During a vaginal delivery the midwife tells you that a shoulder dystocia has occurred. Which of the following initial nursing actions is appropriate at this time?

Apply Oxygen

Increase IV Pitocin

Apply downward pressure on the woman's fundus

Flex the woman's thighs sharply toward her abdomen

Answer and Explanation

The Correct Answer is D

A. Apply oxygen. While oxygen may be administered if fetal distress is present, it does not directly resolve shoulder dystocia, which is a mechanical issue requiring immediate positional maneuvers to free the impacted shoulder.

B. Increase IV Pitocin. Increasing oxytocin (Pitocin) is contraindicated in shoulder dystocia because it can cause stronger contractions, worsening the impaction and increasing the risk of fetal injury or uterine rupture.

C. Apply downward pressure on the woman's fundus. Fundal pressure should never be applied in shoulder dystocia, as it can further wedge the fetal shoulder against the pubic bone, increasing the risk of brachial plexus injury and fetal distress.

D. Flex the woman's thighs sharply toward her abdomen. The McRoberts maneuver, which involves sharply flexing the mother’s thighs to widen the pelvic outlet, is the first-line intervention for shoulder dystocia. This maneuver helps rotate the pelvis and reposition the fetal shoulder, increasing the chances of a successful vaginal delivery.

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Correct Answer is A

Explanation

A. "I don't need to see the doctor for another year when I will come back for follow-up." This statement is incorrect because close follow-up is essential after a molar pregnancy to monitor for gestational trophoblastic disease (GTD) or choriocarcinoma. Regular hCG level monitoring is required weekly until levels are undetectable, then monthly for at least 6–12 months. Delaying follow-up for a year could lead to missed complications.

B. "I will use contraception for the next year." This statement is correct. Pregnancy should be avoided for at least one year after a molar pregnancy to ensure accurate monitoring of hCG levels. A rising hCG level could indicate malignant transformation rather than a new pregnancy.

C. "I need to be monitored for choriocarcinoma during the next year." This statement is correct. Choriocarcinoma is a potential complication of molar pregnancy, and early detection through serial hCG monitoring is crucial. Any persistent or rising hCG levels may indicate malignancy requiring chemotherapy.

D. "I am so sad that I lost this baby." This statement is understandable. A molar pregnancy is an emotionally distressing event, and feelings of grief and loss are valid. Emotional support, counseling, or support groups may be beneficial for the patient’s mental well-being.

A. "My baby dropped, and I have to urinate more frequently now." B. The contractions in my uterus are getting stronger and closer together" C. I passed some thick pink mucus where I urinated this morning" D. "My bag of waters just broke’

Correct Answer is B

Explanation

A. Increased urinary frequency and the baby "dropping" indicate lightening, which occurs in the weeks before labor begins. While this is a sign that labor is approaching, it does not confirm true labor.
B. True labor is characterized by contractions that progressively become stronger, closer together, and more regular, leading to cervical dilation and effacement. This distinguishes it from false labor, where contractions are irregular and do not cause cervical changes.
C. Passing thick pink mucus, known as the bloody show, is a sign that labor may begin soon, but it does not confirm that the woman is in active labor. Cervical changes must be assessed to determine true labor.
D. The rupture of membranes, or "water breaking," can occur before or during labor, but it does not necessarily indicate the onset of true labor. Cervical dilation and regular contractions are required to confirm active labor.

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During a vaginal delivery the midwife tells you that a shoulder dystocia has occurred. Which of the following initial nursing actions is appropriate at this time?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is being discharged from the hospital after the evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the patient makes which statement?

Correct Answer is A

Explanation

The nurse recognizes that a woman is in true labor when she states…., and finds that her cervix has dilated and effaced on examination.

Correct Answer is B

Explanation

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During a vaginal delivery the midwife tells you that a shoulder dystocia has occurred. Which of the following initial nursing actions is appropriate at this time?