Nokea
The nurse is providing discharge instructions to a person who was evaluated for possible labor. How does the nurse explain how losing the mucus plug could be a sign of impending labor?
- A. The mucus plug starts to be expelled due to increased estrogen before contractions begin.
- B. The mucus plug is expelled after the membranes rupture during labor.
- C. Effacement and dilation of the cervix decrease the area where the mucus plug sits.
- D. Labor is unable to begin until the mucus plug is expelled and creates a space for the fetus.
Correct Answer: A
Rationale: The correct answer is A because the mucus plug is expelled due to increased estrogen levels before contractions start. Estrogen stimulates the production of mucus that forms the plug, which is then released as a result of hormonal changes signaling the body to prepare for labor. This process occurs before labor contractions begin.
Choice B is incorrect because the mucus plug is typically expelled before the membranes rupture during labor.
Choice C is incorrect because effacement and dilation of the cervix do not directly cause the expulsion of the mucus plug.
Choice D is incorrect because labor can begin even if the mucus plug has not been expelled, and the plug itself does not create a space for the fetus.
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What changes in hormones initiate labor?
- A. decreased progesterone, decreased estrogen, absence of oxytocin
- B. increased progesterone, decreased estrogen, absence of oxytocin
- C. increased progesterone, decreased estrogen, presence of oxytocin
- D. decreased progesterone, increased estrogen, effects of oxytocin
Correct Answer: D
Rationale: The correct answer is D because decreased progesterone, increased estrogen, and the effects of oxytocin are the hormonal changes that initiate labor. Progesterone inhibits contractions, so its decrease allows labor to begin. Estrogen promotes uterine sensitivity to oxytocin, which stimulates contractions. Oxytocin is released in response to labor contractions and helps to strengthen contractions.
A: Incorrect because decreased progesterone is needed for labor to start, estrogen needs to increase, and oxytocin is present during labor.
B: Incorrect because increased progesterone inhibits labor, estrogen should increase, and oxytocin is present during labor.
C: Incorrect because progesterone should decrease, estrogen should increase, and oxytocin is present during labor.
A patient who is 8 cm dilated develops circumoral numbness and dizziness. What is the nurse’s priority intervention?
- A. Call the health care provider immediately.
- B. Increase intravenous fluid, as these are signs of hypovolemia.
- C. Have the patient slow down her breathing.
- D. Have her start pushing, as these are signs of the beginning of the second stage.
Correct Answer: C
Rationale: The correct answer is C: Have the patient slow down her breathing. Circumoral numbness and dizziness are signs of hyperventilation, which can occur due to rapid breathing during labor. Slowing down the patient's breathing helps prevent respiratory alkalosis and promotes proper oxygenation for both the mother and the baby. Calling the health care provider immediately (A) may cause a delay in addressing the immediate issue. Increasing IV fluids (B) may not address the root cause of the symptoms. Having her start pushing (D) prematurely can be harmful if she is not fully dilated.
What changes in hormones initiate labor?
- A. decreased progesterone, decreased estrogen, absence of oxytocin
- B. increased progesterone, decreased estrogen, absence of oxytocin
- C. increased progesterone, decreased estrogen, presence of oxytocin
- D. decreased progesterone, increased estrogen, effects of oxytocin
Correct Answer: D
Rationale: The correct answer is D because during labor, progesterone levels decrease, estrogen levels increase, and oxytocin plays a key role in initiating contractions. Progesterone inhibits contractions, so its decrease is necessary for labor to start. Estrogen helps stimulate uterine contractions. Oxytocin, released from the brain, triggers and enhances contractions.
Option A is incorrect because an absence of oxytocin would not initiate labor. Option B is incorrect because increased progesterone would inhibit labor. Option C is incorrect because oxytocin is needed to initiate labor.
Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis?
- A. Station
- B. Flexion
- C. Descent
- D. Engagement
Correct Answer: B
Rationale: Flexion is the correct answer. During labor, fetal head flexion allows the smallest anterior-posterior diameter of the head to enter the pelvis first, reducing the risk of cephalopelvic disproportion. Station refers to the level of the presenting part in the maternal pelvis, not the head orientation. Descent is the downward movement of the fetus in the birth canal, not related to head position. Engagement occurs when the widest part of the presenting part reaches the level of the maternal ischial spines, not specifically related to the orientation of the fetal head.
The primary difference between the labor of a nullipara and that of a multipara is
- A. total duration of labor.
- B. level of pain experience
- C. amount of cervical dilation.
- D. sequence of labor mechanisms.
Correct Answer: A
Rationale: The correct answer is A: total duration of labor. Nullipara refers to a woman giving birth for the first time, while multipara refers to a woman who has given birth multiple times. The primary difference between their labors is the total duration. Nulliparas typically have longer labors due to the body's first experience with childbirth. The other choices (B, C, D) are not the primary difference between nullipara and multipara labors. Pain experience, cervical dilation, and labor mechanisms can vary based on individual factors, but the key distinction lies in the overall duration of labor based on parity.