Unit M-Postpartum

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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.

Question 3

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

Answer 3

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

Question 4

Which hormone remains elevated in the immediate after birth period of the breastfeeding
woman?
a. Estrogen
b. Progesterone
c. Prolactin
d. Human placental lactogen

Answer 4

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.

Question 5

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.

Answer 5

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

Question 6

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

Answer 6

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.

Question 7

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.

Answer 7

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.

Question 8

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.

Answer 8

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

Question 9

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.”

Answer 9

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.

Question 10

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.

Answer 10

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

Question 11

The self-destruction of excess hypertrophied tissue in the uterus is called:

a. autolysis.
b. subinvolution.
c. afterpain.
d. diastasis.

Answer 11

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.

Question 12

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.

Answer 12

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.

Question 13

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.

Answer 13

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.

Question 14

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

Answer 14

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.

Question 15

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.

Answer 15

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

Question 16

As relates to the condition and reconditioning of the urinary system after childbirth, nurses
should be aware that:
a. kidney function returns to normal a few days after birth.
b. diastasis recti abdominis is a common condition that alters the voiding reflex.
c. fluid loss through perspiration and increased urinary output accounts for a weight
loss of more than 2 kg during the puerperium.
d. with adequate emptying of the bladder, bladder tone usually is restored 2 to 3
weeks after childbirth.

Answer 16

ANS: C
Excess fluid loss through other means occurs as well. Kidney function usually returns to
normal in about a month. Diastasis recti abdominis is the separation of muscles in the
abdominal wall; it has no effect on the voiding reflex. Bladder tone usually is restored 5 to 7
days after childbirth.

Question 17

Knowing that the condition of the new mother’s breasts will be affected by whether she is
breastfeeding, nurses should be able to tell their patients all the following statements except:
a. breast tenderness is likely to persist for about a week after the start of lactation.
b. as lactation is established, a mass may form that can be distinguished from cancer
by its position shift from day to day.
c. in nonlactating mothers colostrum is present for the first few days after childbirth.
d. if suckling is never begun (or is discontinued), lactation ceases within a few days
to a week.

Answer 17

ANS: A
Breast tenderness should persist for 24 to 48 hours after lactation begins. That movable,
noncancerous mass is a filled milk sac. Colostrum is present for a few days whether the
mother breastfeeds or not. A mother who does not want to breastfeed should also avoid
stimulating her nipples.

Question 18

With regard to the after birth changes and developments in a woman’s cardiovascular system,
nurses should be aware that:
a. cardiac output, the pulse rate, and stroke volume all return to prepregnancy normal
values within a few hours of childbirth.
b. respiratory function returns to nonpregnant levels by 6 to 8 weeks after birth.
c. the lowered white blood cell count after pregnancy can lead to false-positive
results on tests for infections.
d. a hypercoagulable state protects the new mother from thromboembolism,
especially after a cesarean birth.

Answer 18

ANS: B
Respirations should decrease to within the woman’s normal prepregnancy range by 6 to 8
weeks after birth. Stroke volume increases, and cardiac output remains high for a couple of
days. However, the heart rate and blood pressure return to normal quickly. Leukocytosis
increases 10 to 12 days after childbirth and can obscure the diagnosis of acute infections
(false-negative results). The hypercoagulable state increases the risk of thromboembolism,
especially after a cesarean birth.

Question 19

Which condition, not uncommon in pregnancy, is likely to require careful medical assessment
during the puerperium?
a. Varicosities of the legs
b. Carpal tunnel syndrome
c. Periodic numbness and tingling of the fingers
d. Headaches

Answer 19

ANS: D
Headaches in the after birth period can have a number of causes, some of which deserve
medical attention. Total or nearly total regression of varicosities is expected after childbirth.
Carpal tunnel syndrome is relieved in childbirth when the compression on the median nerve is
lessened. Periodic numbness of the fingers usually disappears after birth unless carrying the
baby aggravates the condition.

Question 20

Several changes in the integumentary system that appear during pregnancy disappear after
birth, although not always completely. What change is almost certain to be completely
reversed?
a. Nail brittleness
b. Darker pigmentation of the areolae and linea nigra
c. Striae gravidarum on the breasts, abdomen, and thighs
d. Spider nevi

Answer 20

ANS: A
The nails return to their prepregnancy consistency and strength. Some women have permanent
darker pigmentation of the areolae and linea nigra. Striae gravidarum (stretch marks) usually
do not completely disappear. For some women spider nevi persist indefinitely.

Question 21

Childbirth may result in injuries to the vagina and uterus. Pelvic floor exercises also known as
Kegel exercises will help to strengthen the perineal muscles and encourage healing. The nurse
knows that the patient understands the correct process for completing these conditioning
exercises when she reports:
a. “I contract my thighs, buttocks, and abdomen.”
b. “I do 10 of these exercises every day.”
c. “I stand while practicing this new exercise routine.”
d. “I pretend that I am trying to stop the flow of urine midstream.”

Answer 21

ANS: D
The woman can pretend that she is attempting to stop the passing of gas or the flow of urine
midstream. This will replicate the sensation of the muscles drawing upward and inward. Each
contraction should be as intense as possible without contracting the abdomen, buttocks, or
thighs. Guidelines suggest that these exercises should be done 24 to 100 times per day.
Positive results are shown with a minimum of 24 to 45 repetitions per day. The best position
to learn Kegel exercises is to lie supine with knees bent. A secondary position is on the hands
and knees.

Question 22

Which maternal event is abnormal in the early after birth period?

a. Diuresis and diaphoresis
b. Flatulence and constipation
c. Extreme hunger and thirst
d. Lochial color changes from rubra to alba

Answer 22

ANS: D
For the first 3 days after childbirth, lochia is termed rubra. Lochia serosa follows, and then at
about 11 days, the discharge becomes clear, colorless, or white. Diuresis and diaphoresis are
the methods by which the body rids itself of increased plasma volume. Urine output of 3000
mL/day is common for the first few days after delivery and is facilitated by hormonal changes
in the mother. Bowel tone remains sluggish for days. Many women anticipate pain during
defecation and are unwilling to exert pressure on the perineum. The new mother is hungry
because of energy used in labor and thirsty because of fluid restrictions during labor.

Question 23

Which finding 12 hours after birth requires further assessment?

a. The fundus is palpable two fingerbreadths above the umbilicus.
b. The fundus is palpable at the level of the umbilicus.
c. The fundus is palpable one fingerbreadth below the umbilicus.
d. The fundus is palpable two fingerbreadths below the umbilicus.

Answer 23

ANS: A
The fundus rises to the umbilicus after delivery and remains there for about 24 hours. A
fundus that is above the umbilicus may indicate uterine atony or urinary retention. A fundus
that is palpable at or below the level of the umbilicus is a normal finding for a patient who is
12 hours after birth. Palpation of the fundus 2 fingerbreadths below the umbilicus is an
unusual finding for 12 hours after birth; however, it is still appropriate

Question 24

If the patient’s white blood cell (WBC) count is 25,000/mm on her second after birth day, the
nurse should:
a. tell the physician immediately.
b. have the laboratory draw blood for reanalysis.
c. recognize that this is an acceptable range at this point after birth.
d. begin antibiotic therapy immediately.

Answer 24

ANS: C
During the first 10 to 12 days after childbirth, values between 20,000 and 25,000/mm are
common. Because this is a normal finding there is no reason to alert the physician. There is no
need for reassessment or antibiotics because it is expected for the WBCs to be elevated.

Question 25

Which documentation on a woman’s chart on after birth day 14 indicates a normal involution
process?
a. Moderate bright red lochial flow
b. Breasts firm and tender
c. Fundus below the symphysis and not palpable
d. Episiotomy slightly red and puffy

Answer 25

ANS: C
The fundus descends 1 cm/day, so by after birth day 14 it is no longer palpable. The lochia
should be changed by this day to serosa. Breasts are not part of the involution process. The
episiotomy should not be red or puffy at this stage.

