NR-327 Maternal-Child Nursing - Set 4 - Part 1

Correct Answer: Cephalopelvic disproportion calls for cesarean birth

Arrest with proven adequate contractions and a head that will not engage points to a mismatch between the fetal head and the pelvis. Cesarean birth is the answer, since forcing labor risks rupture. Option b is incorrect because the catheter has already documented contractions of adequate strength. Adding more stimulation pushes the fetus against an obstruction, and that is the pathway to a torn uterus. Option c is incorrect because therapeutic rest is the treatment for painful uncoordinated contractions in the latent phase. This client contracts effectively, so sedation and quiet would waste time the fetus does not have. Option d is incorrect because position changes help a fetus lying occiput posterior to rotate. They cannot create room where the pelvis is simply too small for this head to pass through.

Correct Answer: Stimulate her and give oxygen while summoning help

Neuraxial morphine depresses respiration for many hours after surgery, and a rate of ten with drowsiness is the warning. Breathing outranks the surgical and postpartum checks, which are already reassuring here. Option a is incorrect because the uterus is already firm and needs nothing from the nurse's hands. Charting can follow once the client is breathing adequately and the team has been alerted. Option b is incorrect because a dry dressing needs no reinforcement at all. Waiting an hour to look again would let a slowing respiratory drive become an arrest while the nurse is elsewhere. Option d is incorrect because a client whose legs are still blocked cannot be sat upright safely, and coaching a sedated client accomplishes little. Deep breathing exercises belong later, once she is alert.

Correct Answer: Stop the oxytocin and summon help immediately

This picture fits uterine rupture, a known hazard of oxytocin stimulation. The infusion is stopped, help is called for immediate surgery, and oxygen, lateral positioning, and wide open fluids follow while blood is crossmatched. Option a is incorrect because more drug drives further damage through a wall that has already given way. Contractions ceasing after tearing pain is a warning sign, never an invitation to titrate upward. Option b is incorrect because rubbing the uterus does nothing for a tear through its wall, and a ten minute delay is unacceptable. Bleeding is often concealed inside the abdomen while she deteriorates. Option c is incorrect because pushing raises intraabdominal pressure against a compromised uterus and assumes a vaginal birth that is no longer safe. Laparotomy, not maternal effort, is what this emergency requires.

Correct Answer: Setting up for a sterile speculum examination

Suspected preterm rupture is confirmed by sterile speculum, looking for pooling and confirming with nitrazine and ferning. Digital examination is avoided because it carries organisms upward and shortens the interval to birth. Option b is incorrect because each digital check pushes vaginal flora toward the cervix, raising the chance of chorioamnionitis in a client whose membranes are already open. Dilation information is not worth that trade. Option c is incorrect because lubricant contaminates a fetal fibronectin specimen and still involves a digital approach. Anything placed in the vagina during expectant management works against the goal of keeping the uterus sterile. Option d is incorrect because an internal electrode requires ruptured membranes and an accessible cervix, and it introduces another route for bacteria. External monitoring answers the fetal question without that added exposure.

Correct Answer: Premature closure of the fetal ductus arteriosus

Indomethacin blocks prostaglandin synthesis in the fetus as well as the uterus, so it is limited to short courses before thirty two weeks. Beyond that the ductus arteriosus may close early. Option a is incorrect because falling pressure with a compensatory faster pulse describes nifedipine, the calcium channel blocker. This drug acts on prostaglandins instead and leaves maternal vascular tone largely alone. Option b is incorrect because dangerous neuromuscular blockade is the reason nifedipine and magnesium sulfate are kept apart. Pairing this nonsteroidal drug with magnesium raises no such respiratory depression warning. Option d is incorrect because fluid overload in the lungs is watched for when a beta agonist runs alongside corticosteroids and brisk intravenous fluids. Gastric irritation and bleeding are the maternal worries here.

Correct Answer: Twice weekly nonstress tests with fluid assessment

Surveillance begins at forty one weeks with nonstress testing twice weekly paired with an amniotic fluid index or biophysical profile. Induction between forty one and forty two weeks follows, lowering both stillbirth and cesarean rates. Option a is incorrect because fundal height and a routine visit tell nothing about how well an aging placenta is oxygenating this fetus. Late pregnancy surveillance needs testing that looks at the fetus directly. Option b is incorrect because surgery is not the default at forty one weeks. Induction is offered instead, and evidence shows it actually lowers the cesarean rate compared with waiting for spontaneous labor. Option c is incorrect because counting movements at home is useful but far too coarse to stand alone once the stillbirth risk starts climbing. Formal testing in the office supplements what she does herself.

Correct Answer: "I should call if my flow turns bright red again."

