Chapter 13 Puerperium

28 Questions | Total Attempts: 2860

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Tissue Quizzes & Trivia

Questions and Answers
  • 1. 
    A previously energetic woman complains of crying, loss of appetite, difficulty in sleeping, and feeling of low self-worth, beginning approximately 3 days after a normal vaginal delivery. These feelings persisted for approximately 1 week and then progressively diminished. Which of the following is the best term to describe her symptoms postpartum?
    • A. 

      Blues

    • B. 

      Manic depression

    • C. 

      Neurosis

    • D. 

      Psychosis

    • E. 

      Schizoid affective disorder

  • 2. 
    A patient has just delivered her first child after an uncomplicated pregnancy and term vaginal delivery. She is anxious to breast-feed. As part of her postpartum discharge counseling, she should be told that few things interfere with lactation, but she should avoid which of the following?
    • A. 

      Depo-Provera

    • B. 

      Frequent suckling

    • C. 

      High dose (≥50 μ gestradiol) oral contraceptive pills

    • D. 

      Levonorgestrel intrauterine device (IUD)

    • E. 

      Progestin-only oral contraceptive pill (minipill)

  • 3. 
    At delivery, a perineal laceration tore through the skin of the fourchette, vaginal mucous membrane, and the fascia and perineal muscles of the perineal body but not the anal sphincter or mucosa. This should be recorded in the medical record as what type of laceration?
    • A. 

      First-degree

    • B. 

      Second-degree

    • C. 

      Third-degree

    • D. 

      fourth-degree

    • E. 

      Complete

  • 4. 
    A patient is being discharged from the hospital following an uncomplicated vaginal delivery. Discharge counseling and plans would include which of the following?
    • A. 

      Discontinue prenatal vitamins

    • B. 

      No driving for 4 weeks

    • C. 

      No coitus for 6 weeks

    • D. 

      Return to work only after 6 weeks of maternity leave

    • E. 

      Rubella immunization for nonimmune patients

  • 5. 
    A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing 4,300 g after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine segment transverse cesarean section for breech. She has had no problems during the pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal bleeding of greater than 500 cc. Although all of the following can be the cause for postpartum hemorrhage, which is the mostfrequent cause of immediate hemorrhage as seen in this patient?
    • A. 

      Coagulopathies

    • B. 

      Retained placental fragments

    • C. 

      Uterine atony

    • D. 

      Uterine rupture

    • E. 

      Vaginal and/or cervical lacerations

  • 6. 
    A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing 4,300 g after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine segment transverse cesarean section for breech. She has had no problems during the pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal bleeding of greater than 500 cc. In this patient with a significant postpartum bleed, when should transfusions be started?
    • A. 

      After the loss of 750 cc of blood

    • B. 

      Before giving other volume expanders

    • C. 

      Before using prostaglandin E2 (PGE2)-alpha

    • D. 

      If the patient becomes hypotensive despite other volume expanders

    • E. 

      When packed cell volume (PCV) is

  • 7. 
    A 24-year-old patient (gravida 2, para 2) has just delivered vaginally an infant weighing 4,300 g after a spontaneous uncomplicated labor. Her prior obstetric history was a low uterine segment transverse cesarean section for breech. She has had no problems during the pregnancy and labor. The placenta delivers spontaneously. There is immediate brisk vaginal bleeding of greater than 500 cc. After a significant period of hypovolemic shock, the bleeding was controlled and the vascular volume replaced. Estimates of blood loss were over 2,500 cc. The patient apparently recovered well. However, she was unable to breast-feed and gradually noted breast atrophy and no resumption of menses. Later, she developed constipation, slurred speech, and moderate nonpitting edema. Which of the following is the most likely diagnosis?
    • A. 

      Acute tubular necrosis (ATN)

    • B. 

      Amenorrhea-galactorrhea syndrome

    • C. 

      Asherman’s syndrome (uterine synechiae)

    • D. 

      Pituitary tumor

    • E. 

      Sheehan’s syndrome (pituitary necrosis)

  • 8. 
    A patient calls your clinic complaining of continued heavy vaginal bleeding. She had an “uncomplicated” vaginal birth 2 weeks ago of her second child. What is the most likely diagnosis from the following differentials?
    • A. 

      Coagulopathies

    • B. 

      Retained placental fragments

    • C. 

      Uterine atony

    • D. 

      Uterine rupture

    • E. 

      Vaginal lacerations

  • 9. 
    The most efficacious treatment of persistent uterine hemorrhage in the second to fourth week of the puerperium, as observed in this patient is which of the following?
    • A. 

      Dilation and curettage (D&C)

    • B. 

      Ergotrate

    • C. 

      High doses of estrogen

    • D. 

      High doses of progesterone

    • E. 

      Uterine packing

  • 10. 
    The postpartum nurse calls about a patient who had an uncomplicated vaginal delivery 12 hours ago. She is concerned that the patient has the following findings. Which of them should be of most concern to you?
    • A. 

      Abdominal rigidity

    • B. 

      Leukocytosis of 16,000

    • C. 

      Proteinuria

    • D. 

      A pulse rate of 60

    • E. 

      a single temperature of 100.4°F

  • 11. 
    A patient had a prolonged labor requiring a C-section in the setting of chorioamnionitis. She has continued with spiking temperatures despite antibiotics and a diagnosis of postpartum pelvic thrombophlebitis is being made. She suddenly complains of chest pain and dyspnea. Which of the following tests will be most helpful to diagnose a pulmonary embolism?
    • A. 

      Arterial blood gas

    • B. 

