The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply.

Correct Answer: B

Rationale: The correct answer is B: Increased number of elective or maternal request cesareans. This is correct because the rise in elective cesarean births, often due to patient preference or convenience, can contribute to the overall high rates of cesarean births. A: Fetuses in breech position unable to deliver vaginally - This is a valid reason for cesarean births, but it does not address the question about high rates of cesarean births. C: Incidences of women of older maternal age getting pregnant - While advanced maternal age can be a factor in cesarean births, it is not directly related to the high rates of cesarean births at the facility. D: Decreasing rate of malpractice litigation with cesarean birth - This is an irrelevant factor in determining the reasons for high rates of cesarean births at the facility.

Correct Answer: A

Rationale: The correct answer is A: Doppler. Doppler requires the use of a gel to enhance the transmission of sound waves for accurate assessment of the fetal heart rate. Gel helps to eliminate air between the Doppler probe and the skin, improving signal quality. Fetoscope (B) is a direct listening device; Scalp electrode (C) and Tocodynamometer (D) do not require gel for fetal heart rate assessment.

Correct Answer: D

Rationale: The correct answer is D: Obtain an order from the health care provider for an intrauterine pressure catheter. This is the most appropriate action because an intrauterine pressure catheter provides the most accurate assessment of intrauterine pressure, especially in cases where obesity may interfere with external monitoring methods. Repositioning the tocotransducer (choice A) or Doppler transducer (choice B) may not significantly improve accuracy in this situation. Obtaining an order for a spiral electrod (choice C) is not necessary as it does not directly address the issue of accurate intrauterine pressure assessment.

Correct Answer: C

Rationale: The correct answer is C. After vibroacoustic stimulation, an increase in fetal heart rate baseline indicates an expected response, showing the fetus is healthy and responding appropriately to the stimulus. This increase is a sign of fetal well-being and does not suggest worsening hypoxia (choice A) or progressive acidosis (choice B). Additionally, parasympathetic stimulation (choice D) would typically lead to a decrease in heart rate, not an increase as observed in this scenario. Therefore, choice C is the best interpretation based on the positive response of the fetal heart rate to the stimulation, indicating a healthy and expected reaction.

Correct Answer: C

Rationale: The correct answer is C: Intrauterine pressure catheter (IUP). This device directly measures the pressure within the uterus, providing precise data on uterine contraction strength. It is considered the gold standard for assessing uterine activity. A: External fetal monitoring (EFM) measures fetal heart rate and uterine contractions but doesn't provide direct information on contraction strength. B: Internal fetal monitoring measures fetal heart rate and uterine contractions internally but focuses on fetal well-being, not contraction strength. D: Maternal comments based on perception are subjective and not reliable for accurately assessing uterine contraction strength.