Chapter 20: Postpartum Physiologic Changes
MULTIPLE CHOICE
1. A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate
this woman’s fundus?
a. 1 centimeter above the umbilicus
b. 2 centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
ANS: A
The fundus descends approximately 1 to 2 cm every 24 hours. Within 12 hours after
delivery the fundus may be approximately 1 cm above the umbilicus. By the sixth
postpartum week the fundus is normally halfway between the symphysis pubis and the
umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference
point.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
2. What are the most common causes for subinvolution of the uterus?
a. Postpartum hemorrhage and infection
b. Multiple gestation and N
poUstR
paSrtINGhT
um Bo.rrChaOgMe
em
c. Uterine tetany and overproduction of oxytocin
d. Retained placental fragments and infection
ANS: D
Subinvolution is the failure of the uterus to return to a nonpregnant state. The most common
causes of subinvolution are retained placental fragments and infection. Subinvolution may
be caused by an infection and result in hemorrhage. Multiple gestations may cause uterine
atony, resulting in postpartum hemorrhaging. Uterine tetany and overproduction of oxytocin
do not cause subinvolution.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. Which client is most likely to experience strong and uncomfortable afterpains?
a. A woman who experienced oligohydramnios
b. A woman who is a gravida 4, para 4-0-0-4
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 5 pounds, 3 ounces
ANS: B
, Afterpains are more common in multiparous women. In a woman who experienced
polyhydramnios, afterpains are more noticeable because the uterus was greatly distended.
Breastfeeding may cause the afterpains to intensify. In a woman who delivered a large
infant, afterpains are more noticeable because the uterus was greatly distended.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
4. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse
expect to find when evaluating this client?
a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa
ANS: D
Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally
occurs around day 4 after childbirth. Lochia rubra consists of blood and decidual and
trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or
brown. Lochia sangra is not a real term. Lochia alba occurs in most women after day 10 and
can continue up to 6 weeks after childbirth.
PTS: 1 DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
NURSINGTB.COM
5. Which hormone remains elevated in the immediate postpartum period of the breastfeeding
woman?
a. Estrogen
b. Progesterone
c. Prolactin
d. Human placental lactogen
ANS: C
Prolactin levels in the blood progressively increase throughout pregnancy. In women who
breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen levels
decrease significantly after expulsion of the placenta, reaching their lowest levels 1 week
into the postpartum period. Progesterone levels decrease significantly after expulsion of the
placenta, reaching their lowest levels 1 week into the postpartum period. Human placental
lactogen levels dramatically decrease after expulsion of the placenta.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
6. 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.
Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is
experiencing?
, a. Elevated temperature caused by postpartum infection
b. Increased basal metabolic rate after giving birth
c. Loss of increased blood volume associated with pregnancy
d. Increased venous pressure in the lower extremities
ANS: C
Within 12 hours of birth, women begin to lose the excess tissue fluid that has accumulated
during pregnancy. One mechanism for reducing these retained fluids is the profuse
diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth.
Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. An
elevated temperature causes chills and possibly dehydration, not diaphoresis and diuresis.
Diaphoresis and diuresis are sometimes referred to as reversal of the water metabolism of
pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal
of increased venous pressure in the lower extremities.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
7. Which term best describes the interval between the birth of the newborn and the return of
the reproductive organs to their normal nonpregnant state?
a. Involutionary period because of changes to the uterus
b. Lochia period because of the nature of the vaginal discharge
c. Mini-tri period because it lasts only 3 to 6 weeks
d. Puerperium, or fourth trimester of pregnancy
ANS: D
The puerperium, also called the fourth trimester or the postpartum period of pregnancy, is
NUand
the final period of pregnancy RSlas
INtsGaT B. Oately 3 to 6 weeks. Involution marks the
pproxim
end of the puerperium. Lochia refers to the various vaginal discharges during the
puerperium. Mini-tri period is not a commonly used term.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
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 1500 ml. When evaluating the woman’s vital signs,
which finding would be of greatest concern to the nurse?
a. Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20
breaths per minute, and blood pressure 90/50 mm Hg
b. Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and
blood pressure 126/68 mm Hg
c. Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and
blood pressure 110/80 mm Hg
d. Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and
blood pressure 140/90 mm Hg
ANS: A
MULTIPLE CHOICE
1. A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate
this woman’s fundus?
