Chapter 18 - Postpartum Physiologic Changes (Maternity) EAQ's

The nurse provides care to a non-breastfeeding mother after birth who reports tenderness in the breasts. Upon assessment, the nurse confirms the breasts are distended and teaches the patient about the physiology of the breasts for non-breastfeeding women. Which statement made by the patient indicates teaching was effective? 1 "The swelling is caused by a congestion of veins." 2 "I should express the build-up of milk in the breasts." 3 "Heat packs or hot towels can be used to relieve discomfort." 4 "It is normal for me to lactate for about two weeks after I give birth."

1 - "The swelling is caused by a congestion of veins." pg 464 - The breasts of non-breastfeeding mothers differ from those of breastfeeding mothers. It is important for the nurse to be able to identify normal and abnormal alterations in breast tissue for postpartum patients. Distended, or swollen, breasts are a normal finding for non-breastfeeding women, which is caused by a temporary congestion of veins and lymphatics. This finding is not caused by the accumulation of milk. The milk is present in the breasts but should not be expressed. Lactation will cease within a few days to a week, but it is not normal for the patient to continue lactating for 2 weeks. Cold packs, not hot packs, can be used to relieve discomfort in the breasts.

The nurse provides care to a postpartum mother after birth. The patient has type 1 diabetes and asks about ways to manage her disease now that she is postpartum. What is the nurse's best response to the patient? 1 "You will likely require much less insulin for a few days." 2 "Your blood glucose levels will appear higher since you just gave birth." 3 "You should not expect any alterations to your glucose or insulin levels." 4 "Your carbohydrate metabolism will be unaffected by the changes in your body."

1 - "You will likely require much less insulin for a few days." pg 462 - Mothers with type 1 diabetes likely require less insulin for several days after birth. This is due to the metabolic changes that occur within the endocrine system. There are decreased levels in various hormones that result in lower blood glucose levels in the immediate peurperium. These normal hormonal changes make the peurperium a transitional period for carbohydrate metabolism, so it's harder to interpret the results of glucose tolerance tests during this time frame. It is incorrect to tell the patient that there are no alterations to glucose or insulin levels, as metabolic changes are normal after birth. It is incorrect to tell the patient that glucose levels will appear higher, as the opposite is true. It is incorrect to tell the patient that carbohydrate metabolism will be unaffected, as it is impacted by the metabolic changes of the body.

While examining the postpartum patient, the nurse finds that her fundus is located halfway between the umbilicus and the symphysis pubis. When would the nurse suspect was about the time of the patient's delivery? 1 6 days ago 2 12 hours ago 3 24 hours ago 4 6 weeks ago

1 - 6 days ago pg 460 - The fundus descends gradually from the time of childbirth and returns to its normal nonpregnant state. By the sixth day after childbirth, it can be located halfway between the umbilicus and the symphysis pubis. The fundus rises to approximately 1 cm above the umbilicus within 12 hours of childbirth. Within 24 hours, the fundus descends 1 to 2 cm, and the size of the uterus is the same as during 20 weeks of gestation. By the sixth week, the uterus returns to its normal, nonpregnant state.

A nonbreastfeeding postpartum patient reports a lump formation in the breast. Upon assessment, the nurse finds that the lumps are not restricted to a single place. What does the nurse expect to be the possible reason for this? 1 Accumulation of milk 2 Fibrocystic breast cancer 3 Temporary congestion of arteries 4 Temporary congestion of lymphatics

1 - Accumulation of milk pg 464 - After childbirth, the excess extracellular fluid and proteins of the breast milk accumulate and are drained via the lymphatic system. This can result in congestion of the breast tissue and can be felt as a lump in the breast. The lumps of fibrocystic breast cancer are fixed and not mobile. Arterial or lymphatic congestion is not the reason for lump formation.

A patient who gave birth 4 days ago reports that her vaginal discharge has an offensive odor. What patient clinical condition does the nurse infer from this? 1 Infection 2 High oxytocin levels 3 Postpartum hemorrhage 4 Normal lochial discharge

1 - Infection pg 461 - Offensive odor of the vaginal discharge (lochia) after delivery is a symptom of infection. Ideally, uterine discharge after childbirth should smell like normal menstrual flow. Oxytocin levels are not related to odor of the lochial discharge or the menstrual bleeding. Offensive odor is not a sign of hemorrhage. Signs of hemorrhage include heavy bleeding, increased pulse rate, and low blood pressure. If the lochial discharge has an offensive odor, then it is not a normal finding.

