Module 6 Postpartum Canvas Practice Questions

Question 1

Lochia that is whitish-yellow and contains leukocytes and decidual cells is called

A) serosa
B) alba
C) rubra
D) yeast infection

Answer 1

B) alba

Question 2

Midwifery/NP management for increased sweating in the postpartum period includes:

A) reassurance and encouragement to decrease fluid intake.
B) reassurance and encouragement to increase fluids and shower frequently.
C) reassurance that this will only last one day.
D) reassurance, decrease fluids, and wear minimal clothing.

Answer 2

B) reassurance and encouragement to increase fluids and shower frequently.

Question 3

T/F: Endocrine changes in the postpartum might be a causative factor in postpartum mood disorders.

Answer 3

True

Question 4

Regarding the effects of the placental site on FUTURE pregnancies, a CORRECT statement is:

A) The placental site leaves a very small scar in the lining of the uterus.
B) The placental site will regenerate in about 6 weeks with new tissue, leaving no scar.
C) The placental site will take about 2-3 weeks to regenerate, leaving no scar.
D) The placental site will usually leave a scar but subsequent pregnancies will implant in a different area.

Answer 4

B) The placental site will regenerate in about 6 weeks with new tissue, leaving no scar.

Question 5

Swelling and increased vascularity of the vagina will be decreased by

A) 1 week
B) 2 weeks
C) 3-4 weeks
D) 5-6 weeks

Answer 5

C) 3-4 weeks

Question 6

A woman who had a normal vaginal birth 11 days ago calls to report a brief episode of a sudden increase of bright red vaginal bleeding. She does not have any pain, and the bleeding has no odor. The most likely cause is:

A) retained products of conception.
B) endometritis.
C) normal lochia serosa.
D) sloughing of the eschar.

Answer 6

D) sloughing of the eschar.

Question 7

Which statement is correct about afterbirth pains?

A) Afterbirth pains are caused by the continuous contraction of the uterus.
B) They are more common in nulliparous women.
C) Afterbirth pains are more severe in multiparous women due to relaxed uterine tone.
D) The suckling of the newborn triggers oxytocin release from the anterior pituitary gland.

Answer 7

C) Afterbirth pains are more severe in multiparous women due to relaxed uterine tone.

Question 8

A patient has a 500ml estimated blood loss with her birth. What would you expect her hemoglobin to drop (how many point(s)) postpartally?

A) 1
B) 2
C) 3
D) 4

Answer 8

A) 1

Question 9

The midwife/NP explains that two hormones released while breastfeeding give the mother a peaceful calm feeling. The two hormones are:

A) Estrogen and Relaxin
B) Prolactin and Oxytocin
C) PIF and Progesterone

Answer 9

B) Prolactin and Oxytocin

Question 10

If your patient has a hematocrit of 33 on admission and has one drawn at 36 hours postpartum and it is 30, what is her estimated blood loss?

A) 250ml
B) 500ml
C) 750ml
D) 1000ml

Answer 10

B) 500ml

Question 11

Approximately how much weight do women lose with the birth?

A) 5-7 lb
B) 10-12 lb
C) 15-17 lb
D) 20-22 lb

Answer 11

B) 10-12 lb

Question 12

Healing at the placental site takes about

A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks

Answer 12

C) 6 weeks

Question 13

Choose what platelet count is considered abnormal during the postpartum period.

A) 146
B) 187
C) 295
D) 335
E) 410

Answer 13

A) 146

Question 14

SATA: Right after birth the maternal cardiovascular system instability is due to what factors?

A) blood loss
B) autotranfusion of fluid from losing placenta
C) extracellular fluid
D) hypertension

Answer 14

A) blood loss
B) autotranfusion of fluid from losing placenta
C) extracellular fluid

Question 15

A patient is 36 hours post normal spontaneous vaginal birth of an eight pound, 5 ounce baby. She is bottle feeding. During postpartum rounds the patient explains that her cramping is stronger than with her last birth. The midwife assesses her and explains that cramping is the primary mechanism for hemostasis in the uterus following birth. The main contributor to hemostasis is:

A) exogenous Pitocin.
B) contraction of the myometrial fibers.
C) oxytocin release.
D) suckling from the newborn.

Answer 15

B) contraction of the myometrial fibers.

Question 16

T/F: It is common for women right after giving birth to feel a full bladder and void.

Answer 16

False

Question 17

Increased urination following vaginal birth is most likely due to:

A) postpartum urinary tract infection.
B) pressure of fundus on bladder.
C) postpartum diuresis.
D) increased use of IV fluids in labor.

Answer 17

C) postpartum diuresis.

Question 18

At 4 days postpartum where should you feel the uterine fundus?

A) at umbilicus
B) 1 below umbilicus
C) 2 below umbilicus
D) 3 below umbilicus
E) 4 below umbilicus

Answer 18

E) 4 below umbilicus

Question 19

Breast milk is synthesized within the

A) secretory cells of the alveoli
B) lobules of the breasts
C) mammary epithelial cells

Answer 19

A) secretory cells of the alveoli

Question 20

When during the day are prolactin levels the highest?

A) morning
B) noon
C) night
D) upon waking

Answer 20

C) night

Question 21

T/F: Women who breastfeed may experience uterine cramping related to oxytocin release during the “let down” response.

Answer 21

True

Question 22

Once the placenta has delivered, progesterone

A) rises with a decrease in oxytocin and an increase in prolactin
B) rises with a increase in oxytocin and an increase in prolactin
C) falls with an increase in oxytocin and an increase in prolactin
D) falls with a decrease in oxytocin and an increase in prolactin

Answer 22

C) falls with an increase in oxytocin and an increase in prolactin

Question 23

Maternal serum estrogen returns to pre-pregnancy levels (follicular phase) by

A) after 21 days postpartum
B) 5 days postpartum
C) 7-8 days postpartum
D) 9-10 days postpartum

Answer 23

A) after 21 days postpartum

Question 24

The largest portion of calories in breast milk comes from

A) protein
B) fat
C) carbohydrates
D) oligosaccharides

Answer 24

B) fat

Question 25

Prolactin is secreted by the

A) hypothalamus
B) anterior pituitary
C) posterior pituitary
D) myoepithelial cells

Answer 25

B) anterior pituitary

Question 26

Lactogenesis I occurs

A) at beginning of pregnancy
B) from early pregnancy to about the third postpartum day
C) at end of pregnancy
D) at end of pregnancy until about the 5th postpartum day

Answer 26

B) from early pregnancy to about the third postpartum day

Question 27

A drop in the maternal serum progesterone after the placenta is delivered will initiate

A) Lactogensis I
B) Lactogensis II
C) “let down” response

Answer 27

B) Lactogensis II

Question 28

Colostrum contains immunoglobulins, especially immunoglobulin

A) M
B) G
C) A
D) D

Answer 28

C) A

Question 29

If the breasts are not stimulated by suckling and removal of milk, the ___________ decreases and production ceases.

