FA25 NUR 404 W Exam Two at Massachusetts College of Pharmacy and Health Sciences

A sudden fetal heart rate drop after amniotomy strongly suggests umbilical cord prolapse. The immediate priority is to relieve pressure off the cord. Placing the client in the knee-chest position (or Trendelenburg if necessary) uses gravity to shift the fetus upward, reducing cord compression and restoring fetal oxygenation while emergency measures are initiated.

This mother is expressing grief, disappointment, and emotional adjustment after an unexpected cesarean birth — a normal part of the taking-hold to letting-go phase. The best response acknowledges her feelings and encourages further communication, providing emotional support and validating her experience. Offering an open-ended question allows her to express and process the experience safely.

B. Tense (firm) uterus With excessive amniotic fluid, the uterus becomes overdistended and feels unusually firm or tense on palpation. This increased pressure is due to the large volume of fluid filling the uterus, which can make it difficult for the uterus to relax between assessments. C. Difficulty auscultating heart sounds Excess fluid cushions fetal movements and heart sounds, making it harder for the nurse to hear fetal heart tones. Polyhydramnios increases the distance between the fetus and abdominal wall, reducing clarity of auscultation. E. Maternal shortness of breath The enlarged uterus presses upward on the diaphragm, restricting lung expansion. This leads to maternal dyspnea, especially in the second and third trimesters as fluid volume increases significantly. F. Uterus larger than expected for gestational week A uterus measuring larger than gestational age is one of the hallmark findings of polyhydramnios. Fundal height will exceed expected measurements due to excessive amniotic fluid volume.

A tocolytic is given in preterm labor to suppress uterine contractions and delay delivery, typically to allow time for fetal lung maturity interventions such as corticosteroids. At 31 weeks gestation, delaying labor can significantly improve neonatal outcomes by reducing the risks of respiratory distress syndrome, intraventricular hemorrhage, and other prematurity-related complications.

The uterine contractions are hypotonic—infrequent and weak (<25 mm Hg), with normal resting tone (5–20 mm Hg). Hypotonic labor pattern typically occurs in active phase labor and leads to ineffective cervical dilation. Oxytocin is commonly ordered to augment labor by increasing contraction strength and frequency, promoting cervical change and labor progression.

A client two days postpartum with increasing perineal pain, especially after a vaginal birth and prolonged rupture of membranes, is most at risk for a perineal infection. Increased pain, swelling, tenderness, foul odor, or purulent discharge at the perineal site are hallmark signs. Prolonged ROM increases bacterial exposure, allowing infection at the perineal wound or laceration repair site.

Mastitis is a breast infection often occurring in breastfeeding mothers, typically 2–4 weeks postpartum but can happen anytime during lactation. Symptoms include localized breast pain, redness, warmth, fever, and flu-like malaise. The presence of systemic symptoms (temperature 38.2°C and malaise) alongside localized inflammation strongly indicates mastitis and requires provider notification for antibiotic therapy.

Labetalol is a commonly prescribed antihypertensive medication considered safe for use during pregnancy. It is a first-line choice for managing chronic hypertension in pregnant clients because it effectively lowers blood pressure without reducing uteroplacental blood flow. Using safe, pregnancy-approved antihypertensives like labetalol helps prevent maternal complications such as stroke and preeclampsia while supporting fetal well-being.

A. Increase intravenous fluid replacement Increasing IV fluids supports circulatory volume and helps prevent hypovolemic shock during postpartum hemorrhage caused by uterine atony. Restoring fluid volume improves tissue perfusion and stabilizes blood pressure while other interventions address the cause of bleeding. B. Insert an indwelling urinary catheter An indwelling catheter keeps the bladder empty, which promotes effective uterine contraction. A distended bladder can prevent the uterus from contracting well, worsening uterine atony and bleeding. Catheterization helps maintain optimal uterine tone. D. Initiate a peri-pad count Tracking pad saturation provides an objective measure of blood loss. Accurate monitoring is essential for recognizing worsening hemorrhage, determining response to interventions, and guiding clinical decisions. E. Perform a fundal massage Fundal massage is the primary intervention for uterine atony because it stimulates uterine contraction. A firm, contracted uterus reduces bleeding and helps return uterine tone after delivery.