Postpartum Complications and Contraception
Risk factors for urinary retention include:
a. A small-for-gestational-age infant
b. Multiparty
c. An intact perineum
d. Use of epidural anesthesia during labor and delivery
d. Use of epidural anesthesia during labor and delivery
i. Rationale: Other risk factors for urinary retention include: LGA infants, nulliparity, and having a laceration or episiotomy
A postpartum client comes to the office 3 weeks after having a baby. What is an expected examination finding?
a. Fundus at the umbilicus
b. Uterus about the size of a grapefruit
c. Firm fundus 1cm above the umbilicus
d. Uterus no longer palpated abdominally
d. Uterus no longer palpated abdominally
i. Rationale: by 2 weeks postpartum, the uterus is no longer palpated abdominally and has descended into the pelvis
A midwife has recently attended the birth of a full term infant. She wants to assess the preductal capillary oxygen saturation of the newborn. The proper placement of the probe would be
a. On the right axilla
b. On the left wrist
c. On the right ankle
d. On the right wrist
d. On the right wrist
Which of the following statements about the newborn’s first breaths is false?
a. The first inhalation requires less ventilatory pressure than do later breaths
b. The first breaths trigger the conversion from fetal to extrauterine circulation
c. The initial breathing serves to clear the newborn’s lungs of fluid
d. The first breaths establish lung volume and expand the alveoli
a. The first inhalation requires less ventilatory pressure than do later breaths
i. Rationale: This is false; the others are true. The first inhalation requires more ventilatory pressure than do later breaths
The process of involution takes place over which timeframe?
a. The first 6 weeks postpartum
b. The first 24 hours postpartum
c. The first 2 weeks postpartum
d. The first year postpartum
a. The first 6 weeks postpartum
Rationale: Normal postpartum involution takes a full 6 weeks to be complete
A patient presents to the office complaining of "feeling ill". They are noted to have a temperature of 101.8F and reports that their symptoms have come on suddenly. They are chest feeding. During examination of their left breast, the clinician identifies a localized area of swelling, redness, and warmth. This area is intensely painful upon palpation. The right breast, by comparison demonstrates no abnormal findings. From history and physical exam, the correct diagnosis for this patient is:
a) engorgement
b) mastitis
c) galactocele
d) cancer
b) mastitis
Thrity hours after she gave birth, you find a patient crying quietly with the baby in her room as you perform morning rounds. What would be the most helpful response?
a. prescribe an SSRI
b. encourage the patient to focus on her baby's needs as her priority now
c. explain that it is normal to have a combination of sadness and euphoria so close to the time of the birth
d. conduct a screening test for possible postpartum depression
c. It is important to acknowledge the mother's feelings and provide nonjudgemental support. Provide the patient with an explanation of normal psychological responses to childbirth.
Which of the following infants is least at risk for neonatal hypoglycemia?
a. The infant of a pregnancy with pre-pregnancy DM
b. The infant of a pregnancy with GDM
c. An infant who had intrapartum fetal monitoring findings suggestive of
perinatal acidemia
d. The infant of a pregnancy with opioid use
d. The infant of a pregnancy with opioid use
Rationale: Opioid use is not a risk factor for neonatal hypoglycemia; all other options are risk factors
At her 6-month well-child checkup, a baby weighs 12lb, compared to a birth weight of 6lb. The parent says that she seems to breastfeed well but frequently spits up afterward. The midwife:
a. Obtains a consultation with the pediatrician.
b. Recommends supplementation of formula in addition to continuing breastfeeding.
c. Orders metabolic screening, including screening for PKU.
d. Reassures the parent that the baby’s weight gain is normal and reinforces the parent’s breastfeeding technique.
d. Reassures the parent that the baby’s weight gain is normal and reinforces the parent’s breastfeeding technique.
A client is home from a normal spontaneous vaginal delivery 12 hours ago. She calls the triage unit concerned about frequent urination. She denies having fever, chills, or dysuria. The client states, “I have been going to the bathroom constantly to pee. I don’thave any pain when I go. Is this normal?” The right response is:
a. “Antibiotics need to be started immediately to prevent the infection from getting worse.”
b. “During the immediate postpartum period, it is common to have increased urination.”
c. “Sounds like you have a urinary tract infection. Try some cranberry juice to help make it better.”
d. “Avoid drinking too much fluids to allow some rest for your bladder.”
b. “During the immediate postpartum period, it is common to have increased urination.”
