A multipara, LOA, station 3, who has had no pain medication during her labor, is now in stage 2. She states that her pain is 6 on a 10-point scale and that she wants an epidural. Which of the following responses by the nurse is appropriate?

Correct Answer: B

Rationale: Option A is incorrect because there is no evidence to support the statement that epidurals do not work well when the pain level is above 5. Pain is subjective, and each individual experiences pain differently. The decision to administer an epidural should be based on the patient's request and assessment of their pain level, not an arbitrary cutoff point. Option C is incorrect because it is never too late for an epidural. While it is true that the baby may be born soon in stage 2 labor, epidurals can still be administered to provide pain relief during delivery. The timing of the epidural should be based on the patient's request and pain level, not assumptions about the progression of labor. Option D is incorrect because the decision to administer an epidural should not be based on the fetal heart rate alone. Fetal heart rate monitoring is important for assessing the well-being of the baby, but it should not determine whether a patient receives pain relief. The decision to administer an epidural should be based on the patient's request and assessment of their pain level. Option B is the correct answer because the nurse should promptly respond to the patient's request for an epidural by contacting the doctor to obtain an order. It is important to advocate for the patient's preferences and provide timely pain relief during labor. Promptly contacting the doctor for an epidural order demonstrates good communication and patient-centered care.

Correct Answer: B

Rationale: In this scenario, the woman is 40 weeks gestation, with 2 cm dilation, 30% effacement, contracting every 12 minutes and 30 seconds. The fetal heart rate is in the 140s with good variability and spontaneous accelerations. Choice A: The woman is not high risk based on the information provided. Tocolytics are used to stop preterm labor, not indicated in this case. Choice C: Induction is not necessary at this point as the woman is only 2 cm dilated and 30% effaced, indicating early labor. Choice D: The woman is not in active labor as she is only 2 cm dilated and contracting every 12 minutes and 30 seconds. Correct Answer (B): The findings suggest that the woman is in early labor. With 2 cm dilation, 30% effacement, and contractions every 12 minutes and 30 seconds, she is not in active labor. The fetal heart rate is reassuring with good variability and spontaneous accelerations. The nurse can conclude that the woman is in early labor and could potentially be sent home to continue laboring until she is in active labor. This approach allows her to be in a familiar and comfortable environment until labor progresses further.

Correct Answer: A

Rationale: The correct position for a woman to be in when inserting an epidural catheter is the fetal position. This position allows for easier access to the epidural space in the lower back. The fetal position involves the patient curling up on their side with their knees drawn up towards their chest. This position helps to widen the spaces between the vertebrae, making it easier for the anesthesiologist to insert the catheter into the epidural space. Option B, the lithotomy position, is not appropriate for inserting an epidural catheter. The lithotomy position involves the patient lying on their back with their legs elevated and spread apart. This position is typically used for gynecological exams and procedures, not for epidural placement. Option C, the Trendelenburg position, is also not suitable for inserting an epidural catheter. The Trendelenburg position involves the patient lying flat on their back with the legs elevated higher than the head. This position is used to improve venous return to the heart and is not necessary or beneficial for epidural placement. Option D, the lateral recumbent position, is not the ideal position for inserting an epidural catheter either. The lateral recumbent position involves the patient lying on their side with their top leg straight and bottom leg bent. While this position may be used for certain medical procedures, it does not provide the optimal access to the epidural space for catheter insertion.

Correct Answer: B

Rationale: The correct answer is B: Fetal heart acceleration. During a fetal scalp stimulation test, the practitioner will apply pressure to the fetal scalp to stimulate the baby. A normal response to this stimulation is an acceleration in the fetal heart rate. This is because the stimulation causes an increase in sympathetic nervous system activity, leading to an increase in heart rate. This is a reassuring sign of fetal well-being as it indicates that the baby is responding appropriately to stimuli. Now, let's discuss why the other choices are incorrect: A: Spontaneous fetal movement. While fetal movement is a sign of fetal well-being, the fetal scalp stimulation test specifically looks for a response in the fetal heart rate, not fetal movement. Therefore, this choice is not the expected response during this test. C: Increase in fetal heart variability. Fetal heart rate variability is a measure of the fluctuations in the fetal heart rate over time. While variability is a positive sign of fetal well-being, it is not the expected response during a fetal scalp stimulation test. The test is specifically looking for a change in the fetal heart rate in response to stimulation, not an increase in variability. D: Resolution of late decelerations. Late decelerations are a concerning fetal heart rate pattern that indicates uteroplacental insufficiency. The fetal scalp stimulation test is not designed to resolve late decelerations. It is used to assess fetal well-being by evaluating the fetal heart rate response to stimulation. In conclusion, the correct response to a fetal scalp stimulation test is an acceleration in the fetal heart rate. This indicates that the baby is responding appropriately to stimulation and is a reassuring sign of fetal well-being.

Correct Answer: C

Rationale: Choice A is incorrect because encouraging the father to hold his partner's hand during labor is not specifically related to the patient's religious or cultural beliefs as an Orthodox Jewish woman. While emotional support is important during labor, this choice does not address any specific cultural needs of the patient. Choice B is incorrect because asking the woman if she would like to speak with her priest assumes that the patient is Catholic or another faith that has priests. In this case, the patient is identified as being Orthodox Jewish, so it would not be appropriate to offer the services of a priest, as this does not align with her religious beliefs. Choice D is incorrect because placing an order for the woman's postpartum vegetarian diet assumes that all Orthodox Jewish individuals follow a vegetarian diet, which is not necessarily the case. While some may choose to follow a vegetarian diet for religious or personal reasons, it is not a universal practice among Orthodox Jewish individuals. Choice C is the correct answer because providing the woman with a long-sleeved hospital gown aligns with the modesty and privacy guidelines of Orthodox Jewish women. Modesty is an important aspect of Orthodox Jewish culture, and providing appropriate attire that respects this aspect of her beliefs is an important part of culturally competent care.