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The patient with which vaginal exam is most at risk for an umbilical cord prolapse?
- A. 1-2 cm dilated, 70% effaced, -1 station
- B. 5 cm dilated, 60% effaced, -3 station
- C. 7-8 cm dilated, 80% effaced, -2 station
- D. 9 cm dilated, 100% effaced, 0 station
Correct Answer: B
Rationale: The correct answer is B because a patient who is 5 cm dilated, 60% effaced, and at -3 station is most at risk for an umbilical cord prolapse. At this stage, the presenting part of the baby is not well engaged in the pelvis, increasing the likelihood of the cord slipping down in front of the baby. This can lead to compression of the cord during labor, which is a serious obstetric emergency.
Choice A is less likely as the baby is only at -1 station and not as far down in the pelvis. Choice C also has the baby at a higher station (-2) and more dilated, which may help secure the baby's position. Choice D is the least likely as the baby is fully engaged at 0 station, reducing the risk of cord prolapse.
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The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session? (Select all that apply.)
- A. Progesterone levels become higher than estrogen levels.
- B. Natural oxytocin in conjunction with other substances plays a role
- C. Stretching, pressure, and irritation of the uterus and cervix increase
- D. The secretion of prostaglandins from the fetal membranes decreases.
Correct Answer: B
Rationale: The correct answer is B: Natural oxytocin in conjunction with other substances plays a role in the initiation of labor. Oxytocin is a key hormone that stimulates uterine contractions during labor. Its release is crucial for the progression of labor. Other substances, such as prostaglandins, also play a role in initiating labor by softening the cervix and promoting contractions.
Rationale:
1. Oxytocin is a well-known hormone that directly stimulates uterine contractions, leading to the initiation of labor.
2. Prostaglandins are also important in preparing the cervix for labor and promoting contractions, which contradicts option D.
3. Progesterone levels decreasing and estrogen levels increasing typically signal the onset of labor, which contradicts option A.
4. Factors like stretching, pressure, and irritation of the uterus and cervix are more related to the progression of labor rather than the initiation, which contradicts option C.
In summary
The nurse is explaining the physiology of uterine contractions to a group of nursing students. Which statement best explains the maternal-fetal exchange of oxygen and waste products during a contraction?
- A. Little to no affect
- B. Increases as blood pressure decreases
- C. Diminishes as the spiral arteries are compressed
- D. Continues except when placental functions are reduced
Correct Answer: D
Rationale: Rationale for Correct Answer (D):
- During uterine contractions, placental blood flow may be temporarily reduced but not completely halted.
- Fetal-maternal exchange of oxygen and waste products continues to occur even during contractions.
- This is because the placenta acts as a continuous filter, allowing exchange to happen unless placental functions are severely compromised.
Summary of Other Choices:
A: Incorrect. There is an effect on maternal-fetal exchange during contractions.
B: Incorrect. Increased blood pressure does not necessarily correlate with increased exchange.
C: Incorrect. Compression of spiral arteries may impact blood flow but does not completely stop exchange.
A sterile vaginal examination completed on a patient revealed the presenting part to be the mentum. What is this presentation known as?
- A. Face presentation
- B. Breech presentation
- C. Vertex presentation
- D. Shoulder presentation
Correct Answer: A
Rationale: The correct answer is A: Face presentation. In this presentation, the mentum (chin) is the presenting part. The chin is the prominent part of the face, making it a face presentation. In a face presentation, the fetus is in a position where the head is extended rather than flexed. This can lead to complications during delivery.
Summary:
B: Breech presentation - In breech presentation, the baby's buttocks or feet are the presenting part.
C: Vertex presentation - In vertex presentation, the baby's head is the presenting part with the chin tucked towards the chest.
D: Shoulder presentation - In shoulder presentation, the baby is positioned transversely in the uterus with one or both shoulders presenting first.
A primigravida has just been examined. The examination revealed engagement of the fetal head. The nurse is aware that this means which of the following?
- A. The biparietal diameter of the fetal head is at the level of the ischial spines.
- B. The biparietal diameter of the fetal head is at –2 station.
- C. The fetal head is well flexed.
- D. The fetal head is unable to pass under the pubic arch.
Correct Answer: A
Rationale: The correct answer is A because engagement of the fetal head means the widest part of the head (biparietal diameter) is at the level of the ischial spines, indicating the head has descended into the pelvis. Choice B is incorrect as -2 station refers to the presenting part being 2 cm above the ischial spines, not at the level. Choice C is incorrect because engagement does not necessarily mean the head is well flexed. Choice D is incorrect as the ability of the head to pass under the pubic arch is not determined solely by engagement.
What is a direct influence on cervical dilation? Select all that apply.
- A. positioning of the pregnant person
- B. strength of uterine contractions
- C. length of time since ROM
- D. fetal presentation
Correct Answer: A
Rationale: The correct answer is A: positioning of the pregnant person. The position of the pregnant person can directly influence cervical dilation by affecting the alignment of the uterus and baby, allowing for optimal pressure on the cervix. Proper positioning can facilitate the descent of the baby's head onto the cervix, promoting dilation.
Summary of why other choices are incorrect:
B: The strength of uterine contractions indirectly influences cervical dilation by aiding in the effacement and descent of the baby, but it does not directly impact dilation.
C: The length of time since ROM (rupture of membranes) can affect the risk of infection but does not directly influence cervical dilation.
D: Fetal presentation refers to the position of the baby in the uterus and can affect labor progress, but it does not directly impact cervical dilation.