A woman in labor has a history of previous cesarean section. What is the most important factor to monitor for during this labor?

Correct Answer: A

Rationale: The correct answer is A: Uterine rupture. The most important factor to monitor in a woman with a history of previous cesarean section is the risk of uterine rupture during labor. Uterine rupture is a serious complication that can lead to life-threatening hemorrhage for both the mother and the baby. Monitoring for signs such as sudden onset of severe abdominal pain, abnormal fetal heart rate patterns, and cessation of contractions is crucial. Maternal hypotension (Choice B) is important but not as critical as uterine rupture. Fetal malpresentation (Choice C) and prolonged labor (Choice D) are important factors to monitor but do not pose the same level of immediate risk as uterine rupture in this situation.

Correct Answer: A

Rationale: The correct answer is A: Perform a nonstress test (NST). This is the first step in assessing fetal well-being when a patient presents with decreased fetal movement at 40 weeks gestation. The NST evaluates fetal heart rate in response to fetal movement, providing immediate information on fetal well-being. Administering a corticosteroid injection (B) would not be indicated at this point as it is not the first-line management for decreased fetal movement. Monitoring fetal heart rate (C and D) is important, but the NST provides more comprehensive information on fetal well-being.

Correct Answer: B

Rationale: Step 1: The patient tested negative for chlamydia, syphilis, gonorrhea, and HIV, reducing the risk of transmission of these infections to the baby. Step 2: Neonatal conjunctivitis is commonly caused by exposure to maternal genital tract bacteria during birth. Step 3: Since the patient tested negative for the common infections, neonatal conjunctivitis becomes the higher risk for the baby. Summary: A, C, and D are not directly related to the information provided, making them incorrect choices. Neonatal conjunctivitis is the most likely risk due to maternal genital tract bacteria exposure during birth.

Correct Answer: D

Rationale: The correct answer is D: Healthy People 2020. The nurse will use Healthy People 2020 guidelines because they are evidence-based, nationally recognized objectives that focus on improving the health and well-being of individuals, families, and communities. These guidelines specifically address maternal and infant health outcomes, making them the most relevant choice for the nurse's goal. Incorrect Choices: A: WHO Maternal care guidelines - While WHO guidelines are important, they are not specific to the national goals and objectives the nurse is trying to align with. B: State Practice Acts - State Practice Acts govern the scope of practice for nurses and do not provide specific guidelines for maternal health goals. C: AWHONN white papers - AWHONN provides valuable resources, but they may not be as comprehensive or nationally recognized as Healthy People 2020 for setting maternal health goals.

Correct Answer: B

Rationale: The correct answer is B: Notify the healthcare provider immediately. This is the most appropriate action because the pregnant woman is experiencing severe abdominal pain and has not felt her baby move for several hours, which could indicate a potential emergency situation such as placental abruption or fetal distress. Prompt notification of the healthcare provider is crucial for timely evaluation and management to ensure the well-being of both the mother and the baby. Choice A is incorrect because simply encouraging the patient to drink water and rest may delay necessary medical intervention. Choice C is incorrect as monitoring fetal movements without immediate healthcare provider notification may lead to a critical delay in assessment and treatment. Choice D is incorrect as reassuring the patient without further evaluation could overlook a serious issue.