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
A nurse administers oxytocin IV after delivery to a client with postpartum hemorrhage. Which assessment best indicates that the oxytocin is effective?
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The client's blood pressure increases.
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The amount of lochia rubra increases.
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The client reports relief of afterpains.
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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.
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?
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Asking the healthcare provider to prescribe analgesic agents
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Pouring water from a squeeze bottle over the woman's perineum
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Inserting a sterile catheter
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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.
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:
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Draw CBC and blood cultures
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Continue to monitor the client's temperature
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Report these findings immediately to the provider
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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.
A 39 weeks gestation client presents to the emergency room (ER), contracting every 15 minutes. Each contraction lasts for 30 seconds. The client had spontaneous rupture of membranes (SROM) of clear amniotic fluid for 18 hours. Which of the following nursing interventions is contraindicated?
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Intermittent fetal heart auscultation
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Nipple stimulation
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Administration of IV fluids
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Vaginal examinations every hour
Explanation
Frequent vaginal examinations after rupture of membranes lasting more than 18 hours greatly increase the risk of ascending infection, such as chorioamnionitis. Therefore, vaginal exams should be minimized and performed only when necessary to assess labor progress. The nurse should also monitor for fever, fetal tachycardia, or uterine tenderness as signs of infection. The other interventions—monitoring the fetal heart rate, maintaining hydration, and providing comfort—are appropriate and not contraindicated in this scenario.
A postpartum client reports no bowel movement for 3 days and fears pain from her episiotomy. Which nursing action is most appropriate?
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Offer a stool softener and increase fluid and fiber intake.
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Administer an enema immediately.
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Withhold oral intake until flatus is passed.
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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.
A nurse is teaching a client and her partner about oxytocin use for labor induction. Which client statement indicates that further teaching is needed?
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"It's normal for contractions to come one right after another without rest."
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"The nurse will check my baby's heart rate and my contractions often."
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"Once labor progresses, the dose can often be decreased or stopped."
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"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.
A postpartum client asks when her joints and ligaments will return to normal after delivery. Which response is correct?
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"Joint relaxation is permanent after childbirth."
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"They return to normal within 1-2 weeks after birth."
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"They remain loose until breastfeeding stops."
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"It takes about 6-8 weeks for your joints to stabilize."
Explanation
During pregnancy, hormones such as relaxin and progesterone loosen joints and ligaments to prepare the pelvis for childbirth. After delivery, it takes approximately 6 to 8 weeks for these joints and ligaments to return to their pre-pregnancy state. This is why postpartum women may experience joint discomfort or instability during this period. Gentle activity and proper body mechanics help recovery. The other statements are incorrect because joint relaxation is temporary, not permanent or dependent on breastfeeding.
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?
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Administer an IV fluid bolus.
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Insert a urinary catheter.
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Perform a glucose monitoring.
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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.
What is an important nursing consideration when administering oxytocin (Pitocin) in labor?
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Administer the highest effective dose to establish effective labor
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Use of intermittent monitoring with oxytocin infusion
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Administer the dose as ordered
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Discontinue oxytocin for reassuring fetal heart patterns
Explanation
When administering oxytocin (Pitocin), the nurse must strictly follow the provider’s order and facility protocol, as oxytocin is a high-alert medication with significant risks such as uterine tachysystole, fetal distress, and uterine rupture. It must be given via IV infusion pump, titrated carefully based on fetal heart rate and contraction pattern, and accompanied by continuous electronic fetal monitoring. The goal is to achieve adequate contractions without compromising fetal oxygenation. The other options either describe unsafe practices or misinterpret appropriate nursing responsibilities.
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?
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Run warm water on her breasts during a shower
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Express small amounts of milk from the breasts to relieve the pressure
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Wear a loose-fitting bra to prevent nipple irritation
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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.
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