A patient reports to the nurse that she has bright red discharge 3 days after delivery. The patient tells the nurse that a gush of blood comes out of her vagina upon standing upright. What should the nurse interpret from the assessment? 1 Normal finding after delivery 2 Dyspareunia 3 Infection 4 Hemorrhage

1 - Normal finding after delivery pg 461 - After birth uterine discharge is commonly called lochia that accumulates in the vagina when the woman is lying down. This comes out as a gush of blood when the woman assumes an upright position. If the lochia has a strong smell, it may indicate an offensive odor; this patient does not report an offensive odor. During the assessment, the nurse does not find any symptoms associated with hemorrhage, such as increased heart rate or low blood pressure. Dyspareunia is associated with coital discomfort.

The nurse is caring for a postpartum patient. The nurse finds that the patient has continuous discharge of lochia serosa even 3 weeks after delivery. Which manifestations would indicate the presence of endometritis in the patient? Select all that apply. 1 Offensive odor of lochia 2 Persistence of lochia rubra 3 Recurred bleeding after 7 to 14 days 4 Fever, pain, and abdominal tenderness 5 Excessive bright red-colored lochia rubra 6 Gush of dark colored lochia upon standing

1 - Offensive odor of lochia 4 - Fever, pain, and abdominal tenderness pg 461 - A continued flow of lochia serosa or lochia alba 3 to 4 weeks after birth may indicate endometritis. Normal lochia smells like that of normal menstrual flow. An offensive odor of lochia indicates an infection, which may be due to endometritis. In addition, patients with endometritis have fever, pain, and tenderness in the abdomen, which particularly indicate infection and inflammation of the endometrium. Presence of retained fragments of placenta or other membranes can result in continued lochia rubra early in the postpartum period. Bleeding may recur 7 to 14 days after childbirth, which is associated with the healing placental site and does not indicate endometritis. A gush of lochia is seen when a woman lying in bed stands up or when the uterus is massaged. This gush of lochia would be dark in color if it is composed of pooled blood and then reduces to a bright red lochia. This should not be mistaken with hemorrhage or endometritis. Excessive and continuous discharge of bright red colored lochia rubra indicates a vaginal or cervical tear.

The nurse is evaluating a postpartum patient's cervix immediately after birth. Which finding does the nurse expect? 1 The ectocervix appears bruised. 2 The cervical os is closed. 3 The cervical dilation has decreased to 2 cm. 4 The external cervical os takes on a circular shape.

1 - The ectocervix appears bruised. pg 462 - Cervical changes occur after pregnancy. Immediately after birth, the cervix is soft, and the ectocervix appears bruised. It also has some small lacerations. The cervical os closes gradually over the next couple of days but is not closed immediately after birth. Cervical dilation decreases to 2 cm several days after birth but not immediately after. The external cervical os never regains its pre-pregnancy appearance and no longer has a circular shape. Instead, it appears as a jagged slit that looks like the mouth of a fish.

The nurse is providing follow-up care to a patient who is 2½ weeks postpartum. Based on the involution process, which finding does the nurse expect to see when assessing the patient? 1 The uterus will not be abdominally palpable. 2 The uterus will have returned to its nonpregnant location. 3 The uterus will be located halfway between the umbilicus and the symphysis pubis. 4 The uterus will be at about the same size as it was at 20 weeks gestation.

1 - The uterus will not be abdominally palpable. pg 460 - After 2 weeks postpartum, the uterus should not be abdominally palpable. It will have returned to its nonpregnant location by 6 weeks postpartum, not two and a half. The uterus is located halfway between the umbilicus and the symphysis pubis by the sixth postpartum day, not by 2½ weeks. The uterus is about the same size as it was at 20 weeks gestation by 24 hours after birth, not 2½ weeks.

