A woman presents to labor and delivery at 37 weeks plus 6 days gestation with complaints of constant abdominal pain and dark red bleeding that started 30 minutes ago. Upon examination, the woman’s abdomen is consistently rigid and tender. Fetal heart tones are noted to be in the 70s. Which are these findings are associated with?

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Placental abruption. Placental abruption involves the premature separation of the placenta from the uterine wall before delivery, leading to significant complications for both the mother and the fetus. The clinical presentation of constant abdominal pain, dark red bleeding, rigid/tender abdomen, and fetal bradycardia (heart rate in the 70s) is indicative of a severe placental abruption. Option B) Placental accreta refers to abnormal adherence of the placenta to the uterine wall, which typically presents with painless bleeding in the third trimester, not the acute and severe symptoms described in the case. Option C) Placenta previa involves the implantation of the placenta over or near the cervix, leading to painless bleeding in the third trimester, not the characteristic symptoms of abdominal pain, rigidity, and fetal distress seen in placental abruption. Option D) Placenta succenturiata is a rare variation where accessory placental lobes are connected to the main placenta by blood vessels. This condition is not typically associated with the acute clinical presentation described in the case. Understanding these distinctions is crucial for healthcare providers managing pregnant patients to make timely and accurate diagnoses, initiate appropriate interventions, and prevent adverse outcomes for both the mother and the fetus. Early recognition and management of placental abruption are essential to optimize maternal and fetal outcomes in such critical situations.

Correct Answer: D

Rationale: The correct answer is D) "A balloon catheter may be used to manually ripen my cervix, if necessary.” This option demonstrates the best understanding of the nurse’s teaching by the patient because it shows knowledge of the potential need for cervical ripening methods like a balloon catheter in the trial of labor after cesarean (TOLAC) process. Option A is incorrect because while induction can be part of TOLAC, it does not necessarily mean it is safer than spontaneous labor. Option B is incorrect as ripening with prostaglandins is not always the first step in TOLAC. Option C is incorrect because Pitocin is not always contraindicated in TOLAC; its use depends on the individual's situation. In an educational context, understanding the process of TOLAC is crucial for patients to make informed decisions and actively participate in their care. Knowing the different methods of cervical ripening, like a balloon catheter, empowers patients to engage in discussions with healthcare providers and advocate for their preferences during labor and delivery.

Correct Answer: D

Rationale: If the fetal attitude is assessed to be completely deflexed on sonogram or via Leopold's maneuvers, it means the baby is presenting in an extended position with the occiput being the lead point of the presenting part during a vaginal exam. This position is known as occiput posterior. The fetal occiput is the back of the head, and it is the optimal position for vaginal delivery as the smallest diameter of the baby's head will be presenting at the cervix, facilitating an easier descent through the birth canal.

Correct Answer: C

Rationale: In the active second stage of labor, the cervix is fully dilated to 10 centimeters. Grunting noises can be a sign of the transition to the pushing stage, which occurs in the active second stage of labor. Therefore, assessing for dilation of the cervix is crucial to determine if the laboring person is in the active second stage of labor.

Correct Answer: D

Rationale: During the fourth stage of labor, it is important for the nurse to provide a supportive and nurturing environment for the mother and baby. This stage occurs immediately after the baby is born and lasts for about 2 hours. The mother may be exhausted from the physical effort of labor and delivery, so providing rest, space, and time for bonding between assessments is crucial. The nurse should also support the mother's feeding preferences, whether it is breastfeeding or formula feeding. Diligent monitoring for complications, such as postpartum hemorrhage or infection, is essential during this stage. Additionally, providing adequate pain management for any discomfort the mother may be experiencing is important.