How often should the nurse assess the fetal heart rate in a low-risk person during the second stage?

Correct Answer: B

Rationale: During the second stage of labor, it is crucial for the nurse to monitor the fetal heart rate regularly to ensure the well-being of the baby. Choice A, assessing every 5 minutes with contractions, may be too frequent and unnecessary in a low-risk person as it could interrupt the natural progression of labor. Choice C, assessing every 5-15 minutes, may be too variable and not provide a consistent monitoring schedule. Choice D, only assessing when the physician orders, is incorrect because continuous monitoring of the fetal heart rate is essential during labor, regardless of physician orders. This is to ensure any changes or signs of distress in the baby are promptly identified and addressed. The correct answer is B, to assess the fetal heart rate at least every 30 minutes during the second stage. This interval allows for regular monitoring without being overly intrusive, striking a balance between ensuring the baby's well-being and allowing the labor to progress naturally. It also aligns with best practice guidelines for fetal monitoring during labor in low-risk individuals.

Correct Answer: B

Rationale: A second-degree laceration involves tearing through the vaginal mucosa and perineal muscles. This means that choice B is correct. Choice A is incorrect because a second-degree laceration extends beyond the vaginal mucosa and involves the perineal muscles as well. Choice C is also incorrect because a second-degree laceration is actually considered a moderate level of severity. First-degree lacerations involve only the vaginal mucosa, while third and fourth-degree lacerations are more severe and involve the anal sphincter and rectal mucosa. Choice D is incorrect because second-degree lacerations typically require suturing to promote proper healing and prevent complications such as infection or excessive bleeding. Suturing also helps to restore the anatomy of the perineum and promote optimal recovery for the patient.

Correct Answer: D

Rationale: Option D, providing the baby a bottle so that the birthing person can rest, is the correct answer for supporting involution of the uterus. This is because rest and relaxation are essential for the body to heal and recover effectively. By allowing the birthing person to rest while providing nourishment to the baby through a bottle, the nurse is promoting optimal conditions for the uterus to undergo involution, which is the process of the uterus returning to its pre-pregnancy size and position. Option A, uterotonics, may be used to help stimulate contractions of the uterus and promote involution. However, in the context of supporting involution, providing rest to the birthing person is more directly related to allowing the body to heal naturally without the use of medication. Option B, encouraging the birthing person to urinate, is important for preventing urinary retention and promoting comfort, but it is not directly related to supporting involution of the uterus. While emptying the bladder can help reduce pressure on the uterus, it is not as crucial as providing rest for promoting involution. Option C, fundal massage, is a technique used to stimulate contractions of the uterus and help prevent postpartum hemorrhage. While fundal massage can be beneficial in certain situations, it is not directly related to supporting involution of the uterus through rest and relaxation. Rest is more essential for promoting involution in this context.

Correct Answer: C

Rationale: Pelvic dystocia occurs when the fetal head is unable to navigate through the maternal pelvis during labor. This can happen due to a variety of reasons such as the shape or size of the pelvis, abnormalities in the pelvis, or the position of the baby's head. A: Uterine dystocia is when the uterus is not contracting effectively during labor, leading to a prolonged labor. This is not related to the fetus being unable to navigate the pelvis, so it is not the correct answer. B: Fetal dystocia occurs when there are issues with the size or position of the fetus itself, such as a large baby or abnormal presentation. While fetal dystocia can contribute to difficulty in labor, it is not specifically related to the inability of the fetal head to navigate the pelvis, making it an incorrect choice. D: Contraction dystocia is related to ineffective contractions during labor, which can lead to prolonged labor. This is not directly related to the fetal head being unable to navigate the pelvis, so it is not the correct answer. In conclusion, pelvic dystocia is the correct answer because it specifically refers to the inability of the fetal head to pass through the maternal pelvis during labor. This can be due to various anatomical factors of the pelvis, making it a distinct type of dystocia.

Correct Answer: D

Rationale: The Bishop score is used to assess the favorability of the cervix for induction of labor. It is based on five components: cervical dilation, effacement, station, consistency, and position. A Bishop score of 8 or higher is considered the most favorable cervix for induction of labor. Choice A: A Bishop score of 2 indicates a closed, thick, posterior, and high cervix with no effacement or dilation. This is not considered favorable for induction of labor. Choice B: A Bishop score of 4 suggests a slightly more favorable cervix compared to a score of 2, but still indicates a cervix that is not fully prepared for labor. It may have some effacement, but minimal dilation. Choice C: A Bishop score of 6 indicates further progress in cervical effacement and dilation, but it may still not be considered optimal for induction of labor. The cervix may be starting to soften and move forward, but it is not as favorable as a score of 8. Choice D: A Bishop score of 8 signifies a cervix that is fully effaced, dilated to at least 2 cm, soft, and anterior in position. This indicates that the cervix is well-prepared for labor and is the most favorable score for induction. In conclusion, a Bishop score of 8 is the correct answer as it represents the most favorable cervix for induction of labor, with optimal effacement, dilation, consistency, and position.