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What is the function of contractions during the second stage of labor?
- A. Align the infant into the proper position for delivery.
- B. Dilate and efface the cervix.
- C. Push the infant out of the mother's body.
- D. Separate the placenta from the uterine wall.
Correct Answer: C
Rationale: The contractions push the infant out of the mother's body as the second stage of labor ends with the birth of the infant.
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What is the nurse primarily concerned about maintaining in the initial care of the newborn?
- A. Fluid intake
- B. Feeding schedule
- C. Thermoregulation
- D. Parental bonding
Correct Answer: C
Rationale: Thermoregulation is necessary to keep heat loss minimal and oxygen consumption low. Hypothermia can cause cold stress, which leads to hypoxia.
It is determined that the presenting part of the fetus is the buttocks. At delivery the fetus's hips are flexed and the knees are extended. How would the nurse record this presentation?
- A. Complete breech
- B. Frank breech
- C. Double footing
- D. Buttocks presentation
Correct Answer: B
Rationale: When a fetus presents in a frank breech position, the legs are flexed at the hips and extend toward the shoulders.
What is the best nursing action to implement when late decelerations occur?
- A. Reposition the patient to supine.
- B. Decrease flow of intravenous (IV) fluids.
- C. Increase oxygen to 10 L/minute.
- D. Prepare to increase oxytocin drip.
Correct Answer: C
Rationale: The major objective of care for late decelerations is to increase maternal oxygen. IV fluids are increased, oxytocin drips are stopped, and the patient is positioned to prevent supine hypotension.
The nurse knows that what indicates the beginning of true labor?
- A. Contractions that are relieved by walking
- B. Discomfort in the abdomen and groin
- C. A decrease in vaginal discharge
- D. Regular contractions becoming more frequent and intense
Correct Answer: D
Rationale: In true labor, contractions gradually develop a regular pattern and become more frequent, longer, and more intense.
At 1 and 5 minutes of life, a newborn's Apgar score is 9. What does the nurse understand that a score of 9 indicates?
- A. The newborn will require resuscitation.
- B. The newborn may have physical disabilities.
- C. The newborn will have above average intelligence.
- D. The newborn is in stable condition.
Correct Answer: D
Rationale: Apgar scoring evaluates the infant's need for resuscitation. A score of 9 indicates that the newborn is stable.