Nokea
A patient admitted to the labor unit asks the nurse to discuss the episiotomy procedure with her. Which is true regarding episiotomy?
- A. An episiotomy is required for all vaginal births.
- B. A midline episiotomy is associated with more third- and fourth-degree lacerations.
- C. A mediolateral episiotomy is easier to repair than a medial episiotomy.
- D. A midline episiotomy is associated with more blood loss.
Correct Answer: B
Rationale: A midline episiotomy is not required for all vaginal births, but it is associated with more third- and fourth-degree lacerations.
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While attending the delivery of a patient with GODM, the nurse notices the retraction of the fetal head onto the perineum. What is the nurse’s next best action?
- A. Apply fundal pressure
- B. Assist the woman to left lateral position
- C. Flex the mother to left lateral position
- D. Assist the woman to hands-and-knees position
Correct Answer: D
Rationale: The retraction of the fetal head onto the perineum during labor can be indicative of shoulder dystocia or other obstructive complications, requiring immediate action. The best response is to assist the mother into hands-and-knees position, which can relieve pressure on the perineum and help with fetal descent.
Which assessment finding indicates that cervical dilation and/or effacement has occurred?
- A. Onset of irregular contractions
- B. Cephalic presentation at 0 station
- C. Bloody mucus drainage from vagina
- D. Fetal heart tones (FHTs) present in the lower right quadrant
Correct Answer: C
Rationale: Bloody mucus drainage from the vagina, also known as "bloody show," is a common sign that indicates cervical dilation and/or effacement has occurred in anticipation of labor. This occurs as the mucus plug, which seals the cervix during pregnancy, is released as the cervix begins to soften, dilate, and efface in preparation for childbirth. This physical change in the cervix is a significant indicator that labor is approaching. The other options listed do not directly indicate cervical changes associated with labor progression like the presence of bloody mucus drainage does.
A fetus is in the occiput anterior position. During the cardinal movement of extension, which events are occurring? Select all that apply.
- A. The fetal head lines up with the pelvic outlet.
- B. The occiput passes under the symphysis pubis.
- C. The fetal head is engaged.
- D. The head is delivered.
Correct Answer: A
Rationale: During extension, the fetal head lines up with the pelvic outlet, and the occiput passes under the symphysis pubis.
If the fetal attitude is assessed to be completely deflexed on sonogram or via Leopold's maneuvers, what presenting part do you anticipate palpating in a vaginal exam?
- A. brow
- B. breech
- C. face
- D. occiput
Correct Answer: D
Rationale: If the fetal attitude is assessed to be completely deflexed on sonogram or via Leopold's maneuvers, it means the baby is presenting in an extended position with the occiput being the lead point of the presenting part during a vaginal exam. This position is known as occiput posterior. The fetal occiput is the back of the head, and it is the optimal position for vaginal delivery as the smallest diameter of the baby's head will be presenting at the cervix, facilitating an easier descent through the birth canal.
During the second stage, what do the birthing person's vital signs most likely show?
- A. increased heart rate during contractions, baseline heart rate between contractions
- B. increased heart rate during contractions, decreased heart rate between contractions
- C. decreased heart rate during contractions, increased heart rate between contractions
- D. decreased heart rate during contractions, baseline heart rate between contractions
Correct Answer: A
Rationale: During the second stage of labor (pushing stage), the birthing person's vital signs most likely show an increased heart rate during contractions and a baseline heart rate between contractions. This increase in heart rate is a normal physiological response to the exertion and pressure of pushing during contractions. Between contractions, the heart rate should return to a more stable baseline. It is important to monitor these vital signs to ensure the well-being of both the birthing person and the baby during childbirth.