Maternity Nursing Chap 13

Question 1

True or False: Within 12 hours of birth the fundus of the uterus may be approximately 1 cm above the umbilicus.

Answer 1

True

Question 2

True or False: The uterus is slightly smaller after every pregnancy.

Answer 2

False–additional cells laid down during pregnancy remain, and account for the slight increase in uterine size after birth.

Question 3

True or False: Regeneration of the endometrium at the placental site is complete in approximately 4 weeks after birth.

Answer 3

False–occurs slowly and not complete until 6 weeks after birth. Endometrial regeneration is completed by postpartum day 16.

Question 4

True or False: The external os of the cervix has a jagged, slitlike appearance once healing has taken place after vaginal birth.

Answer 4

True

Question 5

True or False: Until estrogen levels rise, the postpartum woman is likely to experience discomfort during intercourse (dyspareunuia) associated with inadequate secretion of lubricating mucus.

Answer 5

True

Question 6

True or False: The appearance of colostrum is bluish white and thin.

Answer 6

False–clear, yellow fluid

Question 7

True or False: For most nonlactating women, menstruation resumes by 4 to 6 weeks after birth.

Answer 7

True

Question 8

True or False: During the first 24 hours after birth an elevated temperature of 38* C most likely indicates the onset of infection.

Answer 8

False–a result of dehydrating effects of labor or a consequence of epidural anesthesia. After 24 hours the woman should be afebrile.

Question 9

True or False: By 8 weeks after childbirth the majority of women have a normal hematocrit.

Answer 9

True

Question 10

True or False: In the postpartum period a leukocytosis of 20,000/mm^3 strongly indicates uterine or bladder infection.

Answer 10

False–This is a common value after birth for the first 10 to 12 days.

Question 11

True or False: During involution the process of autolysis often produces a pregnancy associated proteinuria which resolves by 6 weeks postpartum.

Answer 11

True

Question 12

True or False: An elevated level of follicle stimulating hormone in the postpartum period is responsible for the suppression of ovulation in lactating women.

Answer 12

False–prolactin levels is responsible for this.

Question 13

True or False: Lochia normally has a fleshy odor similar to that of menstrual flow.

Answer 13

True

Question 14

True or False: Women with type 1 diabetes mellitus usually require more insulin for several weeks after they give birth.

Answer 14

False–Decreases in human chorionic somatomammotropin, estrogens, cortisol, and the placental enzyme insulinase reverse the diabetogenic effects of pregnancy, resulting in significantly lower blood sugar levels in the puerperium.

Question 15

Why is bladder distention more likely to occur during the immediate postpartum period?

Answer 15

• include birth induced trauma to urethra and bladder
• edematous urethra
• increased bladder capacity
• effect of conduction anesthesia
• pelvic soreness
• lacerations and episiotomy
• increased urine production as a result of diuresis

Question 16

What problems can occur when the bladder becomes distended?

Answer 16

-early: pushes uterus up and to the side, preventing
uterus from contracting firmly and leading to excessive bleeding
-later: overdistention can lead to stasis of urine and urinary tract infection

Question 17

Factors interfering with bowel elimination:

Answer 17

• decreased muscle tone on the intestine
• effect of progesterone
• prelabor diarrhea
• lack of oral intake and dehydration from labor
• anticipated discomfort related to hemorrhoids and perineal trauma
• resistance to urge to defecate

Question 18

Why is hypovolemic shock less likely to occur in postpartum woman?

Answer 18

• pregnancy induced hypervolemia allows most women to tolerate considerable blood loss during childbirth
• decreased size of maternal vascular bed occurs with delivery of placenta, stimulus for vasodilation is lost, and extravascular water stored during pregnancy is mobilized

Question 19

What are the factors that increase the risk for thromboembolism?

Answer 19

• increase in clotting factors and fibrinogen levels during pregnancy continues into the postpartum period
• hypercoagulable state plus vessel damage with childbirth and decreased activity level of postpartum period increase risk

Question 20

A nurse has assessed a woman who gave birth vaginally 12 hours ago. Which of the following findings would require further assessment?

a. bright to dark red uterine discharge–3 quarters of pad saturated in 2 to 3 hours
b. midline episiotomy–approximated, moderate edema, slight erythema, absence of ecchymosis
c. protusion of abdomen with slight separation of abdominal wall muscles
d. fundus firm at level of umbilicus and to the right of midline

Answer 20

d.

• fundus should be at midline
• deviation from midline might indicate a full bladder
• bright to dark red uterine discharge refers to lochia rubra
• edema and erythema are common shortly after repair of a wound
• decrased abdominal muscle tone and enlarged uterus result in abdominal protrusion
• separation of the abdominal muscle walls, diastasis rectus abdominis, is common during pregnancy and the postpartum period

Question 21

A woman at 24 hours after birth complains to the nurse that her sleep was interrupted the night before because of sweating and the need to have her gown and bed linen changed. The nurse’s first action would be to:

a. assess this woman for additional clinical manifestations of infection
b. explain to the woman that the sweating represents her body’s attempt to eliminate the fluid that was accumulated during pregnancy
c. notify her physician of the finding
d. document the finding as postpartum diaphoresis

Answer 21

b.

• the woman is describing the normal finding of postpartum diaphoresis, which is the body’s attempt to excrete fluid retained during pregnancy
• documentation is important but not the first nursing action
• infection assessment and physician notification are not needed at this time

Question 22

Which of the following women at 24 hours following birth is least likely to experience afterpains?

a. primipara who is breastfeeding her twins who were born at 38 weeks of gestation
b. multipara who is breastfeeding her 10 lb full term baby girl
c. multipara who is bottle feeding her 8 lb baby boy
d. primipara who is bottle feeding her 7 lb baby girl

Answer 22

d.

-afterpains are most likely to occur in the following circumstances: multiparity, overdistention of the uterus (macrosomia, multifetal pregnancy), breastfeeding (endogenous oxytocin secretion), and administration of an oxytocic