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A gravida 2, para 1 is in active labor at 39 weeks gestation. Her cervical exam is 6 cm dilated, 60% effaced, and 0 station. An amniotomy is performed by the physician. The fluid is noted to be bloody and the fetal heart tones have decelerated to the 50s. What is the nurse’s next best action?
- A. Notify the operating team of emergent cesarean delivery
- B. Assist the patient to left lateral position
- C. Apply O2 at 10-12 L/min per nonrebreather
- D. Administer an IV fluid bolus
Correct Answer: A
Rationale: The correct answer is A: Notify the operating team of emergent cesarean delivery. In this scenario, the presence of bloody amniotic fluid and fetal heart rate decelerations to the 50s indicate potential fetal distress. Given the critical nature of this situation, an emergent cesarean delivery should be considered to expedite delivery and prevent further compromise to the fetus. This decision is based on the principle of prioritizing fetal well-being in situations of acute distress. Options B, C, and D do not address the immediate need for prompt intervention to ensure the safety of the fetus in distress.
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A gravida 2, para 1 is in active labor at 39 weeks gestation. Her cervical exam is 6 cm dilated, 60% effaced, and 0 station. An amniotomy is performed by the physician. The fluid is noted to be bloody and the fetal heart tones have decelerated to the 50s. What is the nurse’s next best action?
- A. Notify the operating team of emergent cesarean delivery
- B. Assist the patient to left lateral position
- C. Apply O2 at 10-12 L/min per nonrebreather
- D. Administer an IV fluid bolus
Correct Answer: A
Rationale: The correct answer is A: Notify the operating team of emergent cesarean delivery. Given the scenario of a gravida 2, para 1 in active labor with bloody fluid and fetal heart decelerations to the 50s following amniotomy, these signs indicate fetal distress. In this critical situation, immediate intervention with emergent cesarean delivery is necessary to prevent adverse outcomes for the baby. This step takes priority over other actions, as it ensures timely delivery and assessment of the fetus's well-being. Choices B, C, and D are not appropriate in this emergent situation as they do not directly address the fetal distress and the need for expedited delivery.
The nurse is explaining the physiology of uterine contractions to a group of nursing students. Which statement best explains the maternal-fetal exchange of oxygen and waste products during a contraction?
- A. Little to no affect
- B. Increases as blood pressure decreases
- C. Diminishes as the spiral arteries are compressed
- D. Continues except when placental functions are reduced
Correct Answer: D
Rationale: Rationale for Correct Answer (D):
- During uterine contractions, placental blood flow may be temporarily reduced but not completely halted.
- Fetal-maternal exchange of oxygen and waste products continues to occur even during contractions.
- This is because the placenta acts as a continuous filter, allowing exchange to happen unless placental functions are severely compromised.
Summary of Other Choices:
A: Incorrect. There is an effect on maternal-fetal exchange during contractions.
B: Incorrect. Increased blood pressure does not necessarily correlate with increased exchange.
C: Incorrect. Compression of spiral arteries may impact blood flow but does not completely stop exchange.
The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session? (Select all that apply.)
- A. Progesterone levels become higher than estrogen levels.
- B. Natural oxytocin in conjunction with other substances plays a role
- C. Stretching, pressure, and irritation of the uterus and cervix increase
- D. The secretion of prostaglandins from the fetal membranes decreases.
Correct Answer: B
Rationale: The correct answer is B: Natural oxytocin in conjunction with other substances plays a role in the initiation of labor. Oxytocin is a key hormone that stimulates uterine contractions during labor. Its release is crucial for the progression of labor. Other substances, such as prostaglandins, also play a role in initiating labor by softening the cervix and promoting contractions.
Rationale:
1. Oxytocin is a well-known hormone that directly stimulates uterine contractions, leading to the initiation of labor.
2. Prostaglandins are also important in preparing the cervix for labor and promoting contractions, which contradicts option D.
3. Progesterone levels decreasing and estrogen levels increasing typically signal the onset of labor, which contradicts option A.
4. Factors like stretching, pressure, and irritation of the uterus and cervix are more related to the progression of labor rather than the initiation, which contradicts option C.
In summary
When caring for a woman with a complete placenta previa, which finding should the nurse report to the physician?
- A. BP of 95/60
- B. Temperature of 100.1°F
- C. Urine output of 40 mL/hour
- D. O2 saturation less that 95%
Correct Answer: D
Rationale: The correct answer is D: O2 saturation less than 95%. In placenta previa, there is a risk of maternal hemorrhage, which can lead to decreased oxygen delivery to tissues. Reporting low O2 saturation is crucial as it indicates potential hypoxia, necessitating immediate intervention. Choice A (BP of 95/60) may be within normal limits. Choice B (Temperature of 100.1°F) can indicate infection but is not directly related to placenta previa. Choice C (Urine output of 40 mL/hour) may reflect renal function but is not the priority in this situation.
What makes up the powers of labor and birth?
- A. contractions and pushing efforts
- B. pelvis and pelvic floor tissues
- C. fetal position, attitude, lie, and presentation
- D. oxytocin
Correct Answer: A
Rationale: The correct answer is A: contractions and pushing efforts. During labor and birth, contractions help to dilate the cervix and push the baby down the birth canal. Pushing efforts from the mother help to expel the baby out. Pelvis and pelvic floor tissues (choice B) provide the passage for the baby but do not actively contribute to the powers of labor. Fetal position, attitude, lie, and presentation (choice C) refer to the baby's position and orientation in the womb, which can affect the progress of labor but do not constitute the powers of labor. Oxytocin (choice D) is a hormone that stimulates contractions but is not the sole component of the powers of labor and birth.