A woman in labor begins to experience a sudden increase in vaginal bleeding and the fetal heart rate decelerates. What is the likely cause of these symptoms?

Correct Answer: B

Rationale: The correct answer is B: Placental abruption. Placental abruption is the premature separation of the placenta from the uterine wall, leading to vaginal bleeding and fetal distress. The sudden increase in bleeding and fetal heart rate deceleration are hallmark signs of placental abruption. Placenta previa (choice A) involves bleeding without fetal distress. Uterine rupture (choice C) typically presents with severe abdominal pain and shock. Cervical laceration (choice D) would not cause fetal heart rate deceleration.

Correct Answer: C

Rationale: The correct answer is C: Assess the fetal heart rate. This is the next priority action because monitoring the fetal heart rate is crucial to ensure the well-being of the baby during labor. It helps in identifying any signs of fetal distress and guides the healthcare provider in making timely interventions to prevent complications. Administering an epidural block (choice A) can be considered later once the fetal well-being is ensured. Performing a vaginal examination (choice B) may not be necessary at this moment as the woman is already in active labor and has progressed to 8 cm dilation. Preparing for delivery (choice D) should only be done after assessing the fetal well-being to ensure a safe delivery.

Correct Answer: B

Rationale: The correct answer is B: Check for a cord prolapse. This is the first step because cord prolapse is a critical emergency that can lead to fetal compromise. By checking for cord prolapse, the nurse can quickly assess the situation and take appropriate actions to relieve pressure on the cord. Administering oxygen (choice A) may be necessary later but not the first step. Performing a vaginal examination (choices C and D) can exacerbate the situation by pushing the cord further into the birth canal.

Correct Answer: C

Rationale: The correct answer is C: Perform a vaginal exam to assess for fetal position. This is important because the position of the fetus can affect the safety and efficacy of administering an epidural in a patient with a history of back surgery. If the fetus is in a breech position or in any other position that could complicate the epidural placement, alternative pain management options may need to be considered. A: History of spinal surgery or deformity is important but assessing the fetal position takes precedence in this scenario. B: Fetal heart rate monitoring is essential during labor but not the most important assessment before proceeding with the epidural in this case. D: Administering Pitocin is unrelated to the assessment needed before proceeding with the epidural.

Correct Answer: D

Rationale: 1. The correct answer is D: Hospital support for breastfeeding. This is the most different trend compared to the early 1980s. 2. In the past, breastfeeding support in hospitals was minimal, but now it is a standard practice to provide education and assistance. 3. Fetal monitoring throughout labor (A) has been a common practice for many years and is not a recent trend. 4. Postpartum stay of 10 days (B) is excessive; postpartum stays have actually become shorter over time. 5. Having expectant partners and family in the operating room for cesarean birth (C) is a more recent practice but has become increasingly common in recent years.