Chapter 20 Postpartum Adaptations

Chapter 20  Postpartum Adaptations

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A postpartum 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 I flexed your foot.”
d. “You have a ‘fleshy’ odor to your vaginal drainage.”

ANS: C
Discomfort in the calf with sharp dorsiflexion of the foot may indicate a deep vein
thrombosis. It does not indicate edema, rate deep tendon reflexes, or describe the odor of
lochia.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 404 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

2. Which woman is most likely to have severe afterbirth pains and request a narcotic analgesic?

a. Gravida 5, para 5
b. Woman who is bottle-feeding her first child
c. Primipara who delivered a 7-lb boy
d. Woman who has started to breastfeed

ANS: A
The discomfort of after pains is more acute for multiparas because repeated stretching of
muscle fibers leads to loss of uterine muscle tone. After pains are particularly severe during
breastfeeding, not bottle-feeding. The uterus of a primipara tends to remain contracted. The
breastfeeding woman may have increased pain due to engorgement, but the multipara
probably will have the most severe afterbirth pains.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 396 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

3. Which maternal event is abnormal in the early postpartum period?

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

ANS: D

For the first 3 days after childbirth, lochia is mostly red and is termed rubra. Lochia serosa
follows, and then at about 11 days, the discharge becomes clear, colorless, or white. The body
rids itself of increased plasma volume after birth. 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 after birth, leading to flatulence and constipation. The new
mother is hungry and thirsty because of energy used in labor and thirsty because of fluid
restrictions during labor.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 396 | Table 20.1 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance

4. 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.

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. The nurse
needs to make further assessments. The other findings are within normal limits for the time
period.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 395 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

5. If the patient’s white blood cell (WBC) count is 25,000/mm3 on her second postpartum 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.
d. begin antibiotic therapy immediately.

ANS: C
Marked leukocytosis occurs with WBC counts increasing to as high as 30,000/mm3 during
labor and the immediate postpartum period. The WBC falls to normal within 6 days
postpartum. No action is necessary.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 397 OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance