Module 6 Kelsey Chapter 9

Question 1

A patient who had a vaginal birth 1 day ago desires a contraceptive method to use prior to her postpartum visit in 6 weeks. She had a fourth-degree laceration that was repaired and she is currently breastfeeding. What is the best choice for this patient?

A) Diaphragm
B) Vaginal ring
C) Combined hormonal oral contraceptive pills
D) Etonogestrel implant

Answer 1

D) Etonogestrel implant

Combined hormonal contraceptive methods are not recommended prior to 21 days postpartum due to the patient’s hypercoagulable state. Additionally, the client is breastfeeding and should not use estrogen-containing contraceptives that may affect milk production. Lastly, this client has a fourth-degree laceration and should wait a few weeks to be fitted for a diaphragm after giving birth.

Question 2

Thirty-six hours after she gave birth, you find Megan, a 16-year-old, crying quietly with the baby in her room as you perform morning rounds. What would be the most helpful response?

A) Prescribe an SSRI because adolescents are prone to postpartum depression.
B) Encourage the patient to focus on her baby’s needs as her first priority now.
C) Explain that it is normal to have a combination of sadness and euphoria so close to the time of the birth.
D) Conduct a screening test for possible postpartum depression.

Answer 2

C) Explain that it is normal to have a combination of sadness and euphoria so close to the time of the birth.

It is important to acknowledge the mother’s feelings and provide nonjudgmental support. Provide the patient with an explanation of normal psychological responses to childbirth.

Question 3

Mrs. Smith presents to the office complaining of “feeling ill.” She is noted to have a temperature of 101.8°F and reports that her symptoms came on “suddenly.” She is breastfeeding. During examination of her left breast, the clinician identifies a localized area of swelling, redness, and warmth. This area is intensely painful upon palpation. The right breast, by comparison demonstrates no abnormal findings. From the history and physical exam, the correct diagnosis for this patient is:

A) engorgement.
B) mastitis.
C) galactocele.
D) cancer.

Answer 3

B) mastitis.

Given the patient’s symptoms of unilateral breast swelling and an erythematous area with a fever, the likely diagnosis is mastitis.

Question 4

Which postpartum patient should be offered the Tdap vaccine?

A) A patient who received the Tdap vaccine during a previous pregnancy
B) A patient who received the Tdap vaccine during the second trimester of pregnancy
C) A patient who did not receive the Tdap vaccine during pregnancy
D) A patient who received the Tdap vaccine during the last trimester only

Answer 4

C) A patient who did not receive the Tdap vaccine during pregnancy

All pregnant patients should be offered the Tdap vaccine during each pregnancy. Although this vaccine is safe during any trimester, ACOG recommends that it be given between 27 and 36 weeks’ gestation to provide the most protection for newborns. If a patient does not receive the Tdap vaccine during pregnancy, she should be offered the vaccine during the immediate postpartum period.

Question 5

A postpartum client’s concerned partner calls the OB/GYN office stating that their girlfriend had a baby 6 months ago and is acting erratic and bizarre. The caller states that their girlfriend has been “acting off” for a few weeks and has not been wanting to care for herself or her infant. The client’s partner states, “She’s hearing things that I do not hear. Is that a weird thing to say? What should we do?” What is the best response?

A) The client should be brought to the nearest emergency room to be evaluated for postpartum psychosis.
B) Reassure the partner that this is normal transition to parenthood and ask the partner to monitor the client at home for the next few days for postpartum depression.
C) Check for allergies and call in a prescription for a SSRI to the client’s pharmacy.
D) Encourage the partner to help the girlfriend start a self-care routine that will have longer-lasting effects.

Answer 5

A) The client should be brought to the nearest emergency room to be evaluated for postpartum psychosis.

The client is showing signs and symptoms of psychosis such as hallucinations and erratic behavior.

Question 6

A new mother asks, “If formula is prepared to meet the nutritional needs of a newborn, what is in breastmilk that makes it better?” The proper response is that breastmilk contains:

A) more calcium.
B) important antibodies.
C) essential amino acids.
D) more calories.

Answer 6

B) important antibodies.

Although formula may be prepared with similar nutritional components tailored to the newborn, it lacks the important antibodies that breastmilk contains.

