NUR 4455 Care of Families- Childbearing Nursing at Florida International University
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Free NUR 4455 Care of Families- Childbearing Nursing at Florida International University Questions
1. A postpartum client reports no bowel movement for 3 days and fears pain from her episiotomy. Which nursing action is most appropriate?
- A. Offer a stool softener and increase fluid and fiber intake.
- B. Administer an enema immediately.
- C. Withhold oral intake until flatus is passed.
- D. Encourage a low-fiber diet and rest.
Explanation
After childbirth, constipation is common due to decreased bowel tone, effects of analgesics, and fear of pain from an episiotomy or perineal repair. The nurse should promote gentle bowel movements by encouraging stool softeners (e.g., docusate sodium), adequate hydration, and a high-fiber diet (fruits, vegetables, whole grains). This approach minimizes straining and discomfort.
2. What is the recommended position to improve fetal oxygenation when oxytocin-induced uterine tachysystole occurs?
- A. Prone
- B. Left lateral
- C. Trendelenburg
- D. Supine
Explanation
When uterine tachysystole occurs, the nurse should place the client in the left lateral position to improve uteroplacental blood flow and fetal oxygenation. This position reduces pressure on the inferior vena cava, enhances venous return, and promotes optimal cardiac output. It also helps relieve compression of the placenta and umbilical cord. The supine and Trendelenburg positions reduce uterine perfusion, while the prone position is inappropriate and unsafe for pregnant clients.
3. A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment, the nurse notices that both breasts are swollen, warm, and tender on palpation. Which guidance should the nurse provide to the client at this time?
- A. Run warm water on her breasts during a shower
- B. Express small amounts of milk from the breasts to relieve the pressure
- C. Wear a loose-fitting bra to prevent nipple irritation
- D. Apply ice to the breasts for comfort
Explanation
Because the client has chosen not to breastfeed, the goal is to suppress lactation. The nurse should instruct the client to apply ice packs, wear a supportive (tight-fitting) bra, and avoid breast stimulation such as warm showers, massage, or expressing milk, all of which increase milk production. Discomfort from engorgement usually resolves within 24–48 hours as milk production ceases. Loose-fitting bras (option C) and warm water (option A) promote milk flow rather than suppression.
4. A client G3 T2 P0 A0 L2 pregnant at 37 weeks gestation has a chief complaint of contractions which began 3 hours ago. Vaginal exam on admission was 6 cm/70%/−2. Fetal heart baseline is 145 bpm with moderate variability and accelerations. Uterine contractions are 6 minutes apart, lasting 50 seconds. The nurse performs another cervical exam 2 hours later and reports no change. What orders would the nurse anticipate?
- A. Continue to monitor the client
- B. Obtain an order from the health care provider to start Oxytocin
- C. Perform a vaginal exam
- D. Administer an enema
Explanation
The client is in active labor (6 cm dilated) but has shown no cervical change over 2 hours, indicating labor dystocia or ineffective contractions. The nurse should anticipate an order to augment labor with oxytocin (Pitocin) to strengthen and regularize uterine contractions. Continuous fetal monitoring is necessary during administration.
5. A nurse assesses a postpartum client who is 6 hours post-vaginal delivery. The fundus is noted to be above the umbilicus and deviated to the right. What is the priority nursing action?
- A. Encourage the client to void and reassess the fundus.
- B. Perform a fundal massage to promote contraction.
- C. Notify the health care provider immediately.
- D. Assess for retained placental fragments.
Explanation
A deviated and elevated fundus, especially to the right, most commonly indicates a distended bladder pushing the uterus out of its normal midline position. The priority nursing action is to assist the client to void, which allows the uterus to contract and return to the midline. After voiding, the nurse should reassess the fundus for firmness and position.
6. A nurse is teaching a client and her partner about oxytocin use for labor induction. Which client statement indicates that further teaching is needed?
- A. "It's normal for contractions to come one right after another without rest."
- B. "The nurse will check my baby's heart rate and my contractions often."
- C. "Once labor progresses, the dose can often be decreased or stopped."
- D. "The contractions may get stronger and closer together as the dose increases."
Explanation
This statement shows a misunderstanding of oxytocin use. Contractions should never occur one right after another without rest, as this indicates uterine tachysystole, which can reduce placental perfusion and cause fetal distress. When administering oxytocin, the nurse monitors the fetal heart rate and contraction pattern closely to ensure contractions occur every 2–3 minutes, lasting 45–60 seconds, with adequate relaxation in between. The other statements correctly describe safe and expected effects of oxytocin during induction.
7. A nurse administers oxytocin IV after delivery to a client with postpartum hemorrhage. Which assessment best indicates that the oxytocin is effective?
- A. The client's blood pressure increases.
- B. The amount of lochia rubra increases.
- C. The client reports relief of afterpains.
- D. The uterus is firm on palpation.
Explanation
Oxytocin (Pitocin) promotes uterine contraction and is the primary medication used to manage or prevent postpartum hemorrhage. A firm, well-contracted uterus indicates effective action, as this compresses uterine blood vessels and minimizes bleeding.
8. A multiparous client with a history of previous cesarean birth is admitted for labor induction with oxytocin. Which of the following actions is most important before initiating therapy?
- A. Administer an IV fluid bolus.
- B. Insert a urinary catheter.
- C. Perform a glucose monitoring.
- D. Verify continuous electronic fetal monitoring is in place.
Explanation
Before starting oxytocin (Pitocin), it is essential to establish continuous electronic fetal monitoring to closely assess both fetal heart rate and uterine activity. Clients with a prior cesarean section are at increased risk for uterine rupture, especially when uterine stimulation is used. Continuous monitoring allows early detection of fetal distress or excessive uterine activity, ensuring prompt intervention. While IV fluids, catheterization, and glucose checks may be indicated, fetal and uterine monitoring is the most critical safety measure prior to induction.
9. When caring for a woman who just gave birth, what would the nurse educate the client in preventing postpartum complications?
- A. Change sanitary pad only when completely saturated
- B. Change sanitary pad 2 times per day
- C. Cleanse from the periurethral to the perineal area
- D. Remind her to vigorously wipe to remove excess blood
Explanation
Proper perineal hygiene after childbirth is essential to prevent infection and promote healing. The nurse should teach the client to cleanse from the periurethral area (front) to the perineal area (back) to prevent bacteria from the rectal area from contaminating the urethra or vagina. Sanitary pads should be changed frequently—not only when saturated—and vigorous wiping should be avoided, as it can irritate or injure delicate tissues and delay healing.
10. A nurse is caring for a client in OB triage who is a primigravida, at term, reporting low back pain radiating to the lower abdomen every 5 minutes for 2 hours. The client states, "I am not really sure if I'm in labor or not." Which of the following should the nurse recognize as a sign of true labor?
- A. Contractions stop with comfort measures
- B. Rupture of membranes
- C. Regular contractions with cervical change
- D. Station of the presenting part
Explanation
True labor is identified by regular contractions that increase in frequency, duration, and intensity, and most importantly, lead to progressive cervical dilation and effacement. Discomfort typically starts in the lower back and radiates to the abdomen. In false labor (Braxton Hicks contractions), contractions are irregular and stop with rest or comfort measures. Rupture of membranes (B) and fetal station (D) may accompany labor but do not alone confirm it; only cervical change differentiates true from false labor.
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