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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 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 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 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.
The nurse is caring for a patient during induction of labor. The oxytocin is currently infusing at 6 mU/min. The fetal heart tracing displays a 130 baseline, moderate variability, and no accelerations or decelerations. Uterine contractions have been every 2 minutes for the last 30 minutes. What is the nurse’s next best action?
- A. Reduce the oxytocin infusion to 3 mU/min
- B. Delay the next scheduled oxytocin increase
- C. Maintain infusion at 6 mU/min
- D. Discontinue the oxytocin infusion
Correct Answer: C
Rationale: The fetal heart rate (FHR) is stable, with moderate variability and no decelerations, indicating that the fetus is not in distress. The contractions are occurring at appropriate intervals, so the nurse should maintain the current oxytocin infusion to continue labor progression.
Which clinical finding should the nurse expect to assess in the third stage of labor that indicates the placenta has separated from the uterine wall? (Select all that apply.)
- A. A gush of blood appears.
- B. The uterus rises upward in the abdomen.
- C. The fundus descends below the umbilicus.
- D. The cord descends further from the vagin
Correct Answer: C
Rationale: A. A gush of blood appears: This clinical finding is indicative of the placenta detaching from the uterine wall and the subsequent expulsion. The sudden release of a significant amount of blood is expected as the placenta separates.