Question 26

Changes in blood volume after childbirth depend on several factors such as blood loss during
childbirth and the amount of extravascular water (physiologic edema) mobilized and excreted.
A after birth nurse anticipates blood loss of: (Select all that apply.)
a. 100 mL.
b. 250 mL or less.
c. 300 to 500 mL.
d. 500 to 1000 mL.
e. 1500 mL or greater.

Answer 26

ANS:C,D
The average blood loss for a vaginal birth of a single fetus ranges from 300 to 500 mL (10%
of blood volume). The typical blood loss for women who gave birth by cesarean is 500 to
1000 mL (15% to 30% of blood volume). During the first few days after birth the plasma
volume decreases further as a result diuresis. Pregnancy-induced hypervolemia (an increase in
blood volume of at least 35%) allows most women to tolerate considerable blood loss during
childbirth.

Question 27

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after
augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right
away, stating, “I’m bleeding a lot.” The most likely cause of after birth hemorrhage in this
woman is:
a. retained placental fragments.
b. unrepaired vaginal lacerations.
c. uterine atony.
d. puerperal infection.

Answer 27

ANS: C
This woman gave birth to a macrosomic boy after Pitocin augmentation. The most likely
cause of bleeding 4 hours after delivery, combined with these risk factors, is uterine atony.
Although retained placental fragments may cause after birth hemorrhage, this typically would
be detected in the first hour after delivery of the placenta and is not the most likely cause of
hemorrhage in this woman. Although unrepaired vaginal lacerations may cause bleeding, they
typically would occur in the period immediately after birth. Puerperal infection can cause
subinvolution and subsequent bleeding; however, this typically would be detected 24 hours
after delivery.

Question 28

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has
completely saturated a perineal pad within 15 minutes. The nurse’s first action is to:
a. begin an intravenous (IV) infusion of Ringer’s lactate solution.
b. assess the woman’s vital signs.
c. call the woman’s primary health care provider.
d. massage the woman’s fundus.

Answer 28

ANS: D
The nurse should assess the uterus for atony. Uterine tone must be established to prevent
excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but
this would not be the first action. Blood pressure is not a reliable indicator of impending shock
from impending hemorrhage; assessing vital signs should not be the nurse’s first action. The
physician would be notified after the nurse completes the assessment of the woman.

Question 29

A woman gave birth vaginally to a 9-lb, 12-ounce girl yesterday. Her primary health care
provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener.
What information is most closely correlated with these orders?
a. The woman is a gravida 2, para 2.
b. The woman had a vacuum-assisted birth.
c. The woman received epidural anesthesia
d. The woman has an episiotomy.

Answer 29

ANS: D
These orders are typical interventions for a woman who has had an episiotomy, lacerations,
and hemorrhoids. A multiparous classification is not an indication for these orders. A
vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate
these interventions. Use of epidural anesthesia has no correlation with these orders.

Question 30

The laboratory results for a after birth woman are as follows: blood type, A; Rh status,
positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret
these data?
a. Rubella vaccine should be given.
b. A blood transfusion is necessary.
c. Rh immune globulin is necessary within 72 hours of birth.
d. A Kleihauer-Betke test should be performed.

Answer 30

ANS: A
This patient’s rubella titer indicates that she is not immune and that she needs to receive a
vaccine. These data do not indicate that the patient needs a blood transfusion. Rh immune
globulin is indicated only if the patient has a negative Rh status and the infant has a positive
Rh status. A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is
suspected, especially if the mother is Rh negative. The data do not provide any indication for
performing this test

Question 31

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed.
During your assessment you notice that both of her breasts are swollen, warm, and tender on
palpation. The woman should be advised that this condition can best be treated by:
a. running warm water on her breasts during a shower.
b. applying ice to the breasts for comfort.
c. expressing small amounts of milk from the breasts to relieve pressure.
d. wearing a loose-fitting bra to prevent nipple irritation.

Answer 31

ANS: B
Applying ice to the breasts for comfort is appropriate for treating engorgement in a mother
who is bottle-feeding. This woman is experiencing engorgement, which can be treated by
using ice packs (because she is not breastfeeding) and cabbage leaves. A bottle-feeding
mother should avoid any breast stimulation, including pumping or expressing milk. A
bottle-feeding mother should wear a well-fitted support bra or breast binder continuously for
at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation
suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples
and thereby stimulate lactation.

Question 32

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband
brings a large container of brown seaweed soup to the hospital. When the nurse enters the
room, the husband asks for help with warming the soup so that his wife can eat it. The nurse’s
most appropriate response is to ask the woman:
a. “Didn’t you like your lunch?”
b. “Does your doctor know that you are planning to eat that?”
c. “What is that anyway?”
d. “I’ll warm the soup in the microwave for you.”

Answer 32

ANS: D
“I’ll warm the soup in the microwave for you” shows cultural sensitivity to the dietary
preferences of the woman and is the most appropriate response. Cultural dietary preferences
must be respected. Women may request that family members bring favorite or culturally
appropriate foods to the hospital. “What is that anyway?” does not show cultural sensitivity.

Question 33

In many hospitals new mothers are routinely presented with gift bags containing samples of
infant formula. This practice:
a. is inconsistent with the Baby-Friendly Hospital Initiative.
b. promotes longer periods of breastfeeding.
c. is perceived as supportive to both bottle-feeding and breastfeeding mothers.
d. is associated with earlier cessation of breastfeeding

Answer 33

ANS: A
Infant formula should not be given to mothers who are breastfeeding. Such gifts are associated
with earlier cessation of breastfeeding. Baby-Friendly USA prohibits the distribution of any
gift bags or formula to new mothers.

Question 34

A after birth woman overhears the nurse tell the obstetrics clinician that she has a positive
Homans’ sign and asks what it means. The nurse’s best response is:
a. “You have pitting edema in your ankles.”
b. “You have deep tendon reflexes rated 2+.”
c. “You have calf pain when the nurse flexes your foot.”
d. “You have a ‘fleshy’ odor to your vaginal drainage.”

Answer 34

ANS: C
Discomfort in the calf with sharp dorsiflexion of the foot may indicate deep vein thrombosis.
Edema is within normal limits for the first few days until the excess interstitial fluid is
remobilized and excreted. Deep tendon reflexes should be 1+ to 2+. A “fleshy” odor, not a
foul odor, is within normal limits.

Question 35

In the recovery room, if a woman is asked either to raise her legs (knees extended) off the bed
or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most
likely she is being tested to see whether she:
a. has recovered from epidural or spinal anesthesia.
b. has hidden bleeding underneath her.
c. has regained some flexibility.
d. is a candidate to go home after 6 hours.

Answer 35

ANS: A
If the numb or prickly sensations are gone from her legs after these movements, she has likely
recovered from the epidural or spinal anesthesia.

Question 36

Under the Newborns’ and Mothers’ Health Protection Act, all health plans are required to
allow new mothers and newborns to remain in the hospital for a minimum of _____ hours
after a normal vaginal birth and for _____ hours after a cesarean birth.
a. 24, 73
b. 24, 96
c. 48, 96
d. 48, 120

Answer 36

ANS: C
The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a
cesarean birth. The attending provider and the mother together can decide on an earlier
discharge.

Question 37

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the
mother shares the care of the infant with:
a. the father of the infant.
b. her mother (the infant’s grandmother).
c. her eldest daughter (the infant’s sister).
d. the nurse.

Answer 37

ANS: D
In couplet care the mother shares a room with the newborn and shares infant care with a nurse
educated in maternity and infant care.

Question 38

Excessive blood loss after childbirth can have several causes; the most common is:

a. vaginal or vulvar hematomas.
b. unrepaired lacerations of the vagina or cervix.
c. failure of the uterine muscle to contract firmly.
d. retained placental fragments.

