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 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?
- Encourage the client to void and reassess the fundus.
- Perform a fundal massage to promote contraction.
- Notify the health care provider immediately.
- 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.
2. A postpartum client asks when her joints and ligaments will return to normal after delivery. Which response is correct?
- "Joint relaxation is permanent after childbirth."
- "They return to normal within 1-2 weeks after birth."
- "They remain loose until breastfeeding stops."
- "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.
3. A postpartum client reports no bowel movement for 3 days and fears pain from her episiotomy. Which nursing action is most appropriate?
- Offer a stool softener and increase fluid and fiber intake.
- Administer an enema immediately.
- Withhold oral intake until flatus is passed.
- 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.
4. 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:
- Draw CBC and blood cultures
- Continue to monitor the client's temperature
- Report these findings immediately to the provider
- 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.
5. A postpartum client with a history of rheumatoid arthritis reports increased joint pain. The nurse recognizes this as:
- A complication of oxytocin administration.
- A normal immune rebound after pregnancy.
- Hormonal imbalance caused by breastfeeding.
- A sign of infection requiring antibiotics.
Explanation
During pregnancy, the immune system is naturally suppressed to protect the fetus. After delivery, the immune system reactivates or “rebounds”, which can lead to flare-ups of autoimmune conditions such as rheumatoid arthritis. This increase in immune activity explains the client’s joint pain. It is a normal physiological response rather than a complication or infection. Oxytocin and breastfeeding hormones do not cause such inflammation, and antibiotics are unnecessary unless infection is confirmed.
6. 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?
- Reassuring fetal heart tracing
- Continuous contraction lasting 2 minutes
- Contractions 4 minutes apart
- 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.
7. 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?
- Intermittent fetal heart auscultation
- Nipple stimulation
- Administration of IV fluids
- 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.
8. 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?
- Continue to monitor the client
- Obtain an order from the health care provider to start Oxytocin
- Perform a vaginal exam
- 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.
9. What is the recommended position to improve fetal oxygenation when oxytocin-induced uterine tachysystole occurs?
- Prone
- Left lateral
- Trendelenburg
- 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.
10. 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?
- Run warm water on her breasts during a shower
- Express small amounts of milk from the breasts to relieve the pressure
- Wear a loose-fitting bra to prevent nipple irritation
- 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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