Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
CHAPTER 18: MATERNAL PHYSIOLOGIC CHANGES (2023)
1. A woman gave birth to an infant boy 10 hour*s ago. Where would the nurse expect
to locate this woman’s fundus?
a. One centimeter above the umbilicus
ANS: A Within 12 hours after delivery fundus-approximately 1 cm above umbilicus.
fundus descends about 1-2 cm every 24 hours. By 6th postpartum week-fundus
normally halfway between symphysis pubis and umbilicus.
2. Which woman is most likely to experience strong afterpains?
b. A woman who is a gravida 4, para 4-0-0-4
ANS: B Afterpains-more common in multiparous,with births in which uterus was
greatly distended,in woman who experienced polyhydramnios or delivered large
infant. Breastfeeding may cause afterpains to intensify.
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?
d. Lochia serosa
ANS: D Lochia serosa-blood, serum, leukocytes,tissue debris,around day 3 or 4 after
childbirth. Lochia rubra-blood,decidual,trophoblastic debris;3 to 4 days and pales,
becoming pink or brown.Lochia alba-after day 10,continue up to 6 wks
4. Which hormone remains elevated in the immediate postpartum period of the
breastfeeding woman?
c. Prolactin
,Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
ANS: C Prolactin-increase progressively throughout pregnancy. In breastfeed-remain
elevated into 6th week after birth. Estrogen,progesterone -decrease markedly after
expulsion of placenta,reach their lowest levels 1 week into postpartum period. Human
placental lactogen levels decrease dramatically after expulsion of placenta.
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 postpartum period is:
c. Loss of increased blood volume associated with pregnancy.
ANS: C Within 12 hours of birth women begin to lose excess tissue fluid.1st
mechanism for reducing retained fluids-profuse diaphoresis-often occurs, especially at
night, for 1st 2-3 days after childbirth. Postpartal diuresis-mechanism by which body
rids itself of excess fluid. Diaphoresis,diuresis-referred to as reversal of water
metabolism of pregnancy.Postpartal diuresis may be caused by removal of increased
venous pressure in lower extremities.
6. A woman gave birth to a 7-pound, 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 postpartum
period, the most serious consequence likely to occur from bladder distention is:
b. Excessive uterine bleeding.
ANS: B Excessive bleeding-occur immediately after birth if bladder becomes
distended because it pushes uterus up,to side,prevents it from contracting firmly.UTI-
may result from overdistention of bladder,not most serious consequence.ruptured
bladder may result from severely overdistended bladder.vaginal bleeding most likely
would occur before bladder reaches this level of overdistention.Bladder distention
may result from bladder wall atony.
7. The nurse caring for the postpartum woman understands that breast engorgement is
caused by:
,Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
d. Congestion of veins and lymphatics.
ANS: D
8. A woman gave birth to a 7-pound, 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.
ANS: A EBL=1500 mL with tachycardia,hypotension suggests hypovolemia-
excessive blood loss. Increased respiratory rate of 36 may be 2ry to pain from birth.
Temperature may increase to 38° C during 1st 24 hrs-result of dehydrating effects of
labor.BP140/90-slightly elevated-may be caused by use of oxytocic medications.
9. Which statement by a newly delivered woman indicates that she knows what to
expect about her menstrual activity after childbirth?
b. “My first menstrual cycle will be heavier than normal and will return to
my prepregnant volume within three or four cycles.”
ANS: B
10. The interval between the birth of the newborn and the return of the reproductive
organs to their normal nonpregnant state is called the:
d. Puerperium, or fourth trimester of pregnancy.
ANS: D Puerperium-4th trimester or postpartum period of pregnancy, lasts about 3-6
weeks. Involution marks end of puerperium, or 4th trimester of pregnancy. Lochia
refers to the various vaginal discharges during puerperium
,Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
11. The self-destruction of excess hypertrophied tissue in the uterus is called:
a. Autolysis.
ANS: A Autolysis-caused by decrease in hormone levels. Subinvolution-failure of
uterus to return to nonpregnant state. Afterpain-caused by uterine cramps 2-3 days
after birth. Diastasis-separation of muscles.
12. With regard to the postpartum uterus, nurses should be aware that:
b. After 2 weeks postpartum it should not be palpable abdominally.
ANS: B After 2 wks postpartum-uterus should not be palpable abdominally; it has not
yet returned to original size.At end of 3rd stage of labor,uterus weighs approximately
1000 g. It takes 6 full weeks for uterus to return to its original size.After 2 weeks
postpartum uterus weighs about 350 g, not original size.Normal self-destruction of
excess hypertrophied tissue accounts for slight increase in uterine size after each
pregnancy.