A) oxytocin
B) estrogen
C) progesterone
D) prolactin

Answer 29

D) prolactin

Question 30

Which of the following are higher in amount in colostrum than in mature milk?

A) fat
B) protein
C) carbohydrates

Answer 30

B) protein

Question 31

Oxytocin causes the “let down” response by causing

A) Calcium influx into the breast cells
B) contraction of the alveoli of the breasts
C) contraction of the myoepithelial cells of the breasts
D) contraction of the posterior pituitary

Answer 31

C) contraction of the myoepithelial cells of the breasts

Question 32

SATA: Which of the following should be done at the 2 week postpartum visit?

A) depression screening
B) diastasis recti
C) vital signs
D) breast exam on breastfeeding women
E) perineal exam on everyone

Answer 32

A) depression screening
C) vital signs
D) breast exam on breastfeeding women

Question 33

A woman who is G4 P3013 reports very painful uterine cramping while nursing her 2-day-old baby. Which advice is most likely to be helpful in relieving her discomfort?

A) Place an icepack over the lower abdomen.
B) Between nursing sessions, lie prone over a rolled towel to put gentle pressure on the uterus.
C) Avoid nonsteroidal anti-inflammatory medications because of rebound pain.
D) Breastfeed in a side-lying position every 4-6 hours.

Answer 33

B) Between nursing sessions, lie prone over a rolled towel to put gentle pressure on the uterus.

Question 34

Measurement of diastasis recti occurs in

A) centimeters
B) inches
C) fingerbreadths

Answer 34

C) fingerbreadths

Question 35

A G4P4004 patient had a spontaneous vaginal birth 2 days ago. She is complaining of cramping. On exam the midwife notes a uterus that is firm and midway between the umbilicus and symphysis. Management includes:

A) analgesics, maintaining an empty bladder, and lying prone.
B) analgesics, lying supine, and heat packs to abdomen.
C) breastfeeding, methergine, and lying prone.
D) analgesics, breastfeeding, and lying supine.

Answer 35

A) analgesics, maintaining an empty bladder, and lying prone.

Question 36

At the two week exam, where does the clinician expect to find the patient’s uterus?

A) non-palpable abdominally.
B) three fingerbreadths above the symphysis pubis.
C) midway between symphysis and umbilicus.
D) one fingerbreadth above the symphysis.

Answer 36

A) non-palpable abdominally.

Question 37

During postpartum rounds, a new mother asks about losing the weight she gained during the pregnancy. A correct response to her question would be:

A) During breast feeding you will lose the weight put on during pregnancy.
B) You can expect to lose 5 pounds a week until it’s all off.
C) The majority of women reach their pre-pregnant weight by 6 months postpartum.
D) The average weight loss at the time of birth is 20 pounds.

Answer 37

C) The majority of women reach their pre-pregnant weight by 6 months postpartum.

Question 38

T/F: It is important to assess for costovertebral angle tenderness (CVAT) at the postpartum visit as the postpartum woman is at increased risk for UTI.

Answer 38

True

Question 39

Six days postpartum a patient calls the office complaining that her discharge has become mucous appearing, pinkish, and somewhat malodorous. After assessing that the odor is not foul smelling, and there is no associated cramping or increased bleeding, the midwife reassures the patient that this is normal and called:

A) Resumption of menses
B) Serosa
C) Alba
D) Rubra

Answer 39

B) Serosa

Question 40

The midwife examines a woman who delivered a baby girl vaginally 16 days ago. The woman’s uterus is nonpalpable abdominally and the woman reports no unusual symptoms. The midwife correctly assesses that:

A) this involution happened unusually quickly.
B) the woman might have abnormal prolactin levels.
C) this is normal involution.
D) the placental eschar probably has not sloughed yet.

Answer 40

C) this is normal involution.

Question 41

Ideal timing for giving RhoGAM is

A) within 24 hours, up to14 days
B) within 48 hours, up to 7 days
C) within 72 hours, up to 14 days
D) with 96 hours, up to 4 weeks

Answer 41

C) within 72 hours, up to 14 days

Question 42

Which of the following tests should be ordered on the cord blood when an Rh negative mother delivers an Rh positive baby?

A) CBC
B) Direct coombs
C) Indirect coombs
D) Rosette

Answer 42

B) Direct coombs

Question 43

When reviewing the chart of an Rh negative postpartum woman at 13 days postpartum, it is noted that she never received RhoGAM. The clinician should explain that:

A) The woman needs RhoGAM only if her infant is A+ or B+.
B) The woman needs RhoGAM only if her infant is O+.
C) RhoGAM can be given only within 72 hours of birth, so it is ineffective to give today.
D) The woman should be given RhoGAM today if her infant has a positive blood type.

Answer 43

D) The woman should be given RhoGAM today if her infant has a positive blood type.

Question 44

The clinician is completing discharge teaching and the mother says “the nurse gave me a hand out about H1N1 flu, but I know I shouldn’t get any shots while I’m breastfeeding.” Which of the following is correct information to inform how the clinician responds?

A) Maternal vaccination postpartum helps prevent transmission to the newborn.
B) Wait until your baby is six months old before you get vaccinated.
C) H1N1 is only dangerous to pregnant women, the elderly, and people with chronic illness.
D) The H1N1 vaccine is only given to pregnant women after the first trimester.

Answer 44

A) Maternal vaccination postpartum helps prevent transmission to the newborn.

Question 45

A woman was concerned with getting the Tdap vaccine while pregnant, so she declined it at that time. The clinician seeing her on day 2 postpartum should provide which of the following recommendations?

A) To wait until 6 weeks postpartum to get immunization.
B) That she should receive immunization prior to discharge.
C) That if she is breastfeeding she cannot receive immunization until she is done breastfeeding.
D) Since she received the immunization as a child, she does not need it now.

Answer 45

B) That she should receive immunization prior to discharge.

Question 46

T/F: The Tdap vaccine should be given postpartally even if it was given antenatally.

Answer 46

False

Question 47

On admission to labor and delivery a patient had a hemoglobin of 11.3. On the second day postpartum, her hemoglobin is 9.2. What is the estimated blood loss according to these labs?

