Chapter 21: Maternal Physiological Changes
MULTIPLE CHOICE
1. A woman gave birth to an infant boy 12 hours ago. Where would the nurse expect to locate this
woman’s fundus?
a. One centimetre above the umbilicus
b. Two centimetres below the umbilicus
c. Midway between the umbilicus and the
symphysis pubis
d. Nonpalpable abdominally
ANS: A
The fundus descends about 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
normally is halfway between the symphysis pubis and the umbilicus. The fundus should be
easily palpated using the maternal umbilicus as a reference point.
DIF: Cognitive Level: Comprehension REF: p. 556 OBJ: Nursing
Process: Assessment
2. Which woman is most likely to experience strong afterpains?
a. A woman who experienced
oligohydramnios
b. A woman who gave birth to twins
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 2400
g
ANS: B
Afterpains are more noticeable after births in which the uterus was overdistended (e.g., large
baby, multifetal gestation, polyhydramnios). Breastfeeding may cause afterpains to intensify,
not bottle-feeding. An average-weight baby does not intensify afterpains.
DIF: Cognitive Level: Comprehension REF: p. 557
OBJ: Nursing Process: Assessment
, 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?
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 3 or 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. There is no such
term as lochia sangra. Lochia alba occurs in most women after day 10 and can continue up to 6
weeks after childbirth.
DIF: Cognitive Level: Comprehension REF: p. 558
OBJ: Nursing Process: Assessment
4. 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 increase progressively throughout pregnancy. In women who
breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and
progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest
levels 1 week into the postpartum period. Human placental lactogen levels decrease
dramatically after expulsion of the placenta.
DIF: Cognitive Level: Comprehension REF: p. 559
OBJ: Nursing Process: Assessment
5. What is responsible for the diaphoresis and diuresis that a woman experiences during the early
postpartum period?
MULTIPLE CHOICE
1. A woman gave birth to an infant boy 12 hours ago. Where would the nurse expect to locate this
woman’s fundus?
a. One centimetre above the umbilicus
b. Two centimetres below the umbilicus
c. Midway between the umbilicus and the
symphysis pubis
d. Nonpalpable abdominally
ANS: A
The fundus descends about 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
normally is halfway between the symphysis pubis and the umbilicus. The fundus should be
easily palpated using the maternal umbilicus as a reference point.
DIF: Cognitive Level: Comprehension REF: p. 556 OBJ: Nursing
Process: Assessment
2. Which woman is most likely to experience strong afterpains?
a. A woman who experienced
oligohydramnios
b. A woman who gave birth to twins
c. A woman who is bottle-feeding her infant
d. A woman whose infant weighed 2400
g
ANS: B
Afterpains are more noticeable after births in which the uterus was overdistended (e.g., large
baby, multifetal gestation, polyhydramnios). Breastfeeding may cause afterpains to intensify,
not bottle-feeding. An average-weight baby does not intensify afterpains.
DIF: Cognitive Level: Comprehension REF: p. 557
OBJ: Nursing Process: Assessment
, 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?
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 3 or 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. There is no such
term as lochia sangra. Lochia alba occurs in most women after day 10 and can continue up to 6
weeks after childbirth.
DIF: Cognitive Level: Comprehension REF: p. 558
OBJ: Nursing Process: Assessment
4. 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 increase progressively throughout pregnancy. In women who
breastfeed, prolactin levels remain elevated into the sixth week after birth. Estrogen and
progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest
levels 1 week into the postpartum period. Human placental lactogen levels decrease
dramatically after expulsion of the placenta.
DIF: Cognitive Level: Comprehension REF: p. 559
OBJ: Nursing Process: Assessment
5. What is responsible for the diaphoresis and diuresis that a woman experiences during the early
postpartum period?