What statement by a patient who just gave birth indicates that she knows what to expect about her menstrual activity after childbirth? 1 "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." 2 "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." 3 "I will not have a menstrual cycle for 6 months after childbirth." 4 "My first menstrual cycle will be heavier than normal and then will be light for several months after that."

2 - "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." pg 463 - Most patients experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. They can expect the first menstrual cycle to be heavier than normal, and the volume of subsequent cycles to return to prepregnant levels within three or four cycles.

What amount of blood loss is considered normal in a patient who has undergone a vaginal delivery? 1 100 mL 2 400 mL 3 700 mL 4 1000 mL

2 - 400 mL pg 464 - There is an average blood loss of 300 to 500 mL in patients who have delivered vaginally. Therefore, 400 mL would be considered normal blood loss in a patient who has undergone a vaginal delivery. There is a minimum loss of 300 mL of blood in a vaginal delivery. Thus, a patient who has delivered vaginally will have blood loss of more than 100 mL. Blood loss of 700 or 1000 mL is normal in a cesarean delivery but would be considered excessive blood loss in a vaginal delivery.

What is true of postbirth uterine/vaginal discharge (called lochia)? 1 It is similar to a light menstrual period for the first 6 to 12 hours. 2 It is usually greater after cesarean births. 3 It will usually decrease with ambulation and breastfeeding. 4 It should smell like normal menstrual flow unless an infection is present.

4 - It should smell like normal menstrual flow unless an infection is present. pg 461 - An offensive odor 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 cesarean births. Lochia usually increases with ambulation and breastfeeding.

The nurse finds that a postpartum patient has high levels of prolactin. What could be the reason behind it? Select all that apply. 1 Decreased suckling 2 Decreased estrogen 3 Decreased aldosterone 4 Increased progesterone 5 Increased breastfeeding

2 - Decreased estrogen 5 - Increased breastfeeding pg 463 - An increase in breastfeeding enhances the production of prolactin as there are receptors in the nipples that stimulate the pituitary gland to release prolactin. Estrogen has an inhibitory action on the hormone prolactin. During pregnancy, both prolactin and estrogen are present, but the levels of prolactin are suppressed because of the high levels of estrogen. After childbirth, the levels of estrogen drop; therefore there is no inhibitory action on the production of prolactin. This, in turn, causes the levels of prolactin to increase. Progesterone also has an inhibitory action on prolactin, so an increase in progesterone levels causes prolactin levels to decrease. There is no direct effect of aldosterone on prolactin. Sucking on the breast increases the production of prolactin due to stimulation of the nipple.

The primary health care provider (PHP) instructed the nurse to administer oxytocin (Pitocin) to the patient immediately after birth. What could be the patient's clinical status for the PHP's instruction? 1 Thyroiditis 2 Postvaginal delivery 3 Delivery by cesarean section 4 Gestational diabetes

2 - Postvaginal delivery pg 460 - Oxytocin (Pitocin) is administered immediately after birth to retain a firm and well-contracted uterus. A patient with vaginal delivery may need oxytocin (Pitocin) because the uterine muscles are stretched to a larger extent. Therefore oxytocin (Pitocin) is administered to induce contraction. Thyroiditis, or the inflammation of the thyroid gland, causes anemia and postpartum hemorrhage, but it does not affect elasticity of the uterus. A patient who had a cesarean delivery may not need oxytocin (Pitocin), because the uterus is not as stretched compared with that of a patient who had a vaginal delivery. Gestational diabetes does not decrease oxytocin levels, so the patient may not need an oxytocin supplement.

Which description of postpartum restoration or healing times is accurate? 1 The cervix shortens, becomes firm, and returns to form within a month postpartum. 2 Rugae reappear within 3 to 4 weeks. 3 Most episiotomies heal within a week. 4 Hemorrhoids usually decrease in size within 2 weeks of childbirth.

2 - Rugae reappear within 3 to 4 weeks. pg 462 - Rugae appear within 3 weeks, but they are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. 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.

