Chapter 18 - Maternal Physiologic Change EAQs(All
answered)
A pregnant patient complains to the nurse about periodic numbness, tingling of fingers, and the
inability to lift and carry any object. What patient clinical condition does the nurse interpret from
this assessment? correct answers Carpal tunnel syndrome
Fluid retention and swelling are common during pregnancy and increase the pressure in the
narrow and inflexible space in the hand, compressing the median nerve that runs through the
hand. This results in numbness, tingling of fingers, and the inability to lift and carry objects and
is a condition known as carpal tunnel syndrome, which this patient has. Itching and discomfort
around the anus and bright red bleeding upon defecation are the symptoms of hemorrhoids.
These symptoms are not observed in the patient; therefore the patient does not have hemorrhoids.
Fever, pain, and abdominal tenderness during menstrual discharge are the symptoms of
endometritis. The nurse does not find these symptoms in the patient, so the patient does not have
endometritis. Vitamin A deficiency does not affect the muscles, nor does it cause periodic
numbness or tingling of the fingers. Therefore the patient does not have a vitamin A deficiency.
A patient who had a cesarean birth is immobile in the immediate postoperative period. Which
risk is increased in the patient as a result of the hypercoagulable state of the puerperal period?
correct answers Thromboemolism
Thromboembolism refers to the condition in which a blood vessel is blocked by a blood clot. As
the postpartum period is characterized by a hypercoagulation state, the patient is at risk of
thromboembolism. Thrombophlebitis is the inflammation of the vein and is not associated with
hypercoagulation. Thrombocytopenia refers to the condition in which low levels of platelet are
found in the blood. Thrombocytosis is a condition characterized by a significant increase in the
number of platelets in the blood.
Postbirth uterine/vaginal discharge (called lochia): correct answers should smell like normal
menstrual flow unless an infection is present.
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. Lochia usually increases with ambulation and breastfeeding.
The nurse is caring for a postpartum patient who had a normal vaginal delivery. The nurse tells
the patient, "This will help you prevent uterine prolapse in later stages of life." Which instruction
from the primary health care provider (PHP) is the nurse most likely explaining to the patient?
correct answers "Do Kegel exercises every day."
Vaginal deliveries cause the pelvic muscles and ligaments to stretch and weaken. Kegel exercises
help strengthen the pelvic floor muscles and thereby can prevent uterine complications, such as
prolapse. The physical activity of climbing stairs may delay the process of healing from an
episiotomy, so it is usually avoided. However, avoiding stairs does not prevent uterine prolapse.
, A diet high in protein is necessary to build muscle strength, but it cannot prevent uterine
prolapse. Because the patient has already undergone delivery, sleeping in prone position does not
cause any harm.
The nurse assesses a postpartum patient several hours after delivery and suspects that the uterus
is subinvoluted. What could be a potential etiology for this finding? correct answers Retained
placental fragments
Retained placental fragments or infection cause subinvolution of the uterus. Therefore the nurse
should assess the patient for any placental fragments in the uterus. Estrogen and progesterone
stimulate massive growth of the uterus during pregnancy. In the postpartum stage, the hormone
levels are reduced and, therefore, do not affect involution of the uterus. Platelet aggregation
causes uterine muscle contraction, but it does not result in involution of the uterus.
What amount of blood loss is considered normal in a patient who has undergone a vaginal
delivery? correct answers 400 mL
There is an aerage blood loss of 300 -500 mL in patients who have delivered vaginally.
Therefore, 400 mL would be considered normal blood loss is a patient who has undergone a
vaginal delivery. Thus, a patient who has delivered vaginally will have blood loss of more than
100 mL. Blood loss of 700 - 1000 is normal in a cesarean delivery but would be considered
excessive blood loss in a vaginal delivery
The nurse advises a pregnant patient to do static abdominal exercises. How would these
exercises benefit the patient? correct answers They will help the patient to gain proper abdominal
tone after delivery
A firm, muscular wall with less adipose tissue would ensure that the patient is able to regain the
prepregnancy abdominal tone after delivery. Thus the nurse should advise the patient to do static
abdominal exercises during pregnancy. The abdominal tone is not a factor based on which the
nurse can determine whether the patient would have a normal vaginal delivery. Patients with
weak abdominal muscles, especially those who have multifetal gestation or a large fetus, are at
the risk of having diastasis recti abdominis. These abdominal striations usually do not fade away
completely. Although the abdominal skin retains its tone, some striae always remain.
The nurse is caring for a postpartum patient who reports dizziness upon standing. What does the
nurse believe to be the most likely cause for this occurrence? correct answers Orthostatic
hypotension
Orthostatic hypotension develops as a result of splanchnic engorgement after birth, which causes
dizziness immediately upon standing upright. Decreased blood pressure results from
hypovolemia due to hemorrhage. Manifestations of endometritis include pain, fever, and
abdominal tenderness, along with continued flow of lochia serosa or alba up to 3 to 4 weeks.