A 26-year-old is brought to the ED by her partner because of her disturbing behavior over the past 24 hours. Her partner says he has noticed his wife talking to herself and sitting in the corner of a room throughout the day without eating or drinking. She gave birth to their son two weeks ago but has not seen or acknowledged his presence since he was born. Last night, his wife told him that their child was the son of the devil and they ought to get rid of him. Which of the following describes this patient's reaction to her child?
a. major depressive disorder
b. postpartum blues
c. brief psychotic disorder
d. postpartum psychosis
d. postpartum psychosis
rationale: The woman is exhibiting psychotic symptoms of delusions and infanticide during the postpartum period. Postpartum psychosis has its onset within 1–4 weeks after delivery. It is characterized by cognitive impairment and disorganized behavior that does not correspond with the patient's previous behavioral pattern. Postpartum psychosis is rare among patients who develop mood disturbances in the postpartum period. More commonly reported are postpartum blues and postpartum depression. However, compared to the other two conditions, these patients' impaired judgment requires immediate attention and therapy.
Which of the following is a recommended birth control during the first 6 weeks postpartum?
a. Hormonal patch
b. Combined oral contraceptives
c. Hormonal IUD
d. Hormonal ring
c. Hormonal IUD
The midwife noticed that the baby, within the first day of life, drools copiously, feeds poorly with excessive reflux, and turns bluish gray while feeding. Which condition does the midwife suspect?
a) tracheoesophageal malformation
b) pyloric stenosis
c) gastroschisis
d) omphalocele
a) tracheoesophageal malformation
The Parent of a 1-month-old infant contacts the midwife on call. The parent sounds distraught and tells the midwife that the baby “just cries and cries, all the time, and cries so hard that he gets red in the face. He’s starting to drive me crazy!” The midwife asksquestions about the baby’s temperature, feeding habits, and voiding and stooling, all of which appear to be normal despite the baby’s behavior. The midwife correctly tells the parent that:
a. She should take the baby to the emergency room immediately.
b. The baby’s behavior is normal, and getting used to the demands of an infant is a normal part of adjusting to parenthood.
c. Some babies are prone to this behavior, and one of the biggest problems is the effect on the baby’s parents-when it gets to be too much, position thebaby safely in his crib and go outside for a “sanity break.”
d. The baby’s problem results from lack of stimulation-put on some upbeat music,turn on all the lights, make sure he can move freely, and engage him in active play.
c. Some babies are prone to this behavior, and one of the biggest problems is the effect on the baby’s parents-when it gets to be too much, position thebaby safely in his crib and go outside for a “sanity break.”
Common pharmacologic pain relief options for postpartum patients include:
a. Acetaminophen 650mg every 4 hours as needed for pain
b. Acetaminophen 1200mg every 4 hours as needed for pain
c. Ibuprofen 650mg every 4 hours as needed for pain
d. Ibuprofen 1200mg every 4 hours as needed for pain
a. Acetaminophen 650mg every 4 hours as needed for pain
A patient presents to the office complaining of "feeling ill". They are noted to have a temperature of 101.8F and reports that their symptoms have come on suddenly. They are chest feeding. During examination of their left breast, the clinician identifies a localized area of swelling, redness, and warmth. This area is intensely painful upon palpation. The right breast, by comparison demonstrates no abnormal findings. From history and physical exam, the correct diagnosis for this patient is:
a) engorgement
b) mastitis
c) galactocele
d) cancer
b) mastitis
During postpartum rounds, your multiparous client is very pleased with her birth and is clearly bonding with her new baby girl. She is successfully nursing her baby every 3 hours for 5 minutes. She is asking about early discharge and wants to go home as soon as possible. Her only complaint is that her left leg is sore because she needed to deliver in stirrups. What would be the most important piece of your assessment?
