1) On completing a fundal assessment, the nurse notes the fundus is situated on the

clients left abdomen. Which of the following actions is appropriate?

a Ask the client to empty her bladder
b traight catheteri!e the client immediately
c "all the clients health pro#ider for direction
d traight catheteri!e the client for half of her uterine #olume
A. A full bladder may displace the uterine fundus to the left or right side of the abdomen.
"atheteri!ation is unnecessary in#asi#e if the woman can #oid on her own.
$) %he nurse is about the gi#e a %ype $ diabetic her insulin before breakfast on her first
day postpartum. Which of the following answers best describes insulin re&uirements
immediately postpartum?
a 'ower than during her pregnancy
b (igher than during her pregnancy
c 'ower than before she became pregnant
d (igher than before she became pregnant
" . )) insulin re&uirements are usually significantly lower than prepregnancy
re&uirements. Occasionally, clients may re&uire little to no insulin during the first $* to
*+ hours postpartum.
,) Which of the following findings would be e-pected when assessing the postpartum
client?
a .undus 1 cm abo#e the umbilicus 1 hour postpartum
b .undus 1 cm abo#e the umbilicus on postpartum day ,
c .undus palpable in the abdomen at $ weeks postpartum
d .undus slightly to the right/ $ cm abo#e umbilicus on postpartum day $
A . Within the first 1$ hours postpartum, the fundus usually is appro-imately 1 cm abo#e
the umbilicus. %he fundus should be below the umbilicus by )) day ,. %he fundus
shouldnt be palpated in the abdomen after day 10.
*) A client is complaining of painful contractions, or afterpains, on postpartum day $.
Which of the following conditions could increase the se#erity of afterpains?
a 1ottle2feeding
b 3iabetes
c 4ultiple gestation
d )rimiparity
" . 4ultiple gestation, breastfeeding, multiparity, and conditions that cause
o#erdistention of the uterus will increase the intensity of after2pains. 1ottle2feeding and
diabetes arent directly associated with increasing se#erity of afterpains unless the client
has deli#ered a macrosomic infant.
5) On which of the postpartum days can the client e-pect lochia serosa?
a 3ays , and * ))
b 3ays , to 10 ))
c 3ays 1021* ))
d 3ays 1* to *$ ))
1 . On the third and fourth )) days, the lochia becomes a pale pink or brown and
contains old blood, serum, leukocytes, and tissue debris. %his type of lochia usually lasts
until )) day 10. 'ochia rubra usually last for the first , to * days )). 'ochia alba, which
contain leukocytes, decidua, epithelial cells, mucus, and bacteria, may continue for $ to 6
weeks )).
6) Which of the following beha#iors characteri!es the )) mother in the taking in phase?
a )assi#e and dependant
b tri#ing for independence and autonomy
c "urious and interested in care of the baby
d 7-hibiting ma-imum readiness for new learning
A . 3uring the taking in phase, which usually lasts 12, days, the mother is passi#e and
dependent and e-presses her own needs rather than the neonates needs. %he taking hold
phase usually lasts from days ,210 )). 3uring this stage, the mother stri#es for
independence and autonomy/ she also becomes curious and interested in the care of the
baby and is most ready to learn.
8) Which of the following complications may be indicated by continuous seepage of
blood from the #agina of a )) client, when palpation of the uterus re#eals a firm uterus 1
cm below the umbilicus?
a 9etained placental fragments
b :rinary tract infection
c "er#ical laceration
d :terine atony
" . "ontinuous seepage of blood may be due to cer#ical or #aginal lacerations if the
uterus is firm and contracting. 9etained placental fragments and uterine atony may cause
subin#olution of the uterus, making it soft, boggy, and larger than e-pected. :%; wont
cause #aginal bleeding, although hematuria may be present.
+) What type of milk is present in the breasts 8 to 10 days ))?
a "olostrum
b (ind milk
c 4ature milk
d %ransitional milk
3 . %ransitional milk comes after colostrum and usually lasts until $ weeks )).
<) Which of the following complications is most likely responsible for a delayed
postpartum hemorrhage?
a "er#ical laceration
b "lotting deficiency
c )erineal laceration
d :terine subin#olution
3 . 'ate postpartum bleeding is often the result of subin#olution of the uterus. 9etained
products of conception or infection often cause subin#olution. "er#ical or perineal
lacerations can cause an immediate postpartum hemorrhage. A client with a clotting
deficiency may also ha#e an immediate )) hemorrhage if the deficiency isnt corrected at
the time of deli#ery.
10) 1efore gi#ing a )) client the rubella #accine, which of the following facts should the
nurse include in client teaching?
a %he #accine is safe in clients with egg allergies
b 1reast2feeding isnt compatible with the #accine
c %ransient arthralgia and rash are common ad#erse effects
d %he client should a#oid getting pregnant for , months after the #accine because the
#accine has teratogenic effects .
3 .client must understand that she must not become pregnant for , months after the
#accination because of its potential teratogenic effects. %he rubella #accine is made from
duck eggs so an allergic reaction may occur in clients with egg allergies. %he #irus is not
transmitted into the breast milk, so clients may continue to breastfeed after the
#accination. %ransient arthralgia and rash are common ad#erse effects of the #accine.
11) Which of the following changes best described the insulin needs of a client with type
1 diabetes who has =ust deli#ered an infant #aginally without complications?
a ;ncrease
b 3ecrease
c 9emain the same as before pregnancy
d 9emain the same as during pregnancy
1 . %he placenta produces the hormone human placental lactogen, an insulin antagonist.