Question 7

Hemodynamic changes during the initial postpartum period include:

A) elevated cardiac output for up to 48 hours after the birth.
B) decreased white blood count (WBC) during the first 72 hours postpartum.
C) elevated blood pressure for 48 hours after the birth.
D) decreased urine output for the first 24 hours postpartum. `

Answer 7

A) elevated cardiac output for up to 48 hours after the birth.

Within the first hours postdelivery, the mother’s cardiac output increases by 60% to 80%.

Question 8

What is the appearance of a multiparous individual’s cervix?

A) It is the same as the cervix of a nulliparous individual.
B) The external os appears to be a pinpoint circle.
C) Only the external os is the same as that of a nulliparous individual.
D) The external os appears to be a slit resembling a fish mouth.

Answer 8

D) The external os appears to be a slit resembling a fish mouth.

For multiparous women, at completion of involution, the external os does not return to its pre-pregnant appearance. Instead, it remains somewhat wider, with a transverse opening resembling a fish mouth

Question 9

A possible contraindication to breastfeeding is:

A) herpes, where an active lesion is present on the vulva.
B) HIV infection.
C) the mother’s experience of having chickenpox as a toddler.
D) Tylenol use.

Answer 9

B) HIV infection.

Contraindications to breastfeeding include HIV-positive status, active herpes lesion on the nipple(s) and/or breast(s), and varicella infection that developed 5 days prior to birth to 2 days after birth.

Question 10

A client comes to the postpartum visit 4 weeks after the vaginal birth of a 10-pound baby. The client states that her abdomen feels separated. What should be the next step?

A) Assess for diastasis recti
B) Consult general surgery for possible uterine myoma
C) Obtain liver function tests
D) Send the patient immediately for an X-ray

Answer 10

A) Assess for diastasis recti

The patient had a 10-lb infant and feels the abdomen has separated. Although the patient may need a consult with general surgery for a possible diastasis recti, the first step is to assess the patient.

Question 11

Management of breast engorgement includes:

A) pumping to increase milk production.
B) waiting at least 6 hours between feedings.
C) offering formula until the nipples completely heal and engorgement decreases.
D) assessing that infant is positioned correctly and properly latched.

Answer 11

D) assessing that infant is positioned correctly and properly latched.

Breast engorgement is a common postpartal discomfort. Engorgement can worsen with an incorrect latch and infrequent feedings.

Question 12

The first stage of lactogenesis typically occurs during:

A) the second trimester only.
B) the latter part of the third trimester until 6 weeks postpartum.
C) early pregnancy to the third day postpartum.
D) days 2–4 postpartum.

Answer 12

C) early pregnancy to the third day postpartum.

The first stage of lactogenesis begins during early pregnancy and continues until the third day postpartum.

Question 13

What part of the breasts supports the shape of the breasts?

A) Milk ducts
B) Cooper’s ligaments
C) Basic glandular unit
D) Montgomery tubercles

Answer 13

B) Cooper’s ligaments

Cooper’s ligaments provide support to the breasts. The milk ducts and Montgomery tubercles do not provide support and shape to the breasts.

Question 14

Postpartum ovulation and menstruation are inhibited by:

A) increased prolactin.
B) maintenance of prolactin levels.
C) increased estrogen.
D) maintenance of estrogen levels.

Answer 14

A) increased prolactin.

Through a negative feedback mechanism, ovulation and menstruation are inhibited by increased prolactin and the resulting estrogen suppression.

Question 15

Postpartum depression:

A) may begin within 3 to 5 days after birth.
B) may happen 12 months after birth.
C) includes symptoms that improve within a few days after birth.
D) requires the immediate start of an SSRI.

Answer 15

B) may happen 12 months after birth.

Postpartum depression may happen within the immediate postpartum period or even after a year after giving birth.

Question 16

A normal exam for a postpartum client who had a baby 3 days ago includes:

A) a firm fundus 3 cm below the umbilicus.
B) a firm fundus 3 cm above the umbilicus.
C) a firm fundus 1 cm below the umbilicus.
D) a firm fundus 1 cm above the umbilicus.

Answer 16

A) a firm fundus 3 cm below the umbilicus.

At 3 days postpartum, the fundus can be found 3 fingerbreadths or 3 cm below the umbilicus.