a. Availability of assistance at home with her two other children to ensure that she can rest
b. Breast exam and assessment to check for milk production to ensure adequacy of feeding before discharge
c. Dietary recall to ensure adequate kilocalories and fluids to produce adequate human milk
d. Examination of the lower legs to be sure that the muscle strain she is complaining about is simply related to positioning
d. Examination of the lower legs to be sure that the muscle strain she is complaining about is simply related to positioning
i. Rationale: important to assess for possible DVT
Which of the following statements is true about newborn metabolic disorders?
a. Federal law mandates testing for PKU, galactosemia, and cystic fibrosis.
b. For early-discharge neonates, screening at 8 hours of life is acceptably reliable.
c. Most of these disorders are characterized by enzyme deficiency, resulting in toxic accumulation of metabolites.
d. Breastfeeding is strongly recommended for infants with galactosemia.
c. Most of these disorders are characterized by enzyme deficiency, resulting in toxic accumulation of metabolites.
Compared to fetal circulation, which of the following is not characteristic of circulation after birth?
a. Increased pressure on the left atrium that facilitates closure of the foramen ovale
b. Relatively low pulmonary vascular resistance that results in increased circulation to the lungs
c. Decreased systemic vascular resistance due to loss of high-resistance placental circuit
d. Increased oxygenation of circulating blood that causes constriction of the ductus arteriosus
c. Decreased systemic vascular resistance due to loss of high-resistance placental circuit
Rationale: The placental circuit has low resistance. The opposite is true after birth, when systemic vascular resistance increases with the loss of the placental circuit
Which of the following is a true statement about thermoregulation in the transitional period?
a. Shivering and muscular activity are the newborn’s most effective means of thermoregulation.
b. Convection, conduction, radiation, and evaporation are important thermoregulatory mechanisms in the newborn period
c. Metabolism of BAT is limited as a means of thermoregulation.
d. Alkalosis is a potentially serious consequence of ineffective thermoregulation in the newborn.
c. Metabolism of BAT is limited as a means of thermoregulation
Rationale: The infant has a limited supply of BAT, thus limiting the effectiveness of BAT metabolism as a means of thermoregulation
When speaking with your patient on the postpartum unit 1 day after delivery, you begin to speak about options for contraception. She states that she would like to go back on the combined oral contraceptive pills that she took prior to her pregnancy. You explain to her the contraindications.
Which of the following statements by the patient would not demonstrate an understanding of your teaching?
a. The estrogen in birth control pills may have an impact on levels of breastmilk
b. I am at a higher risk of developing blood clots in postpartum period
c. I can never take combined oral contraceptive pills again
d. I am eligible for forms of LARC such as Nexplanon or IUDs
c. I can never take combined oral contraceptive pills again
A postpartum client who is chest feeding is concerned about mastitis because she experienced this condition while chest feeding her last baby. Which of the following would be appropriate for the nurse to suggest as a preventative measure?
a) switch to formula
b) frequent feedings
c) wear a tight fitting bra
d) limit feedings to every 6 hours
b) frequent feedings
The midwife performs a physical examination on a newborn 2 hours after birth. Which of the following findings indicates a need for pediatric consultation?
a. Respiratory rate of 50 breaths/minute
b. Intermittent episodes of apnea, lasting less than 10 seconds each
c. Yellow blanching of the skin when pressure is applied to the infant’s nose
d. Preauricular skin tag
c. Yellow blanching of the skin when pressure is applied to the infant’s nose
Rationale: Jaundice in the first 24 hrs of life is a pathologic finding that warrants immediate further eval and treatment
A baby boy was born one minute ago. The infant is floppy. The pulse is 118 bpm, he has some light purple coloring around the hands and feet. There is a weak cry when stimulated, with slow irregular breathing. What is the APGAR score at one minute?
a. 5
b. 4
c. 6
d. 9
a. 5
Your patient is interested in utilizing the lactational amenorrhea form of contraception postpartum. Which statement by the patient would demonstrate understanding of utilizing this method.
a. The baby must be under two years old
b. I can still use this method if my period returns
c. I must exclusively or nearly exclusively breastfeed in order to use this method
d. This method is more effective than Nexplanon
c. I must exclusively or nearly exclusively breastfeed in order to use this method