Answer 38

ANS: C
Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder
distention. Although vaginal or vulvar hematomas, unpaired lacerations of the vagina or
cervix, and retained placental fragments are possible causes of excessive blood loss, uterine
muscle failure (uterine atony) is the most common cause.

Question 39

A hospital has a number of different perineal pads available for use. A nurse is observed
soaking several of them and writing down what she sees. This activity indicates that the nurse
is trying to:
a. improve the accuracy of blood loss estimation, which usually is a subjective
assessment.
b. determine which pad is best.
c. demonstrate that other nurses usually underestimate blood loss.
d. reveal to the nurse supervisor that one of them needs some time off.

Answer 39

ANS: A
Saturation of perineal pads is a critical indicator of excessive blood loss, and anything done to
aid in assessment is valuable. The nurse is noting the saturation volumes and soaking
appearances. It is possible that the nurse is trying to determine which pad is best, but it is
more likely that the nurse is noting saturation volumes and soaking appearances to improve
the accuracy of blood loss estimation. Nurses usually overestimate blood loss, if anything.

Question 40

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help
the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing
the nurse could try is:
a. pouring water from a squeeze bottle over the woman’s perineum.
b. placing oil of peppermint in a bedpan under the woman.
c. asking the physician to prescribe analgesics.
d. inserting a sterile catheter.

Answer 40

ANS: D
Invasive procedures usually are the last to be tried, especially with so many other simple and
easy methods available (e.g., water, peppermint vapors, pain medication). Pouring water over
the perineum may stimulate voiding. It is easy, noninvasive, and should be tried early. The oil
of peppermint releases vapors that may relax the necessary muscles. If the woman is
anticipating pain from voiding, pain medications may be helpful. Other nonmedical means
and pain medication should be tried before insertion of a catheter.

Question 41

If a woman is at risk for thrombus and is not ready to ambulate, nurses may intervene by
performing a number of interventions. Which intervention should the nurse avoid?
a. Putting the patient in antiembolic stockings (TED hose) and/or sequential
compression device (SCD) boots.
b. Having the patient flex, extend, and rotate her feet, ankles, and legs.
c. Having the patient sit in a chair.
d. Notifying the physician immediately if a positive Homans’ sign occurs.

Answer 41

ANS: C
Sitting immobile in a chair will not help. Bed exercise and prophylactic footwear may. TED
hose and SCD boots are recommended. Bed exercises, such as flexing, extending, and rotating
her feet, ankles, and legs, are useful. A positive Homans’ sign (calf muscle pain or warmth,
redness, or tenderness) requires the physician’s immediate attention.

Question 42

As relates to rubella and Rh issues, nurses should be aware that:
a. breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.
b. women should be warned that the rubella vaccination is teratogenic, and that they
must avoid pregnancy for 1 month after vaccination.
c. Rh immune globulin is safely administered intravenously because it cannot harm a
nursing infant.
d. Rh immune globulin boosts the immune system and thereby enhances the
effectiveness of vaccinations.

Answer 42

ANS: B
Women should understand they must practice contraception for 1 month after being
vaccinated. Because the live attenuated rubella virus is not communicable in breast milk,
breastfeeding mothers can be vaccinated. Rh immune globulin is administered
intramuscularly; it should never be given to an infant. Rh immune globulin suppresses the
immune system and therefore could thwart the rubella vaccination.

Question 43

Discharge instruction, or teaching the woman what she needs to know to care for herself and
her newborn, officially begins:
a. at the time of admission to the nurse’s unit.
b. when the infant is presented to the mother at birth.
c. during the first visit with the physician in the unit.
d. when the take-home information packet is given to the couple.

Answer 43

ANS: A
Discharge planning, the teaching of maternal and newborn care, begins on the woman’s
admission to the unit, continues throughout her stay, and actually never ends as long as she
has contact with medical personnel

Question 44

A recently delivered mother and her baby are at the clinic for a 6-week after birth checkup.
The nurse should be concerned that psychosocial outcomes are not being met if the woman:
a. discusses her labor and birth experience excessively.
b. believes that her baby is more attractive and clever than any others.
c. has not given the baby a name.
d. has a partner or family members who react very positively about the baby.

Answer 44

ANS: C
If the mother is having difficulty naming her new infant, it may be a signal that she is not
adapting well to parenthood. Other red flags include refusal to hold or feed the baby, lack of
interaction with the infant, and becoming upset when the baby vomits or needs a diaper
change. A new mother who is having difficulty would be unwilling to discuss her labor and
birth experience. An appropriate nursing diagnosis could be Impaired parenting related to a
long, difficult labor, or unmet expectations of birth. A mother who is willing to discuss her
birth experience is making a healthy personal adjustment. The mother who is not coping well
would find her baby unattractive and messy. She may also be overly disappointed in the
baby’s sex. The patient may voice concern that the baby reminds her of a family member
whom she does not like. Having a partner and/or other family members react positively is an
indication that this new mother has a good support system in place. This support system will
help reduce anxiety related to her new role as a mother.

Question 45

Postpartal overdistention of the bladder and urinary retention can lead to which
complications?
a. After birth hemorrhage and eclampsia
b. Fever and increased blood pressure
c. After birth hemorrhage and urinary tract infection
d. Urinary tract infection and uterine rupture

Answer 45

ANS:C
Incomplete emptying and overdistention of the bladder can lead to urinary tract infection.
Overdistention of the bladder displaces the uterus and prevents contraction of the uterine
muscle, thus leading to after birth hemorrhage. There is no correlation between bladder
distention and high blood pressure or eclampsia. The risk of uterine rupture decreases after the
birth of the infant.

Question 46

Rho immune globulin will be ordered after birth if which situation occurs?

a. Mother Rh–, baby Rh+
b. Mother Rh–, baby Rh–
c. Mother Rh+, baby Rh+
d. Mother Rh+, baby Rh–

Answer 46

ANS: A
An Rh– mother delivering an Rh+ baby may develop antibodies to fetal cells that entered her
bloodstream when the placenta separated. The Rho immune globulin works to destroy the fetal
cells in the maternal circulation before sensitization occurs. If mother and baby are both Rh+
or Rh– the blood types are alike, so no antibody formation would be anticipated. If the Rh+
blood of the mother comes in contact with the Rh– blood of the infant, no antibodies would
develop because the antigens are in the mother’s blood, not the infant’s.

Question 47

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and
to the right of the umbilicus?
a. Notify the physician of an impending hemorrhage.
b. Assess the blood pressure and pulse.
c. Evaluate the lochia.
d. Assist the patient in emptying her bladder.

Answer 47

ANS: D
Urinary retention may cause overdistention of the urinary bladder, which lifts and displaces
the uterus. Nursing actions need to be implemented before notifying the physician. It is
important to evaluate blood pressure, pulse, and lochia if the bleeding continues; however, the
focus at this point in time is to assist the patient in emptying her bladder.

Question 48

When caring for a newly delivered woman, the nurse is aware that the best measure to prevent
abdominal distention after a cesarean birth is:
a. rectal suppositories.
b. early and frequent ambulation.
c. tightening and relaxing abdominal muscles.
d. carbonated beverages

Answer 48

ANS:B
Activity will aid the movement of accumulated gas in the gastrointestinal tract. Rectal
suppositories can be helpful after distention occurs; however, they do not prevent it.
Ambulation is the best prevention. Carbonated beverages may increase distention.

Question 49

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 and glands.
c. hyperplasia of mammary tissue.
d. congestion of veins and lymphatics.

Answer 49

ANS: D
Breast engorgement is caused by the temporary congestion of veins and lymphatics. Breast
engorgement is not the result of overproduction of colostrum. Accumulation of milk in the
lactiferous ducts and glands does not cause breast engorgement. Hyperplasia of mammary
tissue does not cause breast engorgement.

