Five minutes after delivery of the infant, the umbilical cord is protruding more from the woman's vaginal introitus and there is a sudden gush of blood with a contracted uterus. What does this signal to the nurse?

Correct Answer: C

Rationale: The sudden gush of blood and the contracted uterus indicate a separation of the placenta, which is a serious complication called placental abruption. This condition can lead to significant bleeding and jeopardize the health of both the mother and the baby. It is essential for the nurse to recognize this situation promptly and take immediate action to manage the hemorrhage and stabilize the patient. Explanation for incorrect choices: A: Laceration of the genital tract would not typically cause a sudden gush of blood and a contracted uterus. B: The second stage of labor is characterized by the delivery of the baby, not by a sudden gush of blood and a contracted uterus. D: Postpartum hemorrhage could be a consequence of placental separation, but it is not the primary issue indicated by the symptoms described in the scenario.

Correct Answer: C

Rationale: The correct answer is C: Give magnesium sulfate to inhibit uterine contractions. Magnesium sulfate is used to delay preterm labor by relaxing the uterine muscles, thus decreasing contractions. This intervention helps to delay delivery and give time for other interventions to be implemented, such as administering corticosteroids to promote fetal lung development. Providing an epidural for pain management (B) does not address the issue of preterm labor. Beginning oxytocin infusion (D) would speed up labor, which is not appropriate in this scenario. Administering corticosteroids (A) is a beneficial intervention but should be done after delaying delivery with magnesium sulfate.

Correct Answer: B

Rationale: The correct answer is B: Prepare for an emergency cesarean section. Uterine rupture during labor is a life-threatening emergency requiring immediate surgical intervention to prevent catastrophic outcomes for both the mother and the baby. A cesarean section is the most effective and timely intervention to address the uterine rupture and ensure the safety of both individuals. Administering pain relief medication (A) may be necessary but is not the most urgent intervention. Administering oxygen to the mother (C) can help with oxygenation, but it does not address the underlying issue of uterine rupture. Increasing IV fluid rate (D) may be helpful in some situations but is not the primary intervention needed to manage uterine rupture.

Correct Answer: D

Rationale: The correct answer is D because it addresses the potential causes of late decelerations comprehensively. Stopping Pitocin helps to eliminate uteroplacental insufficiency, administering oxygen improves fetal oxygenation, and changing the patient's position can alleviate pressure on the umbilical cord. Each intervention targets a different aspect contributing to late decelerations, making it crucial to implement all of them to optimize fetal well-being.

Correct Answer: B

Rationale: The correct answer is B: Maternal blood pressure. Before administering an epidural, it is crucial to assess the maternal blood pressure to ensure it is within the normal range. Hypotension can occur as a common side effect of epidural anesthesia, which can lead to decreased placental perfusion and compromise fetal oxygenation. Assessing maternal blood pressure helps in preventing potential complications. Incorrect choices: A: Cervical dilation - Not directly related to the administration of an epidural. C: Fetal heart rate - Important but not the immediate assessment needed before administering an epidural. D: Maternal temperature - While it is important in general assessment, it is not specifically required before giving an epidural.