Nokea
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 a complete breech presentation, the fetus is positioned with its head in the fundus, hips flexed, and knees flexed. This position is unique to the complete breech presentation. A: Frank breech would have the hips flexed, but the knees extended. C: Vertex position is when the head is down towards the birth canal. D: Transverse is when the fetus is lying horizontally across the uterus. Therefore, based on the description provided in the question, the correct answer is B as it matches the specific presentation described.
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The nurse is planning care for a patient during the fourth stage of labor. Which interventions should the nurse plan to implement? (Select all that apply.)
- A. Offer the patient a warm blanket.
- B. Place an ice pack on the perineum.
- C. Massage the uterus if it is boggy.
- D. Delay breastfeeding until the patient is reste
Correct Answer: A
Rationale: The correct answer is A: Offer the patient a warm blanket. In the fourth stage of labor, the mother experiences postpartum hemorrhage risk due to uterine atony. Keeping the patient warm helps prevent hypothermia, which can lead to increased bleeding. Ice packs (B) are not indicated as they can cause vasoconstriction and inhibit proper blood flow. Massaging the uterus (C) is appropriate in the third stage of labor to prevent hemorrhage but not in the fourth stage. Delaying breastfeeding (D) is incorrect as early breastfeeding promotes uterine contractions, reducing the risk of postpartum hemorrhage.
Which explains why infants who are delivered via cesarean section before the start of labor have more difficulty transitioning to extrauterine life?
- A. The use of warm IV fluids precipitates hyperthermia.
- B. Regional anesthesia causes respiratory depression.
- C. The maternal left tilt position reduces placental blood flow.
- D. Residual amniotic fluid in the lungs makes spontaneous respirations difficult.
Correct Answer: D
Rationale: The correct answer is D because residual amniotic fluid in the lungs can lead to a condition called transient tachypnea of the newborn (TTN), making spontaneous respirations difficult. This occurs more commonly in infants born via cesarean section before the onset of labor as they may not have had the opportunity to expel the fluid through the vaginal passage. A: Warm IV fluids can help maintain normal body temperature. B: Regional anesthesia may not directly cause respiratory depression in the infant. C: Maternal left tilt position is used to improve blood flow during labor, not relevant to respiratory issues in the newborn.
The nurse is assessing a patient in the active phase of labor. What should the nurse expect during this phase?
- A. The patient is sociable and excite
- B. The patient is requesting pain medication.
- C. The patient begins to experience the urge to push.
- D. The patient experiences loss of control and irritability.
Correct Answer: C
Rationale: During the active phase of labor, contractions become stronger and more frequent, leading to cervical dilation. This is when the patient typically experiences the urge to push as the cervix reaches around 7-10 cm dilation. This signifies progress towards the second stage of labor. Choices A, B, and D are incorrect as they do not specifically align with the characteristics of the active phase of labor. A patient may exhibit a range of emotions and behaviors during labor, but the key indicator of the active phase is the urge to push due to cervical dilation.
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. In the second stage of labor, the cervix is fully dilated, and the woman experiences the urge to push. The intense rectal pressure reported by the patient indicates the baby's descent into the birth canal, a characteristic of the second stage. In contrast, in the first stage (choices A and C), the cervix is still dilating, and in the fourth stage (choice D), immediate postpartum period, the focus is on maternal stabilization.
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).