A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

No action is necessary since a decrease in the woman's blood pressure is expected.

Decrease her intravenous (IV) rate to a keep vein-open rate.

Encourage her to empty her bladder.

Turn the woman to the left lateral position or place a pillow under her hip.

Answer and Explanation

The Correct Answer is D

A. No action is necessary since a decrease in the woman's blood pressure is expected. While a drop in blood pressure is a common side effect of a spinal block, a 20% decrease is significant and can compromise placental perfusion, leading to fetal distress. Intervention is necessary to restore circulation.

B. Decrease her intravenous (IV) rate to a keep vein-open rate. This is incorrect because IV fluids help counteract hypotension. Instead of decreasing the IV rate, the nurse may need to increase fluid administration to improve blood pressure and maintain perfusion.

C. Encourage her to empty her bladder. A full bladder can affect labor progression but does not directly cause or correct hypotension. The priority in this scenario is restoring blood pressure to ensure adequate fetal oxygenation.

D. Turn the woman to the left lateral position or place a pillow under her hip. This is the most appropriate intervention. A left lateral position or elevating her right hip helps relieve aortocaval compression, improving blood flow to the uterus and stabilizing blood pressure. Additional interventions, such as IV fluid boluses or vasopressors (e.g., ephedrine), may be needed if hypotension persists.

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Correct Answer is C

Explanation

A. Midplane contracture of the pelvis. Pelvic contractures can lead to dystocia by restricting the fetal head's descent. A midplane contracture narrows the pelvic midsection, making labor prolonged and difficult. This is a common cause of dystocia.

B. Disproportion of the pelvis. Cephalopelvic disproportion (CPD), where the fetal head is too large for the maternal pelvis, is a well-known cause of dystocia. It often results in prolonged labor, failure to progress, and the need for cesarean delivery.

C. Low-lying placenta. A low-lying placenta does not directly cause dystocia. Instead, it may lead to placenta previa, which often requires cesarean delivery before labor even begins. Since it does not typically cause prolonged or difficult labor, it is the least common cause of dystocia.

D. Compromised bearing-down efforts as a result of pain medication. Excessive pain medication, especially epidurals or narcotics, can weaken maternal pushing efforts, leading to prolonged second-stage labor. This is a recognized cause of dystocia, particularly in multiparous women.

A. To prevent uterine atony B. To facilitate the delivery of the baby's head. C. To facilitate the delivery of the baby's shoulders D. To prepare for the third stage of labor.

Correct Answer is C

Explanation

A. To prevent uterine atony. Suprapubic pressure is not used to prevent uterine atony. Uterine atony, which leads to postpartum hemorrhage, is managed through uterine massage and medications such as oxytocin.

B. To facilitate the delivery of the baby's head. The baby's head has already been delivered in shoulder dystocia. The emergency arises because the shoulders are stuck behind the pubic bone, requiring specific maneuvers to release them.

C. To facilitate the delivery of the baby's shoulders. Shoulder dystocia occurs when the anterior shoulder becomes impacted behind the maternal pubic bone, preventing delivery. Suprapubic pressure is applied to help dislodge the shoulder by compressing it downward, allowing it to pass under the pubic bone. This maneuver, along with the McRoberts position, is commonly used to resolve the dystocia.

D. To prepare for the third stage of labor. The third stage of labor refers to the delivery of the placenta, which occurs after the baby is born. Suprapubic pressure is specifically used to assist in the second stage of labor when shoulder dystocia occurs.

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A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The least common cause of long. difficult, or abnormal labor (dystocia) is:

Correct Answer is C

Explanation

An emergency shoulder dystocia delivery occurred that requires the nurse to apply suprapubic pressure. What is the rationale for this action?

Correct Answer is C

Explanation

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