A postpartum patient complains of a headache. What could be the reasons for the headache in the patient? Select all that apply. 1 Orthostatic hypotension 2 Stress of childbirth in the patient 3 Postpartum-onset preeclampsia 4 Leakage of the cerebrospinal fluid 5 Presence of varices and hemorrhoids

2 - Stress of childbirth in the patient 3 - Postpartum-onset preeclampsia 4 - Leakage of the cerebrospinal fluid pg 465 - Persistent headache in postpartum patients need to be evaluated further. However, the stress and physical fatigue of childbirth may cause the patient to experience headaches. Postpartum-onset preeclampsia, characterized by high blood pressure and the presence of proteins in the urine, may also cause headaches. Epidural or spinal anesthesia involves the placement of the needle into the spinal space. This may lead to leakage of cerebrospinal fluid into the extradural space, resulting in a headache. Orthostatic hypotension may cause dizziness, but it does not cause headache. The presence of varices and hemorrhoids may cause discomfort and pain, but these do not cause headache.

The nurse is caring for a postpartum patient who had a normal vaginal delivery. The nurse tells the patient, "This will help you prevent uterine prolapse in later stages of life." Which instruction from the primary health care provider (PHP) is the nurse most likely explaining to the patient? 1 "Avoid climbing of the stairs." 2 "Maintain a high-protein diet." 3 "Do Kegel exercises every day." 4 "Avoid sleeping in the prone position."

3 - "Do Kegel exercises every day." pg 462 - Vaginal deliveries cause the pelvic muscles and ligaments to stretch and weaken. Kegel exercises help strengthen the pelvic floor muscles and thereby can prevent uterine complications, such as prolapse. The physical activity of climbing stairs may delay the process of healing from an episiotomy, so it is usually avoided. However, avoiding stairs does not prevent uterine prolapse. A diet high in protein is necessary to build muscle strength, but it cannot prevent uterine prolapse. Because the patient has already undergone delivery, sleeping in prone position does not cause any harm.

The nurse is caring for a pregnant woman who has low levels of estrogen and progesterone. What does the nurse expect may occur as a result of the low hormone levels? 1 Massive growth of the uterus during pregnancy 2 Increased uterine contractions (UCs) during labor 3 Decreased growth of the uterus during pregnancy 4 Increased blood circulation to the uterus during pregnancy

3 - Decreased growth of the uterus during pregnancy pg 460 - Estrogen and progesterone play a vital role in the development of the uterus during pregnancy. They are responsible for the growth of the uterus and may cause hypertrophy and hyperplasia of the uterine muscle cells. A decrease in estrogen and progesterone results in decreased growth of the uterus, which might even lead to miscarriage. Low estrogen and progesterone may not cause increased UCs. Moreover, the pituitary hormone oxytocin is primarily responsible for UCs during labor. Low levels of estrogen and progesterone lead to abnormally low growth of the uterus. Estrogen and progesterone also increase the blood circulation in the mother. Low levels of these hormones would decrease blood circulation.

A lactating patient with type 1 diabetes in her immediate puerperium period undergoes a glucose tolerance test. The test results are nonconclusive. What could be the reason for the test to be nonconclusive? 1 Breastfeeding the baby 2 Loss of blood in the form of lochia 3 Decreased levels of maternal hormones 4 Decreased food intake and diet regulations

3 - Decreased levels of maternal hormones pg 463 - In the immediate puerperium, a decrease in the levels of human placental lactogen, estrogens, and cortisol is seen. This results in significantly lowered blood glucose levels. Therefore it is a transitional period for carbohydrate metabolism, making it difficult to interpret the glucose tolerance test. Breastfeeding the baby gradually depletes the mother's energy stores deposited during the pregnancy and does not have a significant influence on the glucose tolerance. Blood, tissue debris, fluids, and retained fragments of membranes are discharged out in the form of lochia, which does not affect the glucose tolerance test. Dietary regulations prevent the mother from consuming additional calories, but this does not influence the glucose tolerance of the woman in her immediate puerperium.

The nurse is providing follow-up care to a patient 3 days after birth. The nurse notes post-birth uterine discharge that is a pinkish-brown color and trickles from the vaginal opening. How does the nurse document this? 1 Lochia alba 2 Lochia rubra 3 Lochia serosa 4 Nonlochial bleeding

3 - Lochia serosa pg 461 - Lochia is a post-birth uterine discharge that changes in color and consistency as the body recovers from birth. Lochia serosa is lochia that appears pink or brown 3 or 4 days after birth. It consists of old blood, serum, leukocytes, and tissue debris. Lochia rubra is bright red and consists of blood and decidual and trophoblastic debris, which is present right after birth. The lochia becomes more pale with time. Lochia alba is drainage that becomes yellow to white and occurs 10 to 14 days after birth. It mostly consists of leukocytes, decidua, epithelial cells, mucus, serum, and bacteria. Nonlochial bleeding is bloody discharge that comes from the vagina and is bright red.

