OB - Chapter 15: Postpartum Adaptations More good questions

You are the home health nurse making an initial call on a new mother who delivered her third baby five days ago. The woman says to you "I just feel so down this time. Not at all like when I had my other babies. And this one just doesn't sleep. I feel so inadequate." What is the best response to this new mother? a) "It sounds like you need to make an appointment with a counselor. You may have postpartum depression." b) "It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the delivery. They will most likely go away in a day or two." c) "Tell me, are you seeing things that aren't there, or hearing voices?" d) "Every baby is different with their own temperament. Maybe this one just isn't ready to sleep when you want him to."

"It sounds like you have the 'baby blues.' They are common after having a baby when you are not getting enough sleep, are busy with your other children, and are still a bit uncomfortable from the delivery. They will most likely go away in a day or two."

A new mother is concerned because it is 24 hours after childbirth and her breasts have still not become engorged with breast milk. How should the nurse respond to this concern? a) "It takes about 3 days after birth for milk to begin forming." b) "You are experiencing lactational amenorrhea. It may be several weeks before your milk comes in." c) "I'm sorry to hear that. There are some excellent formulas on the market now, so you will still be able to provide for your infant's nutritional needs." d) "You may have developed mastitis. I'll ask the physician to examine you."

"It takes about 3 days after birth for milk to begin forming."

A woman who gave birth to a healthy newborn 2 months ago comes to the clinic and reports discomfort during sexual intercourse. Which suggestion by the nurse would be most appropriate? a) "It takes a while to get your body back to its normal function after having a baby." b) "This is entirely normal, and many women go through it. It just takes time." c) "Try doing Kegel exercises to get your pelvic muscles back in shape." d) "You might try using a water-soluble lubricant to ease the discomfort."

"You might try using a water-soluble lubricant to ease the discomfort."

The nurse is assigned to a patient on postpartum day 1. Prior to assessing her uterus, where should the nurse anticipate she will locate the fundus? a) At level of umbilicus b) 1cm above the umbilicus c) 1cm below the umbilicus d) At the symphysis pubis

1cm below the umbilicus

Louisa has just delivered her second child and will breast-feed. Although she wants "lots of kids," she doesn't want to become pregnant again until her second child is at least 2 years old. You counsel her to start using birth control at what point? a) Within 6 weeks b) As soon as she stops breast-feeding c) As soon as she resumes sexual activity d) Within 18 months

As soon as she resumes sexual activity

A woman has just delivered a baby. Her prelabor vital signs were temperature: 98.8°F (37.1°C); blood pressure: 120/70 mmHg; pulse; 80 beats/min. and respirations: 20breaths/min. Which combination of findings during the early postpartum period are the most concerning? a) Shaking chills with a fever of 100.4°F (38°C) b) Blood pressure 90/50 mmHg, pulse 120 beats/min, respirations 24 breaths/min. c) Bradycardia and excessive, soaking diaphoresis d) Blood loss of 250 mL and WBC 25,000 cells/mL

Blood pressure 90/50 mmHg, pulse 120 beats/min, respirations 24 breaths/min.

While making a follow up home visit to a client in her first week postpartum, the nurse notes that she has lost 5 pounds. Which of the following would be the most likely reason for the weight loss? a) Blood loss b) Diuresis c) Lactation d) Nausea

Diuresis

For several hours after delivery, Norah, a multigravida who experienced a much more difficult labor this time than any time previously, wants to talk about why the birthing process was so hard for her this time. In fact, she's focusing on this aspect to the point that she seems relatively indifferent to her newborn. How should you handle this situation? a) Redirect her attention to the baby by reminding her of the details of newborn care b) Encourage her to discuss her experience of the birth and answer any questions or concerns she may have c) Ask her to describe how she plans to integrate the newcomer into her existing family, including any actions she has taken to prepare the siblings d) Point out positive features of her baby and encourage her to hold and cuddle the baby

Encourage her to discuss her experience of the birth and answer any questions or concerns she may have

The patient under your care is complaining she has not had a bowel moment since her infant was born 2 days ago. She asks the nurse what she can do to help her have a bowel movement. What intervention is appropriate to encourage having a bowel movement? a) Encourage the patient to eat more fiber rich foods b) Offer the patient a stimulant laxative c) Have her hold her feces until she really feels the need to defecate d) Add dairy products to the patient's diet

