Unit 3 Maternity Exam - Greater Lowell Technical School

Explanation:

Correct Answer: (B) "At the beginning of a contraction, hold your breath and push for 10 seconds."

This describes the Valsalva or closed-glottis pushing technique, which is the traditional coached pushing method used during the second stage of labor. When a contraction begins, the patient takes a deep breath, holds it, and bears down for approximately 10 seconds, then repeats this process during the contraction. This technique maximizes intra-abdominal pressure to facilitate fetal descent with each uterine contraction.

Why Other Options are Incorrect:

A. Pushing with the second exhalation at the start of a contraction does not maximize the use of intra-abdominal pressure needed to effectively facilitate fetal descent, as the pressure generated during exhalation is less than during breath-holding.

C. Pushing between contractions is completely incorrect as the uterine muscle is not contracting during this time, meaning there is no synergistic force to aid fetal descent. All pushing efforts should be coordinated with and during uterine contractions.

D. Pushing continuously for the entire duration of a contraction without structured breath-holding intervals can lead to maternal exhaustion, prolonged Valsalva causing maternal hypotension, and reduced placental perfusion rather than effective directed pushing.

Explanation:

Correct Answer: (D) Obtain a signed consent.

Before any surgical procedure including a cesarean section, obtaining a signed informed consent is a mandatory legal and ethical requirement. The patient must be informed of the procedure, its risks, benefits, and alternatives, and must provide documented voluntary consent before the surgery can proceed. This is a non-negotiable pre-operative requirement that must be completed.

Why Other Options are Incorrect:

A. Inserting an indwelling catheter is a standard pre-operative intervention for cesarean section, but it is a nursing intervention rather than assessment data that must be collected. The question specifically asks for assessment data that must be obtained.

B. Diet history for the past 8 hours is relevant for anesthesia safety regarding aspiration risk, but it is a less critical assessment priority compared to obtaining legal informed consent without which the procedure legally cannot proceed.

C. Cervical dilation and effacement are assessments relevant to vaginal labor progress but are not the priority assessment for a patient being prepared for a scheduled cesarean section, where labor progress does not determine whether the surgery proceeds.

Explanation:

Correct Answer: (D) Facial asymmetry.

Forceps are applied to the sides of the fetal head during delivery and exert pressure on the facial structures. This pressure can compress or injure the facial nerve, resulting in facial nerve palsy which presents as facial asymmetry, particularly noticeable when the infant cries. The affected side of the face will have diminished or absent movement compared to the unaffected side. This is the most common and expected complication to assess for following a forceps-assisted delivery.

Why Other Options are Incorrect:

A. Shoulder dislocation is not a typical complication of forceps delivery, as forceps are applied to the fetal head and not the shoulders. Shoulder complications such as shoulder dystocia are more associated with macrosomic infants and are a separate obstetric emergency.

B. Loss of hair from contact with forceps is not an expected or recognized complication of forceps delivery. The blades of forceps are smooth and designed to fit along the fetal head without causing hair loss.

C. Sacral hematoma is not associated with forceps delivery. A cephalohematoma, which is bleeding beneath the periosteum of one cranial bone, or caput succedaneum may occur but sacral hematoma is not a recognized complication of forceps use.

Explanation:

Correct Answer: (B) Regular contractions becoming more frequent and intense.

True labor is defined by regular uterine contractions that progressively increase in frequency, duration, and intensity over time, and that are accompanied by cervical effacement and dilation. This progressive pattern distinguishes true labor from false labor and is the most reliable indicator that labor has genuinely begun.

Why Other Options are Incorrect:

A. Contractions that are relieved by walking are characteristic of false labor or Braxton-Hicks contractions. True labor contractions persist and typically intensify with ambulation rather than being relieved by it.

C. Discomfort in the abdomen and groin is a vague symptom that can be caused by many conditions during pregnancy, including round ligament pain, Braxton-Hicks contractions, or gastrointestinal discomfort, and is not specific to the onset of true labor.

D. Vaginal discharge typically increases rather than decreases near the onset of labor due to increased cervical mucus production, the passage of the mucus plug, and bloody show. A decrease in vaginal discharge is not a recognized sign of true labor beginning.

Explanation:

Correct Answer: (A) Multiple gestations.

Multiple gestations, such as triplets, are one of the strongest risk factors for preterm labor. Carrying multiple fetuses causes the uterus to become overdistended much earlier than in a singleton pregnancy, leading to premature uterine contractions and cervical changes. The excessive uterine stretch significantly increases the risk of preterm labor and delivery.

Why Other Options are Incorrect:

B. Past obstetric history is not a risk factor in this case because the patient is a primigravida, meaning she has no previous obstetric history that could contribute to preterm labor risk such as prior preterm birth.