With regard to afterbirth pains, nurses should be aware that these pains are what? 1 Caused by mild, continual contractions for the duration of the postpartum period 2 More common in first-time mothers 3 More noticeable in births in which the uterus was overdistended 4 Alleviated somewhat when the mother breastfeeds

3 - More noticeable in births in which the uterus was overdistended pg 460 - Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large infant or multiple infants overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Which term is used to describe the period between childbirth and the reversal of the patient's uterus into its nonpregnant state? 1 Lochia 2 Involution 3 Puerperium 4 Subinvolution

3 - Puerperium pg 460 - The time interval between the birth of the newborn and the return of the patient's reproductive organs to their normal nonpregnant state is termed puerperium, or the fourth trimester of pregnancy. This period usually lasts for 6 weeks. Lochia refers to uterine discharge after birth. Involution refers to the return of the uterus to its nonpregnant state after birth. Subinvolution refers to the failure of the uterus to return to its nonpregnant state after childbirth.

A postpartum patient has urinary incontinence. What is the best nursing intervention to help this patient? 1 Provide an epidural block. 2 Encourage the patient to intake more fluids. 3 Tell the patient to perform more Kegel exercises. 4 Have the patient practice better personal hygiene.

3 - Tell the patient to perform more Kegel exercises. pg 462/463 - The pelvic floor is a broad sling of muscles, ligaments, and sheet-like tissues. It stretches from the pubic bone at the front of the body to the base of the spine at the back. It is responsible for movement, balance, stability, and flexibility. The supportive tissues of the pelvic floor are torn or stretched during childbirth. This results in urinary incontinence while coughing, sneezing, or performing exercises. Kegel exercises consist of repeated contractions and relaxations of the muscles that form the pelvic floor. These exercises help strengthen the perineal muscles and can prevent urinary incontinence. The intake of more fluids is recommended after childbirth if the woman has constipation. However, the administration of fluids for urinary incontinence causes irritation of the bladder. An epidural block is a medicine given in the epidural spaces for causing numbness in the lower half of the body. Therefore it causes urinary incontinence after childbirth. Personal hygiene is not related to urinary incontinence, but it helps prevent infections.

A pregnant patient complains to the nurse about periodic numbness, tingling of fingers, and the inability to lift and carry any object. What patient clinical condition does the nurse interpret from this assessment? 1 Hemorrhoids 2 Endometritis 3 Vitamin A deficiency 4 Carpal tunnel syndrome

4 - Carpal tunnel syndrome pg 465 - Fluid retention and swelling are common during pregnancy and increase the pressure in the narrow and inflexible space in the hand, compressing the median nerve that runs through the hand. This results in numbness, tingling of fingers, and the inability to lift and carry objects and is a condition known as carpal tunnel syndrome, which this patient has. Itching and discomfort around the anus and bright red bleeding upon defecation are the symptoms of hemorrhoids. These symptoms are not observed in the patient; therefore the patient does not have hemorrhoids. Fever, pain, and abdominal tenderness during menstrual discharge are the symptoms of endometritis. The nurse does not find these symptoms in the patient, so the patient does not have endometritis. Vitamin A deficiency does not affect the muscles, nor does it cause periodic numbness or tingling of the fingers. Therefore the patient does not have a vitamin A deficiency.

A patient reports to the nurse that she has yellow uterine discharge 4 weeks after delivery. During the assessment, the nurse finds that the patient has fever, pain, and abdominal tenderness. What patient clinical condition should the nurse suspect based on the assessment? 1 Infection 2 Dyspareunia 3 Hemorrhoids 4 Endometritis

4 - Endometritis pg 461 - Uterine discharge persists up to 4 to 8 weeks after childbirth. Yellow uterine discharge is called lochia alba. Symptoms such as fever, pain, and abdominal tenderness along with the discharge indicate that the patient has endometritis. Offensive odor of the menstrual flow is a sign of infection. Itching, discomfort, and bright red bleeding upon defecation are the symptoms of hemorrhoids. Dyspareunia is associated with coital discomfort; however, the patient does not report any related symptoms. Therefore the patient does not have dyspareunia.

