NUR 325 Nursing Services Childbearing Family at CBU

NUR 325 Nursing Services Childbearing Family at CBU

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Free NUR 325 Nursing Services Childbearing Family at CBU Questions

1.

A patient had a vaginal birth 4 hours ago. Her hematocrit was 35% on admission for labor. Her current hematocrit is 25%. Which of the following statements by the nurse might best explain this change

  • Because you're not eating enough iron-rich foods like meat.

  • Because you are hemoconcentrated the hematocrit dropped after delivery.

  • Because your blood volume has doubled, your hematocrit is lower.

  • This change in hematocrit indicates a postpartum hemorrhage

Explanation

Correct Answer D: This change in hematocrit indicates a postpartum hemorrhage.

Explanation:

D. This change in hematocrit indicates a postpartum hemorrhage.

A drop in hematocrit of 10 percentage points within a few hours of delivery is significant and indicative of excessive blood loss, meeting the criteria for postpartum hemorrhage. Monitoring for further clinical signs and vital signs changes is necessary.

Why the Other Options Are Incorrect:

A. Because you're not eating enough iron-rich foods like meat.

Dietary iron deficiency develops over weeks or months, not within a few hours. This explanation is inappropriate for the acute change seen here.

B. Because you are hemoconcentrated the hematocrit dropped after delivery.

Hemoconcentration leads to a higher, not lower, hematocrit. This explanation is physiologically inaccurate in this context.

C. Because your blood volume has doubled, your hematocrit is lower.

Blood volume increases during pregnancy, not after delivery. Postpartum, blood volume should begin to normalize, not increase, and this explanation does not fit an acute hematocrit drop.


2.

 A patient with pregnancy-induced hypertension is admitted complaining of pounding headache and epigastric pain. Nursing care is based on the knowledge that these signs indicate

  • Anxiety due to hospitalization

  • Impending seizures

  • Effects of magnesium sulfate

  • Panic attack

Explanation

Correct Answer B: Impending seizures

Explanation:

B. Impending seizures

A pounding headache and epigastric pain (often described as right upper quadrant pain) are classic signs of severe preeclampsia and indicate central nervous system and liver involvement, respectively. These symptoms are warning signs of possible eclampsia (seizures) and require immediate intervention, including seizure precautions and likely administration of magnesium sulfate.

Why the Other Options Are Incorrect:

A. Anxiety due to hospitalization

While anxiety can cause headaches, it does not typically cause epigastric pain or indicate severe hypertensive complications.

C. Effects of magnesium sulfate

Magnesium sulfate can cause side effects like flushing, nausea, or muscle weakness, but it is used to prevent seizures, not a cause of symptoms like headache and epigastric pain.

D. Panic attack

Panic attacks may cause chest discomfort and shortness of breath but are not associated with epigastric pain and severe hypertension in pregnancy. These symptoms are more aligned with preeclampsia-related complications.


3. A client tells the nurse she is to have a cerclage and wants to know why the doctor is going to do this. The nurse provides education about a cerclage. Which statement indicates teaching needs to be reinforced?
  • "A cerclage is a suture placed on the cervix."
  • "A cerclage will prevent preterm labor."
  • "A cerclage is done to help prevent the cervix from dilating too early."
  • "A cerclage is done because I have had spontaneous abortions in the past because my cervix opened too early."

Explanation

Teaching needs reinforcement because a cerclage does not prevent preterm labor; it prevents premature cervical dilation caused by cervical insufficiency. The purpose of a cerclage is to mechanically support the cervix and keep it closed until the pregnancy reaches viability, reducing the risk of miscarriage or preterm birth due to cervical weakness. Preterm labor involves uterine contractions, which a cerclage cannot stop. Medications and monitoring are required to manage preterm labor itself.
4.

 The doctor writes an order for Terbutaline to be given SQ. Which assessment finding will cause the nurse to question this order

  • BP 94/60

  • P 132

  • UC's are q 10 minutes

  • FHR is category 1

Explanation

Correct Answer B: P 132

Explanation:

B: P 132

Terbutaline is a beta-adrenergic agonist used as a tocolytic to stop preterm labor. One of its common side effects is tachycardia, and it is contraindicated if the maternal pulse is greater than 120 bpm. A pulse of 132 is too high, and administering Terbutaline could worsen the tachycardia, leading to serious cardiovascular effects.

Why the Other Options Are Incorrect:

A. BP 94/60

While this is on the lower end of normal, it is not a contraindication for Terbutaline. Hypotension should be monitored, but it does not automatically rule out use.

C. UC's are q 10 minutes

Uterine contractions every 10 minutes are infrequent, but Terbutaline may still be considered to space them further if labor suppression is needed. This finding does not contraindicate use.

D. FHR is category 1

A Category 1 fetal heart rate tracing is normal and reassuring, and it does not prevent the administration of Terbutaline.


