EXAM 4 NM705 QUESTIONS AND ANSWERS WITH COMPLETE
SOLUTIONS VERIFIED LATEST UPDATE
List differentials for mastitis spectrum (6)
1. Engorgement
2. Ductal narrowing ("plugged ducts")
3. Galactocele
4. Inflammatory mastitis
5. Bacterial mastitis
6. Breast abscess
When can a postpartum client start combined hormonal birth control and why?
Not until 3 completed PP weeks due to the increased risk for thromboembolism in the
PP timeframe
When dose coagulation return to pre-pregnancy proportions postpartum?
Approximately 4-6 weeks and some levels not until 12 weeks.
Who should NOT take Combined Hormonal Contraception (CHC)? (5 categories)
1. Less than 21 days PP (BF or Non-BF)
2. 21-42 days: If there is a VTE risk, they are category 3: risks outweigh the benefit
3. 21-42 days: If there are no risk factors for VTE, it is category 2
4. Over 42 days: become category 1 for NON-BF clients
5. Over 42 days: becomes category 2 for BF clients
List common VTE risk factors (8 risk factors)
,1. >/=35 years
2. Previous VTE or thrombophilia
3. Immobility such as post-C/S
4. PPH and/or transfusion at delivery
5. Peripartum cardiomyopathy
6. Pre-eclampsia
7. BMI >/= 30
8. Smoker
What are those who take combined hormonal contraceptive (CHC) at higher risk
of having? (2 things)
1. CVA (cerebral vascular accident)
2. MI (myocardial infarction)
Who would you NOT recommend use CHC? (6 things)
1. Smoker
2. Older than 35 years
3. HTN
4. Hx of stroke, MI or DVT
5. Hx of migraines with aura
6. Certain other medical conditions such as breast Ca but check CDC
recommendations
What is a way to assess when clients resume sexual intimacy and if they use
contraception?
Ask:
,1. What do you feel is your risk of becoming pregnant is now? At 2 weeks? At 6
weeks?
2. How would you feel if you found out next week you were pregnant? (or next
month or next year…)
When is the peak onset for PPD?
8 weeks or 2 months
In the postpartum period, within what range of time is optimal to screen for PPD?
2 weeks to -6 months
What tools do we use to screen for PPD?
EPDS
1. Specific for PP clients
2. Not diagnostic but screening
What scores for the EPDS would be concerning? (5 points)
1. 5-9, while not necessarily diagnostic for depression does indicate increased risk for
PPD
2. 10-12 mild to moderate depression. Mental health services and consider
pharmacological therapy
3. Score of >13 is a RED flag indicating need for treatment, referral, and ongoing care
4. Questions 3-5 are related to anxiety. If positive consider GAD7
5. Question 10 is about suicide, examine separately from the overall score.
Can EPDS screen for postpartum anxiety?
, While not validated for PPA, the EPDS is often utilized to screen for anxiety. Follow-up
may be needed for a score of >5 on questions 3-5 as these questions are related to
symptoms of anxiety.
What tools do we use to screen for PPA?
1. GAD 7
2. General anxiety tool but can be used for PP
What tools do we use to screen for IPV?
1. Minnesota State Department of Health "Family Home visiting IPV Screening and
Referral Toolkit"
2. This has 3 IPV screening tools:
a. HARK
b. HITS
c. RAT
What is the peak prevalence for the baby blues? How long does it typically last?
Peak: Days 3-5 PP
Duration: about 7-10 days (ends roughly 2 weeks PP)
When would you consider PPD rather than baby blues?
When depressive symptoms begin after 2 weeks PP
What is the typical peak onset for PPD?
8 weeks (2 months)
When is it optimal for PPD screening?
Between 2 weeks and 6 months PP even though it may last up to 1 year PP
How common is PPD?
SOLUTIONS VERIFIED LATEST UPDATE
List differentials for mastitis spectrum (6)
1. Engorgement
2. Ductal narrowing ("plugged ducts")
3. Galactocele
4. Inflammatory mastitis
5. Bacterial mastitis
6. Breast abscess
When can a postpartum client start combined hormonal birth control and why?
Not until 3 completed PP weeks due to the increased risk for thromboembolism in the
PP timeframe
When dose coagulation return to pre-pregnancy proportions postpartum?
Approximately 4-6 weeks and some levels not until 12 weeks.
Who should NOT take Combined Hormonal Contraception (CHC)? (5 categories)
1. Less than 21 days PP (BF or Non-BF)
2. 21-42 days: If there is a VTE risk, they are category 3: risks outweigh the benefit
3. 21-42 days: If there are no risk factors for VTE, it is category 2
4. Over 42 days: become category 1 for NON-BF clients
5. Over 42 days: becomes category 2 for BF clients
List common VTE risk factors (8 risk factors)
,1. >/=35 years
2. Previous VTE or thrombophilia
3. Immobility such as post-C/S
4. PPH and/or transfusion at delivery
5. Peripartum cardiomyopathy
6. Pre-eclampsia
7. BMI >/= 30
8. Smoker
What are those who take combined hormonal contraceptive (CHC) at higher risk
of having? (2 things)
1. CVA (cerebral vascular accident)
2. MI (myocardial infarction)
Who would you NOT recommend use CHC? (6 things)
1. Smoker
2. Older than 35 years
3. HTN
4. Hx of stroke, MI or DVT
5. Hx of migraines with aura
6. Certain other medical conditions such as breast Ca but check CDC
recommendations
What is a way to assess when clients resume sexual intimacy and if they use
contraception?
Ask:
,1. What do you feel is your risk of becoming pregnant is now? At 2 weeks? At 6
weeks?
2. How would you feel if you found out next week you were pregnant? (or next
month or next year…)
When is the peak onset for PPD?
8 weeks or 2 months
In the postpartum period, within what range of time is optimal to screen for PPD?
2 weeks to -6 months
What tools do we use to screen for PPD?
EPDS
1. Specific for PP clients
2. Not diagnostic but screening
What scores for the EPDS would be concerning? (5 points)
1. 5-9, while not necessarily diagnostic for depression does indicate increased risk for
PPD
2. 10-12 mild to moderate depression. Mental health services and consider
pharmacological therapy
3. Score of >13 is a RED flag indicating need for treatment, referral, and ongoing care
4. Questions 3-5 are related to anxiety. If positive consider GAD7
5. Question 10 is about suicide, examine separately from the overall score.
Can EPDS screen for postpartum anxiety?
, While not validated for PPA, the EPDS is often utilized to screen for anxiety. Follow-up
may be needed for a score of >5 on questions 3-5 as these questions are related to
symptoms of anxiety.
What tools do we use to screen for PPA?
1. GAD 7
2. General anxiety tool but can be used for PP
What tools do we use to screen for IPV?
1. Minnesota State Department of Health "Family Home visiting IPV Screening and
Referral Toolkit"
2. This has 3 IPV screening tools:
a. HARK
b. HITS
c. RAT
What is the peak prevalence for the baby blues? How long does it typically last?
Peak: Days 3-5 PP
Duration: about 7-10 days (ends roughly 2 weeks PP)
When would you consider PPD rather than baby blues?
When depressive symptoms begin after 2 weeks PP
What is the typical peak onset for PPD?
8 weeks (2 months)
When is it optimal for PPD screening?
Between 2 weeks and 6 months PP even though it may last up to 1 year PP
How common is PPD?