Lochia that reverts to bright red after it has lightened suggests retained fragments or subinvolution, both causes of late hemorrhage. Because this happens at home, she must recognize the change and call promptly. Option b is incorrect because scant brownish white discharge lingering for several weeks is the normal tail end of lochia. Calling that abnormal shows she has confused expected healing with a warning sign. Option c is incorrect because saturating a full pad daily during the second week is far more flow than expected by then. Believing that is fine would keep her from calling when she should. Option d is incorrect because large clots signal that blood is pooling faster than the uterus can clamp down. Anything bigger than a small coin needs reporting, so this statement calls for correction.

Correct Answer: Notify the provider and give the ordered uterotonic

Persistent atony after massage and bladder emptying calls for pharmacologic help, so the nurse alerts the provider, gives the ordered uterotonic, and opens the intravenous fluid to support circulation while bleeding is controlled. Option a is incorrect because repeating a measure that has already failed twice wastes time the client does not have. Fifteen more minutes of brisk loss can push a compensating woman into frank shock. Option b is incorrect because suckling does release endogenous oxytocin, but the effect is mild and slow. Relying on it during active hemorrhage substitutes a supportive comfort measure for urgent drug therapy. Option d is incorrect because quantifying loss by weighing pads belongs to ongoing monitoring rather than to stopping the bleed. Measurement documents severity, yet it changes nothing about a uterus that will not stay firm.

Correct Answer: Sharply hyperflex both thighs onto the abdomen

McRoberts maneuver comes first because sharp hyperflexion of the thighs straightens the sacrum and rotates the symphysis upward, freeing the impacted anterior shoulder. It resolves a large share of cases alone. Option b is incorrect because fundal pressure drives the impacted shoulder harder against the symphysis. It deepens the impaction and risks uterine rupture, which is why it is never used for this emergency. Option c is incorrect because maternal pushing cannot move a shoulder wedged behind bone. Harder expulsive effort only lengthens the head to body interval while the compressed cord continues to starve the fetus. Option d is incorrect because lying flat with the legs out narrows the outlet rather than opening it. That position is the opposite of the hyperflexion that lifts the symphysis off the shoulder.

Correct Answer: Meet her physical needs and listen attentively

This is taking in, the dependent first day or two when she restores herself and works through the birth by retelling it. Teaching offered now is not retained, so comfort and listening come first. Option a is incorrect because the productive teaching window opens in taking hold, usually the second or third day, once she turns her attention outward toward the baby. Instruction given today would simply evaporate. Option b is incorrect because dependence and preoccupation with her own recovery describe a normal opening phase, not detachment. Concern would arise if she avoided eye contact or spoke of the infant with disappointment. Option c is incorrect because pushing her toward caregiving before she is ready adds pressure at a moment when rest matters most. Visitors can be managed to her preference rather than used as leverage.

Correct Answer: Apply oxygen by nonrebreather mask

Altered alertness with a thready pulse means tissue oxygen delivery is failing, so airway and breathing come first. High flow oxygen by nonrebreather supports the remaining red cells while volume and blood products are arranged. Option a is incorrect because laboratory results lag behind the bleeding and will not change the immediate plan. Hemoglobin falls only after fluid shifts occur, so a specimen drawn now understates what she has lost. Option c is incorrect because measuring loss documents severity without treating it. Quantification matters for the running total the team tracks, yet a woman losing consciousness needs oxygen before anyone reaches for a scale. Option d is incorrect because keeping her warm genuinely protects clotting and belongs in the plan, just not ahead of oxygenation. Blankets address one leg of the lethal triad while hypoxia continues unchecked.

Correct Answer: Hold the dose and question the order

Carboprost is a prostaglandin that provokes bronchospasm, so asthma is a contraindication. The nurse withholds it, tells the provider about the asthma history, and anticipates methylergonovine or misoprostol as the safer substitute. Option a is incorrect because watching for wheezing after the injection accepts a foreseeable airway crisis rather than preventing one. Contraindicated drugs are questioned before administration, not monitored through their worst effect. Option b is incorrect because premedicating with a bronchodilator does not neutralize a prostaglandin contraindication. No inhaler reliably protects an unstable asthmatic from severe bronchoconstriction, and safer uterotonics are available for this client. Option c is incorrect because a firm fundus is the goal of the drug, so waiting for one defeats the order entirely. The problem here is the client's airway disease, not the timing of the injection.

Correct Answer: Lochia with a foul, fetid odor

Healthy lochia smells fleshy and musty, much like menstrual flow. A foul or fetid odor points to bacterial growth in the uterine lining, so the nurse checks temperature and fundal tenderness and notifies the provider. Option b is incorrect because that musty, fleshy smell is exactly what healthy lochia produces as blood and decidual tissue leave the uterus. Nothing about it suggests bacteria, so no notification is warranted. Option c is incorrect because moderate red flow matches lochia rubra, which runs through about the third day. A four to six inch stain on the pad falls squarely inside the expected range. Option d is incorrect because small clots the size of a dime or nickel are common in the first day or two. Only clots as large as a golf ball, or repeated ones, get reported.