Question 17

Anti-Rho(D) immune globulin is:

A) necessary for postpartum patients whose Rh status is negative and whose infant’s Rh status is positive.
B) necessary for postpartum patients whose Rh status is negative and whose infant’s Rh status is negative.
C) necessary for postpartum patients whose Rh status is positive and whose infant’s Rh status is negative.
D) necessary for postpartum patients whose Rh status is positive and whose infant’s Rh status is positive.

Answer 17

A) necessary for postpartum patients whose Rh status is negative and whose infant’s Rh status is positive.

Anti-Rho(D) immune globulin needs to be given within 72 hours of birth if the patient’s Rh status is negative and the infant is Rh-positive.

Question 18

Common pharmacologic pain relief options for postpartum patients include:

A) acetaminophen 650 mg every 4 hours as needed for pain.
B) acetaminophen 1200 mg every 4 hours as needed for pain.
C) ibuprofen 650 mg every 4 hours as needed for pain.
D) ibuprofen 1200 mg every 4 hours as needed for pain.

Answer 18

A) acetaminophen 650 mg every 4 hours as needed for pain.

The maximum dose for acetaminophen is 4000 mg per day; for ibuprofen, the maximum dose is 3200 mg per day.

Question 19

What is the gold-standard treatment for postpartum endometritis?

A) Clindamycin and gentamycin
B) Fluconazole and pyridium
C) Diflucan and terconazole vaginal
D) Methergine and misoprostol

Answer 19

A) Clindamycin and gentamycin

The gold-standard treatment for postpartum endometritis is to use clindamycin and gentamycin to ensure adequate coverage.

Question 20

The second stage of lactogenesis occurs during:

A) the second trimester only.
B) the latter part of the third trimester until 6 weeks postpartum.
C) early pregnancy to the third day postpartum.
D) days 2–4 postpartum.

Answer 20

D) days 2–4 postpartum.

The second stage of lactogenesis occurs between days 2 and 4 postpartum.

Question 21

A postpartum client delivered a baby vaginally 4 days ago. The client’s vital signs on the morning of discharge are as follows: heart rate 102, temperature 102.4°F, blood pressure 124/70 mm Hg. The client reports that her breasts are enlarged and that they feel uncomfortably full. The client has given up on breastfeeding because of the nipple pain experienced while feeding. She also states that her partner is unsupportive with breastfeeding. The next step includes:

A) physical assessment of the client to examine the nipples and breasts.
B) starting broad-spectrum antibiotics immediately.
C) prescribing analgesics to help with the pain and discomfort.
D) providing formula and artificial nipples.

Answer 21

A) physical assessment of the client to examine the nipples and breasts.

Prior to making a diagnosis, developing a plan, and implementing treatment, assessment of the client is necessary.

Question 22

A 22 year-old postpartum woman had a baby 2 days ago. She would like to resume contraception before discharge from the hospital. Which method would be most appropriate for this client?

A) DMPA
B) IUD
C) Combination oral contraceptive pills
D) Diaphragm with spermicidal cream

Answer 22

A) DMPA

Question 23

The current recommendation for the HPV vaccine includes:

A) offering the vaccine to postpartum patients between 11 and 26 years old, who have not been previously vaccinated.
B) offering the vaccine to postpartum patients older than age 18 years.
C) avoiding the vaccine for postpartum women who are breastfeeding.
D) offering the vaccine to pregnant patients who are at least 26 years old.

Answer 23

A) offering the vaccine to postpartum patients between 11 and 26 years old, who have not been previously vaccinated.

Women ages 9 through 26 years who have not completed a primary series should receive three doses of HPV vaccine at 0, 2, and 6 months. If the HPV series was started prior to pregnancy, the series can be completed postpartum without repeating the initial dose(s). HPV vaccines can and should be given to breastfeeding women 26 years and younger who have not previously been vaccinated.

Question 24

Risk factors for urinary retention include:

A) a small-for-gestational-age infant.
B) multiparity.
C) and intact perineum.
D) use of epidural anesthesia during labor and delivery.

Answer 24

D) use of epidural anesthesia during labor and delivery.

Risk factors for urinary retention during the postpartum period include large-for-gestational-age infants, nulliparity, and having a laceration or episiotomy.

Question 25

The lactational amenorrhea contraceptive method is most effective:

A) if the infant is younger than 18 months.
B) if the mother is breastfeeding at least every 4 hours during the day.
C) if the mother is breastfeeding an average of 8 hours during the night.
D) if the parents are feeding the infant solid foods for at least two-thirds of the meals.