Question 50

After giving birth to a healthy infant boy, a primiparous woman, 16 years old, is admitted to
the after birth unit. An appropriate nursing diagnosis for her at this time is risk for impaired
parenting related to deficient knowledge of newborn care. In planning for the woman’s
discharge, what should the nurse be certain to include in the plan of care?
a. Instruct the patient how to feed and bathe her infant.
b. Give the patient written information on bathing her infant.
c. Advise the patient that all mothers instinctively know how to care for their infants.
d. Provide time for the patient to bathe her infant after she views an infant bath
demonstration.

Answer 50

ANS: D
Having the mother demonstrate infant care is a valuable method of assessing the patient’s
understanding of her newly acquired knowledge, especially in this age group, because she
may inadvertently neglect her child. Although verbalizing how to care for the infant is a form
of patient education, it is not the most developmentally appropriate teaching for a teenage
mother. Advising the patient that all mothers instinctively know how to care for their infants
is an inappropriate statement; it is belittling and false.

Question 51

The nurse observes several interactions between a after birth woman and her new son. What
behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive
behavior regarding parent-infant attachment?
a. Talks and coos to her son
b. Seldom makes eye contact with her son
c. Cuddles her son close to her
d. Tells visitors how well her son is feeding

Answer 51

ANS: B
The woman should be encouraged to hold her infant in the en face position and make eye
contact with the infant. Normal infant-parent interactions include talking and cooing to her
son, cuddling her son close to her, and telling visitors how well her son is feeding

Question 52

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the
nurse can use to facilitate mother-infant attachment in this mother is to:
a. tell the mother she must pay attention to her infant.
b. show the mother how the infant initiates interaction and pays attention to her.
c. demonstrate for the mother different positions for holding her infant while feeding.
d. arrange for the mother to watch a video on parent-infant interaction.

Answer 52

ANS: B
Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant
attachment. Telling the mother that she must pay attention to her infant may be perceived as
derogatory and is not appropriate. Educating the young mother in infant care is important;
however, pointing out the responsiveness of her baby is a better tool for facilitating
mother-infant attachment. Videos are an educational tool that can demonstrate parent-infant
attachment, but encouraging the mother to recognize the infant’s responsiveness is more
appropriate.

Question 53

The nurse hears a primiparous woman talking to her son and telling him that his chin is just
like his dad’s chin. This woman’s statement reflects:
a. mutuality.
b. synchrony.
c. claiming.
d. reciprocity.

Answer 53

ANS: C
Claiming refers to the process by which the child is identified in terms of likeness to other
family members. Mutuality occurs when the infant’s behaviors and characteristics call forth a
corresponding set of maternal behaviors and characteristics. Synchrony refers to the “fit”
between the infant’s cues and the parent’s responses. Reciprocity is a type of body movement
or behavior that provides the observer with cues.

Question 54

New parents express concern that, because of the mother’s emergency cesarean birth under
general anesthesia, they did not have the opportunity to hold and bond with their daughter
immediately after her birth. The nurse’s response should convey to the parents that:
a. attachment, or bonding, is a process that occurs over time and does not require
early contact.
b. the time immediately after birth is a critical period for people.
c. early contact is essential for optimum parent-infant relationships.
d. they should just be happy that the infant is healthy.

Answer 54

ANS: A
Attachment, or bonding, is a process that occurs over time and does not require early contact.
The formerly accepted definition of bonding held that the period immediately after birth was a
critical time for bonding to occur. Research since has indicated that parent-infant attachment
occurs over time. A delay does not inhibit the process. Parent-infant attachment involves
activities such as touching, holding, and gazing; it is not exclusively eye contact. A response
that conveys that the parents should just be happy that the infant is healthy is inappropriate
because it is derogatory and belittling.

Question 55

During a phone follow-up conversation with a woman who is 4 days’ after birth, the woman
tells the nurse, “I don’t know what’s wrong. I love my son, but I feel so let down. I seem to
cry for no reason!” The nurse would recognize that the woman is experiencing:
a. taking-in.
b. postpartum depression (PPD).
c. postpartum (PP) blues.
d. attachment difficulty.

Answer 55

ANS: C
During the PP blues women are emotionally labile, often crying easily and for no apparent
reason. This lability seems to peak around the fifth PP day. The taking-in phase is the period
after birth when the mother focuses on her own psychologic needs. Typically this period lasts
24 hours. PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is
more serious and persistent than the PP blues. Crying is not a maladaptive attachment
response; it indicates PP blues.

Question 56

The nurse can help a father in his transition to parenthood by:

a. pointing out that the infant turned at the sound of his voice.
b. encouraging him to go home to get some sleep.
c. telling him to tape the infant’s diaper a different way.
d. suggesting that he let the infant sleep in the bassinet.

Answer 56

ANS: A
Infants respond to the sound of voices. Because attachment involves a reciprocal interchange,
observing the interaction between parent and infant is very important. Separation of the parent
and infant does not encourage parent-infant attachment. Educating the parent in infant care
techniques is important; however, the manner in which a diaper is taped is not relevant and
does not enhance parent-infant interactions. Parent-infant attachment involves touching,
holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby
sleeps

Question 57

The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other
than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the
woman’s behavior with her infant, the nurse realizes that:
a. what appears to be a lack of interest in the newborn is in fact the Vietnamese way
of demonstrating intense love by attempting to ward off evil spirits.
b. the woman is inexperienced in caring for newborns.
c. the woman needs a referral to a social worker for further evaluation of her
parenting behaviors once she goes home with the newborn.
d. extra time needs to be planned for assisting the woman in bonding with her
newborn.

Answer 57

ANS:A
The nurse may observe a Vietnamese woman who gives minimal care to her infant and
refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is
this cultural group’s attempt to ward off evil spirits and actually reflects an intense love and
concern for the infant. It is important to educate the woman in infant care, but it is equally
important to acknowledge her cultural beliefs and practices.

Question 58

Many first-time parents do not plan on their parents’ help immediately after the newborn
arrives. What statement by the nurse is the most appropriate when counseling new parents
about the involvement of grandparents?
a. “You should tell your parents to leave you alone.”
b. “Grandparents can help you with parenting skills and also help preserve family
traditions.”
c. “Grandparent involvement can be very disruptive to the family.”
d. “They are getting old. You should let them be involved while they can.”

Answer 58

ANS: B
“Grandparents can help you with parenting skills and also help preserve family traditions” is
the most appropriate response. Intergenerational help may be perceived as interference;
however, a statement of this sort is not therapeutic to the adaptation of the family. Not only is
“Grandparent involvement can be very disruptive to the family” invalid, it also is not an
appropriate nursing response. Regardless of age, grandparents can help with parenting skills
and preserve family traditions. Talking about the age of the grandparents is not the most
appropriate statement, and it does not demonstrate sensitivity on the part of the nurse.

Question 59

When the infant’s behaviors and characteristics call forth a corresponding set of maternal
behaviors and characteristics, this is called:
a. mutuality.
b. bonding.
c. claiming.
d. acquaintance.

Answer 59

ANS: A
Mutuality extends the concept of attachment to include this shared set of behaviors. Bonding
is the process over time of parents forming an emotional attachment to their infant. Mutuality
refers to a shared set of behaviors that is a part of the bonding process. Claiming is the process
by which parents identify their new baby in terms of likeness to other family members and
their differences and uniqueness. Like mutuality, acquaintance is part of attachment. It
describes how parents get to know their baby during the immediate after birth period through
eye contact, touching, and talking.

