A laboring woman asks the nurse, "Is my baby getting enough oxygen when I have these strong contractions?" Which response by the nurse demonstrates accurate understanding of placental physiology during labor?

"Your baby receives a constant supply of oxygen regardless of contractions.”.

"During contractions, blood flow to the placenta temporarily decreases, but your baby has reserves to tolerate this.”.

"Strong contractions actually increase oxygen delivery to your baby.”.

"We give you oxygen by mask to ensure your baby gets enough during contractions.”.

Answer and Explanation

The Correct Answer is B

Choice A rationale

This statement is physiologically inaccurate because the supply of oxygen is not constant during the peak of a contraction. During a uterine contraction, the intramyometrial pressure exceeds the blood pressure within the uterine arteries. This temporary obstruction of blood flow into the intervillous spaces means that the exchange of oxygen and carbon dioxide is momentarily paused. The fetus must rely on existing oxygen levels stored within the placental site and fetal blood.

Choice B rationale

During a contraction, the uterine muscles compress the spiral arteries, which significantly reduces the flow of oxygenated maternal blood into the placenta. However, a healthy fetus possesses a functional reserve and higher hemoglobin levels compared to adults, allowing it to withstand these transient periods of reduced perfusion. The intervillous space acts as a reservoir of oxygenated blood that sustains the fetus until the uterus relaxes and the maternal blood flow is fully restored.

Choice C rationale

Strong contractions do not increase oxygen delivery; they physically impede it by squeezing the blood vessels that supply the placenta. While contractions are necessary for cervical dilation and fetal descent, they represent a physiological stressor to the fetal respiratory exchange. If contractions are too frequent or last too long, the intervals of relaxation are insufficient for the fetus to recover its oxygen reserves, which can eventually lead to fetal distress and late decelerations.

Choice D rationale

Administering oxygen to the mother is a medical intervention used only when there are signs of fetal compromise or non-reassuring heart rate patterns. It is not a standard physiological process that ensures oxygenation during every normal contraction. Under normal circumstances, maternal room air provides sufficient oxygenation to maintain fetal well-being. Proposing oxygen masks as a routine necessity for all contractions misrepresents the standard mechanics of labor and the inherent resilience of the fetal-placental unit.

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Correct Answer is ["A","B","C"]

Explanation

Choice A rationale

Amenorrhea, or the cessation of menses, is a classic presumptive sign of pregnancy because it is a subjective symptom reported by the patient. While it often indicates conception due to rising progesterone levels maintaining the endometrial lining, it can also be caused by stress, strenuous exercise, or endocrine disorders. Because it is not a definitive objective finding that can only be attributed to a fetus, it remains categorized as a presumptive rather than a probable or positive sign.

Choice B rationale

Breast tenderness is categorized as a presumptive sign because it is a subjective sensation reported by the woman. During early pregnancy, increasing levels of estrogen and progesterone cause vascular engorgement and ductal proliferation within the mammary tissue. While highly suggestive of pregnancy, this symptom can also occur during the luteal phase of the menstrual cycle or due to hormonal medications. Normal physiologic changes in the breasts are among the earliest indicators recognized by the mother.

Choice C rationale

Frequent urination is a presumptive sign of pregnancy because it is a subjective symptom that can be caused by various factors. In the first trimester, the enlarging uterus remains in the pelvic cavity and exerts direct pressure on the bladder, reducing its capacity. However, urinary frequency can also be a symptom of a urinary tract infection, increased fluid intake, or diabetes. Since it is not an exclusive indicator of a developing fetus, it is categorized as presumptive.

Choice D rationale

A positive urine pregnancy test is considered a probable sign of pregnancy rather than a presumptive one. This is because it is an objective laboratory finding that detects human chorionic gonadotropin (hCG). While hCG is primarily produced by the placenta, it can also be present in cases of hydatidiform mole or certain choriocarcinomas. Because the test measures a hormone rather than directly visualizing the fetus, it is not a positive sign, but it is more objective than presumptive signs.

Choice E rationale

Braxton Hicks contractions are categorized as a probable sign of pregnancy. These are painless, irregular contractions that can be felt through the abdominal wall by an examiner starting in the second trimester. They occur as the uterine muscles tighten to enhance blood flow to the placenta. Unlike presumptive signs, these are objective physical findings observed by a healthcare provider. However, they are not positive signs because they do not confirm the presence of a live fetus.

A. Hegar sign. B. Chadwick sign. C. Goodell sign. D. McDonald sign.

Correct Answer is A

Explanation

Choice A rationale

Hegar sign is the softening and compressibility of the lower uterine segment, which is the isthmus. This typically occurs around 6 to 12 weeks of gestation and is identified during a bimanual examination. It is a probable sign of pregnancy resulting from increased pelvic congestion and hormonal influences on connective tissue. The nurse documents this specific finding when the lower part of the uterus feels thin and soft compared to the firmer cervix and fundus.

Choice B rationale

Chadwick sign refers to the bluish-purple discoloration of the vaginal mucosa and cervix. This occurs as early as 6 to 8 weeks of pregnancy due to increased vascularity and pelvic congestion stimulated by estrogen. While it is a probable sign of pregnancy, it describes a visual color change rather than the tactile softening of the lower uterine segment. It is often one of the first physical signs noted by a practitioner during a speculum examination in early prenatal care.

Choice C rationale

Goodell sign is the softening of the cervical tip, which is often compared to the feeling of an earlobe or lips rather than the firm tip of the nose. This change usually becomes evident around the beginning of the second month of pregnancy. This softening is caused by increased vascularity, hypertrophy, and hyperplasia of the cervical glands. While it is an objective probable sign, it specifically describes the cervix rather than the lower uterine segment or isthmus.

Choice D rationale

McDonald sign is characterized by the ease with which the body of the uterus can be flexed against the cervix. This occurs because of the softening of the uterine isthmus, similar to Hegar sign, but it specifically refers to the flexibility or hinging effect noted during bimanual manipulation. While related to the softening of the uterine tissues, it is a distinct clinical finding used to assess the progress of pregnancy-related anatomical changes during a comprehensive pelvic examination.

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A laboring woman asks the nurse, "Is my baby getting enough oxygen when I have these strong contractions?" Which response by the nurse demonstrates accurate understanding of placental physiology during labor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A woman comes to the clinic reporting a missed period, breast tenderness, nausea, and fatigue. Her home pregnancy test was positive yesterday. When documenting the assessment, which of her reported symptoms should the nurse categorize as presumptive signs of pregnancy? Select all that apply.

Correct Answer is ["A","B","C"]

Explanation

During a prenatal examination at 8 weeks gestation, the nurse practitioner notes that the lower uterine segment feels remarkably soft on bimanual examination. When documenting this probable sign of pregnancy, the nurse should record this finding as:

Correct Answer is A

Explanation

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