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Questions and Answers

A gravida presents to the labor and delivery unit reporting regular contractions. Which finding would MOST definitively differentiate true labor from false labor?

Cervical dilation and effacement observed on serial examination over a period of hours. (correct)
Regular, rhythmic contractions palpated by the nurse upon abdominal assessment.
Patient expresses a sudden urge to push accompanied by intense lower back discomfort.
Subjective report of increasing pain intensity that is not alleviated by ambulation.

A researcher is investigating the hormonal cascade initiating labor. Which of the following best describes the interplay of hormonal actions that establishes parturition?

A synchronized surge of prolactin and hPL (human placental lactogen) that causes direct myometrial contractions.
Progressive decrease in placental progesterone secretion combined with increasing uterine sensitivity to endogenous oxytocin due to up-regulation of oxytocin receptors. (correct)
Surge in fetal cortisol production, which directly stimulates uterine contractions and prostaglandin synthesis.
A sharp increase in estrogen coupled with a dramatic rise in relaxin, desensitizing the uterus to progesterone.

Which of the following scenarios best exemplifies the phenomenon of 'lightening' as it relates to the premonitory signs of labor?

A primigravida at 36 weeks reports decreased fetal movement for 24 hours.
A multigravida at 38 weeks reports increased frequency of urination and decreased dyspnea. (correct)
A patient at term gestation reports severe lower abdominal pain radiating to the back.
A woman at 39 weeks gestation experiences a sudden gush of clear fluid from the vagina.

During the assessment of a laboring patient, the nurse notes the following contraction pattern: contractions occurring every 2 minutes, lasting 90 seconds each, with an intensity that the patient rates as 9/10. What is the MOST appropriate initial nursing intervention?

Administer a bolus of intravenous fluids and notify the physician immediately due to concerns about uterine tachysystole. (D) Signup and view all the answers

A patient at 40 weeks gestation calls the triage line reporting a 'bloody show'. Which of the following statements provides the most accurate and reassuring information to the patient?

'Bloody show is a sign that labor may be starting soon, but it does not necessarily mean you need to come to the hospital right now. Monitor for other signs of labor, such as regular contractions or ruptured membranes.' (B) Signup and view all the answers

A patient reports experiencing irregular contractions that subside with hydration and rest at 37 weeks gestation. These contractions are best described as:

Braxton Hicks contractions. (B) Signup and view all the answers

In the context of spontaneous rupture of membranes (SROM) at term, what is the MOST critical nursing assessment that should be performed immediately?

Fetal heart rate monitoring to assess for potential umbilical cord prolapse. (A) Signup and view all the answers

When timing contractions, what constitutes the MOST accurate method for determining frequency?

Measuring from the start of one contraction to the start of the next contraction. (A) Signup and view all the answers

A patient at 39 weeks gestation presents with a fundal height measurement suggesting macrosomia and is diagnosed with polyhydramnios. Considering the interplay of these conditions, which of the following mechanisms is the MOST likely underlying cause for these concurrent findings?

Impaired fetal swallowing due to neurological compromise, reducing amniotic fluid absorption, coupled with increased fetal urinary output exacerbated by hyperglycemia-induced osmotic diuresis. (A) Signup and view all the answers

A primiparous patient at 42 weeks gestation, with a history of well-controlled gestational diabetes, is admitted in active labor. Her estimated fetal weight is 4200 grams. Upon examination, the nurse notes shoulder dystocia following delivery of the fetal head. Which of the following interventions reflects the MOST comprehensive and evidence-based approach to manage this obstetrical emergency, considering the totality of the patient’s risk factors?

Initiate the Gaskin maneuver, followed by sequential attempts at the Rubin and Woods screw maneuvers while ensuring continuous communication with the patient and documenting each intervention meticulously, alongside preparations for potential neonatal resuscitation. (D) Signup and view all the answers

A patient at 36 weeks gestation presents with a blood pressure of 160/110 mmHg, severe proteinuria, and visual disturbances. Her reflexes are 3+ with clonus. Considering the presented clinical scenario, which intervention, incorporating both pharmacological and non-pharmacological approaches, would be the MOST critical initial step in managing this patient’s condition while mitigating potential adverse effects?

Administer a loading dose of magnesium sulfate followed by a maintenance infusion, while closely monitoring for signs of magnesium toxicity and implementing seizure precautions, alongside antihypertensive therapy to maintain blood pressure within a safe range. (B) Signup and view all the answers

During the second stage of labor, a patient exhibits signs of increasing anxiety, hyperventilation, and a reported loss of control. Considering the physiological and psychological responses to labor, which of the following multifaceted interventions would be MOST effective in re-establishing a sense of mastery and promoting a positive birth experience for this patient?

Providing continuous, empathetic support, reinforcing coping strategies, offering positive affirmations, and collaboratively adjusting the birth plan to accommodate the patient’s evolving needs and preferences. (C) Signup and view all the answers

A patient in active labor exhibits a sudden decrease in blood pressure from 130/80 mmHg to 90/60 mmHg, accompanied by pallor, diaphoresis, and an increased heart rate of 120 bpm. Simultaneously, fetal heart rate monitoring reveals persistent late decelerations. Considering the potential underlying causes, which sequence of immediate interventions reflects the MOST appropriate and comprehensive approach to address this critical situation?

Administer a bolus of intravenous fluids, initiate oxygen therapy via non-rebreather mask, and prepare for immediate cesarean delivery, while simultaneously assessing for signs of amniotic fluid embolism or uterine rupture. (A) Signup and view all the answers

A primiparous woman at 40 weeks gestation presents with a transverse fetal lie diagnosed via ultrasound. Given the absolute contraindication to vaginal delivery, which of the following surgical interventions is MOST appropriate, considering potential complications and maternal history of prior uterine surgeries?

Classical Cesarean section, ensuring rapid fetal extraction and minimizing risk of uterine rupture. (D) Signup and view all the answers

During a prolonged second stage of labor, a fetal assessment reveals a brow presentation. Which of the following is MOST consistent with the expected management strategy, considering the potential for spontaneous conversion and risks associated with operative interventions?

Continue expectant management with close monitoring, as spontaneous conversion to either face or vertex presentation may occur. (A) Signup and view all the answers

In a nulliparous woman experiencing active labor, a vaginal examination reveals the fetal occiput is directed towards the mother's sacrum (OP position). Which intervention is MOST likely to facilitate progression of labor, given common labor dystocia associated with this malposition?

Encourage maternal position changes and ambulation to facilitate spontaneous rotation. (D) Signup and view all the answers

Given the understanding that traditional pelvis shape classifications are rooted in problematic historical contexts, and acknowledging their diminished role in contemporary obstetrical practice, which pelvis type was historically considered most conducive to successful vaginal delivery?

Gynecoid, due to its rounded inlet and wider pelvic dimensions historically associated with easier fetal passage. (D) Signup and view all the answers

A gravida 2 para 1 woman at 39 weeks gestation presents in active labor. Examination reveals a frank breech presentation. Considering established guidelines and risks of vaginal breech delivery, which of the following factors would MOST strongly contraindicate a trial of labor?

Estimated fetal weight of 3600 grams assessed via ultrasound. (D) Signup and view all the answers

A primiparous woman at 40 weeks gestation is admitted to the labor and delivery unit. The nurse notes the cervix is 2 cm dilated, 50% effaced, and the fetal head is at -2 station. Based on these findings, which statement accurately reflects the anatomical and physiological processes occurring?

Effacement is underway, but significant cervical ripening and fetal descent are still required for active labor to progress. (A) Signup and view all the answers

During the first stage of labor, a patient's uterine contractions are being evaluated. Which of the following parameters MOST accurately reflects the intensity of uterine contractions, providing critical information for assessing the adequacy of labor?

Intrauterine pressure measured in Montevideo units (MVUs) over a 10-minute period. (A) Signup and view all the answers

Intrapartum, a patient with a history of complex trauma is undergoing a vaginal examination. Which of the following actions exemplifies trauma-informed care during this procedure?

Obtaining informed consent, explaining each step of the examination in advance, and pausing if the patient expresses discomfort. (D) Signup and view all the answers

A multigravida at term is admitted in active labor. Upon examination, the fetal station is determined to be -2. What does this indicate regarding the position of the fetal presenting part in relation to the ischial spines?

The fetal presenting part is 2 cm above the ischial spines. (B) Signup and view all the answers

Considering the unique anatomy of the fetal skull and its role in navigating the birth canal, a prolonged second stage of labor prompts assessment of fetal head molding. Which statement best describes the underlying mechanism that facilitates this process?

Fontanelles at the intersection of sutures permit slight overlapping of cranial bones, reducing the overall diameter of the fetal head. (C) Signup and view all the answers

A patient in labor is experiencing infrequent and mild uterine contractions. After ruling out cephalopelvic disproportion, which of the following interventions is MOST appropriate to augment labor effectively, considering potential adverse effects and patient-specific factors?

Initiate oxytocin infusion, carefully titrating the dose to achieve adequate contraction frequency and intensity. (C) Signup and view all the answers

During labor, the obstetrician notes significant asynclitism. How do the sutures and fontanelles aid in identifying the degree and direction of asynclitism during a vaginal examination?

By acting as reference points to assess the degree to which the sagittal suture is deflected anteriorly or posteriorly from the midline of the maternal pelvis. (A) Signup and view all the answers

A woman in the second stage of labor exhibits signs of fetal distress. Which of the following actions should be prioritized to optimize fetal oxygenation and expedite delivery, assuming all other standard resuscitative measures have been implemented?

