PMH-C Maternal Well-being & Emotional Support 2 — Questions and Answers
Question 1: A client at 32 weeks gestation reports feeling emotionally numb, detached from her pregnancy, and unable to imagine herself as a mother. Which condition does this presentation most suggest?
- Prenatal depression with anhedonia (Correct answer)
- Normal third-trimester fatigue
- Prenatal anxiety disorder
- Adjustment disorder with depressed mood
Correct answer: Prenatal depression with anhedonia
Emotional numbness, detachment, and inability to bond with the pregnancy are hallmark features of prenatal depression, particularly the anhedonic subtype.
Question 2: When using the EPDS with a postpartum client who scores 13, what is the most appropriate immediate clinical action?
- Schedule a routine follow-up in 4 weeks
- Conduct a thorough clinical interview including suicide risk assessment (Correct answer)
- Automatically refer to inpatient psychiatric care
- Prescribe antidepressant medication without further assessment
Correct answer: Conduct a thorough clinical interview including suicide risk assessment
An EPDS score of 13 or above warrants a detailed clinical interview to assess symptom severity, functioning, and safety before determining the appropriate level of care.
Question 3: A nurse asks how to differentiate postpartum blues from postpartum depression. The most accurate distinguishing factor is:
- Presence of crying spells
- Duration and functional impairment beyond two weeks postpartum (Correct answer)
- Sleep disturbance
- Mood fluctuation
Correct answer: Duration and functional impairment beyond two weeks postpartum
Postpartum blues typically resolve within 10–14 days without functional impairment, whereas postpartum depression persists beyond two weeks and significantly affects daily functioning.
Question 4: A lactating client with postpartum depression asks about medication safety. Which statement about SSRIs and breastfeeding is most accurate?
- All SSRIs are contraindicated during breastfeeding
- Sertraline and paroxetine have the lowest detectable levels in breast milk and are preferred (Correct answer)
- Breastfeeding must stop before initiating any antidepressant
- SSRIs cause permanent neurological harm to breastfed infants
Correct answer: Sertraline and paroxetine have the lowest detectable levels in breast milk and are preferred
Sertraline and paroxetine are considered first-line SSRI options during lactation because they have the lowest relative infant doses detected in breast milk.
Question 5: Which therapeutic approach has the strongest evidence base for treating postpartum depression in a non-pharmacological context?
- Psychodynamic therapy
- Cognitive-behavioral therapy (CBT) (Correct answer)
- Hypnotherapy
- Art therapy
Correct answer: Cognitive-behavioral therapy (CBT)
CBT has the strongest evidence base among non-pharmacological treatments for postpartum depression, targeting negative thought patterns and maladaptive behaviors.
Question 6: A postpartum client reports intrusive thoughts of dropping her baby and feels terrified she will act on them. She has no intent to harm. This presentation is most consistent with:
- Postpartum psychosis
- Postpartum OCD (Correct answer)
- Postpartum depression with psychotic features
- Malingering
Correct answer: Postpartum OCD
Ego-dystonic intrusive thoughts with no intent to act, accompanied by significant distress and fear of acting on them, are characteristic of postpartum OCD rather than psychosis.
Question 7: Social support is considered a critical protective factor against perinatal mood disorders. Which specific dimension of social support is most consistently linked to reduced postpartum depression risk?
- Financial support from the partner
- Emotional support and partner relationship satisfaction (Correct answer)
- Number of friends in the social network
- Professional support from employers
Correct answer: Emotional support and partner relationship satisfaction
Research consistently identifies emotional support quality, particularly partner relationship satisfaction, as the strongest social support factor protective against postpartum depression.
PMH-C Maternal Well-being & Emotional Support 2
A client at 32 weeks gestation reports feeling emotionally numb, detached from her pregnancy, and unable to imagine herself as a mother.
Which condition does this presentation most suggest?