The correct answer is Choice D: Contraction lasting 85 seconds.

Choice A rationale: A contraction resting period of 35 seconds is normal and expected during labor. The resting period allows the uterine muscle to relax and replenish its oxygen supply, which is essential for fetal well-being. The resting period also gives the client a chance to rest and cope with the pain of labor. A normal resting period ranges from 30 to 90 seconds, depending on the stage and phase of labor¹².

Choice B rationale: A heart rate of 100/min for a 10-min period is within the normal range for an adult. The normal resting heart rate for an adult is 60 to 100 beats per minute (bpm)³. During labor, the heart rate may increase due to factors such as pain, anxiety, dehydration, fever, or infection. However, a heart rate of 100/min is not considered a sign of distress or complication, unless it is accompanied by other symptoms such as chest pain, shortness of breath, or palpitations⁴⁵.

Choice C rationale: Four contractions in a 10-min period is a normal frequency for labor contractions. The frequency of contractions refers to how often they occur, measured from the beginning of one contraction to the beginning of the next. The normal frequency of contractions varies depending on the stage and phase of labor, but generally ranges from two to five contractions in 10 minutes¹².

Choice D rationale: A contraction lasting 85 seconds is too long and should be reported to the provider. The duration of contractions refers to how long they last, measured from the beginning to the end of one contraction. The normal duration of contractions ranges from 30 to 70 seconds, depending on the stage and phase of labor¹². A contraction lasting longer than 90 seconds is considered a prolonged contraction, which can reduce the blood flow and oxygen supply to the placenta and the fetus, leading to fetal hypoxia and acidosis. Prolonged contractions can also cause uterine rupture, placental abruption, or maternal hemorrhage .

Choice A rationale: Misoprostol is a prostaglandin analog and is contraindicated for use during labor at 32 weeks of gestation as it can lead to uterine hyperstimulation, which may pose a risk to the preterm fetus.
Choice B rationale: Folic acid is a vitamin supplement and is not contraindicated during labor. However, it is typically taken earlier in pregnancy to prevent neural tube defects.
Choice C rationale: Nifedipine is a calcium channel blocker that may be used to suppress preterm labor, and it is not contraindicated at 32 weeks of gestation.
Choice D rationale: Terbutaline is a beta-adrenergic agonist that may be used to relax the uterine smooth muscles and inhibit preterm labor. It is not contraindicated at 32 weeks of gestation.

Choice A rationale: While this is an important action, it is not the first priority immediately after delivery. The priority is to ensure the newborn's breathing and warmth.
Choice B rationale: Assessing the gestational age of the newborn is important but can be done after ensuring the newborn's immediate well-being.
Choice C rationale: This is important for proper identification, but it can be done after the newborn is stabilized.
Choice D rationale: The first action after delivery is to dry the newborn to prevent hypothermia and stimulate breathing. Drying the baby helps remove amniotic fluid and stimulates the baby's reflexes, making it the priority action.

Choice A rationale: An amniocentesis involves inserting a needle through the abdominal wall into the amniotic sac to obtain a sample of amniotic fluid. Emptying the bladder before the procedure reduces the risk of bladder puncture during the process.
Choice B rationale: Fasting is not typically necessary for an amniocentesis. It is generally done on an outpatient basis, and fasting is not required.
Choice C rationale: An enema is not necessary before an amniocentesis and is not part of the standard preparation.
Choice D rationale: While cleanliness is important, this instruction is not specific to an amniocentesis and is not a standard pre-procedure requirement.

