Cephalohematoma occurring from an operative vaginal delivery increased a newborn’s risk of developing which of the following complications?
- A. Bulging fontanels
- B. Developmental delays
- C. Jaundice
- D. Macrocephaly
Correct Answer: C
Rationale: Cephalohematomas are a common complication from operative vaginal deliveries. The accumulation of blood between the infant's skull and periosteum increases the risk of jaundice because of the breakdown of red blood cells, which can overwhelm the infant's immature liver and lead to hyperbilirubinemia.
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A nurse performs a vaginal examination on her patient in early labor and determines that the head is ballotable. What is this defined as?
- A. Floating
- B. Zero station
- C. +1 station
- D. -2 station
Correct Answer: A
Rationale: Ballotable means the fetal head is floating and can be pushed away from the cervix.
A fetus is positioned in the occiput anterior position. The nurse determines that the fetus is positioned in which way?
- A. The fetal shoulder is closest to the vaginal opening.
- B. The fetal head is closest to the vaginal opening and the occiput is directed toward the maternal symphysis.
- C. The fetal head is closest to the uterine fundus and is directed toward the maternal symphysis.
- D. The fetal head is closest to the vaginal opening and is directed toward the maternal sacrum.
Correct Answer: B
Rationale: The occiput anterior position means the fetal head is closest to the vaginal opening, and the occiput is directed toward the maternal symphysis.
The nurse hears the laboring patient making grunting noises. How will the nurse determine if the person is in the active second stage of labor?
- A. Assess for rupture of membranes.
- B. Assess for bloody show.
- C. Assess for dilation of the cervix.
- D. Assess for stool.
Correct Answer: C
Rationale: In the active second stage of labor, the cervix is fully dilated to 10 centimeters. Grunting noises can be a sign of the transition to the pushing stage, which occurs in the active second stage of labor. Therefore, assessing for dilation of the cervix is crucial to determine if the laboring person is in the active second stage of labor.
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.
A nurse performs a vaginal examination on her patient in early labor and determines that the head is ballotable. What is this defined as?
- A. Floating
- B. Zero station
- C. +1 station
- D. -2 station
Correct Answer: A
Rationale: Ballotable means the fetal head is floating and can be pushed away from the cervix.