Encourage the patient to eat more fiber rich foods

The nurse is assessing a breastfeeding mom 72 hours after delivery. When assessing her breast, the patient complains of bilateral breast pain around the entire breast. What is the most likely cause of the pain? a) Engorgement b) Blocked milk duct c) Mastitis d) Interductal yeast infection

Engorgement

When describing the hormonal changes that occur after birth of a newborn, the nurse would identify a decrease in which hormone as being associated with breast engorgement? a) Progesterone b) Human chorionic gonadotropin (hCG) c) Prolactin d) Estrogen

Estrogen

A woman who has just given birth seems to be bonding with her newborn, despite the fact that earlier in labor she had expressed an intent to give the baby up for adoption. In this case, the nurse should encourage the mother to keep her baby. a) False b) True

False

A nurse is caring for a breastfeeding client who complains of engorgement. The nurse identifies that the client's condition is due to not fully emptying her breasts at each feeding. Which of the following should the nurse suggest to help her prevent engorgement? a) Apply cold compresses to the breasts b) Feed the baby at least every two or three hours c) Provide the infant oral nystatin d) Dry the nipples following feedings

Feed the baby at least every two or three hours

When assessing a postpartum woman, which finding would be most significant in identifying possible postpartum hemorrhage? a) Increased hematocrit level b) Increased blood pressure c) Increased cardiac output d) Increase heart rate

Increase heart rate

A nurse is caring for a client who is nursing her baby boy. The client complains of afterpains. Secretion of which of the following should the nurse identify as the cause of afterpains? a) Estrogen b) Prolactin c) Progesterone d) Oxytocin

Oxytocin

You are used to working on the postpartum floor taking care of women who have had normal vaginal deliveries. Today, however, you have been assigned to help care for woman who are less than 24 hours post cesarean delivery. You know that in making your assessments you will have to change some things that you would not normally assess. What would you leave out of your patient assessments? a) Breasts b) Lower extremities c) Perineum d) Respiratory status

Perineum

A woman who delivered a healthy baby 5 days ago is experiencing fatigue and weepiness, lasting for short periods each day. Which of the following factors/conditions does the nurse believe is causing this experience? a) Postpartum depression. b) Postpartum anxiety. c) Postpartum baby blues. d) Postpartum reaction.

Postpartum baby blues.

A nurse is caring for a client in the postpartum period. The client is emotionally sensitive, feels a sense of failure, and attempts to hurt herself and the baby. The nurse understands that the client is exhibiting symptoms of which of the following conditions? a) Postpartum psychosis b) Postpartum blues c) Anxiety disorders d) Postpartum depression

Postpartum depression Postpartum blues are due to lack of sleep and emotional labilities. Postpartum psychosis is symbolized by confusion, hallucinations, and delusions. Postpartum anxiety disorders involve shortness of breath, chest pain, and tightness.

A nurse is caring for a client on the second day postpartum. The client informs the nurse that she is voiding a large volume of urine frequently. Which of the following should the nurse identify as a potential cause for urinary frequency? a) Urinary overflow b) Trauma to pelvic muscles c) Postpartum diuresis d) Urinary tract infection

Postpartum diuresis

What is the primary function of uterine contractions after delivery of the infant and placenta? a) Return the uterus to normal size b) Seal off the blood vessels at the site of the placenta c) Stop the flow of blood d) Close the cervix

Seal off the blood vessels at the site of the placenta

Which factor might result in a decreased supply of breast milk in a postpartum client? a) Maternal diet high in vitamin C b) Supplemental feedings with formula c) An alcoholic drink d) Frequent feedings

Supplemental feedings with formula

During the second day postpartum, a nurse notices that a client is initiating breastfeeding with her infant and changing her infant's diapers with some assistance from her partner. Which of the following does the nurse recognize as the phase the woman is experiencing? a) The taking hold phase. b) The taking in phase. c) The binding in phase. d) The letting go phase.

The taking hold phase.

