Chapter 17: Postpartum Physiologic Adaptations

Chapter 17: Postpartum Physiologic Adaptations

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A postpartum client overhears the nurse tell the health care provider that she has a positive Homans sign and asks what it means. Which is the nurse’s best response?

ANS:  C

Discomfort in the calf with sharp dorsiflexion of the foot may indicate a 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.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   338

OBJ:   Nursing Process Step: Implementation

MSC:  Client Needs: Physiologic Integrity

2. Which client would be most likely to have severe afterbirth pains and request a narcotic analgesic?

ANS:  A

The discomfort of afterpains is more acute for multiparas because repeated stretching of muscle fibers leads to loss of uterine muscle tone. The uterus of a primipara tends to remain contracted. Afterpains are particularly severe during breastfeeding, not bottle feeding. The non-nursing mother may have engorgement problems. She should empty her breasts regularly to stimulate milk production so she will have the milk when the baby is strong enough to nurse.

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   329

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Physiologic Integrity

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

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. The body rids itself of increased plasma volume. Urine output of 3000 mL/day is common for the first few days after birth 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.

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   329

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Health Promotion and Maintenance

4. Which fundal assessment finding at 12 hours after birth requires further assessment?

ANS:  B

The fundus rises to the umbilicus after birth and remains there for about 24 hours. A fundus that is above the umbilicus may indicate uterine atony or urinary retention. The fundus palpable at the umbilicus is an appropriate assessment finding for 12 hours postpartum. The fundus palpable one fingerbreadth below the umbilicus is an appropriate assessment finding for 12 hours postpartum. The fundus palpable two fingerbreadths below the umbilicus is an unusual finding for 12 hours postpartum, but is still appropriate.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   329

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Physiologic Integrity

5. If the client’s white blood cell (WBC) count is 25,000/mm³ on her second postpartum day, which action should the nurse take?

ANS:  A

An increase in WBC count to 25,000/mm³ during the postpartum period is considered normal and not a sign of infection. The nurse should document the finding. Because this is a normal finding, there is no reason to alert the health care provider. Antibiotics are not needed because the elevated WBCs are caused by the stress of labor and not an infectious process. There is no need for reassessment as it is expected for the WBCs to be elevated.

PTS:   1                    DIF:    Cognitive Level: Application           REF:   331

OBJ:   Nursing Process Step: Implementation

MSC:  Client Needs: Health Promotion and Maintenance