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 D
Explanation
Choice A rationale:
Assisting the client to ambulate is not the immediate action required in this scenario. The nurse has found a small amount of
lochia rubra on the client’s perineal pad, and the fundus is midline and firm at the umbilicus. These are normal findings for a
client who is 4 hours postpartum. However, the nurse should ensure that there is no excessive bleeding, which could be a sign
of postpartum hemorrhage.
Choice B rationale:
Performing a fundal massage is not necessary in this case. Fundal massage is usually performed when the uterus is boggy or
soft, which could indicate uterine atony, a leading cause of postpartum hemorrhage. In this scenario, the fundus is firm and at
the level of the umbilicus, which is a normal finding 4 hours postpartum.
Choice C rationale:
Increasing the rate of IV fluids is not the immediate action required in this scenario. IV fluids are usually increased to expand
intravascular volume in cases of postpartum hemorrhage. In this case, the nurse has found a small amount of lochia rubra on
the client’s perineal pad, which is a normal finding 4 hours postpartum.
Choice D rationale:
Checking for blood under the client’s buttocks is the correct action for the nurse to take in this scenario. This is to ensure that
there is no excessive bleeding, which could be hidden under the client’s buttocks. Excessive bleeding could be a sign of
postpartum hemorrhage, a potentially life-threatening complication.
Correct Answer is A
Explanation
Choice A rationale:
Fever: A hallmark sign of inflammation, fever is a common and often early manifestation of endometritis. The body's
thermostat, located in the hypothalamus, is reset to a higher temperature in response to infection or inflammation. This
triggers a cascade of physiological events, including chills, shivering, and increased heat production, as the body attempts to
fight off pathogens. In endometritis, the fever is typically 100.4°F (38°C) or higher.
Chills: Often accompanying fever, chills are a sensation of coldness despite a normal or elevated body temperature. They result
from involuntary muscle contractions, which generate heat in an attempt to raise the body's temperature. Chills can be mild or
severe, and they often precede a rise in temperature.
Choice B rationale:
Increased heart rate: Tachycardia, or an increased heart rate, can occur in endometritis, but it is not a specific finding. It can be
present in various other conditions, including anxiety, pain, dehydration, anemia, and other infections. While it may be a sign
of endometritis, it's not considered a primary manifestation.
Choice C rationale:
Lower abdominal pain: Lower abdominal pain is a common symptom in postpartum women, but it is not always indicative of
endometritis. It can result from uterine contractions, incisional pain (if a cesarean section was performed), bladder distention,
constipation, or other postpartum complications. While it may be present in endometritis, it's not a specific finding.
Choice D rationale:
Unusual vaginal discharge: Lochia, the normal postpartum vaginal discharge, can vary in color and amount. However, unusual
vaginal discharge, such as foul-smelling or purulent discharge, can be a sign of endometritis. It's important to note that not all
women with endometritis will have abnormal discharge.
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