A) 1000 mL
B) 500 mL
C) 300 mL
D) 750 mL

Answer 47

A) 1000 mL

Question 48

At what point in the postpartum period should pregnancy-related coagulation changes return to a nonpregnant state?

A) 4-6 weeks postpartum
B) 1-2 weeks postpartum
C) 12-14 weeks postpartum

Answer 48

A) 4-6 weeks postpartum

Question 49

A patient’s hematocrit was 37% on admission to labor and delivery. Her hematocrit is 34% on the second day postpartum. What is the estimated blood loss according to these labs?

A) 500 cc
B) 250 cc
C) 1000 cc
D) 750 cc

Answer 49

A) 500 cc

Question 50

T/F: An elevated WBC count after birth indicates infection in the mom.

Answer 50

False

Question 51

On her fifth postpartum day, a woman has a sudden onset of pain in her leg. The woman’s temperature is 101° F, her pulse is 100, and she rates her pain 7/10. The midwife should:

A) prescribe support hose and schedule another evaluation in 2 days.
B) consult a physician immediately.
C) advise over the counter oral anti-inflammatory medications.
D) advise rest and application of moist heat.

Answer 51

B) consult a physician immediately.

Question 52

Women most at risk for subinvolution are those who had:

A) back pain during labor.
B) chorioamnionitis.
C) a growth-restricted infant.
D) a stillborn baby.

Answer 52

B) chorioamnionitis.

Question 53

Which of the following is a significant risk factor for postpartum perineal hematoma formation?

A) intrapartum chorioamnionitis.
B) injection of local anesthesia for perineal laceration repair.
C) GBS bacteriuria.
D) intrapartum epidural anesthesia.

Answer 53

B) injection of local anesthesia for perineal laceration repair.

Question 54

S: A G3P3 with a history of spontaneous vaginal birth of a 9 lb. infant comes to the office at 2 weeks postpartum with continued heavy vaginal bleeding. She describes the bleeding as persistent and heavy since birth, but not saturating a maxi pad every hour. O: Vital signs are normal. Vaginal bleeding is rubra without odor. Fundus is 1 fingerbreadth below the umbilicus, boggy and without tenderness. Appropriate assessment “A” and management plan “P” include

A) A: Endometritis; P: culture, order antibiotics and methergine x 3 days, consult obstetrician.
B) A: Normal postpartum lochia given parity and macrosomia; P: decrease activity and return to care in 1 week to reassess.
C) A: Sloughing of placental site eschar; P: reassure, expectant management.
D) A: Subinvolution; P: start methylergonovine (Methergine) 0.2 mg PO q 3-4 hours x 48 hours

Answer 54

D) A: Subinvolution; P: start methylergonovine (Methergine) 0.2 mg PO q 3-4 hours x 48 hours

Question 55

During her 6 week postpartum visit a G2P2002 is concerned with fatigue, insomnia, palpitations and anxiety. Review of her history reveals diet controlled gestational diabetes (GDM) and hypothyroidism treated with levothyroxine. The nurse-midwife is concerned she may have

A) postpartum thyroiditis (hypertensive phase).
B) postpartum depression.
C) overt diabetes.
D) postpartum thyroiditis (hypotensive phase)

Answer 55

A) postpartum thyroiditis (hypertensive phase).

Question 56

What information from a person’s history and physical would cause the NP to suspect von Willebrand disease for the etiology of their delayed postpartum hemorrhage?

A) menorrhagia and previous postpartum hemorrhage
B) daily baby aspirin on med list
C) 3cm leiomyoma on 28 week ultrasound
D) ASCUS pap and HPV pos

Answer 56

A) menorrhagia and previous postpartum hemorrhage

Varney p. 1223 Table 34-2. Von Willebrand disease is a coagulopathy. If a birthing person has heavy periods and a hx of pph, you must include a clotting disorder on your diff dx.

Question 57

A G3P3 with a history of spontaneous vaginal birth of a 9 lb. infant comes to the office at 2 weeks postpartum with continued heavy vaginal bleeding. She describes the bleeding as persistent and heavy since birth, but not saturating a maxi pad every hour.

Vital signs are normal. Vaginal bleeding is rubra without odor. Fundus is 1 fingerbreadth below the umbilicus, boggy and without tenderness.

An appropriate plan is:

A) Pelvic ultrasound, methergine x 24-48 hours, consult obstetrician.
B) Vaginal culture, order antibiotics and methergine x 3 days, refer to obstetrician.
C) Reassure, expectant management.

Answer 57

A) Pelvic ultrasound, methergine x 24-48 hours, consult obstetrician.

Question 58

A woman at 4 days postpartum arrives at the office with a history of spontaneous vaginal birth after a 24-hour first stage and 2-hour second stage. She had spontaneous rupture of membranes (SROM) 16 hours prior to delivery. Perineum was intact.

Temp 101.2° F. Costovertebral angle non-tender; Fundus is tender at the umbilicus; Speculum exam reveals foul smelling lochia.

What is the best diagnosis?

A) Pyelonephritis
B) Endometritis
C) Subinvolution

Answer 58

B) Endometritis

Question 59

The clinician is seeing a woman who is six months postpartum.

During the first few months after delivery, the woman reports that she felt irritable and intolerant of heat.

Today, she reports that her irritability and heat intolerance are gone. However, she is quite fatigued and feeling depressed.

Appropriate ASSESSMENT includes

A) Postpartum thyroiditis (hypertensive phase) vs. postpartum depression.
B) Postpartum thyroiditis (hypotensive phase) vs. postpartum depression.
C) Normal postpartum transition vs. postpartum depression.

Answer 59

B) Postpartum thyroiditis (hypotensive phase) vs. postpartum depression.

Question 60

A 24 year old woman, G1P1, had a spontaneous vaginal birth of a 9 lb., healthy, term male. Her pregnancy has been uneventful. Mom and baby were discharged on day two. On postpartum day 3, the woman calls with concerns of nausea and vomiting, increased swelling, and a persistent headache. The midwife suspects

A) postpartum preeclampsia.
B) gastritis.
C) sleep deprivation.
D) postpartum migraine.

Answer 60

A) postpartum preeclampsia.

Question 61

A woman at 48 hours postpartum suddenly reports shortness of breath, hemoptysis, and chest discomfort. Appropriate assessment (A) and management plan (P) include

A) A: amniotic fluid emboli; P: iniate oxygen, refer to obstetrician, anticipate ordering a Ventilation/perfusion scintigraphy.
B) A: Pulmonary embolism; P: initiate oxygen, refer to obstetrician, anticipate ordering a chest x-ray.
C) A: asthma; P: order a chest x-ray, encourage use of albuterol inhaler and consult with physician.

