A nurse is caring for a client who had a vaginal birth 2 hours ago.
They are currently receiving Oxytocin, 20 Units in 1000 ml Lactated Ringer's solution infusing at 125 ml/hr. Which of the following findings indicates that the medication is effective?

Choice A rationale

A station of +1 cm indicates the presenting part is below the ischial spines. The ischial spines are the anatomical landmark used to determine station. A measurement of +1 cm signifies a descent of 1 cm past this landmark, not above it. A measurement of -1 cm would be 1 cm above the ischial spines.

Choice B rationale

The station is at 0 when the presenting part is at the level of the ischial spines. This indicates that the widest part of the fetal head has passed through the pelvic inlet and is now engaged. A station of +1 is a further descent past this point, not at the same level.

Choice C rationale

A station of +1 means the presenting part, in this case, the vertex, has descended 1 cm past the level of the ischial spines. The ischial spines are the narrowest part of the pelvis, and a positive station indicates fetal descent through this point and into the midpelvis, which is a progression of labor.

Choice D rationale

The presenting part entering the pelvic inlet is typically associated with a station of -2 or -3, prior to engagement. A station of +1 means the fetus is well past the inlet and has descended through the midpelvis, indicating that engagement has already occurred.

Choice E rationale

The presenting part is on the perineum at a much lower station, typically a +4 or +5, which is when crowning occurs. A station of +1 indicates that the presenting part is in the midpelvis, still needing to descend further before reaching the perineum for delivery.

Choice A rationale

Ignoring temper tantrums can sometimes be effective, but it may also escalate the behavior if the child feels their needs are not being met. From a psychological standpoint, the child is testing boundaries and seeking attention, and ignoring the behavior can be perceived as a lack of engagement, potentially intensifying the tantrum in an attempt to gain a reaction. This approach doesn't address the underlying developmental need for control and independence.

Choice B rationale

Distraction is a highly effective developmental strategy for toddlers. Toddlers have a short attention span and are easily redirected. By introducing a new, engaging activity, the nurse can shift the child's focus away from the source of frustration that triggered the tantrum. This technique prevents the tantrum from escalating and teaches the child to move on from a distressing situation without a power struggle, which is an important step in emotional regulation.

Choice C rationale

A toddler's cognitive development is not yet at a level where they can fully comprehend complex explanations about social norms or acceptable behavior. Their reasoning skills are still very primitive. Attempting to reason with a toddler during a tantrum is often futile and can even prolong the tantrum by giving the child attention for the negative behavior, thereby reinforcing it.

Choice D rationale

Placing a child in their room, or "time-out," is a discipline technique more appropriate for older children who can understand cause and effect. For a toddler, it can be perceived as abandonment or punishment without a clear connection to their behavior. This approach may not be effective and can cause fear or anxiety, failing to teach the child how to manage their emotions constructively.