans’ sign(calf muscle pain,warmth, redness,tenderness)-immediate attention.
- As relates to rubella and Rh issues, nurses should be aware that:
b. (^) Women should be warned that the rubella vaccination is teratogenic, and
that they must avoid pregnancy for 1 month after vaccination.
ANS: B contraception for 1 month after vaccinated.live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated. Rh immune globulin is administered intramuscularly;never be given to infant. Rh immune globulin suppresses immune system,therefore could thwart rubella vaccination.
- Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins:
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ANS: A
- A recently delivered mother and her baby are at the clinic for a 6 - week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:
c. (^) Has not given the baby a name.
ANS: C If mother having difficulty naming her new infant, it may be signal that she is not adapting well to parenthood. red flags-refusal to hold or feed baby, lack of interaction with infant,becoming upset when baby vomits or needs diaper change;unwilling to discuss her labor,birth experience; baby unattractive and messy,overly disappointed in baby’s sex;voice concern that baby reminds her of family member whom she does not like nursing diagnosis could be Impaired parenting related to a long, difficult labor or unmet expectations of birth.
- Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic?
a. (^) Gravida 5, para 5
ANS: A
- Postpartal overdistention of the bladder and urinary retention can lead to which complications?
c. (^) Postpartum hemorrhage and urinary tract infection
ANS: C
- Rho immune globulin will be ordered postpartum if which situation occurs?
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a. (^) Mother Rh2-, baby Rh+
ANS: A
- Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?
d. (^) Assist the patient in emptying her bladder.
ANS: D Urinary retention may cause overdistention of urinary bladder,which lifts,displaces uterus. Nursing actions need to be implemented before notifying physician.important to evaluate blood pressure, pulse,lochia if bleeding continues; focus at this point in time is to assist patient in emptying her bladder.
- When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is:
b. (^) Early and frequent ambulation.
ANS: B Activity will aid movement of accumulated gas in GI tract. Rectal suppositories-helpful after distention occurs;not prevent it.Ambulation-best prevention. Carbonated beverages-increase distention.
- The nurse caring for the postpartum woman understands that breast engorgement is caused by:
d. (^) Congestion of veins and lymphatics.
ANS: D
- Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?