Answer 61

B) A: Pulmonary embolism; P: initiate oxygen, refer to obstetrician, anticipate ordering a chest x-ray.

Question 62

A postpartum mom should call with which of the following symptoms:

A) not having a BM for 2 days, but not uncomfortable
B) saturating a pad an hour
C) temp 100.1
D) passing a quarter size clot

Answer 62

B) saturating a pad an hour

Question 63

A client who had a baby 14 days ago calls the office concerned about her bleeding. She states, “The bleeding is bright red and I am filling up the pad about every hour.”

What instructions should be given to the client?

A) “That sounds like normal bleeding that is to be expected. Call if the bleeding gets worse.”
B) “That type and amount of bleeding is abnormal. Have someone drive you to the triage unit at the hospital and I will meet you there as soon as possible.”
C) “That bleeding is concerning. Monitor your bleeding over the next 24 hours and call back if it gets worse.”
D) “That amount of bleeding is normal. Change your pads often to prevent infections.”

Answer 63

B) “That type and amount of bleeding is abnormal. Have someone drive you to the triage unit at the hospital and I will meet you there as soon as possible.”

Kelsey p. 327

Question 64

Nine months postpartum a G4P3013 complains of fatigue, sleeping all the time, and a lost of interest or pleasure in doing activities she use to enjoy. She feels like she has lost herself. She denies any thoughts of harming herself or baby. An appropriate assessment (A) and management plan (P) include

A) A: Postpartum blues; P: Reassurance normal transition, offer coping strategies.
B) A: Generalized anxiety disorder vs. Postpartum Bipolar disorder; P: refer to mental health specialist
C) A: Chronic Depression; P: discuss initiating individual psychotherapy and pharmacotherapy
D) A: Postpartum depression vs. thyroid disorder; P: order thyroid stimulating hormone (TSH) and administer the Edinburgh Postnatal Depression Scale

Answer 64

D) A: Postpartum depression vs. thyroid disorder; P: order thyroid stimulating hormone (TSH) and administer the Edinburgh Postnatal Depression Scale

Varney, Chapter 8 Mental Health Conditions. p 286

Question 65

Nine months postpartum a G4P3013 complains of fatigue, sleeping all the time, and a lost of interest or pleasure in doing activities she use to enjoy. She feels like she has lost herself. She denies any thoughts of harming herself or baby. An appropriate assessment (A) and management plan (P) include

A) A: Postpartum depression vs. thyroid disorder; P: order thyroid stimulating hormone (TSH), discuss antidepressants and psychotherapy options.
B) A: Postpartum blues; P: Reassurance normal transition, offer coping strategies.
C) A: Hypothyroidism; P: order thyroid stimulating hormone (TSH) and free T4.
D) A: Generalized anxiety disorder; P; discuss pharmacotherapy and psychotherapy options.

Answer 65

A) A: Postpartum depression vs. thyroid disorder; P: order thyroid stimulating hormone (TSH), discuss antidepressants and psychotherapy options.

Question 66

At 3 days postpartum, a woman’s husband calls the office to report that his wife awoke in the morning talking about alien invaders placing a chip in her brain. He can’t make sense of anything she is saying. The midwife should advise him to:

A) have someone stay with her and the baby while he is at work today.
B) bring the woman to the office for evaluation.
C) take her to the nearest hospital or call 911.
D) ensure that she gets uninterrupted sleep and call back if she doesn’t improve.

Answer 66

C) take her to the nearest hospital or call 911.

Question 67

At her 6 week postpartum visit, a woman reports that she is concerned that she has been sad in the last few weeks. The midwife asks the woman to complete an Edinburgh Postnatal Depression Scale (EPDS) and the woman’s score is 4. The midwife will complete an appropriate follow up clinical assessment but the EPDS score indicates that it is most likely that the woman:

A) has significant postpartum depression.
B) is at risk for postpartum psychosis.
C) is experiencing normal postpartum emotional adjustments.
D) needs to see a therapist experienced in counseling postpartum women.

Answer 67

C) is experiencing normal postpartum emotional adjustments.

Question 68

SATA: On Postpartum day 4 a G1P1 calls with concerns that she has been feeling overwhelmed at times with sporadic unprovoked outbursts of crying. The nurse-midwife gathers additional information by asking

A) “ How often are you eating?”
B) “What is your activity and sleep pattern?”
C) “What color is the lochia?”
D) “Have you engaged in any sexual activity since delivery?”
E) “Do you have any history of depression?”
F) “Do you have any feelings of wanting to hurt yourself or your baby?”

Answer 68

A) “ How often are you eating?”
B) “What is your activity and sleep pattern?”
E) “Do you have any history of depression?”
F) “Do you have any feelings of wanting to hurt yourself or your baby?”

Question 69

SATA: During the 6 week postpartum exam, a G2P2002 scores 12 on the Edinburgh Postnatal depression scale. She is adamant that she wants to avoid using any medication while breastfeeding. The nurse-midwife offers self-help measures for combating postpartum depression including

A) participating in a support group
B) eating three meals/day
C) opening window shades during the day
D) minimizing activity
E) avoiding major life changes, i.e. moving
F) staying inside and sleeping
G) ensuring an adequate sleep schedule
H) switching to bottle feeding
I) exercising with daily walks

Answer 69

A) participating in a support group
B) eating three meals/day
C) opening window shades during the day
E) avoiding major life changes, i.e. moving
G) ensuring an adequate sleep schedule
I) exercising with daily walks

Question 70

Postpartum blues occur in approximately what percentage of women?

Answer 70

75%

Question 71

When counseling a woman with postpartum depression it is helpful for the woman to know that postpartum depression

A) during the first 3 weeks postpartum is considered a normal process.
B) is a biochemical process of multifactorial origin.
C) occurs because the woman is not getting enough rest and good nutrition
D) is strongly related to advanced maternal age.

Answer 71

B) is a biochemical process of multifactorial origin.

Question 72

The nurse-midwife should initially assess women for postpartum mood disorders during

A) intrapartum.
B) annual exams.
C) postpartum visits.
D) antepartum visits.

Answer 72

D) antepartum visits.

Question 73

At her six week postpartum exam, a woman scores 12 on the Edinburgh Postnatal Depression Scale. Midwifery management includes

A) an in-depth subjective and objective evaluation.
B) beginning treatment with antidepressants for postpartum depression.
C) reassurance that she is normal.
D) immediate referral to a mental health practitioner.

Answer 73

A) an in-depth subjective and objective evaluation.