Manifestations of hemorrhoids include itching, discomfort, and bright red bleeding upon
defecation. Puerperal sepsis manifests by an increase in the maternal temperature up to 38° C
answered)
A pregnant patient complains to the nurse about periodic numbness, tingling of fingers, and the
inability to lift and carry any object. What patient clinical condition does the nurse interpret from
this assessment? correct answers Carpal tunnel syndrome
Fluid retention and swelling are common during pregnancy and increase the pressure in the
narrow and inflexible space in the hand, compressing the median nerve that runs through the
hand. This results in numbness, tingling of fingers, and the inability to lift and carry objects and
is a condition known as carpal tunnel syndrome, which this patient has. Itching and discomfort
around the anus and bright red bleeding upon defecation are the symptoms of hemorrhoids.
These symptoms are not observed in the patient; therefore the patient does not have hemorrhoids.
Fever, pain, and abdominal tenderness during menstrual discharge are the symptoms of
endometritis. The nurse does not find these symptoms in the patient, so the patient does not have
endometritis. Vitamin A deficiency does not affect the muscles, nor does it cause periodic
numbness or tingling of the fingers. Therefore the patient does not have a vitamin A deficiency.
A patient who had a cesarean birth is immobile in the immediate postoperative period. Which
risk is increased in the patient as a result of the hypercoagulable state of the puerperal period?
correct answers Thromboemolism
Thromboembolism refers to the condition in which a blood vessel is blocked by a blood clot. As
the postpartum period is characterized by a hypercoagulation state, the patient is at risk of
thromboembolism. Thrombophlebitis is the inflammation of the vein and is not associated with
hypercoagulation. Thrombocytopenia refers to the condition in which low levels of platelet are
found in the blood. Thrombocytosis is a condition characterized by a significant increase in the
number of platelets in the blood.
Postbirth uterine/vaginal discharge (called lochia): correct answers should smell like normal
menstrual flow unless an infection is present.
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. Lochia usually increases with ambulation and breastfeeding.
The nurse is caring for a postpartum patient who had a normal vaginal delivery. The nurse tells
the patient, "This will help you prevent uterine prolapse in later stages of life." Which instruction
from the primary health care provider (PHP) is the nurse most likely explaining to the patient?
correct answers "Do Kegel exercises every day."
Vaginal deliveries cause the pelvic muscles and ligaments to stretch and weaken. Kegel exercises
help strengthen the pelvic floor muscles and thereby can prevent uterine complications, such as
prolapse. The physical activity of climbing stairs may delay the process of healing from an
episiotomy, so it is usually avoided. However, avoiding stairs does not prevent uterine prolapse.
, A diet high in protein is necessary to build muscle strength, but it cannot prevent uterine
prolapse. Because the patient has already undergone delivery, sleeping in prone position does not
cause any harm.
The nurse assesses a postpartum patient several hours after delivery and suspects that the uterus
is subinvoluted. What could be a potential etiology for this finding? correct answers Retained
placental fragments
Retained placental fragments or infection cause subinvolution of the uterus. Therefore the nurse
should assess the patient for any placental fragments in the uterus. Estrogen and progesterone
stimulate massive growth of the uterus during pregnancy. In the postpartum stage, the hormone
levels are reduced and, therefore, do not affect involution of the uterus. Platelet aggregation
causes uterine muscle contraction, but it does not result in involution of the uterus.
What amount of blood loss is considered normal in a patient who has undergone a vaginal
delivery? correct answers 400 mL
There is an aerage blood loss of 300 -500 mL in patients who have delivered vaginally.
Therefore, 400 mL would be considered normal blood loss is a patient who has undergone a
vaginal delivery. Thus, a patient who has delivered vaginally will have blood loss of more than
100 mL. Blood loss of 700 - 1000 is normal in a cesarean delivery but would be considered
excessive blood loss in a vaginal delivery
The nurse advises a pregnant patient to do static abdominal exercises. How would these
exercises benefit the patient? correct answers They will help the patient to gain proper abdominal
tone after delivery
A firm, muscular wall with less adipose tissue would ensure that the patient is able to regain the
prepregnancy abdominal tone after delivery. Thus the nurse should advise the patient to do static
abdominal exercises during pregnancy. The abdominal tone is not a factor based on which the
nurse can determine whether the patient would have a normal vaginal delivery. Patients with
weak abdominal muscles, especially those who have multifetal gestation or a large fetus, are at
the risk of having diastasis recti abdominis. These abdominal striations usually do not fade away
completely. Although the abdominal skin retains its tone, some striae always remain.
The nurse is caring for a postpartum patient who reports dizziness upon standing. What does the
nurse believe to be the most likely cause for this occurrence? correct answers Orthostatic
hypotension
Orthostatic hypotension develops as a result of splanchnic engorgement after birth, which causes
dizziness immediately upon standing upright. Decreased blood pressure results from
hypovolemia due to hemorrhage. Manifestations of endometritis include pain, fever, and
abdominal tenderness, along with continued flow of lochia serosa or alba up to 3 to 4 weeks.
Manifestations of hemorrhoids include itching, discomfort, and bright red bleeding upon
defecation. Puerperal sepsis manifests by an increase in the maternal temperature up to 38° C
