Maternal Newborn Nursing Test Perinatal Mental Health 1 — Questions and Answers
Question 1: The Edinburgh Postnatal Depression Scale (EPDS) is used to screen for postpartum depression. What score indicates a positive screen requiring further clinical evaluation?
- Score of 5 or above
- Score of 10 or above (Correct answer)
- Score of 15 or above
- Score of 20 or above
Correct answer: Score of 10 or above
A score of 10 or above on the EPDS is the accepted threshold indicating a positive screen for postpartum depression and warrants further clinical evaluation.
Question 2: A client delivered 3 days ago and reports crying spells, mood swings, and irritability but states these feelings feel temporary and manageable. Which condition does the nurse recognize?
- Postpartum depression
- Postpartum psychosis
- Postpartum blues (baby blues) (Correct answer)
- Postpartum anxiety disorder
Correct answer: Postpartum blues (baby blues)
Postpartum blues typically onset within 3–5 days after delivery, are transient, and resolve within 2 weeks without treatment.
Question 3: A new mother 2 weeks postpartum is brought to the ED by her husband. She reports hearing voices telling her to harm her baby and believes her infant is possessed. Which condition does the nurse recognize?
- Severe postpartum depression
- Postpartum psychosis (Correct answer)
- Postpartum anxiety
- Postpartum PTSD
Correct answer: Postpartum psychosis
Postpartum psychosis presents with hallucinations, delusions, and disorganized thinking, usually within the first 2 weeks postpartum, and is a psychiatric emergency.
Question 4: Which of the following is the strongest risk factor for developing postpartum depression?
- Primiparity
- History of depression or mood disorders (Correct answer)
- Cesarean section delivery
- Maternal age over 35
Correct answer: History of depression or mood disorders
A personal or family history of depression or mood disorders is the strongest predictive risk factor for developing postpartum depression.
Question 5: A nurse is developing a plan of care for a client diagnosed with postpartum depression. Which intervention is the priority?
- Encourage exclusive breastfeeding to promote bonding
- Assess for suicidal ideation and risk of harm to self or infant (Correct answer)
- Recommend formula feeding to allow the mother more sleep
- Instruct the client to exercise daily to improve mood
Correct answer: Assess for suicidal ideation and risk of harm to self or infant
Safety assessment for suicidal ideation or risk of harm to the infant is always the priority intervention when caring for a client with postpartum depression.
Question 6: How is postpartum depression (PPD) distinguished from postpartum blues by timing?
- PPD symptoms last more than 24 hours after delivery
- PPD symptoms persist beyond 2 weeks postpartum (Correct answer)
- PPD symptoms begin only after 6 weeks postpartum
- PPD symptoms occur only during breastfeeding
Correct answer: PPD symptoms persist beyond 2 weeks postpartum
PPD is distinguished from baby blues by symptoms that persist beyond 2 weeks postpartum and significantly impair daily functioning.
Question 7: When is the most appropriate time to administer the Edinburgh Postnatal Depression Scale (EPDS) for universal postpartum screening?
- Immediately after delivery in the labor and delivery unit
- At the 1-week and 6-week postpartum visits (Correct answer)
- Only if the client reports feeling sad or depressed
- At the time of newborn discharge only
Correct answer: At the 1-week and 6-week postpartum visits
ACOG and AAP recommend universal PPD screening using the EPDS at standard postpartum follow-up visits, typically at 1 week and 6 weeks after delivery.