Question 74

During a 2-week postpartum office visit, the partner of a new mother with a history of bipolar disorder tells the NP that she has been crying frequently and is unable to sleep or eat. The partner indicates that the mother is concerned that the baby might be accidentally harmed. He states that last night the mother said, “I wish I could go to sleep and not wake up.” Based on this information what action should the NP take?

A) Recommend that the client make an appointment with a mental health care provider within the next 48 hours..
B) Stay with the client while making arrangements for immediate evaluation by mental health professionals.
C) Ask the partner to bottle feed the infant at night to ensure the mother gets at least 5 hours of uninterrupted sleep at night.
D) Reassure the partner that the mother will improve with proper rest and nutrition.

Answer 74

B) Stay with the client while making arrangements for immediate evaluation by mental health professionals.

Question 75

A G1P0 at 7 weeks gestation discloses that she was started on sertraline (Zoloft) a year ago for depression. She did not seek psychotherapy at that time. She has been symptom free for 9 months and is interested in discontinuing the medication. The nurse-midwife counsels her

A) the risk of relapse is too great to discontinue medication.
B) to initiate psychotherapy before beginning to taper medication dose.
C) the medication poses minimal if any risk to her growing baby.
D) she is a candidate for medication taper and discontinuation.

Answer 75

D) she is a candidate for medication taper and discontinuation.

Question 76

A G1P1001 reports during her annual exam that she continues to have difficulty sleeping since her delivery 9 months ago because she is having nightmares of her daughter not surviving the emergency cesarean section. She is worried that she cannot overcome feeling distant from her daughter. Appropriate assessment (A) and management plan (P) includes

A) A: posttraumatic stress disorder (PTSD); P: refer for psychotherapy and pharmacotherapy.
B) A: Generalized anxiety disorder; P: refer for cognitive behavior therapy and/or pharmacotherapy.
C) A: Postpartum depression; P: refer for psychotherapy and/or pharmacotherapy.
D) A: Postpartum psychosis; P: transport to an emergency department.

Answer 76

A) A: posttraumatic stress disorder (PTSD); P: refer for psychotherapy and pharmacotherapy.

Question 77

SATA: During the 6 week postpartum exam, a G2P2002 scores 12 on the Edinburgh Postnatal depression scale. She is adamant that she wants to avoid using any medication while breastfeeding. The nurse-midwife offers self-help measures for combating postpartum depression including

A) switching to bottle feeding
B) ensuring an adequate sleep schedule
C) minimizing activity
D) opening window shades during the day
E) avoiding major life changes, i.e. moving
F) participating in a support group
G) eating three meals/day
H) exercising with daily walks
I) staying inside and sleeping

Answer 77

B) ensuring an adequate sleep schedule
D) opening window shades during the day
E) avoiding major life changes, i.e. moving
F) participating in a support group
G) eating three meals/day
H) exercising with daily walks

Question 78

Research on the use of antidepressants during pregnancy

A) demonstrates the absolute risk of pulmonary hypertension increases from 1-2/1000 to 10-12/1000 with first trimester serotonin reuptake inhibitors (SSRIs) use.
B) indicates 15-30% of neonates may experience symptoms of tachypnea, hypoglycemia, temperature instability, irritability, a weak cry, and seizures within 2 weeks after birth if exposed to serotonin reuptake inhibitors (SSRIs) during pregnancy.
C) conclusively connects autism spectrum disorders to the use of serotonin reuptake inhibitors (SSRIs) taken in the second and/or third trimester.
D) reveals that 50% of fetuses exposed to paroxetine (Paxil) develop cardiac anomalies like ventricular outflow defects.

Answer 78

B) indicates 15-30% of neonates may experience symptoms of tachypnea, hypoglycemia, temperature instability, irritability, a weak cry, and seizures within 2 weeks after birth if exposed to serotonin reuptake inhibitors (SSRIs) during pregnancy.

Question 79

When discharging a couple home to recover after a stillbirth the nurse-midwife counsels

A) “Typically women feel that sexual activity is comforting as it makes them feel closer to their partner while men experience a loss of interest.”
B) “It’s important to have good communication between each other since you may feel isolated from your normal social networks.”
C) “Women and men find support groups to be very effective tools for working through their grief.”
D) “Men tend to be open and eager to talk about their loss, while women are less disclosing.”

Answer 79

B) “It’s important to have good communication between each other since you may feel isolated from your normal social networks.”

Question 80

At 12 months postpartum a young mother explains that she is worried about her son’s development since at the height of her depression she felt so overwhelmed that she merely went through the daily motions of caring for him and rarely actually interacted with him. Research on postpartum depression’s effect on infant and child development reveal

A) less fighting among peers.
B) fewer behavioral problems.
C) delayed cognitive development.
D) infants of depressed mothers have more frequent vocalizations and facial expressions as they attempt to engage their mothers.

Answer 80

C) delayed cognitive development.

Question 81

Which medication class may decrease maternal milk production and supply in a breastfeeding woman?

A) Diuretics (Ex: Hydrochlorothiazide)
B) Angiotensin converting enzyme inhibitors (ACE inhibitors) (ex: Captopril)
C) Beta-blocker (ex: methyldopa)

Answer 81

A) Diuretics (Ex: Hydrochlorothiazide)

Diuretics. Diuresis may decrease breast milk production and therefore supply. BBs and ACEIs are not associated with reduced milk supply.

Question 82

During a one-month postpartum visit, a lactating woman reports persistently sore, reddened nipples. To make the correct diagnosis of the woman’s breast problem, the midwife should assess the infant for:

A) Number of wet diapers daily
B) Length of breastfeedings
C) Depressed fontanels
D) Evidence of thrush

Answer 82

D) Evidence of thrush

Question 83

Which of the following factors is most likely to result in a newborn taking in an adequate amount of milk?

A) The mother breastfed her other children and she feels confident in her abilities.
B) The baby has a good latch and the breast has a normal number of milk ejections.
C) The baby is spending at least 10 minutes at the breast every 2-3 hours.

Answer 83

B) The baby has a good latch and the breast has a normal number of milk ejections.

Question 84

In order to initiate and maintain breast milk production after birth of the baby, the following must occur:
A) decrease of progesterone with a sustained release of prolactin.
B) decrease of oxytocin with an increase of progesterone.
C) decrease of estrogen with a sharp drop in prolactin.

Answer 84

A) decrease of progesterone with a sustained release of prolactin.

Question 85

Which of these statements is true regarding helping women who choose NOT to breastfeed?
A) Ice packs restrict blood flow to the breasts and inhibit milk production.
B) Hand expressing the milk from the breasts will help to “dry up” the milk supply.
C) Ice packs should be placed directly on the skin of the breasts.

