A 24-year-old patient is in labor and requests pain relief. What is the most appropriate intervention for a patient who is in the active phase of labor?

Correct Answer: A

Rationale: The correct answer is A: Administer an epidural block. In the active phase of labor, the pain is typically intense and continuous. Administering an epidural block can provide effective pain relief by blocking nerve signals, allowing the patient to rest and conserve energy for the pushing phase. It does not affect the ability to push and can improve maternal satisfaction. Non-pharmacological methods (B) may not provide sufficient relief at this stage. Narcotic analgesics (C) can cross the placenta and affect the baby's respiratory system. Encouraging the patient to push (D) is appropriate during the second stage of labor, not the active phase.

Correct Answer: B

Rationale: The correct answer is B: Position the patient on her hands and knees. This position, known as the all-fours position, can help rotate the baby from an occiput posterior position to a more favorable position for delivery. Gravity assists in the rotation of the baby, making delivery easier. Encouraging the patient to push vigorously (option A) may not be effective in this situation as the baby may be facing the wrong way. Performing a cesarean section (option C and D) should be considered only if other interventions fail or if there are complications that necessitate surgical delivery.

Correct Answer: A

Rationale: The correct answer is A: Perform a nonstress test (NST). This is the first step in assessing fetal well-being when a patient presents with decreased fetal movement at 40 weeks gestation. The NST evaluates fetal heart rate in response to fetal movement, providing immediate information on fetal well-being. Administering a corticosteroid injection (B) would not be indicated at this point as it is not the first-line management for decreased fetal movement. Monitoring fetal heart rate (C and D) is important, but the NST provides more comprehensive information on fetal well-being.

Correct Answer: B

Rationale: Step 1: The patient tested negative for chlamydia, syphilis, gonorrhea, and HIV, reducing the risk of transmission of these infections to the baby. Step 2: Neonatal conjunctivitis is commonly caused by exposure to maternal genital tract bacteria during birth. Step 3: Since the patient tested negative for the common infections, neonatal conjunctivitis becomes the higher risk for the baby. Summary: A, C, and D are not directly related to the information provided, making them incorrect choices. Neonatal conjunctivitis is the most likely risk due to maternal genital tract bacteria exposure during birth.

Correct Answer: D

Rationale: The correct answer is D: Healthy People 2020. The nurse will use Healthy People 2020 guidelines because they are evidence-based, nationally recognized objectives that focus on improving the health and well-being of individuals, families, and communities. These guidelines specifically address maternal and infant health outcomes, making them the most relevant choice for the nurse's goal. Incorrect Choices: A: WHO Maternal care guidelines - While WHO guidelines are important, they are not specific to the national goals and objectives the nurse is trying to align with. B: State Practice Acts - State Practice Acts govern the scope of practice for nurses and do not provide specific guidelines for maternal health goals. C: AWHONN white papers - AWHONN provides valuable resources, but they may not be as comprehensive or nationally recognized as Healthy People 2020 for setting maternal health goals.