Answer 25

B) if the mother is breastfeeding at least every 4 hours during the day.

The lactational amenorrhea method is most effective if the patient is fully or nearly fully breastfeeding (i.e., averaging every 4 hours during the day and 6 hours at night), the infant is younger than 6 months, and the parents have not substituted solid foods into the infant’s diet.

Question 26

A postpartum client who is breastfeeding is concerned about mastitis because she experienced this condition while breastfeeding her last baby. Which of the following would be appropriate for the nurse to suggest as a preventive measure?

A) Switch to formula
B) Frequent breastfeeding
C) Wear a tight-fitting bra
D) Limit feedings to every 6 hours

Answer 26

B) Frequent breastfeeding

To prevent mastitis, breastfeeding frequently as the infant desires is recommended.

Question 27

Which stage of lactogenesis happens between 7 and 14 days postpartum, and is the state in which mature milk is established and the milk supply is maintained?

A) Lactogenesis I
B) Lactogenesis II
C) Lactogenesis III
D) Lactogenesis IV

Answer 27

C) Lactogenesis III

The third stage of lactogenesis occurs between days 7 and 14 postpartum.

Question 28

During postpartum rounds, your multiparous client is very pleased with her birth and is clearly bonding with her new baby girl. She is successfully nursing her baby every 3 hours for 5 minutes. She is asking about early discharge and wants to go home as soon as possible. Her only complaint is that her left leg is sore because she needed to deliver in stirrups. What would be the most important piece of your assessment?

A) Availability of assistance at home with her two other children to ensure that she can rest
B) Breast exam and assessment to check for milk production to ensure adequacy of feeding before discharge
C) Dietary recall to ensure adequate kilocalories and fluids to produce adequate human milk
D) Examination of the lower legs to be sure that the muscle strain that she is complaining about is simply related to positioning

Answer 28

D) Examination of the lower legs to be sure that the muscle strain that she is complaining about is simply related to positioning

It would be important to examine her lower extremities to assess for possible deep vein thrombosis (DVT).

Question 29

What is the best contraceptive option for a breastfeeding patient who is asking to start a method immediately after birth of an infant prior to discharge from the hospital?

A) Patch
B) Vaginal ring
C) Combined hormonal oral pills
D) Progestin-only injectable

Answer 29

D) Progestin-only injectable

Combined hormonal contraceptive methods are not recommended prior to 21 days postpartum due to the patient’s hypercoagulable state. Additionally, the client is breastfeeding and should not use estrogen-containing contraceptives that may affect milk production. The best option would be a progestin-only method such as Depo-Provera, an implant, or a progestin-only injectable.

Question 30

During the postpartum period, normal vaginal findings include:

A) edema, relaxed-appearing, and sometimes bruised at 8 weeks postpartum.
B) decreased lubrication, especially for lactating patients.
C) increased bruising at 12 weeks postpartum, but only for patients who are lactating.
D) well lubricated with the return of rugae at 1 week postpartum.

Answer 30

B) decreased lubrication, especially for lactating patients.

During the postpartum period, the vagina may have decreased lubrication, which can lead to dyspareunia during sexual intercourse.

Question 31

A postpartum client is breastfeeding a 2-week old infant, and is feeling extremely tired with a fever of 102°F. The client notices an erythematous, edematous, wedge-shaped area in the left breast. What is the likely diagnosis?

A) Plugged duct
B) Mastitis
C) Engorgement
D) Breast cancer

Answer 31

B) Mastitis

The client was exhibiting symptoms of mastitis: erythematous, edematous, wedge-shaped area in the breast, typically unilateral, fever > 101.3°F, and flu-like symptoms.

Question 32

A postpartum client comes to the office 3 weeks after having a baby. What is an expected examination finding?

A) Fundus at the umbilicus
B) Uterus about the size of a grapefruit
C) Firm fundus 1 cm above the umbilicus
D) Uterus no longer palpated abdominally

Answer 32

D) Uterus no longer palpated abdominally

By 2 weeks postpartum, the uterus is no longer palpated abdominally and has descended into the pelvis.

Question 33

The process of involution takes place over which time frame?

A) The first 6 weeks postpartum
B) The first 24 hours postpartum
C) The first 2 weeks postpartum
D) The first year postpartum

Answer 33

A) The first 6 weeks postpartum

Normal postpartum involution takes a full 6 weeks to be complete.

