Maternity and Pediatric Nursing 4th Edition by Susan Ricci,
All Chapters | Complete Guide A+| Latest updated version
2025/2026.
QUESTION: A client who is breastfeeding her newborn tells the nurse, I notice that when I
feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having
contractions now? Which response by the nurse would be most appropriate?
A) Your uterus is still shrinking in size; that's why you're feeling this pain.
B) Let me check your vaginal discharge just to make sure everything is fine.
C) Your body is responding to the events of labor, just like after a tough workout.
D) The baby's sucking releases a hormone that causes the uterus to contract✓✓ Ans. D
The woman is describing afterpains, which are usually stronger during breast-feeding
because oxytocin released by the sucking reflex strengthens uterine contractions. Afterpains
are associated with uterine involution, but the woman's description strongly correlates with
the hormonal events of breast-feeding. All women experience afterpains, but they are more
acute in multiparous women secondary to repeated stretching of the uterine muscles.
QUESTION: The nurse interprets which of the following as evidence that a client is in the
taking-in phase?
A) Client states, He has my eyes and nose.
B) Client shows interest in caring for the newborn.
C) Client performs self-care independently.
D) Client confidently cares for the newborn✓✓ Ans. A
During the taking-in phase, new mothers when interacting with their newborns spend time
claiming the newborn and touching him or her, commonly identifying specific features in
the newborn such as "he has my nose" or "his fingers are long like his father's."
1|Page
,Independence in self-care and interest in caring for the newborn are typical of the taking-
hold phase. Confidence in caring for the newborn is demonstrated during the letting-go
phase.
QUESTION: A postpartum client is experiencing subinvolution. When reviewing the
woman's labor and birth history, which of the following would the nurse identify as being
least significant to this condition?
A) Early ambulation
B) Prolonged labor
C) Large fetus
D) Pulse rate of 60 beats/minute✓✓ Ans. A
Factors that inhibit involution include prolonged labor and difficult birth, incomplete
expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine
muscles (such as by multiple gestation, hydramnios, or large singleton fetus), full bladder
(which displaces the uterus and interferes with contractions), anesthesia(which relaxes
uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution
include complete expulsion of amniotic membranes and placenta at birth, complication-free
labor and birth process, breast-feeding, and early ambulation.
QUESTION: A woman who gave birth 24 hours ago tells the nurse, I've been urinating so
much over the past several hours. Which response by the nurse would be most
appropriate?
A) You must have an infection, so let me get a urine specimen.
B) Your body is undergoing many changes that cause your bladder to fill quickly.
C) Your uterus is not contracting as quickly as it should.
D) The anesthesia that you received is wearing off and your bladder is working
2|Page
,again.✓✓ Ans. B
Postpartum diuresis occurs as a result of several mechanisms: the large amounts of IV fluids
given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the
buildup and retention of extra fluids during pregnancy, and a decreasing production of
aldosterone—the hormone that decreases sodium retention and increases urine
production. All these factors contribute to rapid filling of the bladder within 12 hours of
birth. Diuresis begins within 12 hours after childbirth and continues throughout the first
week postpartum. Rapid bladder filling, possible infection, or effects of anesthesia are not
involved.
QUESTION: A group of students are reviewing the process of breast milk production. The
students demonstrate understanding when they identify which hormone as
responsible for milk let-down?
A) Prolactin
B) Estrogen
C) Progesterone
D) Oxytocin✓✓ Ans. D
Don't let this confuse you! Milk let-down/stimulation vs milk production (prolactin)
Oxytocin is released from the posterior pituitary to promote milk let-down. Prolactin levels
increase at term with a decrease in estrogen and progesterone; estrogen and progesterone
levels decrease after the placenta is delivered. Prolactin is released from the anterior
pituitary gland and initiates milk production.
QUESTION: A nursing student is preparing a class presentation about changes in the various
body systems during the postpartum period and their effects. Which of the following would
the student include as influencing a postpartum woman's ability to void? (Select all that
apply.)
3|Page
, A) Use of an opioid anesthetic during labor
B) Generalized swelling of the perineum
C) Decreased bladder tone from regional anesthesia
D) Use of oxytocin to augment labor
E) Need for an episiotomy✓✓ Ans. B, C, D
Many women have difficulty feeling the sensation to void after giving birth if they received
an anesthetic block during labor (which inhibits neural functioning of the bladder) or if they
received oxytocin to induce or augment their labor (antidiuretic effect). These women will
be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary
retention. In addition, urination may be impeded by perineal lacerations; generalized
swelling and bruising of the perineum and tissues surrounding the urinary meatus;
hematomas; decreased bladder tone as a result of regional anesthesia; and diminished
sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing
effects of regional anesthesia used during labor
QUESTION: Which of the following would lead the nurse to suspect that a postpartum
woman is experiencing a problem?
A) Elevated white blood cell count
B) Acute decrease in hematocrit
C) Increased levels of clotting factors
D) Pulse rate of 60 beats/minute✓✓ Ans. B
Despite a decrease in blood volume after birth, hematocrit levels remain relatively stable
and may even increase. An acute decrease is not an expected finding. Red blood cell
production ceases early in the puerperium, causing mean hemoglobin and hematocrit levels
to decrease slightly in the first 24 hours. During the next 2 weeks, both levels rise slowly.
The white blood count, which increases in labor, remains elevated for the first 4 to 6 days
after birth but then falls to 6,000 to 10,000/mm3. The WBC count remains elevated for the
4|Page
All Chapters | Complete Guide A+| Latest updated version
2025/2026.
