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. When caring for a woman who just gave birth, what would the nurse educate the client in preventing postpartum complications?
- Change sanitary pad only when completely saturated
- Change sanitary pad 2 times per day
- Cleanse from the periurethral to the perineal area
- 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.
2. 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?
- Perform fetal scalp stimulation
- Apply oxygen
- Discontinue Pitocin
- 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.
3. 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.
4. 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.
5. 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.
6. 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?
- Asking the healthcare provider to prescribe analgesic agents
- Pouring water from a squeeze bottle over the woman's perineum
- Inserting a sterile catheter
- 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.
7. 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?
- Administer an IV fluid bolus.
- Insert a urinary catheter.
- Perform a glucose monitoring.
- 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.
8. 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.
9. What change occurs to the uterus 2 days after birth?
- The uterus descends 2 cm below the umbilicus
- By 1 week postpartum, the uterus should be nonpalpable
- The uterus remains an oval shape
- 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.
10. A nurse administers oxytocin IV after delivery to a client with postpartum hemorrhage. Which assessment best indicates that the oxytocin is effective?
- The client's blood pressure increases.
- The amount of lochia rubra increases.
- The client reports relief of afterpains.
- 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.
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