Answer 85

A) Ice packs restrict blood flow to the breasts and inhibit milk production.

Question 86

An 18 year old G1P1 calls the clinician at 7 pm, 2 days post uncomplicated vaginal birth. She gave birth to a seven pound (3.2 kg) baby and had no immediate postpartum complications. She describes having frustration with breastfeeding. “The baby is fussy, does not want to latch on this evening, and I don’t have any milk.” Baby has voided twice today. She is considering quitting breastfeeding. Midwifery management includes:

A) due to trouble with latch, supplement with formula; review signs of engorgement.
B) come to the emergency room now to assess baby’s weight and for signs of dehydration.
C) continue offering breast frequently; hand express milk; if continued poor latch the next day, come to office.

Answer 86

C) continue offering breast frequently; hand express milk; if continued poor latch the next day, come to office.

The number of voids is OK for day 2. Not an emergency. Be very hesitant to pick an answer that has “supplement with formula”. It is appropriate to see her in the morning if no improvement.

Question 87

Which of the following is the USUAL pattern of onset and duration of primary engorgement in breastfeeding and non-breastfeeding persons?

A) Engorgement typically begins on the fifth postpartum day and lasts 12-18 hours.
B) Engorgement typically begins on the third postpartum day and lasts 24-48 hours.
C) Engorgement typically begins on the first postpartum day and lasts 12-18 hours.
D) Engorgement typically begins on the first postpartum day and lasts 24-48 hours.

Answer 87

B) Engorgement typically begins on the third postpartum day and lasts 24-48 hours.

engorgement occurs with the onset of lactogenesis II. Varney, 6th edition, p. 1249.

Question 88

At a six week postpartum visit, a 32y/o G2P2 complains of bilateral painful red nipples. What is the best way to assess for the likely cause of this condition?

A) Examine the baby’s mouth
B) Obtain vital signs on both mother and baby
C) Examine breasts for palpable lumps

Answer 88

A) Examine the baby’s mouth

Question 89

Management of postpartum mastitis includes:

A) Incision and drainage of the affected breast
B) Discontinuing breastfeeding
C) Binding the breasts
D) Emptying the breast via feeding or pumping

Answer 89

D) Emptying the breast via feeding or pumping

Question 90

Severe engorgement will present with the following symptom:

A) 2X2 cm lump.
B) infant can latch for short periods of time.
C) painful breasts with shiny skin.

Answer 90

C) painful breasts with shiny skin

Question 91

When making postpartum rounds, the clinician determines that the baby has an excellent latch because the clinician observes:

A) audible swallows after several sucks.
B) baby lying in his mothers arms with head turned toward breast.
C) a small amount of the areola in baby’s mouth.

Answer 91

A) audible swallows after several sucks.

Question 92

A breastfeeding woman calls her midwife on Friday evening and reports right breast pain and redness, a temperature of 100.8 F and flu-like muscle aches. The midwife should:

A) ask the woman her preference for treatment, advise rest and increased fluids throughout the weekend, and advise her to schedule an office visit for the following week if she does not improve.
B) take a detailed history by phone, prescribe antibiotics for the woman to pick up at her pharmacy, and give the woman instructions about when to call back if symptoms do not improve.
C) advise the woman to avoid breastfeeding throughout the weekend, prescribe antibiotics for the woman to pick up at her pharmacy, and ask her to call if she is not improved in 7 days.
D) advise the woman to pump and discard milk from that breast through the weekend, monitor her temperature, and call for an office visit on Monday morning.

Answer 92

B) take a detailed history by phone, prescribe antibiotics for the woman to pick up at her pharmacy, and give the woman instructions about when to call back if symptoms do not improve.

Question 93

Engorgement is minimized or prevented in a breastfeeding person by:
A) applying heat to the breasts between feedings.
B) pumping the breasts between feedings.
C) breastfeeding for 15 minutes on each breast at each feeding.
D) early and frequent breastfeeding.

Answer 93

D) early and frequent breastfeeding.

Do NOT apply heat to engorged breasts! Do NOT empty the breast by pumping! Varney, 6th edition p. 1249

Question 94

Which term does the nurse-midwife use when documenting the mammary gland involution that occurs when breastfeeding ceases?

A) Lactogenesis III
B) Lactogenesis I
C) Lactogenesis II
D) Lactogenesis IV

Answer 94

D) Lactogenesis IV

Varney, Anatomy and Physiology of Lactation, Chapter 32. p. 1172

Question 95

A breastfeeding client is postpartum day two and describes pain in their right nipple during breastfeeding. Management includes:

A) Continue breastfeeding on both sides unless pain becomes intolerable.
B) Continue breastfeeding on the left side, but rest the right side for 24 hours.
C) Discontinue breastfeeding until baby’s latch is corrected.

Answer 95

A) Continue breastfeeding on both sides unless pain becomes intolerable.

We wouldn’t tell her not to breastfeed on one side for 24 hours. We would RARELY tell a client to discontinue breastfeeding.

Question 96

A mother who has herpes simplex virus (HSV) and hepatitis B (HBV) wants to breastfeed. The midwife should advise the woman that:

A) women who are positive for HSV cannot breastfeed.
B) women who are positive for hepatitis B cannot breastfeed.
C) it is safe to breastfeed her baby even if there are open lesions on her breast.
D) it is safe to breastfeed her baby as long as there are no open lesions on her breast.

Answer 96

D) it is safe to breastfeed her baby as long as there are no open lesions on her breast.

Question 97

A woman is at her 6 week postpartum visit after the birth of her second baby. The woman reports that her vaginal bleeding has been inconsistent since her birth. It has increased and decreased over time but she doesn’t think it has really tapered like she remembers from her first birth. A few days before this visit, her bleeding became bright red again and is a little heavier. She is exclusively breastfeeding. The midwife correctly concludes that:

A) the bleeding this week is probably the woman’s first menses.
B) this is not a normal pattern and further evaluation is warranted now.
C) provided that the woman’s uterus is down to 12-week size, this is probably normal.
D) if there is no odor to the lochia, the woman should return to the office for reevaluation in 2 weeks.

Answer 97

B) this is not a normal pattern and further evaluation is warranted now.

Question 98

An Edinburgh Postnatal Depression Scale score of 13 most likely indicates:

A) postpartum blues.
B) postpartum depression.
C) postpartum psychosis.
D) a normal finding.

Answer 98

B) postpartum depression.

