Nokea
Which of the following is the priority intervention for a supine patient whose monitor strip shows decelerations that begin after the peak of the contraction and return to the baseline after the contraction ends?
- A. Increase IV infusion.
- B. Elevate lower extremities.
- C. Reposition to left side-lying position.
- D. Administer oxygen per face mask at 4 to 6 L/minut
Correct Answer: C
Rationale: The correct answer is C: Reposition to left side-lying position. This is the priority intervention because decelerations that start after the peak of the contraction and return to baseline after it ends suggest umbilical cord compression. Repositioning the patient to the left side-lying position can alleviate pressure on the cord, potentially improving fetal perfusion.
Increasing IV infusion (A) may not directly address the cord compression. Elevating lower extremities (B) may not alleviate the pressure on the cord. Administering oxygen (D) may be beneficial, but repositioning the patient is the primary intervention to address the underlying issue.
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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.
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.
What is one potential fetal complication of using obstetric forceps?
- A. flexion of the head
- B. abdominal complications
- C. skull fracture
- D. femur fracture
Correct Answer: C
Rationale: The correct answer is C: skull fracture. When obstetric forceps are used during delivery, there is a risk of excessive pressure on the fetal skull, leading to a potential complication such as a skull fracture. This occurs due to the force exerted by the instrument during the delivery process, which can cause trauma to the baby's delicate skull bones. Flexion of the head (choice A) is a normal part of the birthing process and not a complication of forceps use. Abdominal complications (choice B) and femur fracture (choice D) are not typically associated with obstetric forceps use.
The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health care provider about the development of an emergent situation requiring a cesarean delivery?
- A. Maternal blood pressure indicative of hypotension
- B. Maternal exhaustion from prolonged uterine activity
- C. Recognition of a Category II fetal heart rate pattern
- D. Increased maternal temperature related to infection
Correct Answer: C
Rationale: The correct answer is C: Recognition of a Category II fetal heart rate pattern. This indicates fetal distress and potential compromise to the baby's well-being, necessitating immediate intervention like a cesarean delivery to prevent adverse outcomes. A: Maternal hypotension may require intervention but is not an emergent indication for a cesarean section. B: Maternal exhaustion can be managed with support and rest, not an immediate indication for cesarean delivery. D: Maternal fever may indicate infection but does not necessarily require cesarean delivery unless it poses a significant risk to the baby.
Gestational diabetes increases what complication of labor?
- A. breech
- B. macrosomia
- C. macrosomia
- D. precipitous birth
Correct Answer: B
Rationale: The correct answer is B: macrosomia. Gestational diabetes can lead to fetal macrosomia, where the baby is larger than average, increasing the risk of complications during labor such as shoulder dystocia. This is due to the excess glucose crossing the placenta and stimulating the baby's pancreas to produce more insulin, resulting in increased growth. Choice A, breech presentation, is not directly associated with gestational diabetes. Choice C is a duplicate of the correct answer. Choice D, precipitous birth, is not a common complication of gestational diabetes but rather refers to an extremely rapid labor process.