Question 34

Mammary changes during pregnancy include:

A) hypopigmentation of the areola.
B) the blood vessels become less visible.
C) the Montgomery tubercles become enlarged.
D) breast size typically remains the same.

Answer 34

C) the Montgomery tubercles become enlarged.

Mammary changes during pregnancy include enlargement of the Montgomery tubercles, darkening of the areola, enlargement of the breasts, and blood vessels appearing more visible.

Question 35

A client states that she experiences extreme nipple pain as soon as the infant unlatches from the breast and the nipples become exposed to the cold air. According to the client, the nipples then turn a dark purple. What is this client’s likely diagnosis?

A) Raynaud’s phenomenon
B) Mastitis
C) Plugged duct
D) Herpetic lesions on the breast

Answer 35

A) Raynaud’s phenomenon

The client is exhibiting symptoms of Raynaud’s phenomenon: Nipple color changes to purple or blanches, which may be unilateral or bilateral when exposed to cold air. This condition is also associated with severe pain—specifically, a sharp, burning sensation due to the vasospasm of the nipple after breastfeeding or when the nipples are exposed to cool air.

Question 36

A patient at 39 weeks’ gestation reports colostrum production. The patient states, “I am concerned about this leaking. Is this normal? What should I do?” The correct response should be:

A) “Soon your breasts will feel engorged and you’ll have copious milk right in time for when the baby is born.”
B) “This is too early for colostrum production. Place ice packs on your breasts to prevent any more milk from being produced.”
C) “This is normal. Colostrum may be produced prior to the birth of your baby.”
D) “This is normal. This process is called the milk-ejection reflex.”

Answer 36

C) “This is normal. Colostrum may be produced prior to the birth of your baby.”

The body starts making colostrum during the third trimester of pregnancy.

Question 37

The second stage of lactogenesis is initiated by all of the following mechanisms except:

A) delivery of the placenta.
B) decreased progestin hormone concentration.
C) increased prolactin hormone concentration.
D) initiation of exogenous estrogen.

Answer 37

D) initiation of exogenous estrogen.

The second stage of lactogenesis is initiated by the delivery of placenta, a decrease in the progestin concentration, and an increase in the prolactin concentration.

Question 38

On day 2 postpartum, the cervix continues to be dilated at how many centimeters?

A) 0–1 cm
B) 0.5–1 cm
C) 1–1.5 cm
D) 2–3 cm

Answer 38

D) 2–3 cm

It is normal for the cervix to be dilated to 2–3 cm at days 2–3 postpartum.

Question 39

A client who is breastfeeding a 15-month old infant is in the office asking for a nonhormonal contraceptive method that provides protection from STIs. What is the best method for this client?

A) Copper IUD
B) Lactational amenorrhea method
C) Tubal ligation
D) Female condom

Answer 39

D) Female condom

Female and male condoms are nonhormonal forms of contraception that provide some protection against STIs. The lactational amenorrhea method is not reliable past 6 months postpartum and does not provide protection against STIs. The tubal ligation and copper IUD also do not provide protection against STIs.

Question 40

A client who had a baby 14 days ago calls the office concerned about her bleeding. She states, “The bleeding is bright red and I am filling up the pad about every hour.” What instructions should be given to the client?

A) “That sounds like normal bleeding that is to be expected. Call when if the bleeding gets worse.”
B) “That amount of bleeding is normal. Change your pads often to prevent infections.”
C) “That bleeding is concerning. Monitor your bleeding over the next 24 hours and call back if it gets worse.”
D) “That type and amount of bleeding is abnormal. Have someone drive you to the triage unit at the hospital and I will meet you there as soon as possible.”

Answer 40

D) “That type and amount of bleeding is abnormal. Have someone drive you to the triage unit at the hospital and I will meet you there as soon as possible.”

At 14 days postpartum, lochia should be turning pinkish in color and not bright red. The amount should also be decreasing, and the patient should not be soaking pads every hour. The patient should be advised to come to the triage unit to be evaluated for postpartum hemorrhage.