Choice A rationale: Auscultating fetal heart tones in the right upper quadrant is not appropriate based on the information provided by Leopold maneuvers, which indicates the fetal back is on the right side of the mother's abdomen, and the fetal head is in the fundal portion of the uterus.
Choice B rationale: During Leopold maneuvers, the nurse palpated a round, firm, movable part in the fundal portion of the uterus. This finding corresponds to the fetal head, which is typically located at the top of the uterus (fundus). Additionally, the nurse palpated a long, smooth surface on the mother's right side. This finding indicates the fetal back, which typically lies along the right side of the mother's abdomen, suggesting that the fetus's back is positioned anteriorly (toward the mother's front). The location of the fetal heart is typically best heard over the back of the fetus. Therefore, the nurse should auscultate the fetal heart tones in the maternal quadrant corresponding to the back of the fetus, which is the left lower quadrant.
Choice C rationale: The information from Leopold maneuvers does not indicate the fetal back is in the right lower quadrant. The nurse should not auscultate fetal heart tones in this area.
Choice D rationale: Auscultating fetal heart tones in the left upper quadrant is not appropriate based on the information provided by Leopold maneuvers, which indicates the fetal head is in the fundal portion of the uterus and the fetal back is on the right side of the mother's abdomen. The fetal heart is usually best heard over the back of the fetus, which is not in the left upper quadrant.

Choice A rationale: Placing the newborn in the Trendelenburg position (head down, feet up) is not recommended in this situation and can potentially cause harm.
Choice B rationale: While saline drops can help clear nasal congestion, the bubbling mucus is coming from the mouth and nose, and suctioning is more appropriate.
Choice C rationale: The bubbling mucus indicates the presence of mucus and amniotic fluid in the baby's airway, which could interfere with breathing. The first action should be to suction the newborn's mouth to clear the airway.
Choice D rationale: Performing deep suctioning with an endotracheal tube is an invasive procedure and is not necessary for clearing mucus from the newborn's mouth and nose.

Choice A rationale: The umbilical cord contains three blood vessels: two arteries and one vein. The two arteries carry deoxygenated blood and waste products from the fetus back to the placenta, while the one vein carries oxygenated blood and nutrients from the placenta to the fetus.
Choice B rationale: This option is incorrect because the umbilical cord in a newborn does not have two veins. It contains two arteries and one vein.
Choice C rationale: This option is incorrect because the umbilical cord in a newborn does not have two veins and one artery. It contains two arteries and one vein.
Choice D Rationale: This option is incorrect because the umbilical cord in a newborn does not have only one artery and one vein. It contains two arteries and one vein.

Choice A rationale:
Primipara refers to a woman who is giving birth for the first time. While being a primipara may have some implications for the birthing process, it is not a cause of the newborn being small for gestational age.
Choice B rationale:
Maternal obesity may have various effects on pregnancy, but it is not specifically a direct cause of the newborn being small for gestational age.
Choice C rationale:
Perinatal asphyxia refers to a lack of oxygen or oxygen deprivation around the time of birth. While this can lead to various health issues for the newborn, it is not a primary cause of being small for gestational age.
Choice D rationale:
Placental insufficiency occurs when the placenta does not function adequately to provide sufficient oxygen and nutrients to the developing fetus. This can result in the newborn being small for gestational age due to restricted growth in the womb.

Choice A rationale:
A protruding abdomen is not specifically associated with being small for gestational age and can have various other causes in newborns.
Choice B rationale:
A gray umbilical cord is not a typical finding associated with being small for gestational age. Choice C rationale:
Moist skin is not a specific finding associated with being small for gestational age and can be observed in all newborns.
Choice D rationale:
Wide skull sutures are associated with being small for gestational age, as the skull bones may not fully close due to restricted growth in the womb.

Choice A rationale:
Maternal gestational diabetes can lead to the newborn being larger than average (macrosomia) due to the impact of high blood sugar levels in the mother affecting fetal growth.
Choice B rationale:
Newborn hypoglycemia isa common complication of maternal gestational diabetes due to the elevated insulin levels in the newborn at birth
Choice C rationale:
Oligohydramnios refers to decreased amniotic fluid, which can be a complication of various factors, but it is not directly related to maternal gestational diabetes.
Choice D rationale:
Placenta previa is a condition where the placenta partially or completely covers the cervix, which is unrelated to maternal gestational diabetes.