While caring for a pregnant 17-year-old, the client states, "I want to deliver my baby at an alternative birth center.”. Which information would be most important for the nurse to keep in mind when responding to the client?

Adolescent pregnancy is considered a high-risk situation.

Typically, the adolescent's support group would disapprove of this choice.

Alternative birth centers only admit clients over the age of 21 years.

Alternative birth centers are a suitable option for all pregnant women.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Adolescent pregnancy is scientifically categorized as a high-risk situation due to increased incidence of complications like preeclampsia, preterm birth, low birth weight infants, and cephalopelvic disproportion, reflecting an immature maternal physiology and often poorer prenatal care adherence. Alternative birth centers generally cater to low-risk pregnancies to ensure safety, making the client's high-risk status the paramount factor in determining the appropriateness of this delivery setting.

Choice B rationale

While psychosocial support is important, the potential physiological risks associated with an adolescent pregnancy, such as inadequate uterine blood flow or nutritional deficiencies, outweigh the concern regarding the support group's subjective opinion on the birth center choice. The nurse's primary focus must be on maternal-fetal safety based on scientific risk stratification, not social approval.

Choice C rationale

The eligibility criteria for alternative birth centers are based on maternal and fetal risk status, not solely on the client's chronological age. The absolute contraindication for delivery in such centers is the presence of high-risk factors, regardless of age, which include complex medical conditions or anticipated obstetrical complications, thus the age restriction is not the most important consideration.

Choice D rationale

Alternative birth centers are appropriate only for low-risk, uncomplicated pregnancies where a spontaneous, unmedicated birth is expected, and immediate specialized interventions are not anticipated. High-risk conditions, like those often seen in adolescent pregnancies (e.g., preeclampsia, prematurity risk), mandate delivery in a hospital setting where advanced life support is immediately available.

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Correct Answer is B

Explanation

Choice A rationale

While Group B Streptococcus (GBS) screening is important, the rectovaginal swab is typically performed earlier in pregnancy (35-37 weeks). Given that the client's membranes have ruptured (ROM) and she is in active labor (7 cm dilated), the immediate priority shifts to assessing fetal well-being and preventing complications, making a GBS swab a secondary action at this time.

Choice B rationale

Assessing the fetal heart rate (FHR) immediately is the most critical intervention following rupture of membranes (ROM), especially when the fetal station is +1 (well-engaged). ROM increases the risk of cord prolapse, which can lead to acute fetal hypoxia and death. Continuous or frequent FHR monitoring via external or internal methods is essential to detect any signs of distress or umbilical cord compression.

Choice C rationale

Repositioning the client onto their left side (or right side) is a standard intervention to optimize uterine perfusion and placental blood flow when fetal heart rate (FHR) decelerations or non-reassuring patterns are observed. While beneficial, the initial priority is determining the fetal status after the membranes have ruptured by assessing the FHR before implementing general interventions like repositioning.

Choice D rationale

Determining the client's gestational age is important for overall management but does not address the immediate risk posed by the ruptured membranes in the setting of active labor (7 cm dilation). Fetal well-being assessment (FHR monitoring) takes precedence over gathering historical data, as it is a direct life-saving measure in this acute phase of labor with ruptured membranes.

Correct Answer is ["6.7"]

Explanation

Step 1 is: Calculate the total oxytocin in mU:. 20 units × (1000 mU ÷ 1 unit) = 20000 mU.

Step 2 is: Calculate the concentration of the oxytocin solution in mU/mL:. 20000 mU ÷ 500 mL = 40 mU/mL.

Step 3 is: Calculate the total mU of oxytocin infused per hour:. 10 mL/hr × 40 mU/mL = 400 mU/hr.

Step 4 is: Convert the infusion rate from mU/hr to mU/min:. 400 mU/hr ÷ 60 min/hr = 6.666. mU/min.

Step 5 is: Round to the nearest tenths place:. 6.7 mU/min.

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While caring for a pregnant 17-year-old, the client states, "I want to deliver my baby at an alternative birth center.”. Which information would be most important for the nurse to keep in mind when responding to the client?

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Naxlex Comprehensive Predictor Exams

A vaginal exam reveals a client's membranes have ruptured, their cervix is dilated to 7 cm, and the fetal head is at station +1. What priority action would the nurse take in response?

Correct Answer is B

Explanation

Correct Answer is ["6.7"]

Explanation

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The nurse and student are discussing how to evaluate a client receiving Oxytocin in the third stage of labor. What does the nurse include as the desired outcome of this medication?

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