To provide adequate postpartum care, the nurse should be aware that postpartum depression (ppd)

1. Clinical manifestations of a manic episode in the pregnant woman include all except:

a.

Psychomotor agitation and lack of sleep

b.

Increased appetite and lack of interest in activities

c.

Hyperactivity and distractibility

d.

Pressured speech and grandiosity

ANS: B

Clinical manifestations of a manic episode include at least three of the following: grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, psychomotor agitation, and excessive involvement in pleasurable activities. The pregnant woman exhibiting symptoms of a manic episode likely has a decreased interest in eating and an increased level of interest in pleasurable activities without regard for negative consequences.

Psychomotor agitation and lack of sleep are clinical manifestations of a manic episode.

Hyperactivity and distractibility are clinical manifestations of a manic episode.

Pressured speech and grandiosity are clinical manifestations of a manic episode.

2. When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may:

a.

Have outbursts of anger

b.

Neglect her hygiene

c.

Harm her infant

d.

Lose interest in her husband

ANS: C

Thoughts of harm to oneself or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention.

Although outbursts of anger is a symptom attributable to PPD, the major concern is the potential of harm to herself or to her infant.

Neglect of personal hygiene is a symptom attributable to PPD; however, the major concern is the potential of harm to herself or to her infant.

Although this client is likely to lose interest in her spouse, the major concern is the potential of harm to herself or to her infant.

3. During inpatient psychiatric hospitalization, it is important for the new mother to have:

a.

Contact with her significant other

b.

Supervised and guided visits with her infant

c.

No contact with anyone who annoys her

d.

The infant with her at all times

ANS: B

In the hospital setting, the reintroduction of the infant to the mother can occur at the mothers own pace. A schedule is set for increasing the number of hours the mother cares for the infant over several days, culminating in the infant staying overnight in the mothers room. This allows the mother to experience meeting the infants needs and giving up sleep for the infant.

Although this may be important, it is essential for the mother to be reintroduced to her infant while in a supervised setting.

One important task for a mother in psychiatric care is to reestablish positive interactions with others.

Time spent with the infant should occur on a set schedule, one that increases the number of hours the mother cares for the infant over several days.

4. Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. A diagnosis of fetal alcohol syndrome (FAS) is made when there are visible markers in each of three categories. Which isnot a recognized category for diagnosis of FAS?

a.

Respiratory conditions

b.

Impaired growth

c.

Central nervous system (CNS) abnormality

d.

Craniofacial dysmorphologies

ANS: A

Respiratory difficulties are not a category of conditions that are related to FAS. Other abnormalities related to FAS include organ deformities, genital malformations, and kidney and urinary defects.

Impaired growth is a visible marker for FAS.

A CNS abnormality with neurologic and intellectual impairments is a category used to assist in the diagnosis of FAS.

An infant with FAS manifests at least two craniofacial abnormalities such as microcephaly, short palpebral fissures, poorly developed philtrum, thin upper lip, or flattening of the maxillary bone.

5. As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?

a.

Heroin

b.

Alcohol

c.

PCP

d.

Cocaine

ANS: D

Cocaine is a powerful CNS stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor.

The most serious effect of alcohol use in pregnancy is fetal alcohol syndrome.

The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate.

6. According to Becks studies, what risk factor for postpartum depression (PPD) is likely to have the greatest effect on the womans condition?

a.

Prenatal depression

b.

Single-mother status

c.

Low socioeconomic status

d.

Unplanned or unwanted pregnancy

ANS: A

Prenatal depression has been found by Beck to have the greatest likely effect.

Single-mother status is a small-relationship predictor for PPD.

Low socioeconomic status is a small-relationship predictor for PPD.

An unwanted pregnancy may contribute to the risk for PPD; however, it does not pose as great an effect as prenatal depression.

7. To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features:

a.

Is the baby blues plus the woman has a visit with a counselor or psychologist

b.

Is more common among older Caucasian women because they have higher expectations

c.

Is distinguished by pervasive sadness along with mood swings

d.

Will disappear on its own without outside help

ANS: C

PPD is characterized by an intense pervasive sadness along with labile mood swings and is more persistent than postpartum blues.

PPD even without psychotic features is more serious and persistent than postpartum baby blues.

PPD is more common among younger mothers and African-American mothers.