Question 99

A G2P1001 whose pregnancy was complicated with gestational diabetes (GDM) is being seen for her 6 week postpartum visit. Appropriate gestational diabetes (GDM) management includes

A) no additional testing, gestational diabetes (GDM) resolves with delivery of the placenta.
B) a 100-g, 3-hour oral glucose tolerance test (OGTT) at 6 - 8 weeks postpartum.
C) a 75-g, 2-hour oral glucose tolerance test (OGTT) at 4-12 weeks postpartum.
D) a 50-g, 1 hour oral glucose screening test at 6-12 weeks postpartum.

Answer 99

C) a 75-g, 2-hour oral glucose tolerance test (OGTT) at 4-12 weeks postpartum.

Question 100

What should the midwife take into consideration when choosing medications to give to the breastfeeding mother to help minimize risks to the infant? Choose a medication with:

A) a low molecular weight.
B) low protein binding.
C) poor cross over into the central nervous system.

Answer 100

C) poor cross over into the central nervous system.

Question 101

A woman breastfeeding her 4 day old baby reports breast pain in both breasts, primarily on the outer portions of her breasts. The midwife concludes that this pain is probably from:

A) mastitis
B) engorgement
C) candidiasis
D) improper positioning of the baby at the breast

Answer 101

B) engorgement

Question 102

A woman calls her midwife two days after an uncomplicated vaginal birth at a birth center. The woman reports flatulence but no bowel movement since the birth. Correct management is:

A) reassurance and advice to increase fluids, fiber, and ambulation.
B) reassurance and advice to use a Fleet’s enema.
C) an office visit to evaluate for an ileus.
D) prescription laxatives.

Answer 102

A) reassurance and advice to increase fluids, fiber, and ambulation.

Question 103

A woman breastfeeding a 2-day-old baby reports left nipple pain during breastfeeding. After assessing the latch and educating about proper positioning, the midwife should advise the woman to:

A) pump both breasts until the left nipple begins to heal.
B) continue breastfeeding on both breasts unless the discomfort becomes severe.
C) continue breastfeeding on the right breast but do not breastfeed on the left breast for 12-18 hours.
D) discontinue breastfeeding.

Answer 103

B) continue breastfeeding on both breasts unless the discomfort becomes severe.

Question 104

The best pharmacologic treatment for postpartum depression is:

A) benzodiazepine.
B) a selective serotonin reuptake inhibitor.
C) a tricyclic antidepressant.
D) herbal therapy.

Answer 104

B) a selective serotonin reuptake inhibitor.

Question 105

Frozen breast milk that has been thawed must be used within:

A) 12 hours.
B) 24 hours.
C) 48 hours.

Answer 105

B) 24 hours.

Question 106

A new mom calls the midwife at one week postpartum. She states that she feels somewhat overwhelmed with her new role as mother. She is exhausted and says the baby wants to breastfeed all the time. She is weepy. The midwife suspects:

A) postpartum anxiety.
B) postpartum blues.
C) postpartum fatigue.
D) postpartum depression.

Answer 106

B) postpartum blues.

Question 107

First-line pharmacologic treatment for postpartum depression often includes treatment with

A) selective serotonin reuptake inhibitors (SSRI).
B) serotonin norephinephrine reuptake inhibitors (SNRI).
C) tricyclic antidepressants.
D) benzodiazepines.

Answer 107

A) selective serotonin reuptake inhibitors (SSRI).

Question 108

Research on postpartum depression’s effects on family relationships reveal

A) conclusive evidence that postpartum depression does not impact children’s cognitive development.
B) a diminished risk of depression developing in the woman’s partner.
C) an increased risk for more school-age behavioral problems in the infants of postpartum depressed mothers.
D) infants of postpartum depressed mothers tend to have more positive facial expressions and vocalizations.

Answer 108

C) an increased risk for more school-age behavioral problems in the infants of postpartum depressed mothers.

Question 109

Afterbirth pains are relieved by:

A) lying supine with a heating pad on the abdomen.
B) uterine massage.
C) lying prone across a pillow or blanket roll.
D) 500 mg Aspirin every four hours.

Answer 109

C) lying prone across a pillow or blanket roll.

Question 110

SATA: Women are better able to cope with pain if they are

A) prepared antenatally for possible pain postpartally
B) given a variety of methods to relieve the pain (pharmacologic as well as non-pharmacologic)
C) medicated prior to feeling pain
D) asked to rate their pain versus having a discussion with them about comfort levels

Answer 110

A) prepared antenatally for possible pain postpartally
B) given a variety of methods to relieve the pain (pharmacologic as well as non-pharmacologic)

Question 111

A woman’s partner calls the office and explains to the nurse-midwife that his partner, three days postpartum, is “out of her mind!” She is walking around with a blanket covering her head and ranting about the government spies who have implanted a chip in her head! The midwife should advise the partner to

A) bring her to the clinic tomorrow so that she can be evaluated.
B) bring her immediately to the clinic for evaluation.
C) call 911 and to not leave his/her partner or baby unattended.
D) have her breastfeed the baby to calm her while waiting for the paramedics to arrive.

Answer 111

C) call 911 and to not leave his/her partner or baby unattended.

Question 112

A G1P1 patient had a normal spontaneous vaginal birth of an eight pound baby 10 days ago. She is breastfeeding without supplementation. Her lochia has followed a normal course. She calls the office concerned because she has had sudden red bleeding for the past hour with no odor or pain. The most likely cause of this bleeding is:

A) endometritis.
B) she went to the supermarket.
C) release of the eschar.
D) normal course of lochia.

Answer 112

C) release of the eschar.

Question 113

The most significant risk factor for postpartum psychiatric illness is

A) Limited social support
B) Previous history of psychiatric illness
C) Previous perinatal loss
D) Unplanned pregnancy

Answer 113

B) Previous history of psychiatric illness

Question 114

A rapid streptococcal antigen test is recommended for adults with an inflamed pharynx that meet two of four criteria. What signs make up the four criteria?

A) fever, lack of cough, tonsillar exudates, or tender anterior cervical adenopathy
B) cough, palatal petechiae, tender posterior cervical adenopathy, or congestion
C) fever, cough, tonsillar exudates, or palatal petechiae
D) fever, lack of cough, tonsillar enlargement, or chills.

Answer 114

A) fever, lack of cough, tonsillar exudates, or tender anterior cervical adenopathy

Question 115

On her fifth postpartum day, an individual has a sudden onset of pain in their right leg rated at a 7/10. O: pulse is 100, localized heat on right calf, tender, knot palpated. The NP should:

A) prescribe ibuprofen 600 mg PO q 6 hours to reduce inflammation and return to clinic tomorrow for evaluation.
B) perform Homan’s sign maneuver and if negative, advise rest and application of compression hose.
C) consult a physician immediately and anticipate compression ultrasound and Doppler imaging.
D) prescribe support hose and encourage ambulation with alternating ice packs..

