A nurse is assisting with a vaginal birth and is monitoring for signs of placental separation. What is the most reliable clinical indicator that the placenta has separated?

Correct Answer: C

Rationale: The correct answer is C: lengthening of the umbilical cord. This is the most reliable indicator of placental separation because as the placenta detaches from the uterine wall, the cord lengthens as it moves downward. This signifies that the placenta has separated completely. A: A gush of clear amniotic fluid is not a reliable indicator of placental separation as it can occur before or after placental separation. B: Uterine contractions every 2 to 3 minutes are a sign of labor progression, not specifically placental separation. D: Maternal report of intense pain can be subjective and may not always indicate placental separation.

Correct Answer: C

Rationale: The correct answer is C: to reduce the risk of seizures and cerebral hemorrhage. Magnesium sulfate is used during preterm labor to prevent and treat seizures in women with preeclampsia and eclampsia. It acts as a neuroprotective agent by preventing cerebral vasoconstriction and reducing the risk of cerebral hemorrhage. The other choices are incorrect because magnesium sulfate does not primarily relax the uterus to prevent contractions (A), improve fetal oxygenation (B), or decrease blood pressure (D) during preterm labor.

Correct Answer: A

Rationale: The correct answer is A: administer a test dose of anesthesia. Before administering an epidural, it is crucial to perform a test dose to assess the person's response and ensure correct placement of the catheter. This step helps prevent potential complications such as unintentional intravascular injection. Summary: B: Ensuring informed consent is important but not the priority before administering the test dose. C: Administering IV fluids is important for hydration but not the immediate priority before the test dose. D: Continuous fetal monitoring is essential during labor, but it is not the priority before administering the test dose of anesthesia.

Correct Answer: A

Rationale: The correct answer is A: Progressive cervical dilation. This is the most reliable indicator of the active phase of labor because it directly reflects the opening of the cervix, indicating that labor is advancing. Cervical dilation is a key aspect of labor progress and is used to determine the stage of labor. Frequent, regular contractions (choice B) are important but can occur in early labor as well. Fetal descent (choice C) is an important aspect but may happen in conjunction with cervical dilation. Effacement of the cervix (choice D) is also important but does not solely indicate the active phase of labor.

Correct Answer: C

Rationale: The correct answer is C, bradycardia. Bradycardia in the fetal heart rate is a significant finding indicating fetal distress because it signifies a heart rate below normal range, which can lead to inadequate oxygen supply to the fetus. Bradycardia can be a sign of fetal hypoxia, acidosis, or other serious conditions. Variable decelerations (choice A) are often caused by umbilical cord compression, late decelerations (choice B) are associated with uteroplacental insufficiency, and accelerations (choice D) are considered a reassuring sign of fetal well-being. Therefore, in the context of fetal distress, bradycardia is the most concerning finding.