NURSING 7282
Labor & Birth Clinical
Immersion
Q & A w/ Rationales
2024
,.
1. A 25-year-old primigravida at 39 weeks of gestation is
admitted to the labor and delivery unit with regular
contractions. Her cervix is 4 cm dilated and 80% effaced.
The fetal heart rate (FHR) is 140 beats per minute with
moderate variability and no decelerations. The nurse
should:
a) Prepare for an imminent delivery
b) Administer oxytocin to augment labor
c) Monitor the FHR and uterine activity continuously
d) Perform a vaginal exam every hour to assess progress
*Answer: c) Monitor the FHR and uterine activity
continuously*
Rationale: The nurse should monitor the FHR and uterine
activity continuously to assess the well-being of the fetus
and the progress of labor. The FHR pattern is reassuring
and indicates adequate oxygenation. The cervix is not fully
dilated and there is no indication of fetal distress or
maternal complications that would require immediate
delivery or augmentation of labor. A vaginal exam every
hour is unnecessary and may increase the risk of infection.
2. A 32-year-old multipara at 41 weeks of gestation is
undergoing induction of labor with oxytocin. Her cervix is
6 cm dilated and 90% effaced. The FHR is 150 beats per
minute with minimal variability and late decelerations. The
nurse should:
a) Increase the oxytocin infusion rate to hasten delivery
b) Decrease the oxytocin infusion rate and administer
, oxygen to the mother
c) Stop the oxytocin infusion and turn the mother to her left
side
d) Notify the physician and prepare for an emergency
cesarean section
*Answer: d) Notify the physician and prepare for an
emergency cesarean section*
Rationale: The FHR pattern indicates fetal hypoxia and
uteroplacental insufficiency. Late decelerations are a sign
of fetal compromise that requires prompt intervention.
Increasing the oxytocin infusion rate would worsen the
condition by increasing uterine contractions and reducing
placental blood flow. Decreasing the oxytocin infusion rate
and administering oxygen to the mother may improve fetal
oxygenation, but are not sufficient measures to resolve the
problem. Stopping the oxytocin infusion and turning the
mother to her left side may also help, but are not enough to
prevent fetal injury or death. The best option is to notify the
physician and prepare for an emergency cesarean section to
deliver the fetus as soon as possible.
3. A 28-year-old primigravida at 38 weeks of gestation is in
active labor. Her cervix is 8 cm dilated and 100% effaced.
The FHR is 120 beats per minute with moderate variability
and accelerations. The nurse notes a sudden increase in the
frequency and intensity of contractions, accompanied by a
gush of clear fluid from the vagina. The nurse should:
a) Check the FHR for signs of cord prolapse
b) Assess the color, odor, and amount of amniotic fluid
c) Palpate the fundus for signs of uterine rupture
Labor & Birth Clinical
Immersion
Q & A w/ Rationales
2024
,.
1. A 25-year-old primigravida at 39 weeks of gestation is
admitted to the labor and delivery unit with regular
contractions. Her cervix is 4 cm dilated and 80% effaced.
The fetal heart rate (FHR) is 140 beats per minute with
moderate variability and no decelerations. The nurse
should:
a) Prepare for an imminent delivery
b) Administer oxytocin to augment labor
c) Monitor the FHR and uterine activity continuously
d) Perform a vaginal exam every hour to assess progress
*Answer: c) Monitor the FHR and uterine activity
continuously*
Rationale: The nurse should monitor the FHR and uterine
activity continuously to assess the well-being of the fetus
and the progress of labor. The FHR pattern is reassuring
and indicates adequate oxygenation. The cervix is not fully
dilated and there is no indication of fetal distress or
maternal complications that would require immediate
delivery or augmentation of labor. A vaginal exam every
hour is unnecessary and may increase the risk of infection.
2. A 32-year-old multipara at 41 weeks of gestation is
undergoing induction of labor with oxytocin. Her cervix is
6 cm dilated and 90% effaced. The FHR is 150 beats per
minute with minimal variability and late decelerations. The
nurse should:
a) Increase the oxytocin infusion rate to hasten delivery
b) Decrease the oxytocin infusion rate and administer
, oxygen to the mother
c) Stop the oxytocin infusion and turn the mother to her left
side
d) Notify the physician and prepare for an emergency
cesarean section
*Answer: d) Notify the physician and prepare for an
emergency cesarean section*
Rationale: The FHR pattern indicates fetal hypoxia and
uteroplacental insufficiency. Late decelerations are a sign
of fetal compromise that requires prompt intervention.
Increasing the oxytocin infusion rate would worsen the
condition by increasing uterine contractions and reducing
placental blood flow. Decreasing the oxytocin infusion rate
and administering oxygen to the mother may improve fetal
oxygenation, but are not sufficient measures to resolve the
problem. Stopping the oxytocin infusion and turning the
mother to her left side may also help, but are not enough to
prevent fetal injury or death. The best option is to notify the
physician and prepare for an emergency cesarean section to
deliver the fetus as soon as possible.
3. A 28-year-old primigravida at 38 weeks of gestation is in
active labor. Her cervix is 8 cm dilated and 100% effaced.
The FHR is 120 beats per minute with moderate variability
and accelerations. The nurse notes a sudden increase in the
frequency and intensity of contractions, accompanied by a
gush of clear fluid from the vagina. The nurse should:
a) Check the FHR for signs of cord prolapse
b) Assess the color, odor, and amount of amniotic fluid
c) Palpate the fundus for signs of uterine rupture