      Auscultation of the chest

    • C. 

      Chest x-ray

    • D. 

      Electrocardiogram (ECG)

    • E. 

      spiral computed tomography (CT) scan

  • 12. 
    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. Which of the following is the greatest predisposing cause of puerperal infection in this patient?
    • A. 

      Coitus during late pregnancy

    • B. 

      Iron deficiency

    • C. 

      Maternal exhaustion

    • D. 

      Poor nutrition

    • E. 

      Tissue trauma

  • 13. 
    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. he develops a persistent fever of 101°F on the third day postpartum. What is the most likely etiology?
    • A. 

      Cholecystitis

    • B. 

      Endometritis

    • C. 

      Mastitis

    • D. 

      Pneumonia

    • E. 

      Thrombophlebitis

  • 14. 
    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. If this infection spreads to include the supporting connective tissues of the uterus, what is it called?
    • A. 

      Parametritis

    • B. 

      Peritonitis

    • C. 

      Phlebothrombosis

    • D. 

      Pyemia

    • E. 

      Thrombophlebitis

  • 15. 
    An 18-year-old patient finally delivered a 4,000-g infant vaginally. Her prenatal course was complicated by anemia, poor weight gain, and maternal obesity. Her labor was protracted, including a 3-hour second stage, a mid-forceps delivery with a sulcus laceration, and a third-degree episiotomy. Puerperal infection may be spread by several routes. Which of the following is the most common route that results in serious complication of a septic thrombophlebitis?
    • A. 

      Arterial

    • B. 

      Direct extension

    • C. 

      Fomites

    • D. 

      Lymphatic

    • E. 

      Venous

  • 16. 
    A patient who is 12 hours postpartum develops a temperature of 104°F, a tender uterus, and increased lochia without an odor. Her pregnancy course had been complicated only by limited and inconsistent prenatal care. Your antibiotic choice needs to be sure to cover which of the following organisms?
    • A. 

      Bacteroides

    • B. 

      Beta-streptococcus

    • C. 

      Escherichia coli

    • D. 

      Gonococcus

    • E. 

      Staphylococcus

  • 17. 
    Bacteria can be cultured from most endometrial cavities 2 to 3 days postpartum in patients who are asymptomatic. The anaerobic organism most commonly found is which of the following?
    • A. 

      Beta-streptococcus

    • B. 

      Clostridium

    • C. 

      E. coli

    • D. 

      Peptococcus

    • E. 

      Peptostreptococcus

  • 18. 
    During childbirth classes, a patient should be told which of the following regarding breastfeeding?
    • A. 

      Breast milk is a major source of immunoglobulin G (IgG).

    • B. 

      Most ingested drugs that are soluble in maternal blood do not cross into breast milk.

    • C. 

      Mother’s milk contains a large amount of iron.

    • D. 

      The postpartum period of lactation is a time of above-normal fertility.

    • E. 

      Prolactin stimulates milk production and breast development.

  • 19. 
    A 16-year-old patient delivered a term infant yesterday. She is placing the child for adoption and is not going to breast-feed. She asks for something to suppress lactation. What is simplest and safest method of lactation suppression?
    • A. 

      Breast binding, ice packs, and analgesics

    • B. 

      Bromocriptine

    • C. 

      Deladumone

    • D. 

      Depo-Provera

    • E. 

      Oral contraceptive pills

  • 20. 
    A patient presents 1-week postpartum with complaints of her right breast being engorged, hot, red, and painful. She reports a fever of 101 °F. If her breasts were cultured, which of the following is the most likely organism to be found?
    • A. 

      aerobic Streptococcus

    • B. 

      Anaerobic Streptococcus

    • C. 

      E. coli

    • D. 

      Neisseria

    • E. 

      Staphylococcus aureus

  • 21. 
    A class C diabetic patient delivers at term. It is important to check her blood sugar levels immediately postpartum, since there may be a decrease in the insulin requirements of diabetic patients. This can be partly explained by which of the following?
    • A. 

      Decreased activity

    • B. 

      Decrease in plasma chorionic somatomammotropin [hCS or human placental lactogen (hPL)]

    • C. 

      Decrease in plasma estrogen

    • D. 

      Decrease in plasma progesterone

    • E. 

      increased food intake

  • 22. 
    Immediately after the completion of a normal labor and delivery, the uterus should be which of the following?
    • A. 

      At the level of the symphysis pubis

    • B. 

      Boggy

    • C. 

      Discoid

    • D. 

      Firm and rounded

    • E. 

      Immobile

  • 23. 
    A patient had a vaginal delivery of a 4,500-g infant after a prolonged second stage. She is now unable to void. Each of the following could be a reason and can be initially treated with Foley placement. Which of the following can represent a most serious etiology of inability to void in the immediate postpartum period?
    • A. 

      Anesthesia

    • B. 

      Edema

    • C. 

      Emotions

    • D. 

      Hematoma

    • E. 

      Overdistention of the bladder

  • 24. 
    Average blood loss from an uncomplicated vaginal delivery, when carefully measured, has been found to be which of the following?
    • A. 

      G

    • B. 

      Approximately 350 mL

    • C. 

      Approximately 550 mL

    • D. 

      Approximately 750 mL

    • E. 

      approximately 1,000 mL

  • 25. 
    The decidual layer is divided into several parts, pregnancy. The remaining layer can be damaged with a curettage for retained placenta. Which of the following is the part that should remain?
    • A. 

      Decidua capsularis

    • B. 

      Decidua vera

    • C. 

      Zona basalis

    • D. 

      zona functionalis

    • E. 

      Zona spongiosa

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