During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After delivery, during the early postpartum period, the woman eliminates the additional fluid volume she has been carrying. What is one way she does this? a) Urinary elimination b) Being too tired to eat c) Elimination of solid wastes d) Breathing off fluid vapor

Urinary elimination

A nurse is caring for a non-breastfeeding client in the postpartum period. The client complains of engorgement. What suggestion should the nurse provide to alleviate breast discomfort? a) Wear a well-fitting bra b) Apply hydrogel dressing c) Apply warm compress d) Express milk frequentlym

Wear a well-fitting bra

While visiting a client at home on the 10th day postpartum, the nurse assesses the client's lochia. Which of the following would the nurse interpret as an expected finding? a) Yellowish pink b) Yellowish white c) Red d) Pink

Yellowish white

A nurse is assessing a client's lochia every 15 minutes for the first hour during the fourth stage of labor. Which of the following would the nurse expect to assess? a) Lochia alba saturating at least 3 pads b) Moderate lochia rubra with no clots c) Lochia rubra with few clots d) Lochia rubra saturating two pads

Moderate lochia rubra with no clots

When assessing a new father's adaptation to his new role, which statement would indicate that he is in the reality stage? a) "I didn't realize all that went into being a dad. I wasn't prepared for this." b) "It'll be fun to have a baby in the house, but things shouldn't change too much." c) "I may not be a pro at helping out with the baby, but I enjoy being involved." d) "I've learned how to diaper and bathe the baby so I can be a really involved dad."

"I didn't realize all that went into being a dad. I wasn't prepared for this."

A nurse is examining a client who underwent a vaginal birth 24 hours ago. The client asks the nurse why her discharge is such a deep red color. What explanation is most accurate for the nurse to give to the client? a) "It is normal for the discharge to be deep red since it consists of leukocytes, decidual tissue, RBCs, and serous fluid." b) "This discharge is called lochia, and it consists of leukocytes and decidual tissue." c) "The discharge consists of mucus, tissue debris, and blood; this gives it the deep red color." d) "The discharge at this point in the postpartum period consists of RBCs and leukocytes."

"The discharge consists of mucus, tissue debris, and blood; this gives it the deep red color."

A client who had a vaginal delivery 2 days ago asks the nurse when she will be able to breathe normally again. Which response by the nurse is accurate? a) "Within 1 to 3 weeks, your diaphragm should return to normal and your breathing will feel like it did before your pregnancy." b) "Everyone is different, so it is difficult to say when your respirations will be back to normal." c) "It usually takes about 3 months before all of your abdominal organs return to normal, allowing you to breathe normally." d) "You should notice a change in your respiratory status within the next 24 hours."

"Within 1 to 3 weeks, your diaphragm should return to normal and your breathing will feel like it did before your pregnancy."

Five days after giving birth, a new mother tells her nurse that she has lost some weight but still feels as if she has a long way to go to return to her prepregnancy weight. She asks what the average weight loss at 5 days into the postpartal period is. Which of the following should the nurse mention? a) 24 lb b) 14 lb c) 9 lb d) 19 lb

19 lb

The nurse is monitoring a postpartum client who says she's concerned because she feels mildly depressed. The nurse recognizes that she's most likely experiencing "postpartum blues," and reassures the client that this symptom is experienced by approximately what percentage of women? a) 85% b) 25% c) 100% d) 40%

85%

Bonding between a mother and her infant can be defined how? a) A process of developing an attachment and becoming acquainted with each other b) An ongoing process in the year after delivery c) Family growing closer together after the birth of a new baby d) The skin to skin contact that occurs in the delivery room

A process of developing an attachment and becoming acquainted with each other

A client gave birth to a healthy boy 2 days ago. Both mother and baby have had a smooth recovery. The nurse enters the room and tells the client that she and her baby will be discharged home today. The client states, "I do not want to go home." Which of the following is the nurse's most appropriate response? a) Inform the physician that the client does not want to go home. b) Ask the client if she has any support in the home. c) Tell the client that she must go home as per hospital policy. d) Ask the client why she does not want to go home.

Ask the client why she does not want to go home.

