NUR 4455 Care of Families- Childbearing Nursing Exam 2 Fall 2025 at Florida International University
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Free NUR 4455 Care of Families- Childbearing Nursing Exam 2 Fall 2025 at Florida International University Questions
Which client is most likely to experience strong and uncomfortable afterpains?
- A. A woman who is bottle-feeding her infant
- B. A woman who experienced oligohydramnios
- C. A woman whose infant weighed 5 pounds, 3 ounces
- D. A client who delivered twins
Explanation
Afterpains are intermittent uterine contractions that occur as the uterus involutes (shrinks back to its pre-pregnancy size). They are caused by the release of oxytocin, which stimulates uterine contractions. Afterpains are more intense in women with overdistended uteri, such as those who delivered twins, a large baby, or had polyhydramnios. The uterus must contract more forcefully to regain its normal tone, leading to stronger and more uncomfortable cramping.
A nurse is caring for a newborn immediately following birth. After establishing a patent airway, what is the next priority nursing action?
- A. Administer vitamin K
- B. Dry and stimulate the newborn
- C. Administer eye prophylaxis
- D. Place an identification bracelet on the newborn and mom
Explanation
After ensuring the newborn’s airway is clear and patent, the next priority is to dry and stimulate the newborn. Drying prevents heat loss through evaporation, which is a major risk immediately after birth, as newborns cannot regulate body temperature effectively. Stimulating the infant by rubbing the back or soles helps initiate spontaneous respirations and maintain a healthy heart rate and oxygenation. This step supports both thermoregulation and respiratory adaptation, which are essential for neonatal survival.
A postpartum client who delivered 24 hours ago continues to complain of severe perineal pain after being medicated with pain medication. The client’s vital signs are stable. The uterus is firm and midline. Which of the following assessments should the nurse perform?
- A. Reassess the fundus
- B. Reassess need for Oxytocin
- C. Assess client’s temperature
- D. Assess the perineum for hematomas
Explanation
A firm, midline uterus with severe, unrelieved perineal pain suggests the presence of a vaginal or vulvar hematoma rather than uterine atony or infection. Hematomas occur when blood collects under the tissues due to injury of blood vessels during delivery, often presenting with intense localized pain, pressure, and possible swelling or discoloration at the perineal site. Vital signs may remain stable initially despite significant blood loss into the tissue. The nurse should inspect and palpate the perineum carefully, report findings to the provider, and prepare for possible evacuation if the hematoma is large.
A nurse assesses a client’s uterus during contractions and notes that it becomes firm with each contraction, lasting 45 seconds, and softens completely between contractions. Cervical change from 4 cm to 6 cm is noted. What does this indicate?
- A. False labor
- B. Placental abruption
- C. Uterine tachystole
- D. True labor
Explanation
True labor is characterized by regular uterine contractions that increase in frequency, duration, and intensity and lead to progressive cervical change (dilation and effacement). In this case, the uterus becomes firm with contractions lasting 45 seconds, softens between contractions, and the cervix has changed from 4 cm to 6 cm—clear evidence that the labor is active and genuine. True labor contractions result in the descent of the fetus and cervical dilation.
A client is attending her 2-week postpartum follow-up visit. She reports that she is having vaginal discharge. When assessing this client, which finding would the nurse educate the client that this adaptation is normal?
- A. Lochia rubra
- B. Lochia sangra
- C. Lochia serosa
- D. Lochia alba
Explanation
At 2 weeks postpartum, it is normal for vaginal discharge to be lochia serosa. Lochia serosa typically appears from about day 4 through day 10–14 after delivery. It is pink or brownish in color and has a watery or serous consistency as the amount of blood decreases and wound healing progresses. This indicates normal uterine involution and healing of the placental site.
A nurse is teaching a postpartum client about breastfeeding. Which statement best describes the relationship between prolactin and oxytocin?
- A. Prolactin produces milk; oxytocin releases the milk during feeding.
- B. Prolactin decreases as milk supply increases.
- C. Prolactin causes milk ejection; oxytocin causes milk production.
- D. Both prolactin and oxytocin are released only when the baby cries.
Explanation
Prolactin and oxytocin work together to regulate breastfeeding. Prolactin, secreted by the anterior pituitary gland, stimulates the production of milk in the alveolar cells of the breasts. Oxytocin, released from the posterior pituitary gland in response to nipple stimulation, triggers the let-down reflex (milk ejection) by causing contraction of the myoepithelial cells surrounding the milk ducts. Together, these hormones ensure a continuous milk supply and effective feeding.
A first-time mother reports concerns about her milk supply. The nurse explains that prolactin secretion is best stimulated by:
- A. Avoiding breastfeeding at night
- B. Frequent nursing and skin-to-skin contact
- C. Taking hormone supplements
- D. Formula supplementation when away from the newborn
Explanation
Prolactin, the hormone responsible for milk production, is released from the anterior pituitary gland in response to frequent nipple stimulation and infant suckling. The more often the baby nurses—especially during nighttime feedings when prolactin levels peak—the greater the stimulation for milk production. Skin-to-skin contact also enhances oxytocin release, promoting both emotional bonding and the let-down reflex, which helps maintain milk supply.
A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal, and the estimated blood loss (EBL) was 1500 mL. When evaluating the woman’s vital signs, which finding would be of greatest concern to the nurse?
- A. Temperature 37.4°C, heart rate 100 bpm, respirations 18 breaths per minute, and blood pressure 126/68 mm Hg
- B. Temperature 37.9°C, heart rate 115 bpm, respirations 22 breaths per minute, and blood pressure 90/50 mm Hg
- C. Temperature 38°C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg
- D. Temperature 36.8°C, heart rate 60 bpm, respirations 20 breaths per minute, and blood pressure 140/90 mm Hg
Explanation
An EBL of 1500 mL indicates a postpartum hemorrhage (normal EBL for a vaginal birth is ≤500 mL). The vital signs in option B show tachycardia (HR 115) and hypotension (BP 90/50)—classic signs of hypovolemic shock due to significant blood loss. The mild increase in temperature may result from normal exertion or dehydration, but the low blood pressure and elevated heart rate require immediate intervention to prevent circulatory collapse. The nurse should assess the uterus for atony, check bleeding, start IV fluids, and notify the provider immediately.
Four hours postpartum, the nurse notes the uterus is firm but displaced to the right. The client voided 150 mL one hour ago and reports feeling pressure in her bladder. What should the nurse do first?
- A. Document and reassess in one hour
- B. Administer IV pain medication
- C. Massage the fundus
- D. Encourage the client to void again
Explanation
A firm but displaced uterus (commonly to the right) indicates a distended bladder, which pushes the uterus out of the midline position and can interfere with proper uterine contraction, increasing the risk for postpartum hemorrhage. The nurse should assist and encourage the client to void again to fully empty the bladder. After voiding, the fundus should return to the midline and the feeling of bladder pressure should resolve.
A nurse is caring for a postpartum client and is explaining the process of involution. Which of the following statements is true?
- A. Postpartum uterus returns to its pre-pregnancy size by 8 weeks postpartum
- B. At the end of the third stage of labor, the postpartum uterus is positioned 3 cm above the umbilicus
- C. The decline of estrogen and progesterone causes self-destruction of excess uterine tissue
- D. After 2 weeks postpartum, the uterus can be palpated above the symphysis pubis
Explanation
Involution is the process by which the uterus returns to its pre-pregnancy size and condition after childbirth. The drop in estrogen and progesterone levels after delivery triggers autolysis, a process where excess hypertrophied uterine muscle cells self-digest and shrink. This hormonal shift enables the uterus to contract, decrease in size, and shed remaining tissue. By about 6 weeks postpartum, the uterus has typically returned to its pre-pregnancy size.
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