Most women need professional help to get through PPD, including pharmacologic intervention.

8. Anxiety disorders are the most common mental disorders that affect women. While providing care to the maternity client, a nurse should be aware that one of these disorders is likely to be triggered by the process of labor and birth. This disorder is:

a.

Phobias

b.

Panic disorder

c.

Posttraumatic stress disorder (PTSD)

d.

Obsessive-compulsive disorder (OCD)

ANS: C

PTSD can occur as the result of a rape. Symptoms include re-experiencing the event, numbing, irritability, angry outbursts, and exaggerated startle reflex. With the increased bodily touch and vaginal examinations that occur during labor, the client may have memories of the original trauma. The process of giving birth may result in her feeling out of control. The nurse can verbalize understanding and reassure the client as necessary.

Phobias are irrational fears that may lead a person to avoid certain objects, events, or situations.

Panic disorders may occur in as many as 3% to 5% of women in the postpartum period. These are episodes of intense apprehension, fear, and terror. Symptoms may manifest themselves as palpitations, chest pain, choking, or smothering.

OCD symptoms include recurrent, persistent, and intrusive thoughts. The mother may repeatedly check and recheck her infant once he or she is born, even though she realizes that this is irrational. OCD is best treated with medications.

9. _____ use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications.

a.

Alcohol

b.

Caffeine

c.

Tobacco

d.

Chocolate

ANS: C

Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low birth weight.

Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia.

Caffeine may interfere with certain medications and make arrhythmias worse.

Chocolate, particularly dark chocolate, contains caffeine which may interfere with certain medications.

10. With shortened hospital stays, new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching, the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to:

a.

Stay home and avoid outside activities to ensure adequate rest

b.

Be certain that you are the only caregiver for your baby in order to facilitate infant attachment

c.

Keep feelings of sadness and adjustment to your new role to yourself

d.

Realize that this is a common occurrence that affects many women

ANS: D

Should the new mother experience symptoms of the baby blues, it is important that she be aware that this is nothing to be ashamed of. As many as 15% of new mothers experience similar symptoms.

Although it is important for the mother to obtain enough rest, she should not distance herself from family and friends. Her spouse or partner can communicate the best visiting times so that the new mother can obtain adequate rest. It is also important that she not isolate herself at home by herself during this time of role adjustment.

Even if breastfeeding, other family members can participate in the infants care. If depression occurs, the symptoms can often interfere with mothering functions and this support is essential.

The new mother should share her feelings with someone else. It is also important that she not overcommit herself or feel as though she has to be superwoman. A telephone call to the hospital warm line may provide reassurance with lactation issues and other infant care questions. Should symptoms continue, a referral to a professional therapist may be necessary.

Possible alternative and complementary therapies for postpartum depression (PPD) for breastfeeding mothers include (choose all that apply):

a.

Acupressure

b.

Aromatherapy

c.

St. Johns wort

d.

Wine consumption

e.

Yoga

ANS: A, B, E

Possible alternative/complementary therapies for postpartum depression include acupuncture, acupressure, aromatherapy, therapeutic touch, massage, relaxation techniques, reflexology, and yoga.

St. Johns wort has not been proven to be safe for women who are breastfeeding. Women who are breastfeeding and/or have a history of PPD should not consume alcohol.

The standard of care for women who are dependent on heroin or other narcotics is ____________________ maintenance treatment (MMT).

Methadone

MMT should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the human immunodeficiency virus (HIV) rate.

Of all pregnant women being treated for depression, approximately one third have a first occurrence during pregnancy. All pregnant and postpartum women should be screened for perinatal mood disorders by using the _________________ Postnatal Depression Scale.

ANS:

Edinburgh

The 10-item Edinburgh Postnatal Depression Scale accurately identifies depression in pregnant and postpartum women.

Less than 10% of women who are substance abusers receive treatment for their addiction during pregnancy. Is this statement true or false?

ANS: T

Social stigma, labeling, and guilt are significant barriers. Women often do not seek help because of the fear of losing custody of their children or facing criminal prosecution.

To date the U.S. Food and Drug Administration (FDA) has approved several specific categories of psychotropic medications as safe for use during pregnancy. Is this statement true or false?

ANS: F

No consensus exists regarding safety in the use of antidepressant medications with pregnant women. The FDA has not approved any categories of psychotropic medications for use in pregnancy.