Exam 3 - Chapter 20 Flashcards
- A woman gave birth to an infant boy 10 hours ago. Where would the nurse expect to locate this woman’s fundus?
a. One centimeter above the umbilicus
b. Two centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
ANS: A
Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. The fundus descends about 1 to 2 cm every 24 hours. Within 12 hours after delivery the fundus may be approximately 1 cm above the umbilicus. By the sixth after birth week the fundus normally is halfway between the symphysis pubis and the umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference point.
- Which woman is most likely to experience strong afterpains?
a. A woman who experienced oligohydramnios
b. A woman who is a gravida 4, para 4-0-0-4
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 5 lbs, 3 ounces
ANS: B
Afterpains are more common in multiparous women. Afterpains are more noticeable with births in which the uterus was greatly distended, as in a woman who experienced polyhydramnios or a woman who delivered a 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?
a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa
ANS: D
Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally occurs around day 3 or 4 after childbirth. Lochia rubra consists of blood and decidual and trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or brown. There is no such term as lochia sangra. Lochia alba occurs in most women after day 10 and can continue up to 6 weeks after childbirth.
- Which hormone remains elevated in the immediate after birth period of the breastfeeding woman?
a. Estrogen
b. Progesterone
c. Prolactin
d. Human placental lactogen
ANS: C
Prolactin levels in the blood increase progressively throughout pregnancy. In women who breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and progesterone levels decrease markedly after expulsion of the placenta and reach their lowest levels 1 week into the after birth period. Human placental lactogen levels decrease dramatically after expulsion of the 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 after birth period is:
a. elevated temperature caused by after birth infection.
b. increased basal metabolic rate after giving birth.
c. loss of increased blood volume associated with pregnancy.
d. increased venous pressure in the lower extremities.
ANS: C
Within 12 hours of birth women begin to lose the excess tissue fluid that has accumulated during pregnancy. One mechanism for reducing these retained fluids is the profuse diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis is another mechanism by which the body rids itself of excess fluid.
An elevated temperature would cause chills and may cause dehydration, not diaphoresis and diuresis. Diaphoresis and diuresis sometimes are referred to as reversal of the water metabolism of pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal of increased venous pressure in the lower extremities.
- A woman gave birth to a 7-lb, 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 after birth period, the most serious consequence likely to occur from bladder distention is:
a. urinary tract infection.
b. excessive uterine bleeding.
c. a ruptured bladder.
d. bladder wall atony.
ANS: B
Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.
- The nurse caring for the after birth woman understands that breast engorgement is caused by:
a. overproduction of colostrum.
b. accumulation of milk in the lactiferous ducts.
c. hyperplasia of mammary tissue.
d. congestion of veins and lymphatics.
ANS: D
Breast engorgement is caused by the temporary congestion of veins and lymphatics, not by overproduction of colostrum, overproduction of milk, or hyperplasia of mammary tissue.
- A woman gave birth to a 7-lb, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was approximately 1500 mL. When assessing the woman’s vital signs, the nurse would be concerned to see:
a. temperature 37.9° C, heart rate 120, respirations 20, blood pressure (BP) 90/50.
b. temperature 37.4° C, heart rate 88, respirations 36, BP 126/68.
c. temperature 38° C, heart rate 80, respirations 16, BP 110/80.
d. temperature 36.8° C, heart rate 60, respirations 18, BP 140/90.
ANS: A
An EBL of 1500 mL with tachycardia and hypotension suggests hypovolemia caused by excessive blood loss. An increased respiratory rate of 36 may be secondary to pain from the birth. Temperature may increase to 38° C during the first 24 hours as a result of the dehydrating effects of labor. A BP of 140/90 is slightly elevated, which may be caused by the use of oxytocic medications.
- Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth?
a. “My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter.”
b. “My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.”
c. “I will not have a menstrual cycle for 6 months after childbirth.”
d. “My first menstrual cycle will be heavier than normal and then will be light for several months after.”
ANS: B
“My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles” is an accurate statement and indicates her understanding of her expected menstrual activity. She can expect her first menstrual cycle to be heavier than normal (which occurs by 3 months after childbirth), and the volume of her subsequent cycles will return to prepregnant levels within three or four cycles.
- The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the:
a. involutionary period because of what happens to the uterus.
b. lochia period because of the nature of the vaginal discharge.
c. mini-tri period because it lasts only 3 to 6 weeks.
d. puerperium, or fourth trimester of pregnancy.
ANS: D
The puerperium, also called the fourth trimester or the after birth period of pregnancy, lasts about 3 to 6 weeks. Involution marks the end of the puerperium, or the fourth trimester of pregnancy. Lochia refers to the various vaginal discharges during the puerperium, or fourth trimester of pregnancy.
- The self-destruction of excess hypertrophied tissue in the uterus is called:
a. autolysis.
b. subinvolution.
c. afterpain.
d. diastasis.
ANS: A
Autolysis is caused by a decrease in hormone levels. Subinvolution is failure of the uterus to return to a nonpregnant state. Afterpain is caused by uterine cramps 2 to 3 days after birth. Diastasis refers to the separation of muscles.
- With regard to the after birth uterus, nurses should be aware that:
a. at the end of the third stage of labor it weighs approximately 500 g.
b. after 2 weeks after birth it should not be palpable abdominally.
c. after 2 weeks after birth it weighs 100 g.
d. it returns to its original (prepregnancy) size by 6 weeks after birth.
ANS: B
After 2 weeks after birth, the uterus should not be palpable abdominally; however, it has not yet returned to its original size. At the end of the third stage of labor, the uterus weighs approximately 1000 g. It takes 6 full weeks for the uterus to return to its original size. After 2 weeks after birth the uterus weighs about 350 g, not its original size. The normal self-destruction of excess hypertrophied tissue accounts for the slight increase in uterine size after each pregnancy.
- With regard to after birth pains, nurses should be aware that these pains are:
a. caused by mild, continuous contractions for the duration of the after birth period.
b. more common in first-time mothers.
c. more noticeable in births in which the uterus was overdistended.
d. alleviated somewhat when the mother breastfeeds.
ANS: C
A large baby or multiple babies overdistend the uterus. The cramping that causes after birth pains arises from periodic, vigorous contractions and relaxations, which persist through the first part of the after birth period. After birth pains are more common in multiparous women because first-time mothers have better uterine tone. Breastfeeding intensifies after birth pain because it stimulates contractions.
- Post birth uterine/vaginal discharge, called lochia:
a. is similar to a light menstrual period for the first 6 to 12 hours.
b. is usually greater after cesarean births.
c. will usually decrease with ambulation and breastfeeding.
d. should smell like normal menstrual flow unless an infection is present.
ANS: D
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 and usually increases with ambulation and breastfeeding.
- With regard to after birth ovarian function, nurses should be aware that:
a. almost 75% of women who do not breastfeed resume menstruating within a month after birth.
b. ovulation occurs slightly earlier for breastfeeding women.
c. because of menstruation/ovulation schedules, contraception considerations can be postponed until after the puerperium.
d. the first menstrual flow after childbirth usually is heavier than normal.
ANS: D
The first flow is heavier, but within three or four cycles, it is back to normal. Ovulation can occur within the first month, but for 70% of nonlactating women, it returns within 12 weeks after birth. Breastfeeding women take longer to resume ovulation. Because many women ovulate before their first after birth menstrual period, contraceptive options need to be discussed early in the puerperium.