A patient is admitted to the labor and birth room in active labor; contractions are 4 to 5 minutes apart and last for 30 seconds. The nurse needs to perform a detailed assessment. When is the best time to ask questions or perform procedures?

Correct Answer: C

Rationale: The correct answer is C: During the increment of the next contraction. This is the best time for assessment as the patient is likely to be more focused and cooperative during this phase. Asking questions or performing procedures during the contraction or immediately after may be distracting or uncomfortable for the patient. Waiting until the contraction is over (choice A) may delay necessary assessment. Waiting for the coach's approval (choice B) may not always align with the patient's needs. Waiting until after administration of analgesic-anesthetic (choice D) may not be timely for necessary assessment and may also impact the patient's ability to provide accurate information.

Correct Answer: C

Rationale: The correct answer is C: pudendal. Pudendal nerve block is specifically used to provide anesthesia to the lower vagina and perineum during labor. This block targets the pudendal nerve, which innervates these areas, providing effective pain relief for childbirth. A local anesthetic is more general and may not specifically target the lower vagina and perineum. Epidural anesthesia is typically used to provide pain relief during labor but does not specifically target the lower vagina and perineum. A spinal block provides anesthesia for a larger area including the lower abdomen and legs, not specifically the lower vagina and perineum.

Correct Answer: B

Rationale: The correct answer is B. A patient who delivered a stillborn baby last year is more likely to experience increased anxiety and tension during labor due to previous traumatic experience. This can trigger fear and worry about the current pregnancy outcome, leading to heightened emotional distress. Incorrect Choices: A: Refusing medication does not necessarily correlate with increased anxiety during labor. C: Not attending childbirth classes may result in lack of knowledge but does not directly relate to increased anxiety during labor. D: Having two children younger than 3 years may cause stress but does not specifically indicate increased anxiety during labor.

Correct Answer: A

Rationale: The correct answer is A: imagery. Imagery involves creating mental pictures or sensations to help focus and relax the mind. In this scenario, the laboring patient visualizes her body opening to facilitate the birthing process, which can help reduce anxiety and pain perception. Effleurage (B) is a massage technique, dissociation (C) is a coping strategy to mentally detach from pain, and distraction (D) involves diverting attention away from pain stimuli. However, in this case, the patient's focus on visualizing the birthing process aligns with the use of imagery.

Correct Answer: C

Rationale: The correct answer is C. Increased maternal pain perception during labor can lead to decreased perfusion to the placenta due to catecholamine secretion. When a mother experiences pain, stress hormones like catecholamines are released, causing vasoconstriction of blood vessels, including those supplying the placenta. This vasoconstriction reduces blood flow to the placenta, potentially compromising fetal oxygenation and nutrient delivery. Choice A is incorrect because increased catecholamine secretion would not directly cause an increase in uterine contractions. Choice B is incorrect because alpha receptors are not typically involved in decreasing blood pressure in response to pain perception. Choice D is incorrect because increased uterine blood flow would not cause an increase in maternal blood pressure; in fact, it would likely have the opposite effect as increased blood flow typically leads to decreased blood pressure.