Question 60

In follow-up appointments or visits with parents and their new baby, it may be useful if the
nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one
is a facilitating behavior?
a. The parents have difficulty naming the infant.
b. The parents hover around the infant, directing attention to and pointing at the
infant.
c. The parents make no effort to interpret the actions or needs of the infant.
d. The parents do not move from fingertip touch to palmar contact and holding

Answer 60

ANS: B
Hovering over the infant and obviously paying attention to the baby are facilitating behaviors.
Inhibiting behaviors include difficulty naming the infant, making no effort to interpret the
actions or needs of the infant, and not moving from fingertip touch to palmar contact and
holding

Question 61

With regard to parents’ early and extended contact with their infant and the relationships built,
nurses should be aware that:
a. immediate contact is essential for the parent-child relationship.
b. skin-to-skin contact is preferable to contact with the body totally wrapped in a
blanket.
c. extended contact is especially important for adolescents and low-income women
because they are at risk for parenting inadequacies.
d. mothers need to take precedence over their partners and other family matters.

Answer 61

ANS: C
Nurses should encourage any activity that optimizes family extended contact. Immediate
contact facilitates the attachment process but is not essential; otherwise, adopted infants would
not establish the affectionate ties they do. The mode of infant-mother contact does not appear
to have any important effect. Mothers and their partners are considered equally important.

Question 62

In the United States the en face position is preferred immediately after birth. Nurses can
facilitate this process by all of these actions except:
a. washing both the infant’s face and the mother’s face.
b. placing the infant on the mother’s abdomen or breast with their heads on the same
plane.
c. dimming the lights.
d. delaying the instillation of prophylactic antibiotic ointment in the infant’s eyes.

Answer 62

ANS: A
To facilitate the position in which the parent’s and infant’s faces are approximately 8 inches
apart on the same plane, allowing them to make eye contact, the nurse can place the infant at
the proper height on the mother’s body, dim the light so that the infant’s eyes open, and delay
putting ointment in the infant’s eyes.

Question 63

Other early sensual contacts between infant and mother involve sound and smell. Nurses
should be aware that, despite what folk wisdom may say:
a. high-pitched voices irritate newborns.
b. infants can learn to distinguish their mother’s voice from others soon after birth.
c. all babies in the hospital smell alike.
d. a mother’s breast milk has no distinctive odor

Answer 63

ANS: B
Infants know the sound of their mother’s voice early. Infants respond positively to
high-pitched voices. Each infant has a unique odor. Infants quickly learn to distinguish the
odor of their mother’s breast milk.

Question 64

After they are born, a crying infant may be soothed by being held in a position in which the
newborn can hear the mother’s heartbeat. This phenomenon is known as:
a. entrainment.
b. reciprocity.
c. synchrony.
d. biorhythmicity

Answer 64

ANS: D
The newborn is in rhythm with the mother. The infant develops a personal biorhythm with the
parents’ help over time. Entrainment is the movement of newborns in time to the structure of
adult speech. Reciprocity is body movement or behavior that gives cues to the person’s
desires. These take several weeks to develop with a new baby. Synchrony is the fit between
the infant’s behavioral cues and the parent’s responses.

Question 65

Of the many factors that influence parental responses, nurses should be conscious of negative
stereotypes that apply to specific patient populations. Which response could be an
inappropriate stereotype of adolescent mothers?
a. An adolescent mother’s egocentricity and unmet developmental needs interfere
with her ability to parent effectively.
b. An adolescent mother is likely to use less verbal instruction, be less responsive,
and interact less positively than other mothers.
c. Adolescent mothers have a higher documented incidence of child abuse.
d. Mothers older than 35 often deal with more stress related to work and career issues
and decreasing libido.

Answer 65

ANS: C
Adolescent mothers are more inclined to have a number of parenting difficulties that benefit
from counseling; however, a higher incidence of child abuse is not one of them. Midlife
mothers have many competencies, but they are more likely to have to deal with career issues
and the accompanying stress

Question 66

When working with parents who have some form of sensory impairment, nurses should
understand that ________ is an inaccurate statement.
a. “One of the major difficulties visually impaired parents experience is the
skepticism of health care professionals.”
b. “Visually impaired mothers cannot overcome the infant’s need for eye-to-eye
contact.”
c. “The best approach for the nurse is to assess the parents’ capabilities rather than
focusing on their disabilities.”
d. “Technologic advances, including the Internet, can provide deaf parents with a full
range of parenting activities and information.”

Answer 66

ANS: B
Other sensory output can be provided by the parent, other people can participate, and other
coping devices can be used. The skepticism, open or hidden, of health care professionals
places an additional and unneeded hurdle for the parents. After the parents’ capabilities have
been assessed (including some the nurse may not have expected), the nurse can help find ways
to assist the parents that play to their strengths. The Internet affords an extra teaching tool for
the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can
turn sound into light flashes to help pick up a child’s cry. Sign language is readily acquired by
young children.

Question 67

With regard to the adaptation of other family members, mainly siblings and grandparents, to
the newborn, nurses should be aware that:
a. sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings
and behaviors can take a long time to blow over.
b. participation in preparation classes helps both siblings and grandparents.
c. in the United States paternal and maternal grandparents consider themselves of
equal importance and status.
d. in the past few decades the number of grandparents providing permanent care to
their grandchildren has been declining.

Answer 67

ANS: B
Preparing older siblings and grandparents helps everyone to adapt. Sibling rivalry should be
expected initially, but the negative behaviors associated with it have been overemphasized and
stop in a comparatively short time. In the United States, in contrast to other cultures, paternal
grandparents frequently consider themselves secondary to maternal grandparents. The number
of grandparents providing permanent child care has been on the increase.

Question 68

Nursing activities that promote parent-infant attachment are many and varied. One activity
that should not be overlooked is management of the environment. While providing routine
mother-baby care, the nurse should ensure that:
a. the baby is able to return to the nursery at night so that the new mother can sleep.
b. routine times for care are established to reassure the parents.
c. the father should be encouraged to go home at night to prepare for mother-baby
discharge.
d. an environment that fosters as much privacy as possible should be created

Answer 68

ANS: D
Care providers need to knock before gaining entry. Nursing care activities should be grouped.
Once the baby has demonstrated adjustment to extrauterine life (either in the mother’s room
or the transitional nursery), all care should be provided in one location. This important
principle of family-centered maternity care fosters attachment by giving parents the
opportunity to learn about their infant 24 hours a day. One nurse should provide care to both
mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to
return to the nursery at night. In fact, the mother will sleep better with the infant close by.
Care should be individualized to meet the parents’ needs, not the routines of the staff.
Teaching goals should be developed in collaboration with the parents. The father, or other
significant other, should be permitted to sleep in the room with the mother. The maternity unit
should develop policies that allow for the presence of significant others as much as the new
mother desires.

Question 69

The early after birth period is a time of emotional and physical vulnerability. Many mothers
can easily become psychologically overwhelmed by the reality of their new parental
responsibilities. Fatigue compounds these issues. Although the baby blues are a common
occurrence in the after birth period, about one-half million women in America experience a
more severe syndrome known as postpartum depression (PPD). Which statement regarding
PPD is essential for the nurse to be aware of when attempting to formulate a nursing
diagnosis?
a. PPD symptoms are consistently severe.
b. This syndrome affects only new mothers.
c. PPD can easily go undetected.
d. Only mental health professionals should teach new parents about this condition.

Answer 69

ANS: C
PPD can go undetected because parents do not voluntarily admit to this type of emotional
distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with
women having both good and bad days. Both mothers and fathers should be screened. PPD
may also affect new fathers. The nurse should include information on PPD and how to
differentiate this from the baby blues for all patients on discharge. Nurses also can urge new
parents to report symptoms and seek follow-up care promptly if symptoms occur.

Question 70

The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to:
a. the positive feedback an infant exhibits toward parents during the attachment
process.
b. behavior during the sensitive period when the infant is in the quiet alert stage.
c. unidirectional behavior exhibited by the infant, initiated and enhanced by eye
contact.
d. behavior by the infant during the sensitive period to elicit feelings of “falling in love” from the parents.