A woman is bottle-feeding her baby. When the nurse comes into the room the woman says that her breasts are painful and engorged. Which nursing intervention is appropriate? a) Ask if she wants a breast pump to empty her breasts b) Explain to the woman that she should breastfeed because she is producing so much milk c) Assist the woman in placing ice packs on her breasts d) Assist the woman into the shower and have her run cold water over her breasts

Assist the woman in placing ice packs on her breasts

A new mother, who is an adolescent, was cautious at first when holding and touching her newborn. She seemed almost afraid to make contact with baby and only touched it lightly and briefly. However, 48 hours after the birth, the nurse now notices that the new mother is pressing the newborn's cheek against her own and kissing her on the forehead. The nurse recognizes these actions as which of the following? a) Attachment b) Involution c) Engorgement d) Engrossment

Attachment

A nurse is caring for a client who has been treated for a deep vein thrombosis (DVT). Which teaching point should the nurse stress when discharging the client? a) Avoid use of oral contraceptives. b) Avoid using compression stockings. c) Avoid using products containing aspirin. d) Plan long rest periods throughout the day.

Avoid use of oral contraceptives.

A patient who delivered her infant 3 days ago and was discharged home calls her provider's office with a complaint of sweating all night. What is the cause of the increased perspiration? a) Change in pregnancy hormone b) Body secreting the excess fluids from pregnancy c) The body is trying to get rid of the extra blood made during pregnancy d) The patient may be drinking too much fluid

Body secreting the excess fluids from pregnancy

A nurse is caring for a client who has just undergone delivery. What is the best method for the nurse to assess this client for postpartum hemorrhage? a) By assessing blood pressure b) By assessing skin turgor c) By monitoring hCG titers d) By frequently assessing uterine involution

By frequently assessing uterine involution

A nurse is caring for a client postpartum who complains of sore nipples. The nurse observes that the client's newborn is unable to suck properly although latched well. What intervention should the nurse perform to assist the baby to suck properly? a) Prolong the gap between feedings b) Check the baby's frenulum c) Position baby to face the nipple d) Suggest bottle feeding

Check the baby's frenulum

A client in her sixth week postpartum complains of general weakness. The client has stopped taking iron supplements that were prescribed to her during pregnancy. The nurse would assess the client for which of the following? a) Hypovolemia b) Hypertension c) Hypothyroidism d) Hyperglycemia

Hypovolemia

A woman who is breastfeeding her newborn reports that her breasts seem quite full. Assessment reveals that her breasts are engorged. Which of the following would the nurse identify as the most likely factor for this development? a) Cracking of the nipple b) Improper positioning of infant c) Inability of infant to empty breasts d) Inadequate secretion of prolactin

Inability of infant to empty breasts

The nurse is caring for a client who had been administered an anesthetic block during labor. Which of the following are risks that the nurse should watch for in the client? Select all that apply. a) Perineal laceration b) Incomplete emptying of bladder c) Bladder distention d) Urinary retention e) Ambulation difficulty

Incomplete emptying of bladder Bladder distention Urinary retention

The process by which the reproductive organs return to the nonpregnant size and function is termed what? a) Evolution b) Involution c) Decrement d) Progression

Involution

A nurse is caring for a client who has had a vaginal birth. The nurse understands that pelvic relaxation can occur in any woman experiencing a vaginal birth. Which of the following should the nurse recommend to the client to improve pelvic floor tone? a) Sitz baths b) Kegel exercises c) Urinating immediately when the urge is felt d) Abdominal crunches

Kegel exercises

A client complains to the nurse of pain in the lower back, hips, and joints 10 days after the birth of her baby. What instruction should the nurse give the client after birth to prevent low back pain and injury to the joints? a) Apply ice to the sore joints. b) Soak in a warm bath several times a day. c) Maintain correct posture and positioning. d) Try to avoid carrying the baby for a few days.

Maintain correct posture and positioning.

During a postpartum exam on the day of delivery, the woman complains that she is still so sore that she can't sit comfortably. You examine her perineum and find the edges of the episiotomy approximated without signs of a hematoma. Which intervention will be most beneficial at this point? a) Apply a warm washcloth b) Place an ice pack c) Put on a witch hazel pad. d) Notify a physician

Place an ice pack

Charting on the nursing care plan patient care, which nursing diagnosis has the highest priority for a postpartum patient? a) Acute pain related to afterpains or episiotomy discomfort b) Risk for infection related to multiple portals of entry for pathogens, including the former site of the placenta, episiotomy, bladder and breasts c) Risk for injury: postpartum hemorrhage related to uterine atony d) Risk for injury: falls related to postural hypotension and fainting

Risk for injury: postpartum hemorrhage related to uterine atony

Which of the following actions would lead you to assess that a postpartal woman is entering the taking-hold phase of the postpartal period? a) She did her perineal care independently. b) She is eager to talk about her delivery experience. c) She has not asked for anything for pain all day. d) She sits and rocks her infant for long intervals.

