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 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.
2. A nurse is admitting a client who is at 38 weeks of gestation and is 5/70/−1. Which of the following assessment findings is of concern and should be reported to the provider first?
- A. Reassuring fetal heart tracing
- B. Continuous contraction lasting 2 minutes
- C. Contractions 4 minutes apart
- D. Pink mucus plug
Explanation
A continuous contraction lasting 2 minutes indicates uterine tachysystole or hyperstimulation, which can reduce placental blood flow and cause fetal hypoxia or distress. This is an urgent finding that must be reported immediately to the provider and requires prompt intervention, such as discontinuing oxytocin (if infusing), repositioning the mother, and providing oxygen.
3. The nurse has administered Oxytocin 2 hours ago as ordered. The nurse is assessing the fetal heart tracing: baseline 120 with moderate variability and 1 variable deceleration down to 80 bpm followed by a prolonged deceleration. There are 8 contractions in 10 minutes lasting 40–60 seconds. What is the nurse’s initial intervention?
- A. Perform fetal scalp stimulation
- B. Apply oxygen
- C. Discontinue Pitocin
- D. Administer IV bolus
Explanation
The fetal monitor shows uterine tachysystole (more than 5 contractions in 10 minutes) and fetal heart decelerations, both signs of uterine overstimulation from oxytocin (Pitocin). The first nursing action is to discontinue the oxytocin infusion immediately to reduce uterine activity and restore adequate oxygen exchange to the fetus. After stopping the medication, the nurse can then reposition the patient, apply oxygen, and administer an IV fluid bolus as supportive measures. Continuing oxytocin could worsen fetal hypoxia and distress.
4. 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.
5. What change occurs to the uterus 2 days after birth?
- A. The uterus descends 2 cm below the umbilicus
- B. By 1 week postpartum, the uterus should be nonpalpable
- C. The uterus remains an oval shape
- D. After delivery of the placenta, the uterus is 3 cm above the umbilicus
Explanation
After childbirth, the uterus begins the process of involution, returning to its pre-pregnancy size and position. Within 24 hours, it is at or near the umbilicus, and by 2 days postpartum, it typically descends about 2 cm (one fingerbreadth) below the umbilicus each day. By around 10–14 days postpartum, it becomes nonpalpable. This gradual descent helps control bleeding and restore uterine tone. The other options do not accurately describe the normal timeline of uterine involution.
6. 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.
7. Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use?
- A. Asking the healthcare provider to prescribe analgesic agents
- B. Pouring water from a squeeze bottle over the woman's perineum
- C. Inserting a sterile catheter
- D. Placing oil of peppermint in a bedpan under the woman
Explanation
If noninvasive methods fail, placing a few drops of oil of peppermint in a bedpan beneath the woman may help stimulate urination. The aroma of peppermint oil can cause reflex relaxation of the urinary sphincter and promote voiding. Nurses should try simpler measures first—such as running water or using a peri-bottle—before resorting to catheterization. Catheterization (C) is a last resort due to infection risk, while analgesics (A) and pouring water (B) are initial but not final interventions if voiding still does not occur.
8. 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.
9. The nurse is caring for a woman who had a vaginal delivery 1 hour ago. Her vital signs are T 100.4°F, P 92, R 20, BP 120/70. Based on this assessment finding, the nurse should:
- A. Draw CBC and blood cultures
- B. Continue to monitor the client's temperature
- C. Report these findings immediately to the provider
- D. Administer Tylenol STAT
Explanation
A temperature of 100.4°F (38°C) within the first 24 hours after delivery is a common and expected finding, often caused by dehydration and exertion during labor. It usually resolves with rest and oral fluids. The nurse should continue to monitor the client’s temperature and encourage hydration.
10. 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.
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