A postpartum client with a history of rheumatoid arthritis reports increased joint pain. The nurse recognizes this as:
A complication of oxytocin administration
A normal immune rebound after pregnancy
Hormonal imbalance caused by breastfeeding
A sign of infection requiring antibiotics
The Correct Answer is B
Choice A reason: Oxytocin administration is not associated with joint pain. Its effects are primarily on uterine contractions and milk letdown.
Choice B reason: During pregnancy, immune activity is suppressed to protect the fetus. After delivery, immune rebound occurs, which can exacerbate autoimmune conditions such as rheumatoid arthritis. Increased joint pain is a normal manifestation of this rebound.
Choice C reason: Hormonal changes during breastfeeding affect lactation and menstrual cycles but are not directly responsible for joint pain.
Choice D reason: Infection would present with systemic signs such as fever, localized redness, or swelling. Isolated joint pain in a client with rheumatoid arthritis is more consistent with immune rebound rather than infection.
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Correct Answer is D
Explanation
Choice A reason: Pregnancy does not cause permanent immune suppression. Immune suppression occurs temporarily during pregnancy to protect the fetus but resolves postpartum.
Choice B reason: Breastfeeding does not suppress immune function. It primarily affects hormonal balance and lactation but does not directly trigger autoimmune flare-ups.
Choice C reason: Estrogen levels do not rise after birth; they actually decline. Therefore, this is not the cause of lupus flare-ups postpartum.
Choice D reason: The immune system rebounds after delivery, returning to its pre-pregnancy state. This rebound can reactivate autoimmune conditions such as lupus, leading to flare-ups.
Correct Answer is D
Explanation
Choice A reason: Administering an IV fluid bolus may be helpful in preventing hypotension or maintaining hydration, but it is not the most critical action before oxytocin induction. Oxytocin can cause uterine tachysystole and fetal distress, so fluid bolus alone does not address the primary risk.
Choice B reason: Inserting a urinary catheter can help monitor urine output and bladder distension, but it is not essential before starting oxytocin. Catheterization is more relevant in surgical or anesthesia contexts rather than induction safety.
Choice C reason: Performing glucose monitoring is important in diabetic clients, but it is not universally required before oxytocin induction. Oxytocin does not directly alter glucose metabolism, so this is not the priority action.
Choice D reason: Continuous electronic fetal monitoring is the most important action because oxytocin increases uterine contractions, which can reduce placental perfusion and oxygen delivery to the fetus. A client with a prior cesarean is at higher risk for uterine rupture, so monitoring ensures early detection of fetal distress or abnormal contraction patterns.
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