Question 41

A client is home from a normal spontaneous vaginal delivery 12 hours ago. She calls the triage unit concerned about frequent urination. She denies having fever, chills, or dysuria. The client states, “I have been going to the bathroom constantly to pee. I don’t have any pain when I go. Is this normal?” The right response is:

A) “Antibiotics need to be started immediately to prevent the infection from getting worse.”
B) “During the immediate postpartum period, it is common to have increased urination.”
C) “Sounds like you have a urinary tract infection. Try some cranberry juice to help make it better.”
D) “Avoid drinking too much fluids to allow for your bladder some rest.”

Answer 41

B) “During the immediate postpartum period, it is common to have increased urination.”

Diuresis occurs within the first 5 days as a result of extravascular fluid shifts.

Question 42

During postpartum rounds, a client who delivered an infant 6 hours prior states, “I notice that when I breastfeed the baby, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?” Which response would be most appropriate?

A) “Your body is responding to the events of labor, just like after a tough workout.”
B) “Your uterus sometimes enlarges during the postpartum period; that’s why you’re having pain.”
C) “The baby’s suckling releases a hormone that causes the uterus to contract.”
D) “Let me check your vaginal discharge just to make sure everything is okay.”

Answer 42

C) “The baby’s suckling releases a hormone that causes the uterus to contract.”

Suckling stimulates the nipple and areola, which signal the hypothalamus to secrete prolactin and oxytocin hormones. Oxytocin stimulates the uterus to contract to facilitate involution.

Question 43

Which hormone is responsible for stimulating the milk-ejection reflex?

A) Oxytocin
B) Prolactin
C) Human placental lactogen
D) Renin

Answer 43

A) Oxytocin

Oxytocin is the hormone responsible for stimulating the contraction of myoepithelial cells; this contraction of cells causes milk ejection, also referred to as the “let-down reflex.”

Question 44

A new mother wants to nurse her infant for only 5 minutes at each breast to avoid sore nipples. Which of the following is appropriate education to provide the patient?

A) Nipple stimulation will help to reduce engorgement.
B) Keeping early feedings long will delay let-down.
C) Keeping early feedings short lessens nipple trauma.
D) Reposition the infant to have a better latch

Answer 44

D) Reposition the infant to have a better latch

The nipples may be sore with breastfeeding but the breastfeeding mother should not be experiencing pain. Nipple soreness may be due to malposition of the infant. Pacing the infant in a more supported position for latching may prevent further tissue damage.

Question 45

Contraceptive counseling for tubal ligation includes a discussion regarding:

A) the permanence of the procedure.
B) its excellent protection from STIs.
C) the convenience of discontinuing this option at any time.
D) the fact that consent is not necessary.

Answer 45

A) the permanence of the procedure.

Tubal ligation is considered a permanent procedure. This contraceptive method does not provide protection against STIs, and the clinician must obtain consent for the surgery.

Question 46

Women who are not breastfeeding typically have their first menses:

A) around the same time as women who are breastfeeding.
B) later than women who are exclusively breastfeeding.
C) after 6 months postpartum.
D) sooner than breastfeeding women.

Answer 46

D) sooner than breastfeeding women.

Women who are not breastfeeding typically resume their first menses between 6 and 8 weeks postpartum, whereas exclusively breastfeeding women who may not have their first menses until 6 months postpartum.

Question 47

The flu vaccine:

A) is unsafe during pregnancy and the postpartum period.
B) is unsafe for breastfeeding patients.
C) should be offered to pregnant and postpartum patients.
D) is safer in the nasal spray form than in the injectable form.

Answer 47

C) should be offered to pregnant and postpartum patients.

The flu vaccine in injectable form should be offered to pregnant and postpartum patients. The flu vaccine in nasal spray form is a live attenuated vaccine and should not be offered to pregnant patients.

Question 48

Postpartum blues:

A) may begin within 3 to 5 days after birth.
B) may happen 12 months after birth.
C) includes symptoms that do not improve over time.
D) requires the immediate start of an SSRI.

Answer 48

A) may begin within 3 to 5 days after birth.

Concurrent with profound hormonal shifts, postpartum blues begins within 3 to 5 days of birth.

Question 49

What is the best contraceptive option for a patient who is asking to start a method 2 weeks after birth of an infant?

A) Patch
B) Vaginal ring
C) Combined hormonal oral pills
D) Progestin-only injectable

Answer 49

D) Progestin-only injectable

Combined hormonal contraceptive methods are not recommended prior to 21 days postpartum. The best option would be a progestin-only method such as Depo-Provera.