Which of the following patients is an appropriate candidate for augmentation of labor with oxytocin? A G2P1 who presents with:

A fetus displaying signs of distress on the FHR monitor.

Placenta previa.

Active genital herpes lesions.

Hypertension of pregnancy or gestational hypertension.

Answer and Explanation

The Correct Answer is D

Choice A rationale

A fetus displaying signs of distress, such as late decelerations or minimal variability on the FHR monitor, is a contraindication for augmentation of labor. Increasing uterine contractions with oxytocin could further compromise fetal oxygenation, potentially leading to severe fetal hypoxia. In this scenario, alternative interventions to improve fetal well-being or a cesarean delivery may be necessary.

Choice B rationale

Placenta previa, a condition where the placenta partially or completely covers the cervix, is an absolute contraindication for vaginal birth and labor augmentation. The increased contractions from oxytocin could lead to placental separation and massive hemorrhage, endangering both the mother and the fetus. A cesarean delivery is indicated for this condition.

Choice C rationale

Active genital herpes lesions present a high risk of transmitting the herpes simplex virus to the newborn during passage through the birth canal. This can cause severe neonatal morbidity and mortality. Therefore, a vaginal birth is contraindicated, and labor augmentation with oxytocin would not be an appropriate intervention. A cesarean delivery is the recommended course of action.

Choice D rationale

Hypertension of pregnancy or gestational hypertension, as long as it is not severe and there are no signs of fetal compromise or placental insufficiency, is a common reason for labor induction or augmentation. Augmentation with oxytocin can be used carefully to manage labor progression while the patient is closely monitored for signs of worsening hypertension, and the fetus is monitored for distress.

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Correct Answer is C

Explanation

Step 1 is: Identify the start and end of the first stage of labor. The first stage begins with the onset of regular uterine contractions and ends with full cervical dilation (10 cm) and effacement (100%). The patient's contractions started at 3 a.m., and she arrived at the hospital at 8: a.m. with 5 cm dilation. She delivered at 3: p.m. but her labor progression is noted up to 2 p.m. with an overwhelming need to push which indicates she was likely in the second stage of labor.

Step 2 is: The first stage of labor is from 3 a.m. (onset of regular contractions) to the overwhelming need to push at 2 p.m., which indicates the end of the first stage and the beginning of the second stage.

Step 3 is: Calculate the duration. From 3 a.m. to 2 p.m. is 11 hours. The final calculated answer is 11 hours.

A. General anesthesia. B. Pudendal block. C. Epidural anesthesia. D. Local anesthesia.

Correct Answer is A

Explanation

Choice A rationale

General anesthesia, particularly with halogenated inhalational agents, can cause uterine atony. These agents act as uterine smooth muscle relaxants, which can prevent the uterus from contracting effectively after birth. A relaxed, or atonic, uterus is the most common cause of postpartum hemorrhage because it cannot compress the blood vessels at the placental site, leading to uncontrolled bleeding.

Choice B rationale

A pudendal block provides anesthesia to the perineum, vulva, and lower vagina by injecting an anesthetic into the pudendal nerves near the ischial spines. It does not affect the uterine muscle or its contractility. Therefore, a pudendal block would not contribute to uterine atony or increase the risk of postpartum hemorrhage from a relaxed uterus.

Choice C rationale

An epidural provides regional anesthesia by blocking nerve impulses in the lower spinal segments. While high concentrations of anesthetic agents can have a mild effect on uterine contractility, modern low-dose epidurals typically do not significantly impair uterine muscle tone. The risk of postpartum hemorrhage from uterine atony is not as high with epidural anesthesia as it is with general anesthesia.

Choice D rationale

Local anesthesia, such as a perineal infiltration for an episiotomy or repair, involves injecting an anesthetic directly into the tissues of the perineum. This localized effect does not circulate systemically in a way that would relax the uterine smooth muscle. Therefore, local anesthesia would not contribute to a relaxed uterus or postpartum hemorrhage.

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Which of the following patients is an appropriate candidate for augmentation of labor with oxytocin? A G2P1 who presents with:

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Correct Answer is C

Explanation

A patient experienced a large hemorrhage postpartum because of a relaxed uterus. Which of the following anesthesia methods is most likely to have contributed to this problem?

Correct Answer is A

Explanation

Butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) are the preferred opioid analgesics used during labor because these medications:

Which of the following pregnancy complications could explain the changes seen in the fetal heart tracing above?

A nurse is caring for a patient in the first stage of labor and assesses that the patient is 6 cm dilated, 75% effaced, and the baby is at 0 station. Based on these findings, the nurse would document that the patient is in what phase of the first stage of labor?

A patient was given a fentanyl injection during labor. The nurse noted the expected outcome of loss of variability along with a pattern indicating uteroplacental insufficiency. Which of the following strips illustrates this?

A patient in labor has a fetal heart rate with late decelerations. Which of the following are appropriate intrauterine resuscitation measures? Select all that apply.

Which of the following patients does the nurse recognize as a good candidate for a trial of labor after cesarean (TOLAC) and possible VBAC (vaginal birth after cesarean)?

A patient in active labor is told by the nurse-midwife that "the baby is in the flexed attitude.”. When she asks the nurse what that means, what should the nurse say?

A patient in labor arrives at labor and delivery complaining of intense pain with contractions in her lower abdomen and perineal area. What does the nurse suspect?