She did her perineal care independently.

Which maternal reaction is the most concerning? a) She neglects to engage with or provide care for the baby and shows little interest in it b) She expresses doubt about her ability to care for the baby as well as the nurse can c) She hesitates to take her newborn when offered and expresses disappointment with the way the baby looks d) She is tearful for several days and has difficulty eating and sleeping

She neglects to engage with or provide care for the baby and shows little interest in it

Which of the following actions would most make you believe that a postpartum woman is accepting a child well? a) She asks you to use her camera to take a photo of the child. b) She turns her face to meet the infant's eyes when she holds her. c) She states she has named the child after a well-loved friend. d) She comments that her baby has the most hair of any in the nursery.

She turns her face to meet the infant's eyes when she holds her.

A client is exhibiting signs of early engorgement, but her milk is still flowing easily. Which of the following suggestions would the nurse give to treat engorgement? a) Apply ice packs before a feeding. b) Restrict fluid intake. c) Have the baby nurse on both breasts with every feeding. d) Take a warm shower before a feeding.

Take a warm shower before a feeding

While caring for a client following a lengthy labor and delivery, the nurse notes that the client repeatedly reviews her labor and delivery and is very dependent on her family for care. The nurse is correct in identifying the client to be in which phase of maternal role adjustment? a) Taking-in b) Letting-go c) Taking-hold d) Acquaintance/attachment

Taking-in

A new mother gave birth to her baby 24 hours ago and today has been content to rest in her hospital bed, hold her baby, allow the nurse to care for her, and to discuss her labor and birth experience with visitors. Which phase of the puerperium is this client in? a) Letting-go phase b) Taking-hold phase c) Taking-in phase d) Rooming-in phase

Taking-in phase

Rubin identified a series of changes that a new mother makes during the postpartum period. The correct sequence of these changes is a) Taking-in, taking-hold, letting-go b) Taking-in, taking-on, letting-go c) Taking-in, holding-on, letting-go d) Taking, holding-on, letting-go

Taking-in, taking-hold, letting-go

While educating a class of postpartum patients before discharge home after delivery, one woman asks when "will I stop bleeding?" How should the nurse respond? a) The bleeding may slowly decrease over the next 1 to 3 weeks, changing color to a white discharge, which may continue for up to 6 weeks b) You should stop bleeding and have no discharge in the next 1 to 2 weeks c) The bleeding may continue for 6 weeks d) Bleeding may occur on and off for the next 2 to 3 weeks

The bleeding may slowly decrease over the next 1 to 3 weeks, changing color to a white discharge, which may continue for up to 6 weeks

A postpartum client complains of urinary frequency and burning. Which of the following would the nurse suspect? a) Urinary tract infection b) Stress incontinence c) Subinvolution d) Uterine atony

Urinary tract infection

The nurse is caring for a client in the postpartum period. The client has difficulty in voiding and is catheterized. The nurse then would monitor the client for which of the following? a) Stress incontinence b) Loss of pelvic muscle tone c) Increased urine output d) Urinary tract infection

Urinary tract infection

A nurse is caring for a client with postpartum hemorrhage. Which of the following should the nurse identify as the significant cause of postpartum hemorrhage? a) Iron deficiency b) Hemorrhoid c) Uterine atony d) Diuresis

Uterine atony

The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? a) Edematous vagina b) Diaphoresis c) Uterus 1 cm below umbilicus d) Lochia serosa

Uterus 1 cm below umbilicus

The nurse is making a home visit to a woman who is 4 days postpartum. Which finding would indicate to the nurse that the woman is experiencing a problem? a) Uterus 1 cm below umbilicus b) Diaphoresis c) Edematous vagina d) Lochia serosa

Uterus 1 cm below umbilicus

The nurse assesses a postpartum woman for thromboembolism based on the understanding that her risk is increased because of which of the following? a) Increased white blood cell count b) Vessel damage during birth c) Episiotomy d) Decrease in coagulation factors

Vessel damage during birth

The nurse is providing education to a mother who is going to bottle feed her infant. What information will the nurse provide to this mom regarding breast care? a) Wear a tight, supportive bra b) Run warm water over the breast in the shower c) Express small amounts of milk when they are too full d) Massage the breast when they are painful

Wear a tight, supportive bra

A woman who delivered her infant 1 week ago calls the clinic to complain of pain with urination and increased frequency. What response by the nurse is appropriate? a) "It is common for women to have yeast problems, try an over the counter cream and let us know if this continues." b) "Are you washing and providing good perineal hygiene? If not, this may be the reason for the irritation." c) "After delivery it is easier to develop an infection in the urinary system, we need to see you today." d) "This is normal, give it a few days and then call back."