QUESTION: A client who is breastfeeding her newborn tells the nurse, I notice that when I
feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having
contractions now? Which response by the nurse would be most appropriate?
A) Your uterus is still shrinking in size; that's why you're feeling this pain.
B) Let me check your vaginal discharge just to make sure everything is fine.
C) Your body is responding to the events of labor, just like after a tough workout.
D) The baby's sucking releases a hormone that causes the uterus to contract✓✓ Ans. D
The woman is describing afterpains, which are usually stronger during breast-feeding
because oxytocin released by the sucking reflex strengthens uterine contractions. Afterpains
are associated with uterine involution, but the woman's description strongly correlates with
the hormonal events of breast-feeding. All women experience afterpains, but they are more
acute in multiparous women secondary to repeated stretching of the uterine muscles.
QUESTION: The nurse interprets which of the following as evidence that a client is in the
taking-in phase?
A) Client states, He has my eyes and nose.
B) Client shows interest in caring for the newborn.
C) Client performs self-care independently.
D) Client confidently cares for the newborn✓✓ Ans. A
During the taking-in phase, new mothers when interacting with their newborns spend time
claiming the newborn and touching him or her, commonly identifying specific features in
the newborn such as "he has my nose" or "his fingers are long like his father's."
1|Page
,Independence in self-care and interest in caring for the newborn are typical of the taking-
hold phase. Confidence in caring for the newborn is demonstrated during the letting-go
phase.
QUESTION: A postpartum client is experiencing subinvolution. When reviewing the
woman's labor and birth history, which of the following would the nurse identify as being
least significant to this condition?
A) Early ambulation
B) Prolonged labor
C) Large fetus
D) Pulse rate of 60 beats/minute✓✓ Ans. A
Factors that inhibit involution include prolonged labor and difficult birth, incomplete
expulsion of amniotic membranes and placenta, uterine infection, overdistention of uterine
muscles (such as by multiple gestation, hydramnios, or large singleton fetus), full bladder
(which displaces the uterus and interferes with contractions), anesthesia(which relaxes
uterine muscles), and close childbirth spacing. Factors that facilitate uterine involution
include complete expulsion of amniotic membranes and placenta at birth, complication-free
labor and birth process, breast-feeding, and early ambulation.
QUESTION: A woman who gave birth 24 hours ago tells the nurse, I've been urinating so
much over the past several hours. Which response by the nurse would be most
appropriate?
A) You must have an infection, so let me get a urine specimen.
B) Your body is undergoing many changes that cause your bladder to fill quickly.
C) Your uterus is not contracting as quickly as it should.
D) The anesthesia that you received is wearing off and your bladder is working
2|Page
,again.✓✓ Ans. B
Postpartum diuresis occurs as a result of several mechanisms: the large amounts of IV fluids
given during labor, a decreasing antidiuretic effect of oxytocin as its level declines, the
buildup and retention of extra fluids during pregnancy, and a decreasing production of
aldosterone—the hormone that decreases sodium retention and increases urine
production. All these factors contribute to rapid filling of the bladder within 12 hours of
birth. Diuresis begins within 12 hours after childbirth and continues throughout the first
week postpartum. Rapid bladder filling, possible infection, or effects of anesthesia are not
involved.
QUESTION: A group of students are reviewing the process of breast milk production. The
students demonstrate understanding when they identify which hormone as
responsible for milk let-down?
A) Prolactin
B) Estrogen
C) Progesterone
D) Oxytocin✓✓ Ans. D
Don't let this confuse you! Milk let-down/stimulation vs milk production (prolactin)
Oxytocin is released from the posterior pituitary to promote milk let-down. Prolactin levels
increase at term with a decrease in estrogen and progesterone; estrogen and progesterone
levels decrease after the placenta is delivered. Prolactin is released from the anterior
pituitary gland and initiates milk production.
QUESTION: A nursing student is preparing a class presentation about changes in the various
body systems during the postpartum period and their effects. Which of the following would
the student include as influencing a postpartum woman's ability to void? (Select all that
apply.)
3|Page
, A) Use of an opioid anesthetic during labor
B) Generalized swelling of the perineum
C) Decreased bladder tone from regional anesthesia
D) Use of oxytocin to augment labor
E) Need for an episiotomy✓✓ Ans. B, C, D
Many women have difficulty feeling the sensation to void after giving birth if they received
an anesthetic block during labor (which inhibits neural functioning of the bladder) or if they
received oxytocin to induce or augment their labor (antidiuretic effect). These women will
be at risk for incomplete emptying, bladder distention, difficulty voiding, and urinary
retention. In addition, urination may be impeded by perineal lacerations; generalized
swelling and bruising of the perineum and tissues surrounding the urinary meatus;
hematomas; decreased bladder tone as a result of regional anesthesia; and diminished
sensation of bladder pressure as a result of swelling, poor bladder tone, and numbing
effects of regional anesthesia used during labor
QUESTION: Which of the following would lead the nurse to suspect that a postpartum
woman is experiencing a problem?
A) Elevated white blood cell count
B) Acute decrease in hematocrit
C) Increased levels of clotting factors
D) Pulse rate of 60 beats/minute✓✓ Ans. B
Despite a decrease in blood volume after birth, hematocrit levels remain relatively stable
and may even increase. An acute decrease is not an expected finding. Red blood cell
production ceases early in the puerperium, causing mean hemoglobin and hematocrit levels
to decrease slightly in the first 24 hours. During the next 2 weeks, both levels rise slowly.
The white blood count, which increases in labor, remains elevated for the first 4 to 6 days
after birth but then falls to 6,000 to 10,000/mm3. The WBC count remains elevated for the
4|Page