Correct Answer: Gaping edges with purulent yellow drainage

Approximation and drainage are the two REEDA letters that turn abnormal here. Edges that separate mean the repair is failing, and purulent drainage signals infection, so both belong in a report to the provider. Option a is incorrect because a thin band of pink along fresh sutures reflects ordinary inflammation of healing. Concern begins only when the redness spreads outward across the surrounding skin and deepens in color. Option b is incorrect because small areas of discoloration follow the stretching and repair of birth and fade over one to two weeks. Extensive bruising would be different, hinting at deeper trauma underneath. Option d is incorrect because puffiness confined to the immediate area is expected after the tissue was stretched and sutured. A tense, bulging, discolored mass would change the picture entirely and demand urgent attention.

Correct Answer: "Keep nursing on both breasts, including the sore one."

Milk must keep moving, because stasis feeds the infection and invites an abscess. The milk is safe for the infant, so she nurses on both sides while taking the full antibiotic course. Option b is incorrect because resting the affected breast lets milk pool exactly where bacteria are multiplying. Skipping feeds on that side is the change most likely to turn mastitis into an abscess. Option c is incorrect because abrupt weaning creates engorgement on top of an active infection and removes the infant's food supply. Dicloxacillin and cephalexin are both compatible with nursing, so treatment needs no interruption. Option d is incorrect because throwing the milk away assumes it harms the baby, which it does not. Emptying the breast by pump is acceptable only when the infant refuses to latch there.

Correct Answer: Expect the regression and give him focused attention

Bedwetting, baby talk, and clinging are predictable when a young child fears being replaced. Reserved one to one time, a helper role offered without pressure, and having visitors greet him first all ease the transition. Option a is incorrect because silence leaves the child reading the change as proof that he no longer counts. Regression is a request for reassurance, and it fades faster when the parents answer it directly. Option b is incorrect because punishment adds shame to an already anxious preschooler and usually prolongs the very behavior it targets. Nothing about scolding addresses the fear of losing his place in the family. Option d is incorrect because seeing his mother and meeting the baby in the hospital helps a young child make sense of what happened. Keeping him away lengthens the separation that started the trouble.

Correct Answer: Squirt warm water front to back while voiding

The peri bottle is used at every void and bowel movement. Warm water directed front to back dilutes urine so it does not sting the suture line and keeps rectal organisms away from it. Option a is incorrect because that direction drags organisms from the anal area forward across the healing repair and the urethra. Every step of perineal care moves toward the rectum, never away from it. Option c is incorrect because anything placed in the vagina risks carrying bacteria to a healing placental site behind an open cervix. Pads only, until the provider clears her at the postpartum visit. Option d is incorrect because friction pulls at sutures and can separate wound edges that are still fragile. Gentle rinsing followed by patting dry protects the repair far better than any scrubbing does.

Correct Answer: Summon help and prepare for immediate surgery

These findings mean the uterus has torn. Only laparotomy stops the bleeding and delivers the fetus, so the nurse calls for help while opening fluids, drawing a crossmatch and readying the operating room. Option a is incorrect because delay costs the fetus its remaining oxygen and lets the mother bleed into her abdomen. A torn uterus never improves with a change of position and reassessment. Option b is incorrect because massage treats a boggy uterus after birth, when atony is the source of bleeding. Here the wall itself has split, and rubbing it does nothing to close the tear. Option c is incorrect because pushing raises intrauterine pressure against a wall that has already given way. Vaginal birth is no longer the route, and expulsive effort would enlarge the defect.

Correct Answer: A client with a fetus in transverse lie

A fetus lying crosswise has no presenting part able to enter the pelvis, so vaginal birth is impossible and cesarean is required. Rupture of membranes would also bring a high risk of cord prolapse. Option a is incorrect because one low transverse scar carries a rupture risk under one percent and makes this client a reasonable candidate for labor. The scar type, not the skin incision, decides. Option c is incorrect because most fetuses in that position rotate on their own during labor. Back pain and slower descent are the usual consequences, and many of these clients still give birth vaginally. Option d is incorrect because blood pressure at the mild end is managed with monitoring and often with labor itself. Only severe disease that threatens the mother forces an abdominal delivery.

Correct Answer: "I will let warm shower water run over my breasts."

Warm water on the breasts stimulates let down and signals the body to keep producing milk, which prolongs the engorgement she is trying to end. She should keep her back to the spray. Option a is incorrect because continuous firm support is exactly what suppression calls for, since it limits movement and stimulation. Her statement shows she understood, so no correction is needed on this point. Option b is incorrect because cold narrows the vessels feeding the congested tissue and dulls the ache without encouraging production. Ice packs are a standard part of the plan for a woman who is not nursing. Option c is incorrect because physiologic engorgement in a woman who never nurses does resolve on its own across roughly one to two days. Her expectation matches the usual course and requires no reteaching.