NARM Postpartum Care 2 — Questions and Answers
Question 1: Which finding indicates an infant has achieved an adequate breastfeeding latch?
- The infant's lips are pursed tightly around only the nipple
- Audible clicking sounds are heard with each suck
- The infant's mouth covers most of the areola with lips flanged outward (Correct answer)
- The infant suckles for fewer than 5 minutes per breast before falling asleep
Correct answer: The infant's mouth covers most of the areola with lips flanged outward
A proper latch is characterized by the infant's mouth covering most of the areola with lips flanged outward, ensuring effective milk transfer and preventing nipple trauma.
Question 2: A postpartum client on day 3 reports increased bleeding after ambulating. What is the most appropriate initial action?
- Reassure her that increased activity normally increases lochia flow
- Assess fundal tone, quantify blood loss, and evaluate vital signs (Correct answer)
- Administer oxytocin 10 units IM immediately without further assessment
- Arrange immediate emergency transport without further evaluation
Correct answer: Assess fundal tone, quantify blood loss, and evaluate vital signs
Assessment of uterine tone, quantification of blood loss, and vital sign evaluation must precede any intervention to differentiate normal lochia variation from early postpartum hemorrhage.
Question 3: A postpartum woman on day 5 is found to have a blood pressure of 154/98 mmHg with a headache. What condition should the midwife most suspect?
- Normal postpartum physiological blood pressure variation
- Postpartum preeclampsia requiring immediate evaluation and management (Correct answer)
- Newly diagnosed essential hypertension unrelated to pregnancy
- Anxiety-related white coat hypertension
Correct answer: Postpartum preeclampsia requiring immediate evaluation and management
Postpartum preeclampsia can develop up to 6 weeks after delivery; a BP ≥140/90 mmHg with symptoms such as headache requires urgent evaluation and treatment.
Question 4: Which finding in a postpartum perineal wound is most indicative of infection requiring treatment?
- Mild bruising and ecchymosis around the repair site on day 2
- Slight swelling and tenderness at the suture line on day 2
- Purulent discharge, worsening pain, and separation of wound edges (Correct answer)
- Perineal edema requiring continued ice pack application
Correct answer: Purulent discharge, worsening pain, and separation of wound edges
Purulent discharge, escalating pain (rather than improving), and wound dehiscence are hallmark signs of perineal wound infection requiring antibiotic treatment and possible wound management.
Question 5: Which contraceptive method is considered safe to initiate immediately postpartum in a breastfeeding woman?
- Combined estrogen-progestin oral contraceptive pills
- Transdermal estrogen-containing contraceptive patch
- Progestin-only pills (mini-pill) (Correct answer)
- Copper IUD (must wait until 6-week visit for insertion)
Correct answer: Progestin-only pills (mini-pill)
Progestin-only methods do not suppress lactation and are safe to start immediately postpartum, whereas estrogen-containing contraceptives can reduce milk supply and are contraindicated in breastfeeding women until at least 6 weeks.
Question 6: What Edinburgh Postnatal Depression Scale (EPDS) score is the generally accepted threshold warranting further clinical evaluation?
- Score of 5 or higher
- Score of 10 or higher (Correct answer)
- Score of 15 or higher
- Any score above zero requires immediate psychiatric referral
Correct answer: Score of 10 or higher
An EPDS score of 10 or higher indicates possible postpartum depression and warrants further clinical assessment and follow-up by the midwife or referral.
Question 7: According to NARM standards of practice, when should the first postpartum home visit occur after an uncomplicated home birth?
- Within 24–48 hours of delivery (Correct answer)
- At 2 weeks postpartum only
- At the 6-week comprehensive visit
- Only if the mother contacts the midwife with specific concerns
Correct answer: Within 24–48 hours of delivery
NARM standards require the attending midwife to conduct a home visit within 24–48 hours of delivery to assess maternal and newborn wellbeing and detect early complications.
NARM Postpartum Care 2
Which finding indicates an infant has achieved an adequate breastfeeding latch?