You are caring for a term low-risk nulliparous client in the second stage of spontaneous labor.
The client has an epidural and has been pushing for just over 3 hours and reports being exhausted.
The fetal station is +3. What intervention do you anticipate the provider to recommend?
Continue pushing for at least 2 more hours.
Emergent cesarean delivery with general anesthesia.
Vacuum-assisted vaginal delivery.
Administer a fluid bolus of 1000 ml NS. .
The Correct Answer is C
Choice A rationale
Continuing pushing for at least 2 more hours is generally acceptable in the second stage of labor, particularly for nulliparous women. However, in this case, the client is exhausted, and the fetal station is +3, indicating that the fetal head is very low in the pelvis, suggesting the need for assisted delivery.
Choice B rationale
An emergent cesarean delivery with general anesthesia would be considered in cases of severe fetal distress or maternal complications. Given the fetal station of +3, a vaginal delivery is likely feasible, making this option less suitable in this context.
Choice C rationale
Vacuum-assisted vaginal delivery is appropriate when the fetal head is low in the pelvis (station +3), and the mother is too exhausted to continue pushing effectively. This intervention helps to expedite delivery while minimizing the need for a cesarean section.
Choice D rationale
Administering a fluid bolus of 1000 ml NS can be useful in managing maternal hypotension or dehydration, but it would not directly address the client's exhaustion or assist in delivering the baby.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
A loud cry is a normal sign in a newborn and indicates good lung function and adequate oxygenation. It is not a sign of respiratory distress.
Choice B rationale
Grunting is a sign of respiratory distress in newborns. It indicates that the infant is using extra effort to keep the airways open and improve oxygenation.
Choice C rationale
Rooting is a normal reflex in newborns and is not indicative of respiratory distress. It involves the infant turning their head towards a stimulus when the cheek or mouth is touched.
Choice D rationale
Acrocyanosis refers to the bluish discoloration of the hands and feet in newborns. It is typically a normal finding and not a sign of respiratory distress.
Correct Answer is B
Explanation
Choice A rationale
History of preeclampsia is a consideration in future pregnancies, but it is not an absolute contraindication for a trial of labor after cesarean (TOLAC). Each case should be individually evaluated based on the severity and recurrence risk.
Choice B rationale
History of classical uterine incision during cesarean is a contraindication for TOLAC due to the increased risk of uterine rupture during labor. A classical incision involves a vertical cut on the upper uterus, which is more prone to rupture compared to a lower transverse incision.
Choice C rationale
History of cord prolapse is a serious complication, but it does not inherently contraindicate TOLAC. Future labor and delivery plans should involve close monitoring and readiness to address any recurrence of cord prolapse.
Choice D rationale
History of one cesarean section is not a contraindication for TOLAC. In fact, many women with a single previous cesarean delivery are considered good candidates for a trial of labor, depending on other factors and the type of uterine incision. .
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