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A 35-year-old gravida 1, para 0 is admitted to the labor and delivery unit. She reports intense rectal pressure. Which stage of labor is probable?
- A. First stage, latent
- B. Second stage
- C. Third stage
- D. Fourth stage
Correct Answer: B
Rationale: The correct answer is B: Second stage. This stage of labor is characterized by full dilation of the cervix and ends with the delivery of the baby. The intense rectal pressure reported by the patient indicates that the baby is descending through the birth canal, which is a hallmark sign of the second stage. In contrast, the first stage, latent (choice A) is characterized by early labor contractions and cervical dilation up to 6 cm. The third stage (choice C) is the delivery of the placenta, and the fourth stage (choice D) is the immediate postpartum period. The key here is recognizing the specific symptom of intense rectal pressure, which aligns with the second stage of labor.
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Why is precipitous labor most often seen in multiparous women?
- A. The cervix weakens after each delivery.
- B. The cervix can dilate and efface simultaneously.
- C. The multigravida uterus is better able to coordinate muscle movements.
- D. It is more difficult for multiparous women to know when labor begins.
Correct Answer: C
Rationale: The correct answer is C because the multigravida uterus has undergone labor before, making muscle coordination more efficient. This allows for faster and more coordinated contractions, leading to precipitous labor. Choice A is incorrect because the cervix does not weaken after each delivery. Choice B is incorrect as simultaneous dilation and effacement are not specific to multiparous women. Choice D is incorrect because the ability to recognize labor onset is not a determining factor in the occurrence of precipitous labor.
The labor and delivery nurse is caring for a 27-year-old primigravida with the following vaginal exam: 2 to 3 cm dilated/70% effaced/-2 station. For the last 2 hours the FHR tracing has displayed a Category I tracing and uterine contractions that are every 2 minutes. The contractions are strong to palpation and the patient is now 3/70%/-2. Which is the nurse’s next best action?
- A. Encourage the patient to ambulate
- B. Request orders to initiate oxytocin
- C. Assist the patient to a warm bath
- D. Document the findings
Correct Answer: D
Rationale: The correct answer is D: Document the findings. In this scenario, the patient is in active labor with a Category I FHR tracing, optimal contractions, and progressing cervical dilation. Documenting the findings is important to maintain an accurate record of the patient's progress, which is crucial for monitoring labor and ensuring appropriate care. Encouraging ambulation (choice A) may be unnecessary or even unsafe given the frequency and strength of contractions. Initiating oxytocin (choice B) is not indicated as the patient is already in active labor. Assisting the patient to a warm bath (choice C) may provide comfort but is not the priority at this stage. Therefore, documenting the findings is the next best action to ensure proper documentation and monitoring of the patient's progress.
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.
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 midwife caring for a multiparous client who is 5 cm dilated requests intermittent auscultation (IA) of the fetal heart rate. The woman’s history reveals no risk factors. How often should IA be performed in this patient?
- A. Every 15 minutes
- B. Every 5 minutes
- C. Every 20 minutes
- D. Every 30 minutes
Correct Answer: A
Rationale: The correct answer is A: Every 15 minutes. During active labor, intermittent auscultation should be performed every 15 minutes for low-risk women without complications. This frequency allows for close monitoring of fetal well-being while also promoting a woman-centered approach to labor care. Choices B, C, and D are incorrect because they do not align with the standard guidelines for IA frequency during active labor. Every 5 minutes (B) is too frequent and may disrupt the woman's labor progress. Every 20 minutes (C) and every 30 minutes (D) are too far apart to ensure adequate monitoring of the fetal heart rate. Thus, choice A is the most appropriate option for this scenario.