The nurse is providing care for a patient in the second phase of labor.After more than 4 hours of pushing, the nurse suspects fetal dystocia.
Which is the greatest risk related to the nurse's suspected complication?

Greater risk for maternal lacerations.

Fetal injury confirmed by the presence of bruising.

Neonatal asphyxia related to prolonged labor.

Increased consideration for a cesarean delivery.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While maternal lacerations are a risk during childbirth, they are not the greatest risk in cases of fetal dystocia. The focus is primarily on fetal wellbeing.

Choice B rationale

Fetal injury such as bruising can occur with dystocia, but the primary concern is the potential for severe, life-threatening complications.

Choice C rationale

Neonatal asphyxia related to prolonged labor is the greatest risk with fetal dystocia. Prolonged labor can lead to decreased oxygen supply to the fetus, causing asphyxia and potential brain injury.

Choice D rationale

Increased consideration for a cesarean delivery is a possible outcome of fetal dystocia, but it is a management decision rather than a direct risk to the baby’s immediate health.

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Correct Answer is B

Explanation

Choice A rationale

Prior amniotic fluid leakage is not a required criterion for amniotomy. The main concern is cervical readiness and fetal head position, not previous leakage.

Choice B rationale

The fetal head engaged in the maternal pelvis ensures proper pressure and position for safe amniotomy. Engagement reduces the risk of umbilical cord prolapse and injury.

Choice C rationale

Certification of the nurse for amniotomy is not a standard criterion. The procedure is performed by qualified professionals, but certification isn't a prerequisite for the procedure to be scheduled.

Choice D rationale

Ultrasound to check the umbilical cord's position isn't a standard pre-amniotomy criterion. While it can be useful, the primary concern is the fetal head engagement and cervical readiness.

A. A. Increase diuresis. B. Prevent seizures. C. Reduce blood pressure. D. Slow the process of labor.

Correct Answer is B

Explanation

Choice A rationale

Magnesium sulfate is not given to increase diuresis; this is not its primary effect and is incorrect in the context of treating preeclampsia.

Choice B rationale

Magnesium sulfate is administered to prevent seizures in patients with preeclampsia. It acts as a central nervous system depressant and helps in preventing eclampsia.

Choice C rationale

Although magnesium sulfate may have a mild effect on reducing blood pressure due to its vasodilatory properties, this is not its primary purpose in the management of preeclampsia.

Choice D rationale

Magnesium sulfate is not used to slow the process of labor; its main role is seizure prophylaxis in preeclampsia.

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The nurse is providing care for a patient in the second phase of labor.After more than 4 hours of pushing, the nurse suspects fetal dystocia.Which is the greatest risk related to the nurse's suspected complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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The nurse is providing care for a patient in the second phase of labor.After more than 4 hours of pushing, the nurse suspects fetal dystocia.
Which is the greatest risk related to the nurse's suspected complication?