C. The patient's age of 32 years is within the optimal childbearing age range and is not considered a risk factor for preterm labor. Advanced maternal age risk is typically considered at 35 years and older, and even then it is primarily associated with other complications rather than specifically preterm labor.

D. Being at 18 weeks gestation is simply the current gestational age and is not itself a risk factor for preterm labor. Gestational age alone does not constitute a risk factor without other contributing clinical conditions.

Explanation:

Correct Answer: (B) In knee chest position with thighs at right angles to bed.

When a prolapsed umbilical cord is detected, the priority is to immediately relieve pressure on the cord to prevent fetal hypoxia. The knee-chest position uses gravity to shift the presenting part away from the cord, effectively relieving compression. The nurse must also manually hold the presenting part off the cord with a gloved hand while awaiting emergency cesarean delivery.

Why Other Options are Incorrect:

A. Supine with legs elevated does not adequately relieve pressure on a prolapsed cord and the supine position can worsen the situation by allowing the presenting part to continue compressing the cord against the pelvis.

C. Left lateral side-lying with a pillow between the legs is the standard positioning for uteroplacental insufficiency and general labor comfort, but it does not provide sufficient gravity-assisted relief of cord compression in the emergency of cord prolapse.

D. Positioning on her back with her head lower than the rest of her body is a modified Trendelenburg position which can provide some relief but is less effective than the knee-chest position in using gravity to shift the presenting part away from the prolapsed cord.

Explanation:

Correct Answer: (C) Frank breech.

Frank breech is defined as the position where the fetal hips are flexed and the knees are extended, causing the legs to extend straight up along the fetal body with the feet near the head. This is the most common type of breech presentation and creates a presentation where only the buttocks present at the cervix without the feet. The description of hips flexed and knees extended is the textbook definition of frank breech.

Why Other Options are Incorrect:

A. Complete breech occurs when the fetal hips are flexed and the knees are also flexed, with the feet tucked near the buttocks in a cross-legged or sitting position. This differs from the scenario described where the knees are specifically extended.

B. Buttocks presentation is not a standard obstetric classification term used to document fetal presentation. The correct clinical terminology uses the specific breech type such as frank, complete, or footling to describe the exact position.

D. Double footing, also called double footling breech, occurs when both feet are the presenting parts with the hips and knees extended downward. This differs from frank breech where the knees are extended upward toward the head rather than presenting at the cervix.

Explanation:

Correct Answer: (B) A low platelet count.

A low platelet count is a contraindication to epidural block placement because the epidural procedure involves needle insertion into the epidural space near the spinal cord. Thrombocytopenia impairs the blood's ability to clot, significantly increasing the risk of epidural hematoma formation, which can compress the spinal cord and cause permanent neurological injury or paralysis. Most anesthesiologists require a platelet count above 80,000-100,000/mm³ before proceeding with epidural placement.

Why Other Options are Incorrect:

A. A history of diabetes mellitus is not a contraindication to epidural anesthesia. Diabetic patients routinely receive epidural blocks for labor and delivery, and diabetes does not increase the risk of the specific complications associated with epidural placement.

C. Previous cesarean delivery is not a contraindication to epidural block. Many women with previous cesarean deliveries attempt vaginal birth after cesarean and receive epidural analgesia safely. Previous cesarean is related to the mode of delivery decision, not anesthesia eligibility.

D. A history of migraine headaches is not a contraindication to epidural block. While a post-dural puncture headache is a possible complication of epidural placement, a pre-existing history of migraines does not prevent a patient from receiving epidural anesthesia.

Explanation:

Correct Answer: (B) This is a normal response when the infusion begins.

A warm flushing sensation is a well-known, expected, and normal side effect that occurs when magnesium sulfate infusion is initiated. It results from the vasodilatory effects of magnesium and is not a sign of an adverse reaction or toxicity. Reassuring the patient that this sensation is normal reduces anxiety and demonstrates knowledgeable therapeutic communication.

Why Other Options are Incorrect:

A. Stopping the infusion and notifying the healthcare provider is not necessary for a warm sensation, which is an anticipated and benign side effect of magnesium sulfate initiation. Stopping the infusion for a normal side effect would inappropriately interrupt tocolytic therapy.

C. Asking about supplements is not relevant to the complaint of warmth during magnesium sulfate infusion. This response does not address the patient's concern and deflects from providing accurate and reassuring patient education.

D. Getting a cool cloth, while a comfort measure, does not address the patient's primary concern about why she is feeling warm. The priority is to first educate and reassure the patient that the warm sensation is normal before offering comfort measures.