a. 1 centimeter above the umbilicus
b. 2 centimeters below the umbilicus
c. Midway between the umbilicus and the symphysis pubis
d. Nonpalpable abdominally
ANS: A
The fundus descends approximately 1 to 2 cm every 24 hours. Within 12 hours after
delivery the fundus may be approximately 1 cm above the umbilicus. By the sixth
postpartum week the fundus is normally halfway between the symphysis pubis and the
umbilicus. The fundus should be easily palpated using the maternal umbilicus as a reference
point.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
2. What are the most common causes for subinvolution of the uterus?
a. Postpartum hemorrhage and infection
b. Multiple gestation and N
poUstR
paSrtINGhT
um Bo.rrChaOgMe
em
c. Uterine tetany and overproduction of oxytocin
d. Retained placental fragments and infection
ANS: D
Subinvolution is the failure of the uterus to return to a nonpregnant state. The most common
causes of subinvolution are retained placental fragments and infection. Subinvolution may
be caused by an infection and result in hemorrhage. Multiple gestations may cause uterine
atony, resulting in postpartum hemorrhaging. Uterine tetany and overproduction of oxytocin
do not cause subinvolution.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance
3. Which client is most likely to experience strong and uncomfortable afterpains?
a. A woman who experienced oligohydramnios
b. A woman who is a gravida 4, para 4-0-0-4
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 5 pounds, 3 ounces
ANS: B
, Afterpains are more common in multiparous women. In a woman who experienced
polyhydramnios, afterpains are more noticeable because the uterus was greatly distended.
Breastfeeding may cause the afterpains to intensify. In a woman who delivered a large
infant, afterpains are more noticeable because the uterus was greatly distended.
PTS: 1 DIF: Cognitive Level: Analyzing
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
4. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse
expect to find when evaluating this client?
a. Lochia rubra
b. Lochia sangra
c. Lochia alba
d. Lochia serosa
ANS: D
Lochia serosa, which consists of blood, serum, leukocytes, and tissue debris, generally
occurs around day 4 after childbirth. Lochia rubra consists of blood and decidual and
trophoblastic debris. The flow generally lasts 3 to 4 days and pales, becoming pink or
brown. Lochia sangra is not a real term. Lochia alba occurs in most women after day 10 and
can continue up to 6 weeks after childbirth.
PTS: 1 DIF: Cognitive Level: Applying
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
NURSINGTB.COM
5. Which hormone remains elevated in the immediate postpartum period of the breastfeeding
woman?
a. Estrogen
b. Progesterone
c. Prolactin
d. Human placental lactogen
ANS: C
Prolactin levels in the blood progressively increase throughout pregnancy. In women who
breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen levels
decrease significantly after expulsion of the placenta, reaching their lowest levels 1 week
into the postpartum period. Progesterone levels decrease significantly after expulsion of the
placenta, reaching their lowest levels 1 week into the postpartum period. Human placental
lactogen levels dramatically decrease after expulsion of the placenta.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
6. 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.
Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is
experiencing?
, a. Elevated temperature caused by postpartum infection
b. Increased basal metabolic rate after giving birth
c. Loss of increased blood volume associated with pregnancy
d. Increased venous pressure in the lower extremities
ANS: C
Within 12 hours of birth, women begin to lose the excess tissue fluid that has accumulated
during pregnancy. One mechanism for reducing these retained fluids is the profuse
diaphoresis that often occurs, especially at night, for the first 2 or 3 days after childbirth.
Postpartal diuresis is another mechanism by which the body rids itself of excess fluid. An
elevated temperature causes chills and possibly dehydration, not diaphoresis and diuresis.
Diaphoresis and diuresis are sometimes referred to as reversal of the water metabolism of
pregnancy, not as the basal metabolic rate. Postpartal diuresis may be caused by the removal
of increased venous pressure in the lower extremities.
PTS: 1 DIF: Cognitive Level: Understand
TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity
7. Which term best describes the interval between the birth of the newborn and the return of
the reproductive organs to their normal nonpregnant state?
a. Involutionary period because of changes to the uterus
b. Lochia period because of the nature of the vaginal discharge
c. Mini-tri period because it lasts only 3 to 6 weeks
d. Puerperium, or fourth trimester of pregnancy
ANS: D
The puerperium, also called the fourth trimester or the postpartum period of pregnancy, is
NUand
the final period of pregnancy RSlas
INtsGaT B. Oately 3 to 6 weeks. Involution marks the
pproxim
end of the puerperium. Lochia refers to the various vaginal discharges during the
puerperium. Mini-tri period is not a commonly used term.
PTS: 1 DIF: Cognitive Level: Remember
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
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 1500 ml. When evaluating the woman’s vital signs,
which finding would be of greatest concern to the nurse?
a. Temperature 37.9° C, heart rate 120 beats per minute (bpm), respirations 20
breaths per minute, and blood pressure 90/50 mm Hg
b. Temperature 37.4° C, heart rate 88 bpm, respirations 36 breaths per minute, and
blood pressure 126/68 mm Hg
c. Temperature 38° C, heart rate 80 bpm, respirations 16 breaths per minute, and
blood pressure 110/80 mm Hg
d. Temperature 36.8° C, heart rate 60 bpm, respirations 18 breaths per minute, and
blood pressure 140/90 mm Hg
ANS: A
