Which healthcare provider order for a client with cephalopelvic disproportion would the nurse querry

Choice A rationale

Stronger contractions are not a specific complication of breech presentation. Contraction strength is related to uterine action and response to oxytocin, not solely to fetal presentation. Breech presentation primarily poses risks related to the birthing process itself, such as cord prolapse and birth trauma.

Choice B rationale

In a breech presentation, the presenting part (buttocks or feet) is less effective than the head in filling the pelvic inlet, potentially leaving space for the umbilical cord to prolapse, especially upon rupture of membranes. Cord prolapse causes nonreassuring fetal signs such as sudden, severe variable decelerations or prolonged bradycardia due to cord compression and subsequent fetal hypoxia.

Choice C rationale

Precipitate labor is characterized by very rapid cervical dilation and fetal descent, usually occurring within three hours of labor onset. This is not directly caused by a breech presentation. The mechanism of labor in breech is often slower and more complicated due to the less efficient presenting part.

Choice D rationale

Cessation of contractions often indicates uterine fatigue or uterine inertia, which can occur in prolonged labor or with specific uterine conditions, but it is not a direct or common complication of breech presentation. Overstretching of the uterus is typically associated with polyhydramnios or multiple gestation.

Choice A rationale

Facial paralysis in a newborn after a forceps delivery is most often due to trauma to the facial nerve (cranial nerve VII), typically caused by pressure from the instrument against the nerve where it exits the stylomastoid foramen. This injury is usually a temporary neuropraxia (a physiological block with intact axons) which resolves spontaneously as the swelling subsides and compression is relieved, often within a few days to a few weeks, making close monitoring appropriate.

Choice B rationale

Phototherapy is the standard treatment for neonatal hyperbilirubinemia (jaundice), a condition where unconjugated bilirubin levels are elevated (normal total bilirubin is <5 mg/dL in the first 24 hours), which is a metabolic issue. Facial paralysis is a mechanical nerve injury related to birth trauma, and therefore, phototherapy has no therapeutic effect on nerve function or paralysis resolution.

Choice C rationale

While a neurologist consultation might be needed for persistent or severe paralysis that does not begin to show signs of improvement after several weeks, initial management involves expectant monitoring. The vast majority of these injuries are mild and transient, making immediate, routine referral unnecessary and potentially causing undue parental anxiety without an immediate need for specialized intervention.

Choice D rationale

There is typically no physiological contraindication to immediate or continued breastfeeding with this type of facial nerve injury. However, the nurse should assess the infant's ability to latch and suck effectively, as paralysis might compromise the motor function required for feeding, but is not a reason to universally prohibit all attempts at breastfeeding.