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What type of dystocia should the nurse prepare for if she palpates prominent ischial spines during the vaginal exam?
- A. pelvic dystocia
- B. fetal dystocia
- C. contraction dystocia
- D. uterine dystocia
Correct Answer: A
Rationale: The correct answer is A: pelvic dystocia. Prominent ischial spines indicate a contracted pelvis, which can obstruct the baby's passage during labor, leading to pelvic dystocia. Pelvic dystocia involves the bony pelvis causing difficulty in the descent of the fetus. Choices B, C, and D are incorrect because fetal dystocia refers to issues related to the fetus, contraction dystocia involves ineffective contractions, and uterine dystocia pertains to abnormalities of the uterus itself, none of which are indicated by prominent ischial spines.
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A nurse is examining a G1P0 who is 10 weeks gestation. The nurse notes a bluish coloration of her cervix. The nurse should document this finding as which positive sign?
- A. Quickening
- B. Goodell’s sign
- C. Chadwick’s sign
- D. Hegar’s sign
Correct Answer: C
Rationale: The correct answer is C: Chadwick's sign. Chadwick's sign refers to the bluish coloration of the cervix due to increased vascularity in early pregnancy. This is a positive sign of pregnancy, indicating the presence of hormonal changes and increased blood flow to the cervix. Quickening is the first fetal movements felt by the mother, typically around 18-20 weeks gestation. Goodell's sign refers to the softening of the cervix, not discoloration. Hegar's sign is the softening of the lower uterine segment, also not related to discoloration. Chadwick's sign specifically describes the bluish discoloration of the cervix due to increased blood flow, making it the correct answer in this scenario.
Observation of a fetal heart rate pattern indicates an increase in heart rate from the prior baseline rate of 152 bpm. Which physiologic mechanisms would account for this situation?
- A. Inhibition of epinephrine
- B. Inhibition of norepinephrine
- C. Stimulation of the vagus nerve
- D. Sympathetic stimulation
Correct Answer: D
Rationale: The correct answer is D: Sympathetic stimulation. Sympathetic stimulation increases heart rate by releasing norepinephrine, which acts on beta-adrenergic receptors in the heart. This leads to an increase in heart rate. Choices A and B are incorrect because inhibition of epinephrine or norepinephrine would not cause an increase in heart rate. Choice C is incorrect because stimulation of the vagus nerve would actually decrease heart rate by releasing acetylcholine, which acts on muscarinic receptors in the heart.
Why is continuous electronic fetal monitoring generally used when oxytocin is administered?
- A. Fetal chemoreceptors are stimulated
- B. The mother may become hypotensive
- C. Maternal fluid volume deficit may occur.
- D. Uteroplacental exchange may be compromised
Correct Answer: D
Rationale: The correct answer is D because oxytocin can cause increased uterine contractions, potentially impacting uteroplacental exchange and reducing oxygen delivery to the fetus. This can lead to fetal distress, making continuous electronic fetal monitoring crucial to detect any signs of distress promptly.
A: Fetal chemoreceptors being stimulated is not directly related to the need for continuous monitoring with oxytocin administration.
B: Maternal hypotension is a potential side effect of oxytocin but does not directly necessitate continuous fetal monitoring.
C: Maternal fluid volume deficit is a concern with oxytocin, but it does not directly link to the need for continuous fetal monitoring.
When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern?
- A. Early decelerations
- B. Variable decelerations
- C. Nonperiodic accelerations
- D. Increase in baseline variability
Correct Answer: B
Rationale: The correct answer is B: Variable decelerations. When the mother's membranes rupture during active labor, variable decelerations should be observed in the fetal heart rate. This is because the rupture of membranes can lead to umbilical cord compression, causing variable decelerations in the fetal heart rate pattern. Variable decelerations are characterized by abrupt and visually apparent decreases in heart rate variability.
A: Early decelerations are usually associated with head compression during contractions and are benign.
C: Nonperiodic accelerations are not a typical pattern seen in response to ruptured membranes during labor.
D: An increase in baseline variability is a positive sign and does not specifically indicate the occurrence of variable decelerations related to umbilical cord compression.
The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse?
- A. Mother is sitting up with the neonate prone on her chest.
- B. Mother is supine with the neonate prone on her chest.
- C. The neonate is prone on mother’s chest and facing to the side.
- D. Neonate is prone with mother resting in semi-Fowler’s position.
Correct Answer: B
Rationale: B is the correct answer because having the mother in a supine position with the neonate prone on her chest can potentially increase the risk of neonatal suffocation or accidental injury due to the baby slipping off. This position restricts the baby's ability to breathe properly and may lead to adverse outcomes.
A: Sitting up with the neonate prone on her chest allows for better supervision and support for the baby's breathing.
C: The neonate facing to the side is a safe position for skin-to-skin contact and breastfeeding.
D: Neonate resting in semi-Fowler's position is a safe and comfortable position that allows for proper breathing and bonding between mother and baby.