Chapter 20, Postpartum Physiologic Changes

In assessing a postpartum client, the nurse is aware of which characteristic of normal postbirth uterine/vaginal discharge?

It should smell like normal menstrual flow unless infection is present.

The nurse is educating a student nurse regarding postpartum physiologic changes to the placental site. Which statement by the student nurse indicates a need for further teaching?

"Endometrial regeneration takes at least 3 weeks."

Which statement by the client who just gave birth and is not breastfeeding indicates effective learning about menstrual activity after childbirth?

"My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles."

The nurse is caring for a client after a cesarean delivery. The client had read about lochial discharge after delivery and is anxious because of a decreased amount of lochia. Which response by the nurse would reduce the client's anxiety?

"This is normal after a cesarean delivery."

A client who is at 32 weeks of gestation asks the nurse when she will start menstruating after delivery. Which question would the nurse ask before responding to the client's question?

"Will you be breastfeeding your child after delivery?"

The nurse is teaching a primigravida mother who has delivered twins and is breastfeeding about postpartum changes. Which information would the nurse include in the teaching?

"You may have painful uterine spasms while breastfeeding."

While examining the postpartum client, the nurse finds that the client's fundus is located halfway between the umbilicus and the symphysis pubis. Based on this assessment, the nurse would estimate which postdelivery time?

6 days ago

The nurse is assessing a postpartum client 1 day postdelivery. The client reports that she has not had a bowel movement since delivery. Which nursing intervention would be most suitable in this situation?

Inform the client that this finding is normal.

The nurse is caring for a postpartum client with type 1 diabetes. The client reports dizziness on the first day postdelivery in spite of taking her regular medication. Which is the priority nursing action in this case?

Assess the client's blood glucose levels.

Which clinical finding is a primary concern for a client 4 hours post-vaginal delivery?

Bladder distention

The nurse caring for a postpartum client finds that the client has started producing true milk. Which finding would lead the nurse to this conclusion?

Bluish white milk

Which hormone levels decrease postpartum? Select all that apply.

Cortisol Estrogen Progesterone

The nurse is aware that which factor is responsible for postpartal diuresis?

Decreased venous pressure

The nurse is caring for a client who gave birth to triplets and observes that the client's abdomen is overdistended and the abdominal muscle walls are separated. Which client condition is likely and should be further evaluated?

Diastasis recti abdominis

Which physiologic change is appropriate to discuss with a client who is concerned about the resolution of her carpal tunnel syndrome after delivery?

Diuresis

A client gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the client'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 nurse knows the most serious consequence likely to occur from bladder distention is which factor?

Excessive uterine bleeding

The nurse is aware of which factor regarding the conditioning and reconditioning of the urinary system after childbirth?

Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.

Which findings would cause concern for the nurse who is monitoring a postpartum client who had a spontaneous vaginal delivery of a 10-pound infant?

Fundus midline and firm with spurts of bright red blood on fundal massage

Which clinical findings are expected during the first 48 to 72 hours postpartum? Select all that apply.

Glycosuria Diaphoresis Increased urinary output

Which changes are consistent with metabolic function during the postpartum period? Select all that apply.

Increased basal metabolic rate (BMR) in the immediate postpartum period Decrease in estrogen and cortisol levels

During a follow-up postpartum visit 1 month after delivery, the nurse finds that the client has fever, pain, abdominal tenderness, and foul-smelling lochia. Which condition is likely to be found in the client?

Infection

The nurse is caring for a client who is 1 day postpartum. When the client stands for the first time the next morning to empty her bladder, a huge gush of blood is expelled from the vagina. Which is the priority nursing action in this case?

Inform the client that it is a normal finding.

Which physiologic change causes a postpartum increase in circulating blood volume?

Mobilization of extravascular fluid

On the second day postpartum, the client reports feeling dizzy when she stands up. Which is the probable reason for the client's dizziness?

Orthostatic hypotension

The nurse is teaching a postpartum client how to perform Kegel exercises and asks the client to practice these exercises regularly. Which postpartum complication is the nurse trying to prevent with this instruction?

Pelvic relaxation

A postpartum client reports severe headaches. When reviewing the client's medical record, the nurse finds that the client's blood pressure was 150/100 mm Hg and 160/90 mm Hg on the second and third postpartum days, respectively. Which condition may be responsible for these alterations in blood pressure?

Preeclampsia

The nurse would assess for which complication before planning care for a client who has undergone a forceps-assisted delivery?

Presence of vaginal lacerations

Which nursing action is appropriate after performing the final fundal assessment for recovery of a client 2 hours post-vaginal delivery whose fundus is firm, at the umbilicus, midline, with bright red lochia trickling from the vagina?

Reassessing per protocol

The nurse is caring for a client who delivered twins. After delivery, the client reports uterine cramping while breastfeeding. Which action would the nurse take in this situation?

Reassure the client that it will subside within 3 to 7 days.

The nurse is assessing a postpartum client 6 hours after delivery. The nurse finds that the client's body temperature is 100.3°F. Which action would the nurse perform in this situation?

Recheck the temperature again 24 hours after delivery.

The nurse is caring for a client who underwent a cesarean delivery and notes that an epidural opioid medication was administered to the client. Which potential complication would the nurse assess for in the immediate postpartum period?

Respiratory depression

Which change in the respiratory system would the nurse consider to be within normal range when caring for a postpartum client?

Rise in PaCO2 levels

The nurse is caring for a client who delivered a 7-lb baby girl yesterday, and the client is complaining of stress incontinence. The nurse knows which is likely the cause of the client's stress incontinence?

Stress incontinence can be related to tissue trauma to the pelvic floor.

When assessing a postpartum client, the nurse knows that which factors can cause headaches the first week after delivery?

Stress, onset of preeclampsia, and leakage of cerebrospinal fluid into the extradural space

The nurse is conducting a pelvic examination of a postpartum client 6 weeks after delivery and finds that the client has a palpable uterus and an infection caused by retention of placental fragments. Which term would the nurse utilize in describing the client's condition?

Subinvolution

Which vital sign is anticipated to change in association with breast engorgement?

Temperature

Which are considered normal findings of vital signs after childbirth? Select all that apply.

The client is afebrile 24 hours after delivery. Blood pressure shows a transient increase of approximately 5% over the first few days after delivery.

Which assessment finding would the nurse expect in a postpartum client 12 hours after delivery?

The fundus is approximately 1 cm above the umbilicus.

Which finding needs close monitoring for a client returning from the recovery room from a cesarean delivery based on evaluation of the client's electronic health record (EHR)?

Thromboembolism

The nurse is aware of which symptoms of carpal tunnel syndrome when performing a prenatal assessment? Select all that apply.

Tingling of fingers Numbness of fingers

Which fundal height is appropriate on the second postpartum day for a client whose fundal height 1 day postpartum was U+1, midline, and firm?

U/U

The nurse is providing teaching to a postpartum client who is bottle feeding and whose breasts are engorged. Which instruction would the nurse include in the teaching?

Wear a snug, supportive bra.

Based on the postpartum client's description, the nurse concludes that the client has lochia alba. Which description would lead the nurse to this conclusion?

Yellow-colored discharge