Nokea
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.
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Which woman is the best candidate for a trial of labor after cesarean (TOLAC)?
- A. A 34-year-old gravida 2, para 1 with one previous classical cesarean section for prematurity
- B. A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD
- C. A 31-year-old gravida 4, para 2 with one previous low-transverse cesarean section for late decelerations
- D. A 27-year-old gravida 3, para 2 with one previous T-shaped incision for macrosomia
Correct Answer: B
Rationale: Rationale for Choice B (Correct Answer):
- A 21-year-old gravida 2, para 1 with one previous low-transverse cesarean section for CPD is the best candidate for TOLAC.
- Low-transverse incisions have the lowest risk of uterine rupture during labor.
- CPD is not a contraindication for TOLAC.
- Young age and low parity are favorable factors for successful TOLAC.
- Therefore, this candidate has the highest likelihood of a successful VBAC.
Summary for Other Choices:
- Choice A: Classical cesarean section carries a high risk of uterine rupture; prematurity increases this risk.
- Choice C: Low-transverse incision is favorable, but the indication for the previous cesarean (late decelerations) may indicate an ongoing fetal concern.
- Choice D: T-shaped incision increases the risk of uterine rupture; macrosomia is a risk factor for failed TOL
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. When a patient is 8 cm dilated and experiences circumoral numbness and dizziness, these are signs of hyperventilation caused by rapid breathing. Hyperventilation can lead to respiratory alkalosis, which can have serious implications for both the mother and baby. By having the patient slow down her breathing, it can help restore the balance of oxygen and carbon dioxide levels in the blood, reducing the risk of complications. Calling the healthcare provider immediately (choice A) may cause delay in addressing the immediate issue. Increasing intravenous fluid (choice B) is not indicated as the symptoms are not suggestive of hypovolemia. Having her start pushing (choice D) is not advisable as she is not fully dilated, and pushing prematurely can lead to complications.
When does the active phase of labor begin according to ACOG?
- A. 6 cm
- B. 3 cm
- C. 5 cm
- D. 10 cm
Correct Answer: A
Rationale: The active phase of labor begins at 6 cm dilation according to ACOG guidelines. At this point, the cervix is significantly dilated, signaling the transition to active labor. This stage is crucial as it signifies the acceleration of labor progress and typically involves stronger contractions leading to efficient cervical dilation. Choices B, C, and D are incorrect as they do not align with the established criteria for the active phase of labor. Choice B (3 cm) is too early for active labor, choice C (5 cm) is close but not quite at the threshold for active labor, and choice D (10 cm) is actually the full dilation stage, not the beginning of active labor. Hence, choice A (6 cm) is the correct answer.
The labor and delivery nurse is caring for a 27-year-old primigravida with the following vaginal exam: 2 to 3 cm dilated/70% effaced/-2 station. For the last 2 hours the FHR tracing has displayed a Category I tracing and uterine contractions that are every 2 minutes. The contractions are strong to palpation and the patient is now 3/70%/-2. Which is the nurse’s next best action?
- A. Encourage the patient to ambulate
- B. Request orders to initiate oxytocin
- C. Assist the patient to a warm bath
- D. Document the findings
Correct Answer: D
Rationale: The correct answer is D, documenting the findings. In this scenario, the patient is in active labor with regular strong contractions, cervical change, and a reassuring fetal heart rate tracing. The priority is to document these important clinical findings accurately for proper assessment and monitoring of progress. Encouraging ambulation (A) may not be safe due to the frequency and strength of contractions. Initiating oxytocin (B) is unnecessary as labor is progressing well on its own. Assisting the patient to a warm bath (C) may provide comfort but is not the most critical action at this time.
A gravida 3, para 2 is attempting a vaginal birth without the use of pain medicine or anesthesia. Following spontaneous rupture of membranes, the patient’s cervical exam was 5 cm dilated, 60% effaced, -2 station. Which therapeutic intervention is appropriate for this patient?
- A. Ambulation with assistance
- B. Squatting with support from partner
- C. Sitting on birthing ball
- D. Resting on hands and knees
Correct Answer: C
Rationale: The correct answer is C: Sitting on birthing ball. This position helps to open up the pelvis, allowing gravity to assist in descent of the baby. It also promotes optimal positioning for the baby, reducing the risk of malpresentation. The other choices (A, B, D) do not provide the same benefits in terms of promoting optimal fetal positioning and utilizing gravity to aid in labor progress. Ambulation with assistance may not provide as much support for the pelvis, squatting with support from the partner may not be as stable or comfortable for the mother, and resting on hands and knees may not encourage as much engagement of the baby's head in the pelvis.