Nokea
The nurse is caring for a client in the second stage of labor. What finding indicates that birth is imminent?
- A. Cervix is fully dilated.
- B. Contractions every 2 minutes.
- C. Fetal heart rate of 140 beats/minute.
- D. Crowning is observed.
Correct Answer: D
Rationale: Crowning, or the appearance of the fetal head at the vaginal opening, indicates that birth is imminent.
You may also like to solve these questions
A nurse is teaching a client who is 28 weeks of gestation and not up-to date on current immunization. Which of the following immunizations should the nurse inform the client to anticipate receiving following birth?
- A. Pneumococcal
- B. Hepatitis
- C. Human papillomavirus
- D. Rubella
Correct Answer: D
Rationale: The CDC recommends that women who are not up-to-date with the MMR (measles, mumps, rubella) vaccine should receive it immediately postpartum. Rubella, also known as German measles, is particularly important during pregnancy because contracting rubella during pregnancy can lead to serious complications in the baby, such as birth defects and miscarriage. By ensuring the client receives the MMR vaccine postpartum, it helps protect both the mother and any future pregnancies from the risk of rubella infection.
The nurse is describing different types of abruptio placenta to a group of students explaining that the incomplete abruptio placenta is
- A. There is massive bleeding in the presence of almost total separation
- B. Separation beginning at the periphery of the placenta
- C. The placenta separates centrally and there can be concealed bleeding
- D. Blood passes between the fetal membrane of the uterine wall and is skipped vaginally
Correct Answer: B
Rationale: In incomplete abruptio placenta, the separation begins at the periphery of the placenta. This results in partial detachment of the placenta from the uterine wall, rather than almost total separation as seen in complete abruptio placenta. This type of abruptio placenta may present with vaginal bleeding depending on the extent of separation and may lead to various degrees of maternal and fetal compromise.
A patient who has an LNG-IUC in place calls the office and states she just took a pregnancy test, and it is positive. She comes in for a visit, and the nurse does another pregnancy test, which is positive. What does the nurse know that the clinician will inform the patient regarding the IUC?
- A. Removing the IUC may increase the chance of infertility.
- B. The fetus is at risk for congenital defects.
- C. The IUC needs to be removed regardless of the plans for this pregnancy.
- D. There is no risk to the fetus if the IUC is left in place.
Correct Answer: D
Rationale: The correct statement the nurse knows that the clinician will inform the patient regarding the LNG-IUC is that there is no risk to the fetus if the IUC is left in place. The LNG-IUC (levonorgestrel-releasing intrauterine system) is a highly effective form of contraception that works by releasing progesterone locally in the uterus. The hormonal effect of the LNG-IUC is mostly limited to the uterus and very little of it circulates systemically. Therefore, there is no known increased risk of congenital defects or harm to the fetus if the IUC is left in place during pregnancy. The IUC can be left in place if the patient chooses to continue the pregnancy, provided there are no signs of infection or other complications that would necessitate its removal.
Which of the following is true about the three layers juries, and parents are concerned about the long-term of involuntary smooth muscles of the uterus?
- A. Designed to provide expansion of the growing fetus.
- B. Meant to inhibit the contraction of the uterus
- C. These injuries require immediate surgery. prior to the onset of labor.
- D. Your child will have permanent paralysis.
Correct Answer: A
Rationale: The correct statement about the three layers juries, and parents are concerned about the long-term of involuntary smooth muscles of the uterus is that they are designed to provide expansion of the growing fetus. The three layers of the uterus, consisting of the perimetrium, myometrium, and endometrium, play essential roles during pregnancy. The myometrium, which is the middle layer of the uterus, contains involuntary smooth muscle fibers that contract during labor to help expel the fetus. These muscles are designed to expand and contract to accommodate the growing fetus during pregnancy and aid in the birthing process.
A client has just given birth, during labor the fetus was in brow presentation, but after prolonged laboring the fetus convert to occiput presentation and was delivered vaginally by vacuum extraction
- A. What should be explained
- B. Molding of the head will subside in a few days
- C. Meconium aspiration
- D. Infant will have prophylactic antibiotic
Correct Answer: A
Rationale: In this scenario, it is important to explain to the client what happened during labor and delivery. It is essential to communicate that the fetus was in a brow presentation initially, which can sometimes lead to complications during labor. However, the fetus converted to occiput presentation and was successfully delivered vaginally with the help of vacuum extraction. Providing this information to the client helps in ensuring transparency and understanding of the events that occurred, addressing any concerns or questions they may have about the delivery process.