"After delivery it is easier to develop an infection in the urinary system, we need to see you today."

A client who recently gave birth to her third child expresses a desire to have her older two come to the hospital for a visit. Which of the following should the nurse say in response to this request? a) "Your baby is so vulnerable to infections right now that it would be better to wait until you are at home to introduce her to her siblings." b) "I recommend that you introduce the new baby to her siblings once you are back at home. Right now you need to rest and recover." c) "That's a great idea! They can also take the baby out into the hall and walk with it for a while to give you a break." d) "As long as they are well, absolutely. Why don't we give you a dose of pain medication beforehand so that you will enjoy the visit?"

"As long as they are well, absolutely. Why don't we give you a dose of pain medication beforehand so that you will enjoy the visit?"

A client who gave birth 5 days ago complains to the nurse of profuse sweating during the night. What should the nurse recommend to the client in this regard? a) "Be sure to change your pajamas to prevent you from chilling." b) "I'm not sure why this is occurring since this usually doesn't occur until much later in the postpartum perio" c) "Drink plenty of cold fluids before you go to bed." d) "I would suggest that you speak with your physician about this."

"Be sure to change your pajamas to prevent you from chilling."

After teaching a group of pregnant women about the skin changes that will occur after the birth of their newborn, which statement indicates the need for additional teaching? a) "I can't wait for these stretch marks to disappear after delivery." b) "My nipples won't be so dark after I give birth." c) "This line on my belly will go away over time." d) "I might lose some hair, but it will grow back."

"I can't wait for these stretch marks to disappear after delivery."

A nurse is caring for a client who gave birth about 10 hours earlier. The nurse observes perineal edema in the client. What intervention should the nurse perform to decrease the swelling caused due to perineal edema? a) Use ointments locally b) Use a warm sitz bath or tub bath c) Apply moist heat d) Apply ice

Apply ice

Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? a) Applying ice b) Administering bromocriptine (Parlodel) c) Applying warm compresses d) Restricting fluids

Applying ice

On assessment of a 2-day postpartum patient the nurses finds the fundus is boggy, at the umbilicus and slightly to the right. What is the most likely cause of this assessment finding? a) Bladder distention b) Full bowel c) Uteruine atony d) Poor bladder tone

Bladder distention

The nurse, assessing the lochia of a client, attempts to separate a clot and identifies the presence of tissue. Which of the following observations would indicate the presence of tissue? a) Yellowish white lochia b) Easy to separate clots c) Foul-smelling lochia d) Difficult to separate clots

Difficult to separate clots

A client in the postpartum period complains of constipation. The nurse should inform the client of which of the following that contributes to postpartum constipation? a) Separation of rectus muscles b) Relaxation of abdominal muscles c) Distention of abdominal muscles d) Discomfort due to hemorrhoids

Discomfort due to hemorrhoids

As the nurse caring for postpartum patients, what laboratory study would you expect to have ordered by the birth attendant the morning after delivery of the baby? a) Blood type b) Complete blood count (CBC) c) Hemoglobin and hematocrit (H&H) d) Iron level

Hemoglobin and hematocrit (H&H)

Which assessment on the third postpartal day would make you evaluate a woman as having uterine subinvolution? a) She experiences "pulling" pain while breastfeeding. b) Her uterus is at the level of the umbilicus. c) Her uterus is 2 cm above the symphysis pubis. d) Her uterus is three finger widths under the umbilicus.

Her uterus is at the level of the umbilicus.