5. A nurse is developing a care plan for a patient with a medical diagnosis of endometriosis. Based upon her predicted symptoms, what is the priority nursing diagnosis?
  • Infection: At risk for
  • Alteration in comfort: Dysmenorrhea
  • Incontinence: Functional urinary
  • Constipation: At risk for

Explanation

Endometriosis is a condition in which endometrial tissue grows outside the uterus, commonly on the ovaries, fallopian tubes, or pelvic peritoneum. The hallmark symptom is dysmenorrhea (painful menstruation), often accompanied by chronic pelvic pain, dyspareunia (painful intercourse), and infertility. Therefore, the priority nursing diagnosis focuses on alteration in comfort related to pain. Pain management and emotional support are essential components of care. The other options are not typically associated with endometriosis.
6.

A woman who is gravida 3 para 2 enters the intrapartum unit. The most important initial nursing assessments are

  • If she has had prenatal care.

  • Membrane status and her EDD/EDC.

  • Time of last food intake and fasting blood sugar.

  • Pain level and birth plan.

Explanation

Correct Answer B: Membrane status and her EDD/EDC

B. Membrane status and her EDD/EDC

When a woman presents in labor, the most critical initial assessments include whether her membranes have ruptured and her estimated due date (EDD/EDC). Membrane status is essential for assessing infection risk and potential labor progression, while the EDD helps determine gestational age, influencing care decisions (e.g., term vs. preterm protocols).

Why the Other Options Are Incorrect:

A. If she has had prenatal care.

While important for background information, it is not the most immediate priority during labor admission. Urgent clinical data comes first.

C. Time of last food intake and fasting blood sugar.

This is relevant if anesthesia or surgery is anticipated but is not a top initial priority upon arrival to the intrapartum unit.

D. Pain level and birth plan.

Pain assessment and understanding the birth plan are important for ongoing care and patient-centered management, but they do not supersede determining membrane status and gestational age.


7.

A patient had a vaginal birth 4 hours ago. Her hematocrit was 35% on admission for labor. Her current hematocrit is 25%. Which of the following statements by the nurse might best explain this change?

  • "Because you're not eating enough iron-rich foods like meat."
  • "Because you are hemoconcentrated, the hematocrit dropped after delivery."
  • "Because your blood volume has doubled, your hematocrit is lower."
  • "This change in hematocrit indicates a postpartum hemorrhage."

Explanation

A drop in hematocrit from 35% to 25% within a few hours after birth represents a significant loss of red blood cells, suggesting postpartum hemorrhage. Normal blood loss during vaginal delivery should not cause such a drastic drop. This level of decrease indicates excessive bleeding, either externally or internally. The nurse should assess for signs of uterine atony, excessive lochia, or concealed bleeding and notify the provider immediately for evaluation and intervention to prevent hypovolemic shock.
8. Amniotic fluid is important for maintaining fetal well-being. The nurse knows teaching needs to be reinforced when the nurse hears a woman making which statement to her husband:
  • "Amniotic fluid helps maintain our baby's temperature."
  • "Amniotic fluid protects the baby from injury."
  • "Amniotic fluid protects our baby from toxic substances."
  • "Amniotic fluid allows our baby to move freely."

Explanation

Teaching needs reinforcement because amniotic fluid does not protect the fetus from toxic substances. Harmful agents such as alcohol, drugs, and certain medications can cross the placenta and enter the amniotic fluid, posing risks to the fetus. In contrast, amniotic fluid does maintain fetal temperature, cushion against trauma, and allow for free movement—supporting musculoskeletal development and overall fetal comfort within the uterus.
9. In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. What information in her history would make you suspect Disseminated Intravascular Coagulation Disorder (DIC)?
  • She experienced an abruptio placenta and pre-eclampsia with her labor.
  • She had a 4100 gm baby.
  • This is her 5th child.
  • She had hyperemesis gravidarum her first trimester.

Explanation

Disseminated Intravascular Coagulation (DIC) is a life-threatening condition that may develop as a complication of abruptio placentae, pre-eclampsia, or retained dead fetus syndrome. These conditions trigger widespread activation of the clotting cascade, leading to consumption of platelets and clotting factors. As a result, bleeding occurs from sites such as IV punctures, mucous membranes, and surgical incisions. The presence of petechiae and oozing in a patient with these risk factors strongly indicates possible DIC and requires immediate intervention.
10. At the beginning of the fourth stage of labor, the nurse assesses what four things? (Select four correct answers.)
  • Fundal tone
  • Lochia
  • Transcutaneous bilirubin
  • Engorgement
  • Vital signs
  • Bladder distension

Explanation

A. Fundal tone:
Assessing the uterus for firmness and position ensures it is contracted to prevent postpartum hemorrhage. A boggy (soft) uterus indicates uterine atony and requires immediate massage or intervention.
B. Lochia:
Observation of vaginal discharge (lochia) helps evaluate for excessive bleeding or abnormal characteristics such as large clots or foul odor, which may signal complications.
E. Vital signs:
Monitoring blood pressure, pulse, respiration, and temperature detects early signs of shock, hemorrhage, or infection during this critical recovery phase.
F. Bladder distension:
A full bladder can displace the uterus upward and to the side, preventing proper contraction and increasing the risk of postpartum hemorrhage. Assessing and encouraging voiding supports uterine involution and stability.

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