A nurse is assisting with the care of a client who is in labor.
The client's labor is difficult and prolonged and she reports a severe backache.
Which of the following factors is a contributing cause of difficult, prolonged labor?
Fetal attitude is in general flexion
Fetal lie is longitudinal
Maternal pelvis is gynecoid
Fetal position is persistent occiput posterior
The Correct Answer is D
Choice A rationale:
Fetal attitude in general flexion is not a contributing factor to difficult, prolonged labor. In fact, it is the normal fetal attitude
during labor. The fetus is typically in a position of general flexion, where the head is flexed forward, chin to chest, and the arms
and legs are flexed, with the arms crossed over the chest and the legs bent at the knees.
Choice B rationale:
Fetal lie being longitudinal is the normal and most common fetal lie during labor. In a longitudinal lie, the long axis of the fetus
is parallel with the long axis of the mother. This is the ideal and most common position for labor and delivery.
Choice C rationale:
A gynecoid pelvis is the most common type of female pelvis and is the most favorable for childbirth. It has a round shape with
a wide pubic arch, which allows for easier passage of the baby during delivery.
Choice D rationale:
A persistent occiput posterior (OP) position can indeed contribute to difficult, prolonged labor. In an OP position, the baby’s
occipital bone is towards the mother’s posterior side. This position can cause labor to be more painful and last longer because the baby’s head diameter that presents to the birth canal is larger. It can also cause back pain during labor, often referred to as "back labor"1.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Amniotic fluid in the vaginal vault may indicate that the client's membranes have ruptured, but it does not necessarily mean
that labor has begun. Some women experience rupture of membranes before labor starts, while others do not experience it
until labor is well underway.
Additionally, it is not always possible to visually confirm the presence of amniotic fluid, as it may be mixed with other fluids or
present in small amounts.
Therefore, the presence of amniotic fluid alone is not a definitive sign of labor.
Choice B rationale:
Contractions are a common sign of labor, but they can also occur for other reasons, such as Braxton Hicks contractions or a
urinary tract infection.
To be considered a sign of true labor, contractions should be regular, becoming progressively stronger, longer, and closer
together.
A frequency of every 3 to 4 minutes is often suggestive of labor, but it is not always definitive.
Some women may experience contractions that are less frequent or more irregular and still be in labor.
Choice C rationale:
Cervical dilation is the most reliable sign of labor.
During labor, the cervix gradually opens to allow the baby to pass through the birth canal.
Cervical dilation is typically measured in centimeters, with 10 centimeters being considered full dilation.
Once the cervix has dilated to 3-4 centimeters, it is generally considered to be active labor.
This is because dilation of this degree usually indicates that the contractions are strong enough to effectively move the baby
through the birth canal.
Choice D rationale:
Pain just above the navel, also known as suprapubic pain, can be a sign of labor, but it is not a definitive one.
This type of pain can also be caused by other factors, such as bladder fullness or indigestion.
Additionally, not all women experience pain in this area during labor.
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale:
The client is in the second stage of labor because she is actively pushing and the fetal head is at the vaginal station.
The second stage of labor is defined as the time from full cervical dilation to the birth of the baby. It is characterized by strong,
regular contractions and the urge to push.
Decelerations in the fetal heart rate can occur during the second stage of labor due to a variety of factors, including head
compression, cord compression, and uteroplacental insufficiency.
Choice B rationale:
The nurse should apply an oxygen mask to the client to increase the oxygen supply to the fetus.
This can help to improve fetal heart rate and prevent further decelerations.
Oxygen is a vital nutrient for the fetus, and it is essential for maintaining a normal fetal heart rate.
When the fetal heart rate decelerates, it is a sign that the fetus is not getting enough oxygen.
Applying an oxygen mask to the mother can help to increase the amount of oxygen that is available to the fetus.
Choice D rationale:
The nurse should monitor the client's vital signs and fetal heart rate to assess the client's progress and the well-being of the
fetus.
Vital signs, such as blood pressure, pulse, and respiration rate, can provide important information about the mother's health
and how she is coping with labor.
The fetal heart rate is a direct measure of the fetus's well-being.
By monitoring these parameters, the nurse can identify any potential problems and intervene as needed.
Additional notes:
The nurse should also encourage the client to change positions, as this can help to relieve cord compression.
The nurse should also prepare for the possibility of a rapid delivery, as decelerations in the fetal heart rate can sometimes be a
sign of fetal distress.
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