Fetal presentation refers to which of the following descriptions?
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Solution
Fetal body part that enters the maternal pelvis first.
Presentation is the fetal body part that enters the pelvis first; it’s classified by the presenting part; the three main presentations are cephalic/occipital, breech, and shoulder.
Option B: The relationship of the presenting fetal part to the maternal pelvis refers to fetal position.
Option C: The relationship of the long axis to the fetus to the long axis of the mother refers to fetal lie; the three possible lies are longitudinal, transverse, and oblique.
Labor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which are the other four factors?
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Solution
Passageway, contractions, placental position and function, psychological response.
The five essential factors (5 P’s) are passenger (fetus), passageway (pelvis), powers (contractions), placental position and function, and psyche (psychological response of the mother).
A multiparous client who has been in labor for 2 hours states that she feels the urge to move her bowels. How should the nurse respond?
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Solution
Perform a pelvic examination.
A complaint of rectal pressure usually indicates a low presenting fetal part, signaling imminent delivery. The nurse should perform a pelvic examination to assess the dilation of the cervix and station of the presenting fetal part.
A laboring client is in the first stage of labor and has progressed from 4 to 7 cm in cervical dilation. In which of the following phases of the first stage does cervical dilation occur most rapidly
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Solution
Active phase.
Cervical dilation occurs more rapidly during the active phase than any of the previous phases. The active phase is characterized by cervical dilation that progresses from 4 to 7 cm.
Options A and B: The preparatory, or latent, phase begins with the onset of regular uterine contractions and ends when rapid cervical dilation begins.
Option D: Transition is defined as cervical dilation beginning at 8 cm and lasting until 10 cm or complete dilation.
A laboring client has external electronic fetal monitoring in place. Which of the following assessment data can be determined by examining the fetal heart rate strip produced by the external electronic fetal monitor?
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Solution
Oxygenation.
Oxygenation of the fetus may be indirectly assessed through fetal monitoring by closely examining the fetal heart rate strip. Accelerations in the fetal heart rate strip indicate good oxygenation, while decelerations in the fetal heart rate sometimes indicate poor fetal oxygenation.
Which of the following fetal positions is most favorable for birth?
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Solution
Vertex presentation.
Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal.
Option B: Transverse lie is an unacceptable fetal position for vaginal birth and requires a C-section.
Option C: Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery.
Option D: Posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis.
Which of the following observations indicates fetal distress?
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Solution
Fetal scalp pH of 7.14.
A fetal scalp pH below 7.25 indicates acidosis and fetal hypoxia.
A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working she:
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Solution
May lose the ability to push.
A pudendal block provides anesthesia to the perineum.
A client arrives at the hospital in the second stage of labor. The fetus’ head is crowning, the client is bearing down, and the birth appears imminent. The nurse should:
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Solution
Support the perineum with the hand to prevent tearing and tell the client to pant.
Gentle pressure is applied to the baby’s head as it emerges so it is not born too rapidly. The head is never held back, and it should be supported as it emerges so there will be no vaginal lacerations. It is impossible to push and pant at the same time.
During the period of induction of labor, a client should be observed carefully for signs of:
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Solution
Uterine tetany.
Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise.