A pregnant woman presents with a history of recurrent pregnancy losses in the second trimester. On examination, the cervix is dilated, and uterine contractions are absent. Which of the following conditions is the most likely cause of these symptoms?

Correct Answer: D

Rationale: Incompetent cervix refers to a weakened cervix that is unable to support the weight of the growing fetus, leading to painless cervical dilation and second-trimester pregnancy loss. In this condition, the cervix may dilate prematurely without contractions, resulting in a painless cervical dilation. The history of recurrent second-trimester losses, along with cervical dilation and absence of uterine contractions in the presenting pregnant woman, are characteristic of incompetent cervix. Prompt recognition and management with cerclage placement can help prevent further pregnancy losses in women with incompetent cervix.

Correct Answer: C

Rationale: Before initiating hydrotherapy for pain relief during labor, the nurse's priority action should be to assess the maternal and fetal conditions to determine if the mother is eligible for this form of pain management. It is essential to ensure that hydrotherapy is safe and appropriate for the specific situation. Assessing the maternal condition includes evaluating factors such as the stage of labor, maternal and fetal well-being, and any medical conditions that could impact the use of hydrotherapy. This assessment helps to identify any contraindications or risks that may affect the mother and baby during hydrotherapy. By conducting a thorough assessment, the nurse can make an informed decision about whether hydrotherapy is suitable for the woman in labor.

Correct Answer: B

Rationale: A prolapsed umbilical cord is a medical emergency during labor because it can cause compression of the umbilical cord, leading to decreased oxygen supply to the fetus. The priority nursing action in this situation is to prepare for an immediate cesarean section. This is necessary to quickly deliver the baby and relieve pressure on the cord, preventing potential fetal distress or death. Elevating the mother's hips may help reduce pressure on the cord temporarily, but it is not the definitive treatment for a prolapsed cord. Administering intravenous fluids rapidly may be necessary, but it is not the priority intervention when the fetus is at risk due to a prolapsed cord. Performing a vaginal examination to assess cervical dilation is contraindicated in the presence of a prolapsed umbilical cord as it can further compress the cord and worsen the situation.

Correct Answer: D

Rationale: When a woman in active labor demonstrates signs of cephalopelvic disproportion (CPD) with the fetal head failing to descend despite strong contractions, the nursing action that should be prioritized is to prepare for immediate instrumental delivery. CPD can lead to a prolonged and difficult labor, increasing the risks for both the mother and the fetus. In cases where the fetal head is not descending adequately and the mother's contractions are strong, instrumental delivery, like forceps or vacuum extraction, may be necessary to facilitate the safe delivery of the baby. It is important to act promptly to avoid potential complications associated with prolonged labor. Other actions, such as performing a pelvic exam, changing maternal positions, or administering oxytocin, may be considered but addressing the issue of CPD efficiently through instrumental delivery should take precedence in this scenario.

Correct Answer: B

Rationale: Uterine hyperstimulation is a condition in which the uterus contracts too frequently or too intensely, leading to decreased blood flow and oxygenation to the placenta. This can result in maternal fatigue and decreased fetal oxygenation due to the lack of sufficient rest intervals between contractions. Uterine hyperstimulation can be caused by factors such as the use of synthetic oxytocin (Pitocin) to induce or augment labor, uterine abnormalities, or maternal conditions like pre-eclampsia. It is important for the nurse to assess for uterine hyperstimulation in a woman experiencing frequent and intense contractions to intervene promptly and prevent adverse outcomes for both the mother and the baby.