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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.
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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.
How can a nurse support the patient during the fourth stage of labor?
- A. Support pushing efforts with feedback on how much progress is being made
- B. Ensure epidural anesthesia is adequate for pain control, reposition frequently, provide dietary intake per provider's order.
- C. Assess for any bleeding or amniotic fluid presence in the vaginal discharge
- D. Provide rest, space, and time for bonding between assessments, support for feeding
preferences, diligent monitoring for complications, pain management.
Correct Answer: D
Rationale: During the fourth stage of labor, it is important for the nurse to provide a supportive and nurturing environment for the mother and baby. This stage occurs immediately after the baby is born and lasts for about 2 hours. The mother may be exhausted from the physical effort of labor and delivery, so providing rest, space, and time for bonding between assessments is crucial. The nurse should also support the mother's feeding preferences, whether it is breastfeeding or formula feeding. Diligent monitoring for complications, such as postpartum hemorrhage or infection, is essential during this stage. Additionally, providing adequate pain management for any discomfort the mother may be experiencing is important.
On admission to the labor unit, a primigravid woman at 38 weeks gestation states, “I need to urinate more now but at least I can breathe easier.” The nurse is aware that this is likely due to which physiological process?
- A. Onset of labor
- B. Effacement
- C. Lightening
- D. Rupture of membranes
Correct Answer: C
Rationale: Increased urination and easier breathing are signs of lightening, where the fetal head drops lower into the pelvis.
A 24-year-old G4 T1 A2 L1 presents to obstetric triage with complaints of contractions every 3 minutes, accompanied by bright red vaginal bleeding. The woman is 29 weeks gestation with a twin pregnancy. She has had three urinary tract infections during this pregnancy and is currently taking Microbid daily as prophylaxis. Her last baby was born via cesarean section for breech malpresentation. She denies any other significant medical history. What risk factors for placenta previa does this patient have? Select all that apply.
- A. Maternal age of 24
- B. Twin gestation
- C. Gestational age of 29 weeks
- D. Previous delivery by cesarean section
Correct Answer: D
Rationale: The patient's age, history of cesarean section, and twin gestation all contribute to an increased risk of placenta previa. The most significant risk factor here is the previous cesarean section, which can cause scarring and increase the likelihood of abnormal placental implantation.
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.