Answer 70

ANS: A
In this definition, “reciprocal” refers to the feedback from the infant during the attachment
process. This is a good time for bonding; however, it does not define reciprocal attachment.
Reciprocal attachment applies to feedback behavior and is not unidirectional.

Question 71

The after birth woman who continually repeats the story of her labor, delivery, and recovery
experience is:
a. providing others with her knowledge of events.
b. making the birth experience “real.”
c. taking hold of the events leading to her labor and delivery.
d. accepting her response to labor and delivery.

Answer 71

ANS: B
Reliving the birth experience makes the event real and helps the mother realize that the
pregnancy is over and that the infant is born and is now a separate individual. The retelling of
the story is to satisfy her needs, not the needs of others. This new mother is in the taking-in
phase, trying to make the birth experience seem real and separate the infant from herself

Question 72

On observing a woman on her first after birth day sitting in bed while her newborn lies awake
in the bassinet, the nurse should:
a. realize that this situation is perfectly acceptable.
b. offer to hand the baby to the woman.
c. hand the baby to the woman.
d. explain “taking in” to the woman.

Answer 72

ANS: C
During the “taking-in” phase of maternal adaptation (the mother may be passive and
dependent), the nurse should encourage bonding when the infant is in the quiet alert stage.
This is done best by simply giving the baby to the mother. The patient is exhibiting expected
behavior during the taking-in phase; however, interventions by the nurse can facilitate infant
bonding. The patient will learn best during the taking-hold phase

Question 73

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours
ago. Her husband is watching his wife and asking questions about newborn care. The
4-year-old brother is punching his mother on the back. The nurse should:
a. report the incident to the social services department.
b. advise the parents that the toddler needs to be reprimanded.
c. report to oncoming staff that the mother is probably not a good disciplinarian.
d. realize that this is a normal family adjusting to family change.

Answer 73

ANS:D
The observed behaviors are normal variations of families adjusting to change. There is no
need to report this one incident. Giving advice at this point would make the parents feel
inadequate.

Question 74

The best way for the nurse to promote and support the maternal-infant bonding process is to:

a. help the mother identify her positive feelings toward the newborn.
b. encourage the mother to provide all newborn care.
c. assist the family with rooming-in.
d. return the newborn to the nursery during sleep periods.

Answer 74

ANS: C
Close and frequent interaction between mother and infant, which is facilitated by rooming-in,
is important in the bonding process. This is often referred to as the mother-baby care or
couplet care. Having the mother express her feelings is important; however, it is not the best
way to promote bonding. The mother needs time to rest and recuperate; she should not be
expected to do all of the care. The patient needs to observe the infant during all stages so she
will be aware of what to anticipate when they go home.

Question 75

During which phase of maternal adjustment will the mother relinquish the baby of her
fantasies and accept the real baby?
a. Letting go
b. Taking hold
c. Taking in
d. Taking on

Answer 75

ANS: A
Accepting the real infant and relinquishing the fantasy infant occurs during the letting-go
phase of maternal adjustment. During the taking-hold phase the mother assumes responsibility
for her own care and shifts her attention to the infant. In the taking-in phase the mother is
primarily focused on her own needs. There is no taking-on phase of maternal adjustment.

Question 76

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled
for discharge. As you prepare her for discharge, she begins to cry. Your initial action should
be to:
a. assess her for pain.
b. point out how lucky she is to have a healthy baby.
c. explain that she is experiencing after birth blues.
d. allow her time to express her feelings.

Answer 76

ANS:D
Although many women experience transient after birth blues, they need assistance in
expressing their feelings. This condition affects 50% to 80% of new mothers. There should be
no assumption that the patient is in pain, when in fact she may have no pain whatsoever. This
is “blocking” communication and inappropriate in this situation. The patient needs the
opportunity to express her feelings first; patient teaching can occur later.

Question 77

man calls the nurse’s station and states that his wife, who delivered 2 days ago, is happy
one minute and crying the next. The man says, “She was never like this before the baby was
born.” The nurse’s initial response could be to:
a. tell him to ignore the mood swings, as they will go away.
b. reassure him that this behavior is normal.
c. advise him to get immediate psychological help for her.
d. instruct him in the signs, symptoms, and duration of after birth blues

Answer 77

ANS: B
Before providing further instructions, inform family members of the fact that after birth blues
are a normal process. Telling her partner to “ignore the mood swings” does not encourage
further communication and may belittle the husband’s concerns. After birth blues are usually
short-lived; no medical intervention is needed. Patient teaching is important; however, the
new father’s anxieties need to be allayed before he will be receptive to teaching.

Question 78

To promote bonding and attachment immediately after delivery, the most important nursing
intervention is to:
a. allow the mother quiet time with her infant.
b. assist the mother in assuming an en face position with her newborn.
c. teach the mother about the concepts of bonding and attachment.
d. assist the mother in feeding her baby.

Answer 78

ANS: B
Assisting the mother in assuming an en face position with her newborn will support the
bonding process. The mother should be given as much privacy as possible; however, nursing
assessments must still be continued during this critical time. The mother has just delivered and
is more focused on the infant; she will not be receptive to teaching at this time. This is a good
time to initiate breastfeeding; however, the mother first needs time to explore the new infant
and begin the bonding process.

Question 79

A new father states, “I know nothing about babies,” but he seems to be interested in learning.
This is an ideal opportunity for the nurse to:
a. continue to observe his interaction with the newborn.
b. tell him when he does something wrong.
c. show no concern, as he will learn on his own.
d. include him in teaching sessions.

Answer 79

ANS: D
The nurse must be sensitive to the father’s needs and include him whenever possible. As
fathers take on their new role, the nurse should praise every attempt, even if his early care is
awkward. It is important to note the bonding process of the mother and the father; however,
that does not satisfy the expressed needs of the father. The new father should be encouraged in
caring for his baby by pointing out the things that he does right. Criticizing him will
discourage him.

Question 80

Which concerns about parenthood are often expressed by visually impaired mothers? (Select
all that apply.)
a. Infant safety
b. Transportation
c. The ability to care for the infant
d. Missing out visually
e. Needing extra time for parenting activities to accommodate the visual limitations

Answer 80

ANS: A, B, D, E
Concerns expressed by visually impaired mothers include infant safety, extra time needed for
parenting activities, transportation, handling other people’s reactions, providing proper
discipline, and missing out visually. Blind people sense reluctance on the part of others to
acknowledge that they have a right to be parents; however, blind parents are fully capable of
caring for their infants.

Question 81

A parent who has a hearing impairment is presented with a number of challenges in parenting.
Which nursing approaches are appropriate for working with hearing-impaired new parents?
(Select all that apply.)
a. Use devices that transform sound into light.
b. Assume that the patient knows sign language.
c. Speak quickly and loudly.
d. Ascertain whether the patient can read lips before teaching.
e. Written messages aid in communication.

Answer 81

ANS:A,D,E
Section 504 of the Rehabilitation Act of 1973 requires that hospitals use various
communication techniques and resources with the deaf and hard of hearing patient. This
includes devices such as door alarms, cry alarms, and amplifiers. Before initiating
communication, the nurse needs to be aware of the parents’ preferences for communication.
Not all hearing-impaired patients know sign language. Do they wear a hearing aid? Do they
read lips? Do they wish to have a sign language interpreter? If the parent relies on lipreading,
the nurse should sit close enough so that the parent can visualize lip movements. The nurse
should speak clearly in a regular voice volume, in short, simple sentences. Written messages
such as on a black or white erasable board can be useful. Written materials should be
reviewed with the parents before discharge.

