Maternity and Pediatric Nursing 4th Edition
A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse
palpates the client's fundus, expecting it to be at which location?
A) Two fingerbreadths above the umbilicus
B) At the level of the umbilicus
C) Two fingerbreadths below the umbilicus
D) Four fingerbreadths below the umbilicus - correct answer C
During the first few days after birth, the uterus typically descends downward from the level of
the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by day 2, it is about 2
fingerbreadths below the umbilicus.
When caring for a mother who has had a cesarean birth, the nurse would expect the client's
lochia to be:
A) Greater than after a vaginal delivery
B) About the same as after a vaginal delivery
C) Less than after a vaginal delivery
D) Saturated with clots and mucus - correct answer C
Women who have had cesarean births tend to have less flow because the uterine debris is
removed manually along with delivery of the placenta.
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 - correct answer 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
,Maternity and Pediatric Nursing 4th Edition
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.
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 - correct answer 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." 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.
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 - correct answer 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.
, Maternity and Pediatric Nursing 4th Edition
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
again. - correct answer 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.
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 - correct answer 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.
A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse
palpates the client's fundus, expecting it to be at which location?
A) Two fingerbreadths above the umbilicus
B) At the level of the umbilicus
C) Two fingerbreadths below the umbilicus
D) Four fingerbreadths below the umbilicus - correct answer C
During the first few days after birth, the uterus typically descends downward from the level of
the umbilicus at a rate of 1 cm (1 fingerbreadth) per day so that by day 2, it is about 2
fingerbreadths below the umbilicus.
When caring for a mother who has had a cesarean birth, the nurse would expect the client's
lochia to be:
A) Greater than after a vaginal delivery
B) About the same as after a vaginal delivery
C) Less than after a vaginal delivery
D) Saturated with clots and mucus - correct answer C
Women who have had cesarean births tend to have less flow because the uterine debris is
removed manually along with delivery of the placenta.
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 - correct answer 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
,Maternity and Pediatric Nursing 4th Edition
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.
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 - correct answer 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." 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.
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 - correct answer 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.
, Maternity and Pediatric Nursing 4th Edition
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
again. - correct answer 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.
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 - correct answer 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.
