A 40 weeks gestation client delivered a baby girl 20 minutes ago.

The nurse observes a gush of blood from the vagina and lengthening of the umbilical cord.

The nurse prepares Pitocin IV to be administered after delivery of the placenta with the understanding that Pitocin is given:

Choice A rationale

Administering vitamin K (phytonadione) is routinely done to prevent hemorrhagic disease of the newborn, as infants have sterile guts and lack the necessary bacteria to synthesize clotting factors II, VII, IX, and X. While important, this intervention is a prophylactic chemical measure and is performed after the critical initial physiological stabilization steps, making it secondary to maintaining thermal stability.

Choice B rationale

Drying the newborn immediately and thoroughly stimulates breathing, reduces evaporative heat loss, and is critical for stabilizing the newborn's temperature and preventing cold stress. Maintaining a neutral thermal environment is the next priority after ensuring a patent airway, as hypothermia can lead to serious complications like metabolic acidosis and hypoglycemia.

Choice C rationale

Administering eye prophylaxis, typically erythromycin ointment, is a legally mandated procedure to prevent ophthalmia neonatorum from pathogens like Neisseria gonorrhoeae. This is an important preventive measure but is not a critical physiological stabilization step and can be performed after the initial steps of airway, breathing, and circulation stabilization are complete.

Choice D rationale

Placing identification bracelets on the newborn and mother is a vital safety and security measure to prevent infant abduction or mix-ups. This is a crucial procedural task but does not address the immediate, life-sustaining physiological needs of the newborn, such as maintaining respiration and thermoregulation, making it a lower priority than drying and stimulating the infant.

Choice A rationale

Afterpains are intermittent uterine contractions that occur during involution. Breastfeeding stimulates the release of oxytocin, a potent uterotonic hormone, which intensifies these contractions. Therefore, a bottle-feeding woman would be less likely to experience strong afterpains compared to a breastfeeding woman.

Choice B rationale

Oligohydramnios is a condition of low amniotic fluid. Uterine distention is the primary cause of strong afterpains. Since oligohydramnios results in a smaller-than-average uterus, the associated afterpains are typically less intense because the uterus was not excessively stretched during the pregnancy.

Choice C rationale

A newborn weighing 5 pounds, 3 ounces (2353 grams) is considered low birth weight, suggesting the uterus was less distended than in a pregnancy with a larger infant. Afterpains are more severe in conditions causing overdistention, such as macrosomia, where the stretched muscle fibers have a greater distance to retract.

Choice D rationale

Multiple gestation, such as twins, causes excessive stretching and overdistention of the uterine muscle fibers due to the presence of two fetuses and placentas. The more the uterus is stretched, the harder it must contract to return to its pre-pregnancy size, resulting in stronger and more uncomfortable afterpains.