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. Contraction frequency of 1 minute. Misoprostol (Cytotec) is used for cervical ripening, but excessive uterine contractions (tachysystole), defined as more than five contractions in 10 minutes, can lead to fetal distress and uterine rupture. If contractions are occurring every minute, this indicates hyperstimulation, requiring immediate discontinuation of the medication and possible intervention with tocolytics to relax the uterus.

B. Cervix is 50% effaced. Cervical effacement is a normal part of labor progression and does not indicate a need to stop Cytotec treatment. Misoprostol is intended to help soften and ripen the cervix, and 50% effacement suggests the cervix is responding appropriately.

C. Maternal respiratory rate of 24. A respiratory rate of 24 breaths per minute is within the upper normal range for pregnancy due to increased metabolic demands. It does not indicate an adverse reaction to misoprostol or warrant discontinuation of treatment.

D. Fetal heart baseline of 150. A fetal heart rate of 150 beats per minute is within the normal range of 110-160 bpm and does not indicate fetal distress. There is no reason to stop Cytotec based on this finding.

A. Occiput anterior position. B. Breech presentation. C. Cervical dilation 5 cm. D. Station-4.

Correct Answer is ["B","D"]

Explanation

A. Occiput anterior position. The occiput anterior (OA) position is the ideal fetal position for vaginal delivery, where the baby’s head is well-engaged in the pelvis. This positioning reduces the risk of a prolapsed cord since the presenting part (the fetal head) effectively blocks the cord from slipping through.

B. Breech presentation. In a breech presentation, the buttocks or feet are the presenting part, leaving more space in the birth canal. This increases the risk of cord prolapse, especially if the feet or buttocks do not fully block the cervix, allowing the umbilical cord to slip past and become compressed.

C. Cervical dilation 5 cm. While cervical dilation is important in labor progression, it does not directly increase the risk of cord prolapse. The risk is more dependent on fetal position and station rather than the degree of cervical dilation.

D. Station -4. A high fetal station (e.g., -4) means the baby’s presenting part has not yet descended into the pelvis, leaving more room for the umbilical cord to slip through once the membranes rupture. A well-engaged fetus at station 0 or lower helps prevent prolapse by blocking the cervix.

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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 client has been admitted to the labor and delivery suite for induction of labor for post-term pregnancy. Misoprostol (Cytotec) has been inserted. Which of the following findings would warrant stopping the Cytotec treatment?

Correct Answer is A

Explanation

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Correct Answer is ["B","D"]

Explanation

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