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A nurse is caring for a laboring person who has been pushing for several hours without progress. What is the most appropriate intervention?
- A. perform a cesarean section
- B. assist with vacuum extraction
- C. perform an emergency cesarean
- D. assist with forceps delivery
Correct Answer: B
Rationale: The correct answer is B: assist with vacuum extraction. This intervention is appropriate when prolonged pushing has not resulted in progress during labor. Vacuum extraction helps facilitate the delivery of the baby by applying suction to the baby's head to assist with pulling them out. It is less invasive than a cesarean section and forceps delivery, making it a safer option in this scenario. Performing a cesarean section (choices A and C) would be considered if vacuum extraction is unsuccessful or contraindicated due to specific factors. Forceps delivery (choice D) is another option but is generally considered more invasive and carries higher risks compared to vacuum extraction.
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A woman who has had multiple cesarean sections is in labor. What is the most important complication to monitor for?
- A. Uterine rupture
- B. Precipitous labor
- C. Maternal hypotension
- D. Fetal malpresentation
Correct Answer: A
Rationale: Correct Answer: A: Uterine rupture
Rationale:
1. History of multiple cesarean sections increases the risk of uterine rupture.
2. Uterine rupture is a life-threatening complication for both mother and baby.
3. Signs include sudden severe abdominal pain, fetal distress, and hemodynamic instability.
4. Immediate intervention is crucial to prevent adverse outcomes.
Summary:
B: Precipitous labor - Quick labor is not specifically associated with multiple cesarean sections.
C: Maternal hypotension - Important but not the most critical complication in this scenario.
D: Fetal malpresentation - While important, it is not the most immediate concern compared to uterine rupture.
A patient at 40 weeks gestation is admitted with spontaneous rupture of membranes. What is the first priority action?
- A. Perform a vaginal examination to assess for cord prolapse
- B. Start an IV and administer antibiotics
- C. Monitor fetal heart rate for decelerations
- D. Check the amniotic fluid for meconium staining
Correct Answer: A
Rationale: The correct answer is A: Perform a vaginal examination to assess for cord prolapse. This is the first priority action because cord prolapse is a life-threatening emergency that requires immediate intervention to prevent fetal compromise. By performing a vaginal examination, the healthcare provider can quickly determine if the umbilical cord is presenting before the fetus, allowing for prompt management.
Choice B is incorrect because starting an IV and administering antibiotics is important but not the first priority in this situation. Choice C is incorrect as monitoring fetal heart rate for decelerations is essential but not as urgent as assessing for cord prolapse. Choice D is also incorrect as checking for meconium staining is important but does not take precedence over assessing for cord prolapse.
How should the nurse respond to a concern about alcohol exposure during conception?
- A. Inform the doctor
- B. Reassure it's unlikely the baby was affected
- C. Suggest abortion
- D. Recommend ultrasound
Correct Answer: B
Rationale: Occasional alcohol exposure around conception is unlikely to cause significant harm, though ongoing abstinence is advised.
The nurse is caring for a pregnant patient at 32 weeks gestation who reports feeling lightheaded and faint when standing. What should the nurse recommend?
- A. Increase fluid intake and avoid standing for long periods.
- B. Take deep breaths and rise quickly from a seated position.
- C. Rest and avoid any physical activity during the day.
- D. Sit upright and avoid bending forward at the waist.
Correct Answer: A
Rationale: The correct answer is A: Increase fluid intake and avoid standing for long periods. This recommendation is appropriate for the patient's symptoms of lightheadedness and fainting, which could be due to dehydration or low blood pressure common in pregnancy. Increasing fluid intake can help maintain adequate blood volume and pressure. Avoiding prolonged standing can prevent pooling of blood in the lower extremities, reducing the risk of dizziness.
Choices B, C, and D are incorrect:
B: Taking deep breaths and rising quickly may worsen symptoms by causing a sudden drop in blood pressure.
C: Complete rest and avoiding physical activity may not address the underlying issue of hydration or blood pressure.
D: Sitting upright and avoiding bending forward may not directly address the need for increased fluid intake and reduced standing time.
A nurse is educating a pregnant patient about the signs of preterm labor. Which of the following should the nurse include in the teaching plan?
- A. Frequent, regular contractions every 10 minutes or less.
- B. Decreased fetal movement and back pain.
- C. Mild cramping and occasional vaginal spotting.
- D. Headaches and blurred vision, especially after physical activity.
Correct Answer: A
Rationale: The correct answer is A because frequent, regular contractions every 10 minutes or less are a classic sign of preterm labor, indicating the need for immediate medical attention. Decreased fetal movement and back pain (choice B) are not specific signs of preterm labor. Mild cramping and occasional vaginal spotting (choice C) could be normal in pregnancy or may indicate other issues, but they are not definitive signs of preterm labor. Headaches and blurred vision (choice D) are more indicative of preeclampsia, a separate condition from preterm labor. Therefore, choice A is the most accurate and specific sign to include in the teaching plan for preterm labor.