Nokea
A 28-year-old woman without risk factors has now reached the second stage of labor. What is the optimal position for her at this point?
- A. Supine
- B. Lateral recumbent
- C. Lithotomy
- D. Squatting
Correct Answer: B
Rationale: The optimal position for a 28-year-old woman in the second stage of labor is the lateral recumbent position (Choice B). This position helps maximize pelvic diameter and blood flow to the uterus, facilitating labor progress. It also reduces the risk of fetal heart rate abnormalities compared to the supine position (Choice A). Lithotomy position (Choice C) can hinder the descent of the baby and increase the risk of perineal trauma. Squatting (Choice D) may be uncomfortable and less effective in promoting efficient labor progress compared to the lateral recumbent position.
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To determine if the patient is in true labor, the nurse would assess for changes in
- A. cervical dilation.
- B. amount of bloody show.
- C. fetal position and station.
- D. pattern of uterine contractions.
Correct Answer: D
Rationale: Step-by-step rationale:
1. The pattern of uterine contractions is crucial in determining true labor as true contractions are regular, increasing in frequency, duration, and intensity.
2. Assessing cervical dilation alone may not confirm true labor as some women may have cervical changes without being in active labor.
3. Bloody show may occur in both true and false labor, making it an unreliable indicator.
4. Fetal position and station are important for labor progression but do not definitively confirm true labor.
Therefore, by assessing the pattern of uterine contractions, the nurse can accurately determine if the patient is in true labor.
How long is the expected length of the third stage of labor?
- A. 60 minutes or less
- B. 30 minutes or less
- C. 1 hour for a multiparous person, 2 hours for a nulliparous person
- D. 3 hours for a multiparous person, 4 hours for a nulliparous person
Correct Answer: C
Rationale: The correct answer is C because the expected length of the third stage of labor, which is the delivery of the placenta, is typically around 1 hour for a multiparous person (someone who has given birth before) and around 2 hours for a nulliparous person (someone who is giving birth for the first time). This is based on the normal physiological process of the uterus contracting to expel the placenta. Choice A and B are incorrect as they provide specific time limits that are not generally applicable to all individuals. Choice D is incorrect as it suggests longer durations which are beyond the typical range for the third stage of labor.
During an oxytocin induction, which assessment finding is most concerning to the labor and delivery nurse?
- A. A uterine resting tone of 17 mm Hg
- B. A uterine resting tone of 30 mm Hg
- C. Contractions that are every 3 minutes and last 60 seconds
- D. Contractions that are every 5 minutes and last 60 seconds
Correct Answer: B
Rationale: The correct answer is B because a uterine resting tone of 30 mm Hg indicates excessive uterine activity, which can lead to uterine hyperstimulation and fetal distress during an oxytocin induction. A higher resting tone suggests the uterus is not relaxing adequately between contractions, potentially compromising fetal oxygenation. Choices A, C, and D are incorrect because a uterine resting tone of 17 mm Hg is within the normal range, contractions every 3 minutes lasting 60 seconds and every 5 minutes lasting 60 seconds are typical patterns during labor induction, and they do not necessarily indicate complications.
A fetus is positioned in a longitudinal lie with its head in the fundus with both hips and knees flexed. Which presentation is this known as?
- A. Frank breech
- B. Complete breech
- C. Vertex
- D. Transverse
Correct Answer: B
Rationale: The correct answer is B: Complete breech. In this presentation, the fetus is positioned with hips and knees flexed, and the head is in the fundus. This is different from a Frank breech where the hips are flexed but the knees are extended. Vertex presentation refers to the head being down and Transverse presentation is when the fetus is lying horizontally. In this case, the description matches the characteristics of a complete breech presentation, making it the correct answer.
The primary difference between the labor of a nullipara and that of a multipara is
- A. total duration of labor.
- B. level of pain experience
- C. amount of cervical dilation.
- D. sequence of labor mechanisms.
Correct Answer: A
Rationale: The correct answer is A: total duration of labor. This is because nulliparas (women who have never given birth before) generally have longer labors compared to multiparas (women who have given birth before). This is due to factors such as the first-time stretching of the birth canal and the body's learning process. The level of pain experience (B) can vary among individuals and is not a primary difference between nulliparas and multiparas. The amount of cervical dilation (C) can be influenced by various factors and is not a defining difference between the two groups. The sequence of labor mechanisms (D) is a universal process in labor and does not differ based on whether a woman is a nullipara or multipara.