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 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 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?
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Continue to monitor the client
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Obtain an order from the health care provider to start Oxytocin
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Perform a vaginal exam
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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.
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?
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Perform fetal scalp stimulation
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Apply oxygen
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Discontinue Pitocin
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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.
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 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 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.
What change occurs to the uterus 2 days after birth?
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The uterus descends 2 cm below the umbilicus
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By 1 week postpartum, the uterus should be nonpalpable
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The uterus remains an oval shape
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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.
A postpartum client with a history of lupus develops a flare-up 2 weeks after birth. The nurse understands this occurs because:
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Breastfeeding suppresses immune function.
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Pregnancy causes permanent immune suppression.
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Estrogen levels rise after birth, triggering autoimmune reactions.
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The rebound of the immune system postpartum may reactivate autoimmune conditions.
Explanation
During pregnancy, the immune system is suppressed to protect the fetus, which is partially foreign to the mother’s body. After delivery, the immune system rebounds to its normal activity, which can trigger a flare-up of autoimmune diseases such as lupus. This immune rebound can cause inflammation and worsening of symptoms. Breastfeeding does not significantly suppress immunity, and estrogen levels actually drop after birth, not rise. Therefore, the immune system’s rebound is the most accurate explanation.
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.
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?
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Encourage the client to void and reassess the fundus.
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Perform a fundal massage to promote contraction.
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Notify the health care provider immediately.
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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.
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