The labor and delivery nurse is caring for a 27-year-old primigravida with the following vaginal exam: 2 to 3 cm dilated/70% effaced/-2 station. For the last 2 hours the FHR tracing has displayed a Category I tracing and uterine contractions that are every 2 minutes. The contractions are strong to palpation and the patient is now 3/70%/-2. Which is the nurse’s next best action?

Correct Answer: D

Rationale: The correct answer is D: Document the findings. In this scenario, the patient is in active labor with a Category I FHR tracing, optimal contractions, and progressing cervical dilation. Documenting the findings is important to maintain an accurate record of the patient's progress, which is crucial for monitoring labor and ensuring appropriate care. Encouraging ambulation (choice A) may be unnecessary or even unsafe given the frequency and strength of contractions. Initiating oxytocin (choice B) is not indicated as the patient is already in active labor. Assisting the patient to a warm bath (choice C) may provide comfort but is not the priority at this stage. Therefore, documenting the findings is the next best action to ensure proper documentation and monitoring of the patient's progress.

Correct Answer: B

Rationale: The correct answer is B: The fetus must be at least 34 weeks gestation. This is important because before using vacuum or forceps, the fetus should be mature enough to withstand the extraction process. Premature infants may not have fully developed skull bones to withstand the pressure, increasing the risk of injury. Explanation for other choices: A: The woman’s bladder is empty - While it's ideal for the bladder to be empty to prevent injury during the procedure, it's not a criteria that must be verified prior to vacuum or forceps use. C: There is a Category I tracing - Fetal heart rate monitoring is important during labor, but the tracing being Category I does not specifically correlate with the need for vacuum or forceps. D: The cervix must be completely dilated - While full cervical dilation is necessary for vaginal delivery, it is not a specific criteria to verify before vacuum or forceps use.

Correct Answer: C

Rationale: Step 1: In multiparous women, the uterus has gone through labor before, making muscle coordination more efficient. Step 2: Efficient muscle coordination helps in effective contractions, leading to faster labor progress. Step 3: Multiparous women have experienced labor before, allowing the uterus to contract more effectively. Step 4: This efficiency in muscle coordination is why precipitous labor is more often seen in multiparous women. Summary: A: The weakening of the cervix after each delivery is not a direct cause of precipitous labor. B: The ability of the cervix to dilate and efface simultaneously does not explain why precipitous labor is more common in multiparous women. D: The difficulty in knowing when labor begins is not a reason for the occurrence of precipitous labor in multiparous women.

Correct Answer: C

Rationale: The correct answer is C: Sitting on birthing ball. This position helps to open up the pelvis, allowing for optimal fetal positioning and descent. It also helps relieve pressure on the cervix, promoting dilation. Ambulation (A) may slow down labor progress, squatting (B) can increase pressure on the cervix and hinder descent, and resting on hands and knees (D) may not be as conducive to gravity-assisted descent.

Correct Answer: B

Rationale: The correct answer is B because a uterine resting tone of 30 mm Hg indicates excessive uterine activity, which can lead to uterine hyperstimulation and fetal distress during an oxytocin induction. A higher resting tone suggests the uterus is not relaxing adequately between contractions, potentially compromising fetal oxygenation. Choices A, C, and D are incorrect because a uterine resting tone of 17 mm Hg is within the normal range, contractions every 3 minutes lasting 60 seconds and every 5 minutes lasting 60 seconds are typical patterns during labor induction, and they do not necessarily indicate complications.