A postpartum patient complains of increased shedding of hair. What is the reason for her hair loss? 1 Melasma 2 Varicosities 3 Nevus araneus 4 Hormonal imbalance

4 - Hormonal imbalance pg 466 - Hormonal imbalance is common in postpartum women and may disturb the normal hair growth cycle, thereby causing some hair loss. The abundance of fine hair seen during pregnancy usually disappears after giving birth. However, any coarse or bristly hair that appears during pregnancy usually remains. Melasma (chloasma or "mask of pregnancy") usually disappears in the postpartum period but persists in about 30% of women. Hyperpigmentation of the areolae and linea nigra may not regress completely after childbirth. Nevus araneus, or spider angiomas, are the vascular abnormalities that look like thin red lines extending from a central dot near the skin's surface. It occurs due to rapid decrease in estrogen levels after the end of pregnancy. Varicosity is an abnormal condition of the veins in the legs characterized by swelling and tortuosity, which is common during pregnancy and regresses after childbirth.

The nurse is caring for a postpartum patient who reports dizziness upon standing. What does the nurse believe to be the most likely cause for this occurrence? 1 Endometritis 2 Hemorrhoids 3 Puerperal sepsis 4 Orthostatic hypotension

4 - Orthostatic hypotension pg 465 - Orthostatic hypotension develops as a result of splanchnic engorgement after birth, which causes dizziness immediately upon standing upright. Decreased blood pressure results from hypovolemia due to hemorrhage. Manifestations of endometritis include pain, fever, and abdominal tenderness, along with continued flow of lochia serosa or alba up to 3 to 4 weeks. Manifestations of hemorrhoids include itching, discomfort, and bright red bleeding upon defecation. Puerperal sepsis manifests by an increase in the maternal temperature up to 38° C (100.4° F) 24 hours after childbirth. This increased temperature persists or recurs for about 2 days.

The nurse provides care to four patients on the maternity unit who just gave birth. Which patient requires the nurse to notify the health care provider? 1 Patient has puerperal bradycardia 36 hours after birth. 2 Patient has elevated stroke volume 45 minutes after birth. 3 Patient's blood pressure increased 4% the first few days after birth. 4 Patient is febrile with a temperature of 100.2°F 48 hours after birth.

4 - Patient is febrile with a temperature of 100.2°F 48 hours after birth. pg 465 - During the first 24 hours after birth, the woman's temperature can rise, but the woman should be afebrile after 24 hours. Therefore, a fever of 100.2° F 48 hours after birth requires notifying the health care provider, as it can be caused by puerperal sepsis, mastitis, endometritis, urinary tract infection, or other systemic infections. Puerperal bradycardia is common for the first 48 hours after birth. An elevated stroke volume and cardiac output is normal for the first hour or so after birth. An increase in blood pressure is normal up to 5% for the first few days after birth.

After the delivery of a baby, the nurse instructs the patient to immediately start breastfeeding. Which complication is the nurse trying to prevent by giving this instruction? 1 Hemorrhoids 2 Endometritis 3 Maternal infection 4 Postpartum hemorrhage

4 - Postpartum hemorrhage pg 460 - Breastfeeding immediately after childbirth increases the release of the oxytocin hormone, which decreases blood loss and reduces the risk of postpartum hemorrhage. Therefore the nurse instructs the patient to immediately start breastfeeding. Oxytocin does not have any effect on hemorrhoids; therefore it does not help reduce the risk of hemorrhoids. Breastfeeding may not affect endometritis. Breastfeeding prevents infection in the child, but it does not prevent infection in the mother.

