A gravida 2, para 1 is in active labor at 39 weeks gestation. Her cervical exam is 6 cm dilated, 60% effaced, and 0 station. An amniotomy is performed by the physician. The fluid is noted to be bloody and the fetal heart tones have decelerated to the 50s. What is the nurse’s next best action?

Correct Answer: A

Rationale: The correct answer is A: Notify the operating team of emergent cesarean delivery. In this scenario, the presence of bloody amniotic fluid and fetal heart rate decelerations to the 50s indicate potential fetal distress. Given the critical nature of this situation, an emergent cesarean delivery should be considered to expedite delivery and prevent further compromise to the fetus. This decision is based on the principle of prioritizing fetal well-being in situations of acute distress. Options B, C, and D do not address the immediate need for prompt intervention to ensure the safety of the fetus in distress.

Correct Answer: A

Rationale: The correct answer is A because the positioning of the pregnant person affects the alignment of the baby's head in the pelvis, directly influencing cervical dilation. Proper positioning helps the baby apply pressure to the cervix, promoting dilation. In contrast, the strength of uterine contractions (B) affects labor progress but not cervical dilation specifically. The length of time since ruptured membranes (C) may increase infection risk but does not directly impact dilation. Fetal presentation (D) affects the descent of the baby, not cervical dilation.

Correct Answer: A

Rationale: The correct answer is A (contractions and pushing efforts) because they are the main physiological components of labor and birth. Contractions help to thin and dilate the cervix, while pushing efforts help the baby descend through the birth canal. Pelvis and pelvic floor tissues (B) play a role in the mechanics of birth but do not make up the powers of labor. Fetal position, attitude, lie, and presentation (C) are important factors influencing labor progress but do not constitute the powers of labor. Oxytocin (D) is a hormone that stimulates contractions but is not a direct component of the powers of labor.

Correct Answer: D

Rationale: The correct answer is D because the second stage of labor begins when the mother starts pushing to deliver the baby. This stage involves the actual delivery of the baby and ends with the birth. The other choices are incorrect because: A: Labor begins before the second stage. B: The early phase is part of the first stage of labor. C: Full dilation and effacement mark the transition between the first and second stages but pushing is when the second stage actually begins.

Correct Answer: C

Rationale: The correct answer is C because a blood pressure of 142/88 is considered abnormal during the first stage of labor. Elevated blood pressure can indicate preeclampsia, a serious condition that requires immediate medical attention. A: Patient moaning with contractions is a common response to pain during labor and not necessarily abnormal. B: Contractions 3 minutes apart lasting 60 seconds are within the normal range for the first stage of labor. D: Respiratory rate of 22 is within the normal range and not indicative of any abnormalities during labor. In summary, the abnormal finding in this scenario is the elevated blood pressure, which can be a sign of a serious condition like preeclampsia.