Which of the following maneuvers is most commonly used first to relieve shoulder dystocia during childbirth?
Episiotomy.
McRoberts maneuver.
Zavanelli maneuver.
Fundal pressure.
The Correct Answer is B
Choice A rationale
Episiotomy involves an incision in the perineum to enlarge the vaginal opening. While it can facilitate delivery, it does not directly address the mechanical obstruction caused by the shoulder impacting against the maternal symphysis pubis, which is the hallmark of shoulder dystocia.
Choice B rationale
The McRoberts maneuver is most commonly used first to relieve shoulder dystocia. It involves hyperflexing the maternal hips onto the abdomen, which flattens the sacrum, rotates the symphysis pubis cephalad, and often allows the impacted anterior shoulder to clear underneath the symphysis pubis, facilitating delivery.
Choice C rationale
The Zavanelli maneuver involves pushing the fetal head back into the birth canal and performing a Cesarean section. This is a highly invasive and often last-resort maneuver, employed only after less invasive methods like McRoberts and suprapubic pressure have failed due to its significant risks.
Choice D rationale
Fundal pressure involves applying downward pressure on the top of the uterus. This maneuver is contraindicated in shoulder dystocia because it can worsen the impaction of the fetal shoulder against the maternal symphysis pubis, potentially leading to more severe injury to the fetus or mother.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
A newborn's heart rate typically ranges from 120 to 160 beats per minute, and respirations are normally between 30 and 60 breaths per minute. A heart rate of 160/min and respirations of 40/min fall within these normal physiological ranges for a newborn, indicating adequate cardiovascular and respiratory adaptation to extrauterine life.
Choice B rationale
The average head circumference for a full-term newborn ranges from 33 to 35 cm, and the chest circumference is typically 2 to 3 cm less than the head circumference. A head circumference of 40 cm is significantly larger than the normal range, and a chest circumference of 32 cm suggests an abnormal head-to-chest ratio. These measurements could indicate hydrocephalus or other developmental anomalies and warrant immediate reporting to the provider for further assessment.
Choice C rationale
A positive Babinski reflex, characterized by dorsiflexion of the big toe and fanning of the other toes, is a normal neurological finding in newborns and infants up to 12-24 months of age, indicating an immature corticospinal tract. A negative Ortolani's sign indicates the absence of hip dislocation or dysplasia, which is a normal and desired finding, reflecting stable hip joints.
Choice D rationale
Acrocyanosis, which is the bluish discoloration of the hands and feet, is a common and normal finding in newborns during the first 24 to 48 hours after birth due to immature peripheral circulation. Caput succedaneum, a localized swelling of the scalp that crosses suture lines, is also a common and benign finding resulting from pressure during vaginal birth, typically resolving spontaneously within a few days.
Correct Answer is B
Explanation
Choice A rationale
Brain death is a clinical diagnosis characterized by irreversible cessation of all functions of the entire brain, including the brainstem. If the client's heart is still beating and they can breathe on their own, it indicates preserved brainstem function, which is inconsistent with brain death criteria.
Choice B rationale
Brain death is defined as irreversible cessation of all brain functions. When a client is on life support, but their brain has sustained irreversible damage with complete loss of brainstem reflexes, they meet the criteria for brain death, allowing for organ donation consideration.
Choice C rationale
A client able to respond to stimuli and communicate with others exhibits clear signs of brain activity and consciousness. This directly contradicts the definition of brain death, which requires complete and irreversible loss of all brain function, including higher cortical functions.
Choice D rationale
While vital organs may eventually cease functioning after brain death, the initial and primary criterion for brain death is the irreversible cessation of brain function. The vital organs can often be maintained on life support for a period to facilitate organ donation, so they are not necessarily non-functioning.
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