A nurse is teaching a postpartum client about breastfeeding.
Which statement best describes the relationship between prolactin and oxytocin?
Prolactin produces milk; oxytocin releases the milk during feeding.
Prolactin decreases as milk supply increases.
Prolactin causes milk ejection; oxytocin causes milk production.
Both prolactin and oxytocin are released only when the baby cries.
The Correct Answer is A
Choice A rationale
Prolactin is the primary hormone responsible for the synthesis and production of milk within the alveolar cells of the mammary glands. Oxytocin, often called the "milk let-down" or "ejection" hormone, stimulates the myoepithelial cells surrounding the alveoli to contract, forcing the synthesized milk through the ducts toward the nipple during a feeding session.
Choice B rationale
Prolactin levels actually rise in response to nipple stimulation during nursing and remain elevated in the initial weeks to establish the milk supply. The more frequently and effectively the infant nurses, the higher the prolactin levels are maintained, which signals the body to continue milk production, demonstrating a positive, not inverse, relationship with milk supply.
Choice C rationale
This statement reverses the primary roles of the two hormones. Prolactin acts on the secretory cells to produce the milk, establishing the supply. Oxytocin acts on the contractile myoepithelial cells to eject or release the milk, enabling the infant to access the supply during a feeding session.
Choice D rationale
While the baby crying can be a conditioned stimulus that triggers the milk ejection reflex and a small surge of oxytocin in some mothers, both prolactin and oxytocin release are primarily and most potently triggered by physical stimulation of the nipple and areola during suckling, which is the direct, unconditioned physiological response.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Afterpains are intermittent uterine contractions that occur during involution. Breastfeeding stimulates the release of oxytocin, a potent uterotonic hormone, which intensifies these contractions. Therefore, a bottle-feeding woman would be less likely to experience strong afterpains compared to a breastfeeding woman.
Choice B rationale
Oligohydramnios is a condition of low amniotic fluid. Uterine distention is the primary cause of strong afterpains. Since oligohydramnios results in a smaller-than-average uterus, the associated afterpains are typically less intense because the uterus was not excessively stretched during the pregnancy.
Choice C rationale
A newborn weighing 5 pounds, 3 ounces (2353 grams) is considered low birth weight, suggesting the uterus was less distended than in a pregnancy with a larger infant. Afterpains are more severe in conditions causing overdistention, such as macrosomia, where the stretched muscle fibers have a greater distance to retract.
Choice D rationale
Multiple gestation, such as twins, causes excessive stretching and overdistention of the uterine muscle fibers due to the presence of two fetuses and placentas. The more the uterus is stretched, the harder it must contract to return to its pre-pregnancy size, resulting in stronger and more uncomfortable afterpains.
Correct Answer is B
Explanation
Choice A rationale
A cervical tear occurring during birth is typically characterized by a steady trickle or frank hemorrhage of bright red blood after delivery, even with a firm uterus. The signs noted, including the fundus becoming globular and the gush of dark red blood, are classic, sequential physiological signs indicating the separation of the placenta from the uterine wall.
Choice B rationale
The globular shape of the fundus, the sudden gush of dark red blood, and the lengthening of the umbilical cord (if observed) are the three classic signs that indicate the placenta has successfully separated from the uterine wall. This separation is the normal process preceding the third stage of labor, or placental expulsion, and is a non-pathologic finding in this context.
Choice C rationale
Clots forming in the upper uterine segment might contribute to a boggy, displaced uterus if they lead to uterine atony and hemorrhage, but they are not the cause of the described signs. The specific changes observed—globular fundus and gush of blood—are reliable physiological markers signaling the detachment of the placenta, preparing it for delivery.
Choice D rationale
Hemorrhage, particularly postpartum hemorrhage, is generally defined as blood loss > 500 mL following a vaginal birth. While the gush of blood can be significant, the preceding globular change in the fundus confirms the stage of placental separation, which is a normal finding, not a definitive indication that the client is experiencing a life-threatening hemorrhage at this precise moment.
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