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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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Arrange the seven cardinal movements of labor, in order.
- A. Descent
- B. Expulsion
- C. Extension
- D. External rotation
Correct Answer: A
Rationale: The correct order of the seven cardinal movements of labor is: Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, and Expulsion. Descent is the first cardinal movement, as the baby moves down the birth canal. Flexion follows to allow the baby's head to pass through the pelvis. Internal Rotation, Extension, and Restitution then occur to facilitate the baby's shoulders and body turning in alignment with the mother's pelvis. External Rotation follows to help the shoulders rotate to the correct position for delivery. Finally, Expulsion is when the baby is born. This sequence ensures a smooth and safe delivery. The other choices are incorrect as they are not part of the specific sequence of cardinal movements during labor.
Which woman is the best candidate for a trial of labor after cesarean (TOLAC)?
- A. A 34-year-old gravida 2, para 1 with one previous classical cesarean section for prematurity
- B. A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD
- C. A 31-year-old gravida 4, para 2 with one previous low-transverse cesarean section for late decelerations
- D. A 27-year-old gravida 3, para 2 with one previous T-shaped incision for macrosomia
Correct Answer: B
Rationale: The correct answer is B: A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD. This candidate is the best choice for a trial of labor after cesarean (TOLAC) because a low-transverse incision has the lowest risk of uterine rupture during labor compared to classical, T-shaped, or vertical incisions. Additionally, the indication for the previous cesarean section being cephalopelvic disproportion (CPD) suggests that the pelvis may have been the limiting factor in the previous delivery, making a TOLAC a reasonable option. The other choices have higher risks of uterine rupture (classical incision, T-shaped incision) or indications that may increase the likelihood of complications during TOLAC (prematurity, late decelerations).
The nurse is providing discharge instructions to a person who was evaluated for possible labor. How does the nurse explain how losing the mucus plug could be a sign of impending labor?
- A. The mucus plug starts to be expelled due to increased estrogen before contractions begin.
- B. The mucus plug is expelled after the membranes rupture during labor.
- C. Effacement and dilation of the cervix decrease the area where the mucus plug sits.
- D. Labor is unable to begin until the mucus plug is expelled and creates a space for the fetus.
Correct Answer: A
Rationale: Step-by-step rationale:
1. Increased estrogen levels lead to softening of the cervix, causing the mucus plug to be expelled.
2. Contractions usually start after the mucus plug is expelled, not before.
3. The mucus plug is typically expelled before the membranes rupture.
4. Effacement and dilation of the cervix prepare the body for labor but are not directly related to the expulsion of the mucus plug.
In summary, Choice A is correct as increased estrogen leads to the expulsion of the mucus plug, indicating impending labor. Choices B, C, and D are incorrect as they do not accurately explain the relationship between the mucus plug and impending labor.
On admission to the labor and birth unit, a 38-year-old female, gravida 4, para 3, at term in early labor is found to have a transverse lie on vaginal examination. What is the priority intervention at this time?
- A. Perform a vaginal exam to denote progress.
- B. Notify the health care provider.
- C. Initiate parenteral therapy.
- D. Apply oxygen via nasal cannula at 8 L/minut
Correct Answer: B
Rationale: The correct answer is B: Notify the health care provider. This is the priority intervention because a transverse lie is a malpresentation that can lead to complications during labor and delivery. The healthcare provider needs to be informed immediately to determine the best course of action, which may include attempting to manually rotate the baby or preparing for a cesarean section. Performing a vaginal exam (A) can be dangerous and should be avoided in cases of transverse lie. Initiating parenteral therapy (C) and applying oxygen (D) are not priorities in this situation as addressing the malpresentation is more urgent.
Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis?
- A. Station
- B. Flexion
- C. Descent
- D. Engagement
Correct Answer: B
Rationale: The correct answer is B: Flexion. Flexion of the fetal head is crucial for the smallest anterior-posterior diameter to enter the pelvis first. This position optimizes the fit of the fetal head through the maternal pelvis, reducing the risk of complications during labor. Station (A) refers to the level of the presenting part in the pelvis, descent (C) is the downward movement of the fetus, and engagement (D) is when the widest diameter of the fetal head passes through the maternal pelvic inlet. However, these factors do not specifically address the orientation of the fetal head to ensure the smallest diameter enters the pelvis.