13. With regard to afterbirth pains, nurses should be aware that these pains are:
c. More noticeable in births in which the uterus was overdistended.
ANS:C large baby or multiple babies overdistend uterus.cramping that causes after
birth pains arises from periodic, vigorous contractions,relaxations, which persist
through 1st part of postpartum period. Afterbirth pains-more common in multiparous
women because 1st-time mothers have better uterine tone. Breastfeeding intensifies
afterbirth pain because it stimulates contractions.
14. Postbirth uterine/vaginal discharge, called lochia:
d. Should smell like normal menstrual flow unless an infection is present.
, Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
ANS: D Offensive odor-indicates infection. Lochia flow should approximate heavy
menstrual period for 1st 2 hrs,then steadily decrease. Less lochia-seen after cesarean
births,increases with ambulation and breastfeeding.
15. Which description of postpartum restoration or healing times is accurate?
b. Vaginal rugae reappear by 3 weeks postpartum.
ANS: B Vaginal rugae reappear by 3 weeks postpartum;never as prominent as in
nulliparous women.Cervix regains-form within days;cervical os may take longer.Most
episiotomies take 2-3 weeks to heal. Hemorrhoids can take 6 wks to decrease in size.
16. With regard to postpartum ovarian function, nurses should be aware that:
d. The first menstrual flow after childbirth usually is heavier than normal.
ANS: D 1st flow-heavier,within 3 or 4 cycles-back to normal.Ovulation can occur
within 1st mth, but for 70% of nonlactating women,returns within 12 wks after
birth.Breastfeeding take longer to resume ovulation.many women ovulate before1st
postpartum menstrual period, contraceptive needed discussed early in puerperium.
17. As relates to the condition and reconditioning of the urinary system after
childbirth, nurses should be aware that:
c. Fluid loss through perspiration and increased urinary output accounts for
a weight loss of more than 2 kg during the puerperium.
ANS: C Excess fluid loss through other means occurs.Kidney function usually returns
to normal in about 1mth.Diastasis recti abdominis-separation of muscles in abdominal
wall; no effect on voiding reflex. Bladder tone-restored 5-7 days after childbirth.
18. 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 clients all the
following statements except:
Examination Study Guide 2023
Latest Updated versions.
CHAPTER 18: MATERNAL PHYSIOLOGIC CHANGES (2023)
1. A woman gave birth to an infant boy 10 hour*s ago. Where would the nurse expect
to locate this woman’s fundus?
a. One centimeter above the umbilicus
ANS: A Within 12 hours after delivery fundus-approximately 1 cm above umbilicus.
fundus descends about 1-2 cm every 24 hours. By 6th postpartum week-fundus
normally halfway between symphysis pubis and umbilicus.
2. Which woman is most likely to experience strong afterpains?
b. A woman who is a gravida 4, para 4-0-0-4
ANS: B Afterpains-more common in multiparous,with births in which uterus was
greatly distended,in woman who experienced polyhydramnios or delivered large
infant. Breastfeeding may cause afterpains to intensify.
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?
d. Lochia serosa
ANS: D Lochia serosa-blood, serum, leukocytes,tissue debris,around day 3 or 4 after
childbirth. Lochia rubra-blood,decidual,trophoblastic debris;3 to 4 days and pales,
becoming pink or brown.Lochia alba-after day 10,continue up to 6 wks
4. Which hormone remains elevated in the immediate postpartum period of the
breastfeeding woman?
c. Prolactin
,Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
ANS: C Prolactin-increase progressively throughout pregnancy. In breastfeed-remain
elevated into 6th week after birth. Estrogen,progesterone -decrease markedly after
expulsion of placenta,reach their lowest levels 1 week into postpartum period. Human
placental lactogen levels decrease dramatically after expulsion of placenta.
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 postpartum period is:
c. Loss of increased blood volume associated with pregnancy.
ANS: C Within 12 hours of birth women begin to lose excess tissue fluid.1st
mechanism for reducing retained fluids-profuse diaphoresis-often occurs, especially at
night, for 1st 2-3 days after childbirth. Postpartal diuresis-mechanism by which body
rids itself of excess fluid. Diaphoresis,diuresis-referred to as reversal of water
metabolism of pregnancy.Postpartal diuresis may be caused by removal of increased
venous pressure in lower extremities.
6. A woman gave birth to a 7-pound, 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 postpartum
period, the most serious consequence likely to occur from bladder distention is:
b. Excessive uterine bleeding.
