A fetus is positioned in the occiput anterior position. The nurse determines that the fetus is positioned in which way?

Correct Answer: B

Rationale: In labor and delivery, understanding fetal positioning is crucial for monitoring progress and ensuring a safe delivery. In the given scenario, the correct answer is B: "The fetal head is closest to the vaginal opening and the occiput is directed toward the maternal symphysis." This answer is correct because the occiput anterior position indicates that the baby's head is facing downward with the back of the head (occiput) toward the front of the mother's pelvis (maternal symphysis). This is the optimal position for a vaginal delivery as it allows for the smooth passage of the baby through the birth canal. Option A is incorrect because in the occiput anterior position, it is the fetal head, not the shoulder, that is closest to the vaginal opening. Option C is incorrect as it describes the occiput posterior position where the fetal head is closer to the uterine fundus, which is not the case in the given scenario. Option D is incorrect as it describes the occiput transverse position where the fetal head is directed towards the maternal sacrum, which is also not the position mentioned in the question. Understanding fetal positioning is essential for nurses and healthcare providers in labor and delivery settings to assess progress, anticipate potential complications, and provide appropriate care during childbirth. It ensures a positive birth experience for both the mother and the baby.

Correct Answer: B

Rationale: The correct answer is B) A midline episiotomy is associated with more third- and fourth-degree lacerations. Rationale: A midline episiotomy involves an incision made directly in the midline of the perineum towards the anus. This type of episiotomy is associated with a higher risk of extending into the anal sphincter, leading to third- and fourth-degree lacerations. These severe lacerations can result in long-term complications such as fecal incontinence and pelvic floor dysfunction. Explanation of other options: A) An episiotomy is not required for all vaginal births. It is only performed when deemed necessary to facilitate delivery or prevent severe perineal tearing. C) A mediolateral episiotomy is actually easier to repair than a midline episiotomy as it reduces the risk of extending into the anal sphincter. D) A midline episiotomy is not specifically associated with more blood loss compared to other types of episiotomies. Educational context: Understanding the different types of episiotomies and their associated risks is crucial for nurses working in labor and delivery. It is essential to know the implications of each type of episiotomy to provide informed and safe care to laboring women. Educating patients about episiotomy procedures empowers them to make informed decisions about their birth experience and postpartum recovery.

Correct Answer: A

Rationale: Hydration helps to dilute endogenous oxytocin, which can reduce uterine contractions and relax the uterus. Hypertonic labor involves excessive uterine contractions, and hydration can counteract this by regulating contractions and improving perfusion, which ultimately aids in a more coordinated and effective labor progression.

Correct Answer: C

Rationale: In this scenario, the nurse's next best action is to maintain the oxytocin infusion at 6 mU/min (Option C). This is because the fetal heart tracing displays a baseline of 130, moderate variability, and no accelerations or decelerations, indicating that the fetus is tolerating the current dose of oxytocin well. Additionally, the uterine contractions every 2 minutes for the last 30 minutes suggest effective labor progress. Reducing the oxytocin infusion to 3 mU/min (Option A) could potentially slow down labor progress and lead to inadequate contractions, risking fetal compromise. Delaying the next scheduled oxytocin increase (Option B) may not be necessary as the current dose is well-tolerated by the fetus and is resulting in effective contractions. Discontinuing the oxytocin infusion (Option D) would not be appropriate at this point as it may cause labor to stall, leading to the need for alternative interventions to progress labor. Educationally, this scenario highlights the importance of closely monitoring fetal and maternal well-being during labor induction, as well as the need for nurses to understand the effects of oxytocin on uterine contractions and fetal status to make informed clinical decisions.

Correct Answer: C

Rationale: Cephalohematomas are a common complication from operative vaginal deliveries. The accumulation of blood between the infant's skull and periosteum increases the risk of jaundice because of the breakdown of red blood cells, which can overwhelm the infant's immature liver and lead to hyperbilirubinemia.