The nurse assesses a postpartum patient several hours after birth and suspects that the uterus is subinvoluted. What could be a potential etiology for this finding? 1 Estrogen levels 2 Progesterone levels 3 Impaired platelet aggregation 4 Retained placental fragments

4 - Retained placental fragments pg 460 - Retained placental fragments or infection causes subinvolution of the uterus. Therefore the nurse should assess the patient for any placental fragments in the uterus. Estrogen and progesterone stimulate massive growth of the uterus during pregnancy. In the postpartum stage, the hormone levels are reduced and, therefore, do not affect involution of the uterus. Platelet aggregation causes uterine muscle contraction, but it does not result in involution of the uterus.

The nurse advises a pregnant patient to do static abdominal exercises. How would these exercises benefit the patient? 1 They will lead to a normal vaginal childbirth. 2 The patient will have diastasis recti abdominis. 3 The patient will not have any abdominal striations. 4 They will help the patient to gain proper abdominal tone after birth.

4 - They will help the patient to gain proper abdominal tone after birth. pg 466 - A firm, muscular wall with less adipose tissue would ensure that the patient is able to regain the prepregnancy abdominal tone after birth. Thus the nurse should advise the patient to do static abdominal exercises during pregnancy. The abdominal tone is not a factor based on which the nurse can determine whether the patient would have a normal vaginal delivery. Patients with weak abdominal muscles, especially those who have multifetal gestation or a large fetus, are at the risk of having diastasis recti abdominis. These abdominal striations usually do not fade away completely. Although the abdominal skin retains its tone, some striae always remain.

The nurse instructs the pregnant patient to exercise her lower limbs frequently. What clinical condition is the nurse trying to prevent? 1 Hemorrhoids 2 Endometritis 3 Dyspareunia 4 Thromboembolism

4 - Thromboembolism pg 464 - Fibrinogen is normally increased during pregnancy and remains elevated in the immediate puerperium. Fibrinogen may lead to thromboembolism due to immobility. Therefore the nurse instructs the patient to exercise the lower limbs frequently to prevent the risk of thromboembolism. Hemorrhoids occur as a result of the pressure from the fetus on the abdomen, hormonal changes, and increased intraabdominal pressures during pregnancy. Exercise of the lower limbs is not helpful in reducing the risk of hemorrhoids. Lower-limb exercise does not reduce the risk of endometritis either, because it is associated with uterine discharge. Lower-limb exercises do not produce any effect on uterine discharge. Estrogen deficiency is responsible for a decreased amount of vaginal lubrication, and it leads to dyspareunia. Exercise of the lower limbs does not increase estrogen.

A patient who had a cesarean birth is immobile in the immediate postoperative period. Which risk is increased in the patient as a result of the hypercoagulable state of the puerperal period? 1 Thrombocytosis 2 Thrombophlebitis 3 Thrombocytopenia 4 Thromboembolism

4 - Thromboembolism pg 464 - Thromboembolism refers to the condition in which a blood vessel is blocked by a blood clot. As the postpartum period is characterized by a hypercoagulation state, the patient is at risk of thromboembolism. Thrombophlebitis is the inflammation of the vein and is not associated with hypercoagulation. Thrombocytopenia refers to the condition in which low levels of platelet are found in the blood. Thrombocytosis is a condition characterized by a significant increase in the number of platelets in the blood.

The nurse is caring for a postpartum patient. Within 1 to 2 hours of delivery, the primary health care provider (PHP) prescribes intravenous (IV) oxytocin (Pitocin) for the patient. What are the most probable reasons for this prescription? Select all that apply. 1 To treat subinvolution 2 To decrease afterpains 3 To decrease lochia alba 4 To promote hemostasis 5 To compress blood vessels 6 To increase the uterine contractions (UCs)

4 - To promote hemostasis 5 - To compress blood vessels 6 - To increase the uterine contractions (UCs) pg 460 - Oxytocin (Pitocin) is a hormone that is secreted in postpartum patients. Oxytocin causes smooth muscle contractions and increases the UCs, which, in turn, compresses the blood vessels and promotes hemostasis. Lochia alba is a postbirth uterine discharge, and oxytocin has no effect on lochia alba. The afterpains are intensified as a result of the oxytocin; there is a direct effect of oxytocin on smooth muscle contractions. The more intense the contractions are during labor, the greater are the afterpains. Subinvolution is the failure of the uterus to return to its normal shape after delivery, and it cannot be treated by oxytocin.