A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is:

Excessive uterine bleeding

A bladder rupture

Bladder wall atony

Urinary tract infection

Answer and Explanation

The Correct Answer is A

A) Excessive uterine bleeding: A distended bladder can cause the uterus to become displaced to the right, preventing it from contracting effectively. This lack of uterine contraction can lead to uterine atony, which is a significant risk factor for excessive postpartum bleeding. When the uterus cannot contract well, it may result in continued
hemorrhage, which is a serious and immediate concern for postpartum patients.

B) A bladder rupture: While bladder rupture is a rare and severe complication, it is unlikely to occur in this situation. Bladder distention is a concern, but the most immediate danger is related to the uterus, not the bladder itself. A rupture would require significant trauma or extreme overdistention of the bladder, neither of which are described here.
C) Bladder wall atony: Bladder wall atony, where the bladder loses its ability to contract and expel urine, is not the most serious immediate consequence of bladder distention postpartum. While it may be uncomfortable and problematic, the main concern in this scenario is how bladder distention affects uterine contraction, which can lead to excessive bleeding.

D) Urinary tract infection: Although urinary retention can increase the risk of urinary tract infections (UTIs) due to incomplete bladder emptying, this is a less immediate and life-threatening concern compared to excessive bleeding. The primary concern in the immediate postpartum period is the potential for hemorrhage from uterine atony, which is worsened by bladder distention.

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Correct Answer is A

Explanation

A) Prolactin:
Prolactin is the primary hormone responsible for stimulating milk production in the postpartum period. In breastfeeding mothers, prolactin levels remain elevated, especially during the first few weeks after delivery, to support lactation. This hormone is released in response to suckling and is essential for maintaining a steady milk supply. Elevated prolactin levels help establish and maintain breastfeeding during the early postpartum period, even as other pregnancy-related hormones begin to decline.

B) Estrogen:
Estrogen levels drop sharply after childbirth, as the placenta is no longer present to produce this hormone. The decline in estrogen is one of the factors that helps initiate lactation. While estrogen rises later during the postpartum period as the body returns to its non-pregnant state, it is not elevated during the immediate postpartum period in breastfeeding women.

C) Progesterone:
Similar to estrogen, progesterone levels fall quickly after delivery. Progesterone is involved in maintaining pregnancy, and its levels decrease significantly once the placenta is delivered. A reduction in progesterone is one of the hormonal changes that triggers the onset of lactation. It does not remain elevated in the immediate postpartum period.

D) Human placental lactogen (hPL):
hPL is produced by the placenta during pregnancy to support fetal growth and prepare the breasts for lactation. However, after delivery, hPL levels decline rapidly because the placenta is expelled. It is not elevated in the immediate postpartum period.

E) Relaxin:
Relaxin is a hormone that helps to soften the cervix and relax the ligaments in preparation for childbirth. Its levels are elevated during pregnancy and drop significantly after delivery. It does not remain elevated in the postpartum period, particularly in breastfeeding women.

Correct Answer is ["4"]

Explanation

The Apgar score is calculated based on five criteria, each scored from 0 to 2:

Heart rate
- 0 = Absent
- 1 = Below 100 beats per minute ✅
- 2 = 100 or more beats per minute
Respiratory effort
- 0 = Absent
- 1 = Slow, irregular ✅
- 2 = Good, crying
Muscle tone
- 0 = Limp
- 1 = Some flexion of extremities ✅
- 2 = Active motion
Reflex irritability (response to stimulation, e.g., suctioning)
- 0 = No response
- 1 = Grimace ✅
- 2 = Crying, active withdrawal
Color
- 0 = Blue, pale
- 1 = Body pink, extremities blue
- 2 = Completely pink

Apgar Score Calculation:

Heart rate: 1
Respiratory effort: 1
Muscle tone: 1
Reflex irritability: 1
Color: 0

Total Apgar Score: 4

A score of 4 suggests the newborn is in distress and requires immediate medical intervention, such as oxygen support and further assessment.

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Naxlex Comprehensive Predictor Exams

What hormone remains elevated in the immediate postpartum period in a breastfeeding patient?

Correct Answer is A

Explanation

At 1 minute after birth the nurse assesses the newborn and notes the following: Heart rate: 80 beats/minute Respiratory effort: slow, irregular Muscle tone: some flexion of extremities Reflex irritability: grimacing Color: blue and pale The nurse would calculate an Apgar score of:

Correct Answer is ["4"]

Explanation

Apgar Score Calculation:

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