Review the documentation in the EHR and evaluate the most recent assessment findings for the 38-year-old client.
Match the finding of urine output and deep tendon reflexes (DTRs) with the appropriate status.

This clinical scenario describes shoulder dystocia indicated by the turtle sign. Management requires immediate obstetric maneuvers to resolve the obstruction. Knowledge of emergency protocols, including McRoberts maneuver and suprapubic pressure, is essential to prevent fetal asphyxia and maternal trauma during delivery.

Choice A rationale

Fundal pressure is strictly contraindicated in cases of shoulder dystocia because it can further impact the anterior fetal shoulder against the maternal symphysis pubis. This action increases the risk of uterine rupture and severe brachial plexus injury.

Choice B rationale

Suprapubic pressure helps dislodge the impacted anterior shoulder by pushing it under the maternal symphysis pubis. This manual maneuver decreases the fetal bisacromial diameter, allowing the shoulder to rotate and pass through the pelvic outlet during the delivery.

Choice C rationale

Flexing the thighs toward the ears, known as the McRoberts maneuver, flattens the sacral promontory and increases the pelvic inlet diameter. This postural change facilitates the passage of the fetal shoulder and is often the first-line intervention.

Choice D rationale

Shoulder dystocia is a high-risk obstetric emergency that necessitates a multidisciplinary team approach. Calling for help ensures that neonatal resuscitation teams, anesthesia, and additional nursing staff are available to assist with complex maneuvers and provide immediate care.

Choice E rationale

While a cesarean birth is a major surgical procedure, it is typically not the immediate step once the head is delivered. Rescuers first attempt maneuvers to deliver the body vaginally, as reversing the delivery process is extremely difficult and dangerous.

The nurse must identify signs of estrogen-related thromboembolism. Estrogen increases clotting factor synthesis, raising the risk for pulmonary embolism. Recognizing cardiovascular distress and prioritizing urgent medical intervention is essential when assessing clients on hormonal therapy experiencing dyspnea or chest pain.

Choice A rationale

Shortness of breath and chest pain are never considered expected side effects of oral contraceptives. These symptoms indicate pulmonary embolism or myocardial infarction, requiring immediate medical evaluation rather than simple monitoring of common hormonal reactions.

Choice B rationale

Oral contraceptives increase the risk of deep vein thrombosis and pulmonary embolism. Sudden chest pain and dyspnea suggest a life-threatening clot. The client needs emergency care to stabilize respiratory function and initiate anticoagulation therapy immediately.

Choice C rationale

Waiting until the next day is dangerous because pulmonary embolism can cause rapid respiratory failure or death. While stopping the medication is necessary, the acute physical symptoms require higher acuity care than an outpatient clinic appointment.

Choice D rationale

Advising the client to continue the medication is incorrect and potentially fatal. Estrogen-containing pills exacerbate hypercoagulability. Ignoring signs of chest pain and dyspnea delays life-saving treatment for a likely pulmonary or cardiac vascular obstruction.