A nurse is assessing a breastfeeding client in the third week postpartum. During assessment, the nurse observes that the rugae in the vagina have not reappeared. Which of the following should the nurse identify as the possible cause of delayed return of rugae? a) Low circulating progesterone level b) Low circulating oxytocin level c) High circulating estrogen level d) High circulating prolactin level

High circulating estrogen level

Which lochia pattern should be reported immediately? a) Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5 b) Moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5 c) Moderate lochia rubra on day 3, mixed serosa and rubra on day 4, light serosa on day 5 d) Lochia progresses from rubra to serosa to alba within 10 days

Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5

A client delivered vaginally 2 days prior and wishes to prevent getting pregnant again. She asks the nurse when she will need to begin birth control measures. How should the nurse respond? a) You will not ovulate until your menstrual cycle returns b) Ovulation does not return for 6 months after delivery c) You may have intercourse until next month with no fear of pregnancy d) Ovulation may return as soon as 3 weeks after delivery

Ovulation may return as soon as 3 weeks after delivery

A nurse is caring for a client who gave birth a week ago. The client informs the nurse that she experiences painful uterine contractions when breastfeeding the baby. The nurse would be accurate in identifying which hormone as the cause of these afterpains? a) Relaxin b) Prolactin c) Oxytocin d) Progesterone

Oxytocin

During the fourth stage of labor, the nurse assesses the client's fundal height and tone. When completing this assessment, the nurse does which of the following to prevent prolapse or inversion of the uterus? a) Palpates the abdomen while feeling the uterine fundus b) Places index and middle fingers across the muscle c) Massaging the fundus carefully to expel any blood clots d) Placing a gloved hand just above the symphysis pubis

Placing a gloved hand just above the symphysis pubis

A concerned client tells the nurse that her husband, who was very excited about the baby before its birth, is apparently happy but seems to be afraid of caring for the baby. What suggestions should the nurse give to the client's husband to resolve the issue? a) Recommend that she speak to the physician on her husband's behalf. b) Advise that her husband read up on parental care. c) Encourage the husband to speak to his friends who have children. d) Suggest that her husband begin by holding the baby frequently.

Suggest that her husband begin by holding the baby frequently.

A nurse is caring for a client in the postpartum period. The nurse observes that distention of the abdominal muscles during pregnancy has resulted in separation of the rectus muscles. What intervention should the nurse perform to assist in healing the distended abdominal muscles? a) Suggesting proper exercise b) Applying warm compresses c) Massaging the muscles d) Applying moist heat

Suggesting proper exercise

Which reason explains why women should be encouraged to perform Kegel exercises after delivery? a) They assist with lochia removal. b) They promote the return of normal bowel function. c) They assist the woman in burning calories for rapid postpartum weight loss. d) They promote blood flow, enabling healing and muscle strengthening.

They promote blood flow, enabling healing and muscle strengthening.

Based on the nurse's knowledge about the postpartum period and an increase in blood coagulability during the first 48 hours, the nurse closely assesses the client for which of the following? a) Hyperglycemia b) Varicose veins c) Thromboembolism d) Calcium depletion

Thromboembolism

For the first hour after birth, the height of the fundus is at the umbilicus or even slightly above it. a) False b) True

True

A client who gave birth about 12 hours ago informs the nurse that she has been voiding small amounts of urine frequently. The nurse examines the client and notes the displacement of the uterus from the midline to the right. What intervention will help the client most? a) Practicing good body mechanics b) Urinary catheterization c) A warm shower d) A warm compress

Urinary catheterization

The nurse explains to a client who recently gave birth that she will undergo both retrogressive and progressive changes in the postpartal period. Which of the following are retrogressive changes? (Select all that apply.) a) Beginning of a parental role b) Involution of the uterus c) Formation of breast milk d) Return of blood volume to prepregnancy level e) Decrease of pregnancy hormones f) Contraction of the cervix

• Involution of the uterus • Return of blood volume to prepregnancy level • Decrease of pregnancy hormones • Contraction of the cervix

A client who has given birth a week ago complains to the nurse of discomfort when defecating and ambulating. The birth involved an episiotomy. Which of the following should the nurse suggest to the client to provide local comfort? Select all that apply. a) Maintain correct posture b) Use of anesthetic sprays c) Use of warm sitz baths d) Use good body mechanics e) Use of witch hazel pads

• Use of warm sitz baths • Use of witch hazel pads • Use of anesthetic sprays

A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply. a) Uterine infection b) Prolonged labor c) Empty bladder d) Early ambulation e) Breast-feeding f) Hydramnios

• Uterine infection • Prolonged labor • Hydramnios