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 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.
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Which criteria should be verified prior to vacuum or forceps use? Select all that apply.
- A. The woman’s bladder is empty.
- B. The fetus must be at least 34 weeks gestation.
- C. There is a Category I tracing.
- D. The cervix must be completely dilated.
Correct Answer: B
Rationale: The correct answer is B: The fetus must be at least 34 weeks gestation. This is because using vacuum or forceps delivery before 34 weeks gestation can increase the risk of complications for both the mother and the baby. For the other choices:
A: The woman’s bladder being empty is not a specific criteria for vacuum or forceps use.
C: A Category I tracing is related to fetal heart monitoring and does not directly impact the decision to use vacuum or forceps.
D: While it is ideal for the cervix to be completely dilated before vacuum or forceps use, it is not the primary criteria to be verified.
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 (A uterine resting tone of 30 mm Hg) because a high uterine resting tone indicates uterine hyperstimulation, which can lead to uterine rupture, fetal distress, and compromised blood flow to the placenta. A higher resting tone of 30 mm Hg is concerning compared to the normal range of 12-18 mm Hg.
Choice A (A uterine resting tone of 17 mm Hg) is within the normal range, so it is not as concerning as a higher resting tone.
Choices C (Contractions every 3 minutes lasting 60 seconds) and D (Contractions every 5 minutes lasting 60 seconds) describe the frequency and duration of contractions, which are important but are not as immediately concerning as a high uterine resting tone.
A patient who is 8 cm dilated develops circumoral numbness and dizziness. What is the nurse’s priority intervention?
- A. Call the health care provider immediately.
- B. Increase intravenous fluid, as these are signs of hypovolemia.
- C. Have the patient slow down her breathing.
- D. Have her start pushing, as these are signs of the beginning of the second stage.
Correct Answer: C
Rationale: The correct answer is C: Have the patient slow down her breathing. Circumoral numbness and dizziness are signs of hyperventilation, which can occur due to rapid breathing during labor. Slowing down the patient's breathing helps prevent respiratory alkalosis and promotes proper oxygenation for both the mother and the baby. Calling the health care provider immediately (A) may cause a delay in addressing the immediate issue. Increasing IV fluids (B) may not address the root cause of the symptoms. Having her start pushing (D) prematurely can be harmful if she is not fully dilated.
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.
When does the active phase of labor begin according to ACOG?
- A. 6 cm
- B. 3 cm
- C. 5 cm
- D. 10 cm
Correct Answer: A
Rationale: The active phase of labor according to ACOG begins at 6 cm dilation. At this point, contractions become stronger and more frequent, leading to faster cervical dilation. This stage signifies significant progress towards delivery. Choice B (3 cm) is incorrect as it falls within the early phase of labor. Choice C (5 cm) is also incorrect as it is near the beginning of the active phase but not the specific transition point. Choice D (10 cm) is incorrect as it marks full dilation and the transition to the second stage of labor.