The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session? (Select all that apply.)

Correct Answer: B

Rationale: The correct answer is B: Natural oxytocin in conjunction with other substances plays a role in the initiation of labor. Oxytocin is a key hormone that stimulates uterine contractions during labor. Its release is crucial for the progression of labor. Other substances, such as prostaglandins, also play a role in initiating labor by softening the cervix and promoting contractions. Rationale: 1. Oxytocin is a well-known hormone that directly stimulates uterine contractions, leading to the initiation of labor. 2. Prostaglandins are also important in preparing the cervix for labor and promoting contractions, which contradicts option D. 3. Progesterone levels decreasing and estrogen levels increasing typically signal the onset of labor, which contradicts option A. 4. Factors like stretching, pressure, and irritation of the uterus and cervix are more related to the progression of labor rather than the initiation, which contradicts option C. In summary

Correct Answer: A

Rationale: The correct answer is A (3 points). The Apgar score assesses newborns' overall health shortly after birth. Each category (appearance, pulse, grimace, activity, and respiration) is scored from 0 to 2. In this case, the infant exhibits central cyanosis (blue extremities), weak muscle tone (minimal flexion), a weak cry, a heart rate of 110 bpm (slightly below normal), and responsive to suctioning (coughs, pulls away) indicating some respiratory effort. Therefore, the infant would receive 1 point for appearance (cyanosis), 1 point for pulse (110 bpm), 1 point for grimace (weak cry), totaling 3 points. Choices B, C, and D are incorrect as they do not accurately reflect the infant's condition and Apgar scoring criteria.

Correct Answer: A

Rationale: The correct answer is A: The biparietal diameter of the fetal head is at the level of the ischial spines. Engagement of the fetal head occurs when the largest transverse diameter of the presenting part (usually the biparietal diameter) reaches or passes through the pelvic inlet, specifically at the level of the ischial spines. This signifies descent of the fetal head into the maternal pelvis, indicating progress towards labor. Choice B (The biparietal diameter of the fetal head is at –2 station) is incorrect as station refers to the level of the presenting part in relation to the ischial spines, not engagement. Choice C (The fetal head is well flexed) is incorrect as engagement does not necessarily indicate the position of the fetal head. Choice D (The fetal head is unable to pass under the pubic arch) is incorrect as engagement actually signifies that the fetal head is in the optimal position to pass through the pelvis during labor.

Correct Answer: C

Rationale: The correct answer is C: Initiate external fetal monitoring. The nurse should initiate external fetal monitoring to assess the fetus's heart rate and uterine contractions, given the patient's history of placenta previa and vaginal bleeding. This helps to monitor the well-being of the fetus and detect any signs of distress. Performing a vaginal examination (Choice A) may aggravate the placenta previa and increase the risk of bleeding. Artificial rupture of membranes (Choice B) is contraindicated in cases of placenta previa due to the risk of increased bleeding. Encouraging ambulation (Choice D) is not advisable in this situation as it may also worsen bleeding.

Correct Answer: A

Rationale: The correct answer is A: Face presentation. In this presentation, the mentum (chin) of the baby is the presenting part. This is a relatively rare presentation where the baby's head is extended, resulting in the face being the first part to be delivered. In a face presentation, the baby's head is hyperextended rather than flexed as in a vertex presentation. B: Breech presentation is when the baby's buttocks or feet are the presenting part. C: Vertex presentation is when the baby's head is the presenting part with the occiput leading the way. D: Shoulder presentation is when the baby's shoulder is the presenting part, which is a potentially dangerous situation requiring immediate medical intervention.