A 36-week pregnant woman is admitted with ruptured membranes and a positive test for Group B Streptococcus (GBS). What is the appropriate nursing action?

Correct Answer: A

Rationale: The correct answer is A: Start prophylactic antibiotics for the patient. In this scenario, the woman is at risk for ascending infection due to ruptured membranes and positive GBS test. Prophylactic antibiotics are necessary to prevent neonatal GBS sepsis. Performing a cesarean section is not indicated unless there are other obstetric indications. Administering IV fluids is important but not the priority in this case. Patient education on labor progression is not the immediate concern when the woman is at risk for infection.

Correct Answer: B

Rationale: The correct answer is B: Check for a cord prolapse. This is the first step because cord prolapse is a critical emergency that can lead to fetal compromise. By checking for cord prolapse, the nurse can quickly assess the situation and take appropriate actions to relieve pressure on the cord. Administering oxygen (choice A) may be necessary later but not the first step. Performing a vaginal examination (choices C and D) can exacerbate the situation by pushing the cord further into the birth canal.

Correct Answer: C

Rationale: The correct answer is C: Perform a vaginal exam to assess for fetal position. This is important because the position of the fetus can affect the safety and efficacy of administering an epidural in a patient with a history of back surgery. If the fetus is in a breech position or in any other position that could complicate the epidural placement, alternative pain management options may need to be considered. A: History of spinal surgery or deformity is important but assessing the fetal position takes precedence in this scenario. B: Fetal heart rate monitoring is essential during labor but not the most important assessment before proceeding with the epidural in this case. D: Administering Pitocin is unrelated to the assessment needed before proceeding with the epidural.

Correct Answer: D

Rationale: 1. The correct answer is D: Hospital support for breastfeeding. This is the most different trend compared to the early 1980s. 2. In the past, breastfeeding support in hospitals was minimal, but now it is a standard practice to provide education and assistance. 3. Fetal monitoring throughout labor (A) has been a common practice for many years and is not a recent trend. 4. Postpartum stay of 10 days (B) is excessive; postpartum stays have actually become shorter over time. 5. Having expectant partners and family in the operating room for cesarean birth (C) is a more recent practice but has become increasingly common in recent years.

Correct Answer: A

Rationale: The correct answer is A: "My child may be at increased risk for birth injury." This is correct because a pregnant patient with a BMI of 33 is considered obese, which can increase the risk of birth injury to the baby due to complications such as macrosomia (large birth weight). Explanation: 1. Obesity in pregnancy can lead to complications such as macrosomia, shoulder dystocia, and birth trauma. 2. Higher BMI can also increase the risk of cesarean delivery, which may be necessary to prevent birth injuries. 3. Childhood diabetes risk is not decreased with maternal obesity. 4. Mode of delivery (vaginal or cesarean) is not solely determined by BMI. 5. Gestational hypertension risk is actually higher in women with obesity. In summary, choice A is correct because it directly relates to the increased risk of birth injury associated with maternal obesity, while the other choices are not directly linked to the patient's BMI and pregnancy complications.