After birth, the placenta, the ma=or source of insulin resistance, is gone. ;nsulin needs
decrease and women with type 1 diabetes may only need one2half to two2thirds of the
prenatal insulin during the first few )) days.
1$) Which of the following responses is most appropriate for a mother with diabetes who
wants to breastfeed her infant but is concerned about the effects of breastfeeding on her
health?
a 4others with diabetes who breast2feed ha#e a hard time controlling their insulin needs
b 4others with diabetes shouldnt breastfeed because of potential complications
c 4others with diabetes shouldnt breastfeed/ insulin re&uirements are doubled.
d 4others with diabetes may breastfeed/ insulin re&uirements may decrease from
breastfeeding.
3 . 1reastfeeding has an antidiabetogenic effect. ;nsulin needs are decreased because
carbohydrates are used in milk production. 1reastfeeding mothers are at a higher risk of
hypoglycemia in the first )) days after birth because the glucose le#els are lower.
4others with diabetes should be encouraged to breastfeed.
1,) On the first )) night, a client re&uests that her baby be sent back to the nursery so she
can get some sleep. %he client is most likely in which of the following phases?
3epression phase
'etting2go phase
%aking2hold phase
%aking2in phase
,<) Which of the following physiological responses is considered normal in the early
postpartum period?
:rinary urgency and dysuria
9apid diuresis
3ecrease in blood pressure
;ncrease motility of the >; system
*0) 3uring the ,
rd
)) day, which of the following obser#ations about the client would the
nurse be most likely to make?
%he client appears interested in learning about neonatal care
%he client talks a lot about her birth e-perience
%he client sleeps whene#er the neonate isnt present
%he client re&uests help in choosing a name for the neonate.
*1) Which of the following circumstances is most likely to cause uterine atony and lead
to )) hemorrhage?
(ypertension
"er#ical and #aginal tears
:rine retention
7ndometritis
*$) Which type of lochia should the nurse e-pect to find in a client $ days ))?
.oul2smelling
'ochia serosa
'ochia alba
'ochia rubra
*,) After e-pulsion of the placenta in a client who has si- li#ing children, an infusion of
lactated ringers solution with 10 units of pitocin is ordered. %he nurse understands that
this is indicated for this client because?
he had a precipitate birth
%his was an e-tramural birth
9etained placental fragments must be e-pelled
4ultigra#idas are at increased risk for uterine atony.
**) As part of the postpartum assessment, the nurse e-amines the breasts of a primiparous
breastfeeding woman who is one day postpartum. An e-pected finding would be?
oft, non2tender/ colostrum is present
'eakage of milk at let down
wollen, warm, and tender upon palpation
A few blisters and a bruise on each areola
*5) .ollowing the birth of her baby, a woman e-presses concern about the weight she
gained during pregnancy and how &uickly she can lose it now that the baby is born. %he
nurse, in describing the e-pected pattern of weight loss, should begin by telling this
woman that?
9eturn to prepregnant weight is usually achie#ed by the end of the postpartum period
.luid loss from diuresis, diaphoresis, and bleeding accounts for about a , pound
weight loss
%he e-pected weight loss immediately after birth a#erages about 11 to 1, pounds
'actation will inhibit weight loss since caloric intake must increase to support milk
production
*6) Which of the following findings would be a source of concern if noted during the
assessment of a woman who is 1$ hours postpartum?
)ostural hypotension
%emperature of 100.*@.
1radycardia A pulse rate of 55 1)4
)ain in left calf with dorsifle-ion of left foot
*8) %he nurse e-amines a woman one hour after birth. %he womans fundus is boggy,
midline, and 1 cm below the umbilicus. (er lochial flow is profuse, with two plum2si!ed
clots. %he nurses initial action would be to?
)lace her on a bedpan to empty her bladder
4assage her fundus
"all the physician
Administer 4ethergine 0.$ mg ;4 which has been ordered prn
*+) When performing a postpartum check, the nurse should?
Assist the woman into a lateral position with upper leg fle-ed forward to facilitate the
e-amination of her perineum
Assist the woman into a supine position with her arms abo#e her head and her legs
e-tended for the e-amination of her abdomen
;nstruct the woman to a#oid urinating =ust before the e-amination since a full bladder
will facilitate fundal palpation
Wash hands and put on sterile glo#es before beginning the check
*<) )erineal care is an important infection control measure. When e#aluating a
postpartum womans perineal care techni&ue, the nurse would recogni!e the need for
further instruction if the woman?
:ses soap and warm water to wash the #ul#a and perineum
Washes from symphysis pubis back to episiotomy
"hanges her perineal pad e#ery $ B , hours
:ses the peribottle to rinse upward into her #agina
50) Which measure would be least effecti#e in pre#enting postpartum hemorrhage?
Administer 4ethergine 0.$ mg e#ery 6 hours for * doses as ordered
7ncourage the woman to #oid e#ery $ hours
4assage the fundus e#ery hour for the first $* hours following birth
%each the woman the importance of rest and nutrition to enhance healing
51) When making a #isit to the home of a postpartum woman one week after birth, the
nurse should recogni!e that the woman would characteristically?
7-press a strong need to re#iew e#ents and her beha#ior during the process of labor
and birth
7-hibit a reduced attention span, limiting readiness to learn
Cacillate between the desire to ha#e her own nurturing needs met and the need to take