Expedite delivery via the safest and most efficient route, considering fetal station and maternal parity. (D) Signup and view all the answers

During a vaginal examination, the obstetrician palpates the fetal sacrum as the presenting part. This finding is MOST consistent with which type of breech presentation, dictating specific management considerations for delivery?

Complete breech, characterized by flexion of both hips and knees. (D) Signup and view all the answers

In assessing fetal attitude, a critical determinant of labor progress, which specific anatomical relationship defines a 'vertex' presentation, considered optimal for vaginal delivery?

Flexion of the fetal head, with the occiput presenting first and the chin tucked towards the fetal chest. (A) Signup and view all the answers

What is the MOST important reason that fetal attitude of flexion are easier to navigate through the maternal pelvis?

Flexion reduces the presenting diameter of the fetal head, allowing it to pass through the pelvic inlet more easily. (A) Signup and view all the answers

In the context of assessing uterine activity during labor, what is the primary physiological mechanism by which regular, rhythmic contractions promote cervical dilation and fetal descent, facilitating the progression of labor?

Involuntary muscular movements of the uterine myometrium causing effacement and dilation. (C) Signup and view all the answers

During a prenatal visit at 38 weeks gestation, a patient is informed that her fetus is in the transverse lie. What are the MOST appropriate next steps in managing this presentation?

Attempt external cephalic version (ECV) to convert to a longitudinal lie, while closely monitoring fetal heart rate and maternal comfort. (A) Signup and view all the answers

A patient in active labor is experiencing intense back pain with each contraction. Vaginal examination reveals the fetal occiput is directed toward the maternal sacrum. What intervention is MOST effective in alleviating this discomfort and potentially facilitating fetal rotation?

Applying firm counter-pressure to the patient's sacrum during contractions while encouraging position changes such as hands and knees. (A) Signup and view all the answers

Following an uncomplicated vaginal delivery, the obstetrician notes a visible hematoma on the patient's perineum that is rapidly increasing in size. Despite application of ice packs, the patient reports escalating pain. Which intervention is MOST indicated at this time?

Preparing for surgical evacuation of the hematoma, coupled with identification and ligation of the bleeding vessel. (C) Signup and view all the answers

During parturition, the augmentation of intra-abdominal pressure via maternal expulsive efforts is MOST crucial for:

Facilitating fetal descent and expulsion through the birth canal. (A) Signup and view all the answers

Given a patient presenting in early labor, which assessment parameter would be LEAST indicative of imminent delivery?

Uterine resting tone consistently above 25 mmHg. (D) Signup and view all the answers

A primigravid patient is admitted in active labor. Regarding the interpretation of continuous electronic fetal monitoring, which finding necessitates immediate intervention to prevent fetal compromise?

Late decelerations associated with >50% of contractions. (A) Signup and view all the answers

Which of the following prenatal laboratory assessments is MOST critical for preventing vertical transmission of a potentially devastating congenital infection?

Group B Streptococcus (GBS) screening. (A) Signup and view all the answers

A laboring patient's fundal height measures 42 cm at 39 weeks gestation. While considering potential etiologies for this finding, which of the following diagnoses should be given the LOWEST priority in initial assessment?

Intrauterine growth restriction (IUGR). (A) Signup and view all the answers

What is the PRIMARY rationale for assessing uterine tone between contractions during labor?

To ascertain adequate uteroplacental perfusion and fetal oxygenation. (D) Signup and view all the answers

In the context of intrapartum management, under what specific clinical circumstances would the use of a tocotransducer (TOCO) be MOST limited or inappropriate?

Quantifying the intensity of uterine contractions in a patient with suspected placental abruption. (D) Signup and view all the answers

A patient at 38 weeks gestation presents to the labor and delivery unit. Her prenatal labs reveal a positive Hepatitis B surface antigen (HBsAg). Which intervention is MOST critical immediately after delivery to mitigate the risk of vertical transmission?

Administration of Hepatitis B immunoglobulin (HBIG) and Hepatitis B vaccine to the neonate. (A) Signup and view all the answers

A multiparous patient at 41 weeks’ gestation is admitted in active labor. She expresses a strong desire to avoid episiotomy unless absolutely necessary. Which intrapartum maneuver is MOST likely to minimize the risk of perineal trauma during the second stage of labor?

Controlled and slow fetal head delivery with perineal support. (A) Signup and view all the answers

A patient in early labor expresses anxiety about being in the hospital environment. Given the option to return home until labor progresses further, which assessment finding would be the MOST compelling contraindication to this plan?

Ruptured membranes with clear amniotic fluid. (D) Signup and view all the answers

Flashcards

True Labor

Regular contractions with cervical change (dilation and effacement).

Uterine Stretch

Uterine muscles stretching due to the growing fetus.