The nurse and student are discussing clients who are laboring on the unit.
Which clients would the nurse encourage to attempt a vaginal birth after having a cesarean section? Select all that apply.
A client who had rupture of membranes 26 hours ago.
A client with a current separation of symphysis pubis.
A client who had a cesarean section because of placenta previa.
A client who had a cesarean section because of a breech presentation.
A client who was positive for Group B streptococcal infection.
A client who has a gynecoid shaped pelvis.
Correct Answer : C,D,F
Choice A rationale
Prolonged rupture of membranes (PROM), especially beyond 18-24 hours, significantly increases the risk of intrauterine infection (chorioamnionitis) for both mother and fetus. Infection is a contraindication or at least a major caution for a trial of labor after cesarean (TOLAC) as it adds physiological stress and could necessitate an urgent repeat cesarean, complicating recovery. The normal range for time from rupture to delivery is generally under 24 hours.
Choice B rationale
A current separation of the symphysis pubis (diastasis symphysis pubis), often causing significant pelvic girdle pain and instability, presents a mechanical risk during labor and vaginal delivery. The excessive strain and pressure of pushing could exacerbate the separation, leading to severe maternal morbidity, chronic pain, and long-term musculoskeletal dysfunction, thus generally contraindicating a TOLAC.
Choice C rationale
Placenta previa, which occurs when the placenta covers the cervix, necessitating the previous cesarean, is an obstetric indication not expected to recur in subsequent pregnancies with the same certainty as issues like contracted pelvis or certain uterine incision types. With no recurrent previa and an otherwise favorable presentation, the client is a good candidate for a trial of labor after cesarean (TOLAC) because the prior indication was temporary.
Choice D rationale
A breech presentation, which describes the fetus positioned with the buttocks or feet first, was the fetal indication for the previous cesarean section. Assuming the current fetus is in a cephalic (head-down) presentation, this non-recurrent fetal issue makes the client a suitable candidate for a trial of labor after cesarean (TOLAC), as the uterus itself and the maternal pelvis are likely accommodating.
Choice E rationale
Group B streptococcal (GBS) colonization is a common bacterial finding in the lower genital tract, typically managed with prophylactic intravenous antibiotics (e.g., Penicillin) during labor. GBS positivity is a standard infectious risk factor managed with antibiotics and does not contraindicate a trial of labor after cesarean (TOLAC) itself, as it is routinely treated to prevent neonatal sepsis.
Choice F rationale
The gynecoid pelvis is considered the most favorable pelvic shape for vaginal delivery due to its rounded inlet, adequate mid-pelvis, and wide subpubic arch, which allows for optimal fetal head engagement and rotation. This favorable anatomy increases the likelihood of a successful trial of labor after cesarean (TOLAC) and is a strong positive predictive factor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Following the evacuation of a hydatidiform mole, the client is at risk for developing gestational trophoblastic neoplasia (GTN). Pregnancy must be avoided for at least six to twelve months to ensure that any persistent or new human chorionic gonadotropin (hCG) elevation is due to GTN and not a new normal pregnancy. Three months is the minimum duration often discussed.
Choice B rationale
Follow-up care, including weekly hCG level monitoring until the level is undetectable, then monthly for six to twelve months, is crucial for early detection of malignant transformation (choriocarcinoma). Therefore, six weeks of follow-up care is insufficient for proper surveillance and risk management.
Choice C rationale
A history of a hydatidiform mole is indeed a risk factor for recurrence, with a recurrence rate of approximately 1–2%. However, the immediate priority for discharge teaching focuses on preventing the hCG confounding effect of a new pregnancy and ensuring compliance with the necessary hCG monitoring protocol.
Choice D rationale
Chemotherapy is indicated if the hCG levels plateau or increase, or if there is evidence of metastasis, rather than if they decrease. A decrease in hCG levels is the desired outcome after evacuation and indicates successful treatment without the need for chemotherapy.
Correct Answer is B
Explanation
Choice A rationale
Amniotomy, the artificial rupture of membranes, is typically performed to induce or augment labor, especially if the membranes are intact and labor is progressing slowly. However, it carries risks such as cord prolapse, especially when the presenting part is floating (station -3 or higher), as noted, making this intervention inappropriate and potentially hazardous currently.
Choice B rationale
Early decelerations are a benign finding caused by transient fetal head compression during a contraction, mirroring the contraction shape. A floating presenting part (station greater than or equal to -3) signifies the fetal head has not yet entered the pelvic inlet, which is characteristic of the second stage of labor, or the active phase of the first stage of labor.
Choice C rationale
Early decelerations are considered a reassuring fetal heart rate pattern. Fetal distress is indicated by late or severe variable decelerations, persistent bradycardia, or absent variability, which are not present here. The FHR of 140 beats/min is within the normal range (110–160 beats/min), indicating adequate oxygenation.
Choice D rationale
A Cesarean birth is not immediately necessary. The findings—reassuring FHR pattern with early decelerations and a normal FHR of 140 beats/min—do not indicate fetal distress or an immediate maternal or fetal emergency that would necessitate urgent surgical intervention.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.