Answer 115

C) consult a physician immediately and anticipate compression ultrasound and Doppler imaging.

Question 116

Which is a bioactive agent in human milk?

A) immunoglobulin IgA
B) phosphorus
C) water
D) milk fat (lipids)

Answer 116

A) immunoglobulin IgA

Varney 6E page 1234

Question 117

Nine months postpartum, a G4P3013 complains of fatigue, sleeping all the time, and a loss of interest or pleasure in doing activities they used to enjoy. They feel like they have lost themselves. They deny any thoughts of harming themselves or baby. An appropriate assessment (A) and management plan (P) include:

A) A: Generalized anxiety disorder vs. Postpartum Bipolar disorder; P: refer to mental health specialist
B) A: Postpartum blues; P: Reassurance normal transition, offer coping strategies.
C) A: Postpartum depression vs. thyroid disorder; P: order thyroid stimulating hormone (TSH) and administer the Edinburgh Postnatal Depression Scale
D) A: Chronic Depression; P: discuss initiating individual psychotherapy and pharmacotherapy

Answer 117

C) A: Postpartum depression vs. thyroid disorder; P: order thyroid stimulating hormone (TSH) and administer the Edinburgh Postnatal Depression Scale

PPBlues is within 2 weeks. PPD can occur up to a year after birth. Varney, Chapter 8 Mental Health Conditions. p 286

Question 118

Delayed onset of ­­­­­­_____________ is associated with cesarean birth, retained placental fragments, ovarian theca lutein cysts, hypothyroidism, certain types of breast surgery, and severe maternal anemia.

A) lactogenesis III
B) lactogenesis IV
C) lactogenesis I
D) lactogenesis II

Answer 118

D) lactogenesis II

Anatomy and Physiology of Lactation, Chapter 32, Varney p. 1171

Question 119

Four hours after a vacuum-assisted birth, a woman reports worsening perineal pain and rectal pressure. The midwife should anticipate:

A) episiotomy repair breakdown.
B) thrombosed hemorrhoids.
C) wound infection.
D) vaginal hematoma.

Answer 119

D) vaginal hematoma.

Question 120

A postpartum client calls the office because of postpartum depression. Which information is most important for the midwife to obtain?

A) Type of insurance coverage.
B) Eating and sleeping patterns.
C) Available family support.
D) Thoughts of harming herself or infant.

Answer 120

D) Thoughts of harming herself or infant.

Question 121

Anti-D immune globulin should be administered within 72 hours of birth to an individual who:

A) is Rh D positive with an Rh D negative newborn
B) is O positive with a newborn with AB positive blood type
C) is Rh D negative with an Rh D positive newborn.
D) is AB positive with a newborn with O negative blood type

Answer 121

C) is Rh D negative with an Rh D positive newborn.

RhoGam is recommended for all Rh D negative women who have a newborn with Rh D positive blood who are not already sensitized. Varney p. 1189.

Question 122

Risk factors for peripartum cardiomyopathy include:

A) viral infection, placenta previa, family history of Cystic Fibrosis, and preterm birth.
B) chronic hypertension, preeclampsia, twin gestation, and teen pregnancy.
C) bacterial pneumonia, cesarean birth, epidural anesthesia, and precipitous labor
D) anxiety disorders, macrosomia, postterm birth, and mitral valve prolapse.

Answer 122

B) chronic hypertension, preeclampsia, twin gestation, and teen pregnancy.

Postpartum Complications, Varney Chapter 34 p. 1225

Question 123

At four days postpartum, a breastfeeding person comes to the office with a concern of sore nipples. The NP knows that the most important factor to discerning the cause of nipple soreness is:

A) assessing the length of feedings
B) palpating for sunken fontanels
C) evaluating the infant’s latch
D) observing the breastfeeding position.

Answer 123

C) evaluating the infant’s latch

Varney p. 1256. Nipple pain is most commonly related to the infant’s inability to effectively latch onto the nipple.

Question 124

At 2 days postpartum, a 23-year-old, G1P1 asks when they will be able to resume vaginal-penile intercourse with their partner. You explain that intercourse can be resumed:

A) after her first menstrual period postpartum.
B) when she feels comfortable and ready to resume.
C) when birth control is established.
D) after 6 weeks postpartum.

Answer 124

B) when she feels comfortable and ready to resume.

Varney 6th p. 1196

Question 125

A woman who is 2 days postpartum reports an increased volume of urination. This is most likely due to:

A) a urinary tract infection.
B) elevated prolactin levels.
C) normal postpartum diuresis.
D) undiagnosed gestational diabetes.

Answer 125

C) normal postpartum diuresis.

Question 126

During a 2-week postpartum office visit, the male partner of a new mother with a history of bipolar disorder tells the NP that she has been crying frequently and is unable to sleep or eat. He indicates that the mother is concerned that the baby might be accidentally harmed. He states that last night the mother said, “I wish I could go to sleep and not wake up.” Based on this information what action should the NP take?

A) Recommend that the client make an appointment with a mental health care provider within the next 48 hours..
B) Ask the partner to bottle feed the infant at night to ensure the mother gets at least 5 hours of uninterrupted sleep at night.
C) Stay with the client while making arrangements for immediate evaluation by mental health professionals.
D) Reassure the partner that the mother will improve with proper rest and nutrition.

Answer 126

C) Stay with the client while making arrangements for immediate evaluation by mental health professionals.

With PP psychosis, the mother is likely to have suicidal ideations and thoughts of the infant being harmed. Varney p. 284

Question 127

A patient complains of shortness of breath after giving birth. Choose the appropriate management plan.

A) Explain this needs further investigation and plan to assess her after completing documentation.
B) Explain this is normal due to the exertion of giving birth.
C) Explain this needs further investigation and conduct exam immediately.
D) Explain this is normal due to the diaphragm being displaced during the pregnancy and birth.

Answer 127

C) Explain this needs further investigation and conduct exam immediately.

Question 128

A patient wants to know when she will be able to resume intercourse with her boyfriend. You explain that intercourse can be resumed:

A) after her first menstrual period postpartum.
B) when birth control is established.
C) after 6 weeks postpartum.
D) when she feels comfortable and ready to resume.

Answer 128

D) when she feels comfortable and ready to resume

Varney 6th p. 1196

Question 129

Postpartum uterine contractile pain is greater in breast-feeding women because suckling releases:

A) Oxytocin
B) Prolactin
C) Estrogen
D) Progesterone

Answer 129

A) Oxytocin