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. Given the scenario of a gravida 2, para 1 in active labor with bloody fluid and fetal heart decelerations to the 50s following amniotomy, these signs indicate fetal distress. In this critical situation, immediate intervention with emergent cesarean delivery is necessary to prevent adverse outcomes for the baby. This step takes priority over other actions, as it ensures timely delivery and assessment of the fetus's well-being. Choices B, C, and D are not appropriate in this emergent situation as they do not directly address the fetal distress and the need for expedited delivery.

Correct Answer: A

Rationale: The correct answer is A: positioning of the pregnant person. The position of the pregnant person can directly influence cervical dilation by affecting the alignment of the uterus and baby, allowing for optimal pressure on the cervix. Proper positioning can facilitate the descent of the baby's head onto the cervix, promoting dilation. Summary of why other choices are incorrect: B: The strength of uterine contractions indirectly influences cervical dilation by aiding in the effacement and descent of the baby, but it does not directly impact dilation. C: The length of time since ROM (rupture of membranes) can affect the risk of infection but does not directly influence cervical dilation. D: Fetal presentation refers to the position of the baby in the uterus and can affect labor progress, but it does not directly impact cervical dilation.

Correct Answer: A

Rationale: The correct answer is A: contractions and pushing efforts. During labor and birth, contractions help to dilate the cervix and push the baby down the birth canal. Pushing efforts from the mother help to expel the baby out. Pelvis and pelvic floor tissues (choice B) provide the passage for the baby but do not actively contribute to the powers of labor. Fetal position, attitude, lie, and presentation (choice C) refer to the baby's position and orientation in the womb, which can affect the progress of labor but do not constitute the powers of labor. Oxytocin (choice D) is a hormone that stimulates contractions but is not the sole component of the powers of labor and birth.

Correct Answer: D

Rationale: The correct answer is D: when pushing begins. The second stage of labor begins when the cervix is fully dilated, and the mother starts pushing to deliver the baby. This stage ends with the birth of the baby. Option A is incorrect because the second stage begins after birth. Option B is incorrect as it refers to the transition phase, not the second stage. Option C is incorrect because the cervix being fully dilated and effaced marks the beginning of the second stage, not the end of it.

Correct Answer: C

Rationale: The correct answer is C because a blood pressure of 142/88 is considered high and abnormal during the first stage of labor. This could indicate hypertension, which can have serious implications for both the mother and the baby. High blood pressure can lead to complications such as preeclampsia. A, B, and D are incorrect because: A: Patient moaning with contractions is a common response to labor pains and does not necessarily indicate an abnormal finding. B: Contractions 3 minutes apart lasting 60 seconds are within the normal range for the first stage of labor. D: A respiratory rate of 22 is also within the normal range and is not indicative of any abnormal findings during the first stage of labor.