Question 82

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment
reveals that the woman is experiencing profuse bleeding. The most likely etiology for the
bleeding is:
a. uterine atony.
b. uterine inversion.
c. vaginal hematoma.
d. vaginal laceration

Answer 82

ANS: A
Uterine atony is marked hypotonia of the uterus. It is the leading cause of after birth
hemorrhage. Uterine inversion may lead to hemorrhage, but it is not the most likely source of
this patient’s bleeding. Furthermore, if the woman is experiencing a uterine inversion, it
would be evidenced by the presence of a large, red, rounded mass protruding from the
introitus. A vaginal hematoma may be associated with hemorrhage. However, the most likely
clinical finding would be pain, not the presence of profuse bleeding. A vaginal laceration may
cause hemorrhage, but it is more likely that profuse bleeding would result from uterine atony.
A vaginal laceration should be suspected if vaginal bleeding continues in the presence of a
firm, contracted uterine fundus.

Question 83

A primary nursing responsibility when caring for a woman experiencing an obstetric
hemorrhage associated with uterine atony is to:
a. establish venous access.
b. perform fundal massage.
c. prepare the woman for surgical intervention.
d. catheterize the bladder.

Answer 83

ANS: B
The initial management of excessive after birth bleeding is firm massage of the uterine
fundus. Although establishing venous access may be a necessary intervention, the initial
intervention would be fundal massage. The woman may need surgical intervention to treat her
after birth hemorrhage, but the initial nursing intervention would be to assess the uterus. After
uterine massage the nurse may want to catheterize the patient to eliminate any bladder
distention that may be preventing the uterus from contracting properly.

Question 84

The perinatal nurse caring for the after birth woman understands that late postpartum
hemorrhage (PPH) is most likely caused by:
a. subinvolution of the placental site.
b. defective vascularity of the decidua.
c. cervical lacerations.
d. coagulation disorders

Answer 84

ANS: A
Late PPH may be the result of subinvolution of the uterus, pelvic infection, or retained
placental fragments. Late PPH is not typically a result of defective vascularity of the decidua,
cervical lacerations, or coagulation disorders.

Question 85

Which woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean
birth for fetal distress.
b. A woman with severe preeclampsia who is receiving magnesium sulfate and
whose labor is being induced.
c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor.
d. A primigravida in spontaneous labor with preterm twins.

Answer 85

ANS: B
Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a
smooth muscle relaxant, thereby contributing to uterine relaxation and atony. Although many
causes and risk factors are associated with PPH, the primiparous woman being prepared for an
emergency C-section, the multiparous woman with 8-hour labor, and the primigravida in
spontaneous labor do not pose risk factors or causes of early PPH.

Question 86

The first and most important nursing intervention when a nurse observes profuse after birth
bleeding is to:
a. call the woman’s primary health care provider.
b. administer the standing order for an oxytocic.
c. palpate the uterus and massage it if it is boggy.
d. assess maternal blood pressure and pulse for signs of hypovolemic shock.

Answer 86

ANS: C
The initial management of excessive after birth bleeding is firm massage of the uterine
fundus. Although calling the health care provider, administering an oxytocic, and assessing
maternal BP are appropriate interventions, the primary intervention should be to assess the
uterus. Uterine atony is the leading cause of postpartum hemorrhage (PPH).

Question 87

When caring for a after birth woman experiencing hemorrhagic shock, the nurse recognizes
that the most objective and least invasive assessment of adequate organ perfusion and
oxygenation is:
a. absence of cyanosis in the buccal mucosa.
b. cool, dry skin.
c. diminished restlessness.
d. urinary output of at least 30 mL/hr.

Answer 87

ANS: D
Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the
perfusion of body organs may become severely compromised and death may occur. The
presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the
buccal mucosa for cyanosis can be subjective. The presence of cool, pale, clammy skin would
be an indicative finding associated with hemorrhagic shock. Hemorrhagic shock is associated
with lethargy, not restlessness.

Question 88

One of the first symptoms of puerperal infection to assess for in the after birth woman is:
a. fatigue continuing for longer than 1 week.
b. pain with voiding.
c. profuse vaginal bleeding with ambulation.
d. temperature of 38° C (100.4° F) or higher on two successive days starting 24 hours
after birth.

Answer 88

ANS: D
After birth or puerperal infection is any clinical infection of the genital canal that occurs
within 28 days after miscarriage, induced abortion, or childbirth. The definition used in the
United States continues to be the presence of a fever of 38° C (100.4° F) or higher on two
successive days of the first 10 after birth days, starting 24 hours after birth. Fatigue would be a
late finding associated with infection. Pain with voiding may indicate a urinary tract infection,
but it is not typically one of the earlier symptoms of infection. Profuse lochia may be
associated with endometritis, but it is not the first symptom associated with infection

Question 89

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage
(PPH). For instance:
a. PPH is easy to recognize early; after all, the woman is bleeding.
b. traditionally it takes more than 1000 mL of blood after vaginal birth and 2500 mL
after cesarean birth to define the condition as PPH.
c. if anything, nurses and doctors tend to overestimate the amount of blood loss.
d. traditionally PPH has been classified as early or late with respect to birth.

Answer 89

ANS: D
Early PPH is also known as primary, or acute, PPH; late PPH is known as secondary PPH.
Unfortunately PPH can occur with little warning and often is recognized only after the mother
has profound symptoms. Traditionally a 500-mL blood loss after a vaginal birth and a
1000-mL blood loss after a cesarean birth constitute PPH. Medical personnel tend to
underestimate blood loss by as much as 50% in their subjective observations.

Question 90

A woman who has recently given birth complains of pain and tenderness in her leg. On
physical examination the nurse notices warmth and redness over an enlarged, hardened area.
The nurse should suspect __________ and should confirm the diagnosis by ___________.
a. disseminated intravascular coagulation; asking for laboratory tests
b. von Willebrand disease; noting whether bleeding times have been extended
c. thrombophlebitis; using real-time and color Doppler ultrasound
d. coagulopathies; drawing blood for laboratory analysis

Answer 90

ANS: C
Pain and tenderness in the extremities, which show warmth, redness, and hardness, likely
indicate thrombophlebitis. Doppler ultrasound is a common noninvasive way to confirm
diagnosis.

Question 91

What PPH conditions are considered medical emergencies that require immediate treatment?

a. Inversion of the uterus and hypovolemic shock
b. Hypotonic uterus and coagulopathies
c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura
d. Uterine atony and disseminated intravascular coagulation

Answer 91

ANS: A
Inversion of the uterus and hypovolemic shock are considered medical emergencies. Although
hypotonic uterus and coagulopathies, subinvolution of the uterus and idiopathic
thrombocytopenic purpura, and uterine atony and disseminated intravascular coagulation are
serious conditions, they are not necessarily medical emergencies that require immediate
treatment.

Question 92

What infection is contracted mostly by first-time mothers who are breastfeeding?

a. Endometritis
b. Wound infections
c. Mastitis
d. Urinary tract infections

Answer 92

ANS: C
Mastitis is infection in a breast, usually confined to a milk duct. Most women who suffer this
are primiparas who are breastfeeding.

Question 93

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one
of the main concerns is that she may:
a. have outbursts of anger.
b. neglect her hygiene.
c. harm her infant.
d. lose interest in her husband.

Answer 93

ANS: C
Thoughts of harm to oneself’ or the infant are among the most serious symptoms of PPD and
require immediate assessment and intervention. Although outbursts of anger, hygiene neglect,
and loss of interest in her husband are attributable to PPD, the major concern would be the
potential to harm herself or her infant.

Question 94

To provide adequate after birth care, the nurse should be aware that postpartum depression
(PPD) without psychotic features:
a. means that the woman is experiencing the baby blues. In addition she has a visit
with a counselor or psychologist.
b. is more common among older, Caucasian women because they have higher
expectations.
c. is distinguished by irritability, severe anxiety, and panic attacks.
d. will disappear on its own without outside help.

Answer 94

ANS: C
PPD is also characterized by spontaneous crying long after the usual duration of the baby
blues. PPD, even without psychotic features, is more serious and persistent than after birth
baby blues. It is more common among younger mothers and African-American mothers. Most
women need professional help to get through PPD, including pharmacologic intervention.