ANS: B Excessive bleeding-occur immediately after birth if bladder becomes
distended because it pushes uterus up,to side,prevents it from contracting firmly.UTI-
may result from overdistention of bladder,not most serious consequence.ruptured
bladder may result from severely overdistended bladder.vaginal bleeding most likely
would occur before bladder reaches this level of overdistention.Bladder distention
may result from bladder wall atony.
7. The nurse caring for the postpartum woman understands that breast engorgement is
caused by:
,Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
d. Congestion of veins and lymphatics.
ANS: D
8. A woman gave birth to a 7-pound, 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.
ANS: A EBL=1500 mL with tachycardia,hypotension suggests hypovolemia-
excessive blood loss. Increased respiratory rate of 36 may be 2ry to pain from birth.
Temperature may increase to 38° C during 1st 24 hrs-result of dehydrating effects of
labor.BP140/90-slightly elevated-may be caused by use of oxytocic medications.
9. Which statement by a newly delivered woman indicates that she knows what to
expect about her menstrual activity after childbirth?
b. “My first menstrual cycle will be heavier than normal and will return to
my prepregnant volume within three or four cycles.”
ANS: B
10. The interval between the birth of the newborn and the return of the reproductive
organs to their normal nonpregnant state is called the:
d. Puerperium, or fourth trimester of pregnancy.
ANS: D Puerperium-4th trimester or postpartum period of pregnancy, lasts about 3-6
weeks. Involution marks end of puerperium, or 4th trimester of pregnancy. Lochia
refers to the various vaginal discharges during puerperium
,Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
11. The self-destruction of excess hypertrophied tissue in the uterus is called:
a. Autolysis.
ANS: A Autolysis-caused by decrease in hormone levels. Subinvolution-failure of
uterus to return to nonpregnant state. Afterpain-caused by uterine cramps 2-3 days
after birth. Diastasis-separation of muscles.
12. With regard to the postpartum uterus, nurses should be aware that:
b. After 2 weeks postpartum it should not be palpable abdominally.
ANS: B After 2 wks postpartum-uterus should not be palpable abdominally; it has not
yet returned to original size.At end of 3rd stage of labor,uterus weighs approximately
1000 g. It takes 6 full weeks for uterus to return to its original size.After 2 weeks
postpartum uterus weighs about 350 g, not original size.Normal self-destruction of
excess hypertrophied tissue accounts for slight increase in uterine size after each
pregnancy.
13. With regard to afterbirth pains, nurses should be aware that these pains are:
c. More noticeable in births in which the uterus was overdistended.
ANS:C large baby or multiple babies overdistend uterus.cramping that causes after
birth pains arises from periodic, vigorous contractions,relaxations, which persist
through 1st part of postpartum period. Afterbirth pains-more common in multiparous
women because 1st-time mothers have better uterine tone. Breastfeeding intensifies
afterbirth pain because it stimulates contractions.
14. Postbirth uterine/vaginal discharge, called lochia:
d. Should smell like normal menstrual flow unless an infection is present.
, Chapter 18: Maternal Physiologic Changes
Examination Study Guide 2023
Latest Updated versions.
ANS: D Offensive odor-indicates infection. Lochia flow should approximate heavy
menstrual period for 1st 2 hrs,then steadily decrease. Less lochia-seen after cesarean
births,increases with ambulation and breastfeeding.
15. Which description of postpartum restoration or healing times is accurate?
b. Vaginal rugae reappear by 3 weeks postpartum.
ANS: B Vaginal rugae reappear by 3 weeks postpartum;never as prominent as in
nulliparous women.Cervix regains-form within days;cervical os may take longer.Most
episiotomies take 2-3 weeks to heal. Hemorrhoids can take 6 wks to decrease in size.
16. With regard to postpartum ovarian function, nurses should be aware that:
d. The first menstrual flow after childbirth usually is heavier than normal.
ANS: D 1st flow-heavier,within 3 or 4 cycles-back to normal.Ovulation can occur
within 1st mth, but for 70% of nonlactating women,returns within 12 wks after
birth.Breastfeeding take longer to resume ovulation.many women ovulate before1st
postpartum menstrual period, contraceptive needed discussed early in puerperium.
17. As relates to the condition and reconditioning of the urinary system after
childbirth, nurses should be aware that:
c. Fluid loss through perspiration and increased urinary output accounts for
a weight loss of more than 2 kg during the puerperium.
ANS: C Excess fluid loss through other means occurs.Kidney function usually returns
to normal in about 1mth.Diastasis recti abdominis-separation of muscles in abdominal
wall; no effect on voiding reflex. Bladder tone-restored 5-7 days after childbirth.
18. 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 clients all the
following statements except:
