NUR 4455 Care of Families- Childbearing Nursing Exam 2 Fall 2025
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Free NUR 4455 Care of Families- Childbearing Nursing Exam 2 Fall 2025 Questions
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 postpartum client who is 2 days post–vaginal delivery reports cramping in her lower abdomen that worsens while she is breastfeeding. Which response by the nurse best explains this finding?
- A. "Breastfeeding causes the release of oxytocin, which contracts your uterus."
- B. "You should stop breastfeeding until the pain subsides."
- C. "The cramps mean your uterus isn't healing properly."
- D. "This may be a sign of uterine infection."
Explanation
During breastfeeding, the stimulation of the nipples triggers the release of oxytocin from the posterior pituitary gland. Oxytocin causes the uterus to contract, helping it return to its pre-pregnancy size (uterine involution) and reducing the risk of postpartum hemorrhage. These contractions, often called afterpains, are normal, temporary, and more noticeable in multiparous women. They typically subside within a few days.
A newborn is lying naked on a cold mattress near a drafty window. Which two types of heat loss are occurring simultaneously?
- A. Radiation and convection
- B. Conduction and evaporation
- C. Radiation and conduction
- D. Convection and evaporation
Explanation
In this scenario, the newborn is exposed to two mechanisms of heat loss:
●Radiation: Heat is lost from the baby’s body to nearby cooler surfaces, such as the cold window or wall, even without direct contact.
●Convection: Heat is lost to the cool air currents moving around the baby, such as from the drafty window.
Both processes occur when a newborn is unclothed in a cool environment, putting the baby at risk for hypothermia. The nurse should immediately dry, wrap, and move the newborn away from drafts or cold surfaces to prevent further heat loss.
A nurse is caring for a client who experienced a vaginal delivery 48 hours ago. When assessing the client’s uterus, where should the nurse expect to palpate the uterine fundus at this time?
- A. To the right of the umbilicus
- B. 1 cm above the symphysis pubis
- C. 2 cm above the umbilicus
- D. At the level of the umbilicus
Explanation
After birth, the uterus begins a process of involution, returning to its pre-pregnancy size and position. The fundus is typically:
●At the level of the umbilicus immediately after delivery.
●Descends about 1 cm (one fingerbreadth) per day postpartum.
At 48 hours (2 days) postpartum, the fundus should be approximately 2 cm below the umbilicus, or near the level of the symphysis pubis by day 9. So by 48 hours, it is generally about 1 cm above the symphysis pubis, firm and midline.
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.
When educating a postpartum mother about changes she may experience, the nurse explains that which of the following is a normal adaptation?
- A. Lochia serosa in 24 hours
- B. Persistent pain at the episiotomy site for 3 weeks
- C. Regular bowel habits will return by 3 days postpartum
- D. Constant elevated blood pressure
Explanation
After delivery, bowel function typically returns within 2–3 days postpartum as peristalsis resumes and abdominal pressure normalizes. Stool softeners, hydration, and ambulation are encouraged to prevent constipation, especially in women with episiotomies or perineal trauma. This is a normal and expected physiological change as the gastrointestinal system recovers from the effects of pregnancy and delivery.
When assessing a multiparous woman who has just given birth to an 8-pound boy 15 minutes ago, the nurse notes that the woman's fundus has become globular in shape and a gush of dark red blood comes from her vagina. What is the nurse's interpretation of these findings?
- A. A cervical tear occurred during the birth
- B. The placenta has separated
- C. Clots have formed in the upper uterine segment
- D. The woman is beginning to hemorrhage
Explanation
A globular-shaped uterus, lengthening of the umbilical cord, and a gush of dark red blood are classic signs that the placenta has separated from the uterine wall—a normal and expected event in the third stage of labor. The dark color of the blood indicates it is from placental separation, not active bleeding. The nurse should assist with controlled cord traction as prescribed and monitor for complete placental delivery and firm uterine contraction afterward.
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 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 nurse observes a nurse assistant bathing a newborn in a drafty room near an open window. The infant's temperature drops to 97.0°F (36.1°C). Which type of heat loss caused this?
- A. Convection
- B. Evaporation
- C. Conduction
- D. Radiation
Explanation
Convection is the loss of body heat due to cool air currents moving across the newborn’s skin. In this case, the draft from the open window caused warm air near the infant’s body to be replaced by cooler air, leading to heat loss. Newborns are highly susceptible to convection heat loss because they have a large body surface area relative to weight and immature thermoregulation. The nurse should close windows, keep the room warm, and wrap the baby in a blanket to prevent further heat loss.
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