Question 95

To provide adequate after birth care, the nurse should be aware that postpartum depression
(PPD) with psychotic features:
a. is more likely to occur in women with more than two children.
b. is rarely delusional and then is usually about someone trying to harm her (the
mother).
c. although serious, is not likely to need psychiatric hospitalization.
d. may include bipolar disorder (formerly called “manic depression”).

Answer 95

ANS: D
Manic mood swings are possible. PPD is more likely to occur in first-time mothers. Delusions
may be present in 50% of women with PPD, usually about something being wrong with the
infant. PPD with psychosis is a psychiatric emergency that requires hospitalization.

Question 96

With shortened hospital stays, new mothers are often discharged before they begin to
experience symptoms of the baby blues or after birth depression. As part of the discharge
teaching, the nurse can prepare the mother for this adjustment to her new role by instructing
her regarding self-care activities to help prevent after birth depression. The most accurate
statement as related to these activities is to:
a. stay home and avoid outside activities to ensure adequate rest.
b. be certain that you are the only caregiver for your baby to facilitate infant
attachment.
c. keep feelings of sadness and adjustment to your new role to yourself.
d. realize that this is a common occurrence that affects many women.

Answer 96

ANS: D
Should the new mother experience symptoms of the baby blues, it is important that she be
aware that this is nothing to be ashamed of. Up to 80% of women experience this type of mild
depression after the birth of their infant. Although it is important for the mother to obtain
enough rest, she should not distance herself from family and friends. Her spouse or partner
can communicate the best visiting times so the new mother can obtain adequate rest. It is also
important that she does not isolate herself at home during this time of role adjustment. Even if
breastfeeding, other family members can participate in the infant’s care. If depression occurs,
the symptoms can often interfere with mothering functions, and this support will be essential.
The new mother should share her feelings with someone else. It is also important that she not
overcommit herself or think she has to be “superwoman.” A telephone call to the hospital
warm line may provide reassurance with lactation issues and other infant care questions.
Should symptoms continue, a referral to a professional therapist may be necessary.

Question 97

Complicated bereavement:

a. occurs when, in multiple births, one child dies, and the other or others live.
b. is a state in which the parents are ambivalent, as with an abortion.
c. is an extremely intense grief reaction that persists for a long time.
d. is felt by the family of adolescent mothers who lose their babies.

Answer 97

ANS;C
Parents showing signs of complicated grief should be referred for counseling. Multiple births
in which not all the babies survive creates a complicated parenting situation, but this is not
complicated bereavement. Abortion can generate complicated emotional responses, but they
do not constitute complicated bereavement. Families of lost adolescent pregnancies may have
to deal with complicated issues, but this is not complicated bereavement.

Question 98

Early after birth hemorrhage is defined as a blood loss greater than:

a. 500 mL in the first 24 hours after vaginal delivery.
b. 750 mL in the first 24 hours after vaginal delivery.
c. 1000 mL in the first 48 hours after cesarean delivery.
d. 1500 mL in the first 48 hours after cesarean delivery.

Answer 98

ANS: A
The average amount of bleeding after a vaginal birth is 500 mL. Blood loss after a cesarean
birth averages 1000 mL. Early after birth hemorrhage occurs in the first 24 hours, not 48
hours. Late after birth hemorrhage is 48 hours and later.

Question 99

A woman delivered a 9-lb, 10-ounce baby 1 hour ago. When you arrive to perform her
15-minute assessment, she tells you that she “feels all wet underneath.” You discover that
both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood.
What is your first action?
a. Call for help.
b. Assess the fundus for firmness.
c. Take her blood pressure.
d. Check the perineum for lacerations

Answer 99

ANS: B
Firmness of the uterus is necessary to control bleeding from the placental site. The nurse
should first assess for firmness and massage the fundus as indicated. Assessing blood pressure
is an important assessment with a bleeding patient; however, the top priority is to control the
bleeding. If bleeding continues in the presence of a firm fundus, lacerations may be the cause.

Question 100

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests:

a. uterine atony.
b. lacerations of the genital tract.
c. perineal hematoma.
d. infection of the uterus

Answer 100

ANS:B
Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is
uncontrolled by uterine contraction. The fundus is not firm in the presence of uterine atony. A
hematoma would develop internally. Swelling and discoloration would be noticeable;
however, bright bleeding would not be. With an infection of the uterus there would be an odor
to the lochia and systemic symptoms such as fever and malaise.

Question 101

Which instruction should be included in the discharge teaching plan to assist the patient in
recognizing early signs of complications?
a. Palpate the fundus daily to ensure that it is soft.
b. Notify the physician of any increase in the amount of lochia or a return to bright
red bleeding.
c. Report any decrease in the amount of brownish red lochia.
d. The passage of clots as large as an orange can be expected

Answer 101

ANS: B
An increase in lochia or a return to bright red bleeding after the lochia has become pink
indicates a complication. The fundus should stay firm. The lochia should decrease in amount
over time. Large clots after discharge are a sign of complications and should be reported

Question 102

If nonsurgical treatment for late after birth hemorrhage is ineffective, which surgical
procedure is appropriate to correct the cause of this condition?
a. Hysterectomy
b. Laparoscopy
c. Laparotomy
d. D&C

Answer 102

ANS: D
D&C allows examination of the uterine contents and removal of any retained placental
fragments or blood clots. Hysterectomy is the removal of the uterus and is not indicated for
this condition. A laparoscopy is the insertion of an endoscope through the abdominal wall to
examine the peritoneal cavity. It is not the appropriate treatment for this condition. A
laparotomy is also not indicated for this condition. A laparotomy is a surgical incision into the
peritoneal cavity to explore it.

Question 103

Which condition is a transient, self-limiting mood disorder that affects new mothers after
childbirth?
a. After birth depression
b. After birth psychosis
c. After birth bipolar disorder
d. After birth blues

Answer 103

ANS:D
After birth blues or “baby blues” is a transient self-limiting disease that is believed to be
related to hormonal fluctuations after childbirth. After birth depression is not the normal
worries (blues) that many new mothers experience. Many caregivers believe that after birth
depression is underdiagnosed and underreported. After birth psychosis is a rare condition that
usually surfaces within 3 weeks of delivery. Hospitalization of the woman is usually
necessary for treatment of this disorder. Bipolar disorder is one of the two categories of after
birth psychosis, characterized by both manic and depressive episodes.

Question 104

Anxiety disorders are the most common mental disorders that affect women. While providing
care to the maternity patient, the nurse should be aware that one of these disorders is likely to
be triggered by the process of labor and birth. This disorder is:
a. phobias.
b. panic disorder.
c. posttraumatic stress disorder (PTSD).
d. obsessive-compulsive disorder (OCD).

Answer 104

ANS: C
In PTSD, women perceive childbirth as a traumatic event. They have nightmares and
flashbacks about the event, anxiety, and avoidance of reminders of the traumatic event.
Phobias are irrational fears that may lead a person to avoid certain objects, events, or
situations. Panic disorders include episodes of intense apprehension, fear, and terror.
Symptoms may manifest themselves as palpitations, chest pain, choking, or smothering. OCD
symptoms include recurrent, persistent, and intrusive thoughts. The mother may repeatedly
check and recheck her infant once he or she is born, even though she realizes that this is
irrational. OCD is best treated with medications.

Question 105

Medications used to manage postpartum hemorrhage (PPH) include: (Select all that apply.)

a. Pitocin.
b. Methergine.
c. Terbutaline.
d. Hemabate.
e. magnesium sulfate.

Answer 105

ANS: A, B, D
Pitocin, Methergine, and Hemabate are all used to manage PPH. Terbutaline and magnesium
sulfate are tocolytics; relaxation of the uterus causes or worsens PPH.