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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
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What anticipatory guidance should the nurse provide for new parents regarding sociologic changes?
- A. Explain that roles will not change at home
- B. Explain that stresses will be over now that the newborn is born.
- C. Tell the parents not to stress over household changes.
- D. Prepare them for possible strains on relationships.
Correct Answer: D
Rationale: The correct answer is D because it addresses the potential strains on relationships that can occur after the birth of a child. New parents often experience changes in their relationship dynamics due to increased responsibilities, sleep deprivation, and shifts in priorities. By preparing them for these possible strains, the nurse can help them navigate these challenges effectively.
A is incorrect because roles often do change at home with the arrival of a newborn. B is incorrect as stresses can actually increase after the baby is born. C is incorrect as it dismisses the importance of addressing household changes and potential stressors.
Arrange the seven cardinal movements of labor, in order.
- A. Descent
- B. Expulsion
- C. Extension
- D. External rotation
Correct Answer: A
Rationale: The correct order of the seven cardinal movements of labor is: Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, and Expulsion. Descent is the first cardinal movement, as the baby moves down the birth canal. Flexion follows to allow the baby's head to pass through the pelvis. Internal Rotation, Extension, and Restitution then occur to facilitate the baby's shoulders and body turning in alignment with the mother's pelvis. External Rotation follows to help the shoulders rotate to the correct position for delivery. Finally, Expulsion is when the baby is born. This sequence ensures a smooth and safe delivery. The other choices are incorrect as they are not part of the specific sequence of cardinal movements during labor.
Pregnant patients can usually tolerate the normal blood loss associated with childbirth because of which physiologic adaptation to pregnancy?
- A. A higher hematocrit
- B. Increased leukocytes
- C. Increased blood volume
- D. A lower fibrinogen level
Correct Answer: C
Rationale: The correct answer is C: Increased blood volume. During pregnancy, a woman's blood volume increases by about 30-50% to support the growing fetus and prepare for potential blood loss during childbirth. This increased blood volume helps pregnant patients tolerate the normal blood loss associated with childbirth without experiencing severe complications like hypovolemic shock.
Rationale:
A: A higher hematocrit would not directly contribute to increased blood volume and would not help in tolerating blood loss during childbirth.
B: Increased leukocytes are part of the immune response and are not directly related to blood volume or tolerance to blood loss.
D: A lower fibrinogen level would not directly contribute to increased blood volume and would not help in tolerating blood loss during childbirth.
Summary:
Choice C is correct because increased blood volume is a crucial physiologic adaptation during pregnancy that enables pregnant patients to tolerate the normal blood loss associated with childbirth. Choices A, B, and D are incorrect as they are not directly related to this
A 28-year-old gravida 1, para 0 patient who is at term calls the labor and birth unit stating that she thinks she is in labor. She states that she does have some vaginal discharge and feels wet;
- A. She relates a contraction pattern that is irregular, ranging from 5 to 7 minutes and lasting 30 seconds. Which questions should the nurse pose to the patient during this telephone triage? (Select all that apply.)
- B. Does she think that her membranes have ruptured?
- C. Is there any evidence of bloody show?
- D. Instruct the patient to keep monitoring her contraction pattern and call you back if they become more regular.
Correct Answer: A
Rationale: The correct answer is A because the patient's irregular contraction pattern and timing indicate early labor. The nurse should ask about the frequency, duration, and intensity of contractions to assess progression. Choices B and C focus on specific signs of labor but do not address the need for continuous monitoring and assessment like choice A does. Choice D does not address the need to gather specific information about the contraction pattern to determine the appropriate next steps. Therefore, A is the correct choice as it directly addresses the patient's current situation and provides guidance on what information is necessary for appropriate triage.
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.