The nurse midwife caring for a multiparous client who is 5 cm dilated requests intermittent auscultation (IA) of the fetal heart rate. The woman’s history reveals no risk factors. How often should IA be performed in this patient?

Correct Answer: A

Rationale: The correct answer is A: Every 15 minutes. This frequency is recommended for a low-risk multiparous client in active labor without risk factors. Intermittent auscultation every 15 minutes allows for adequate monitoring of fetal well-being while also promoting maternal autonomy and mobility. Choices B, C, and D are incorrect because they are either too frequent or too infrequent for a low-risk client in active labor. Every 5 minutes (B) may be excessive and disrupt the labor process, every 20 minutes (C) may not provide sufficient monitoring, and every 30 minutes (D) may not detect changes in fetal status promptly.

Correct Answer: B

Rationale: The correct answer is B: Complete breech. In a complete breech presentation, the fetus is positioned with its head in the fundus, hips flexed, and knees flexed. This position is unique to the complete breech presentation. A: Frank breech would have the hips flexed, but the knees extended. C: Vertex position is when the head is down towards the birth canal. D: Transverse is when the fetus is lying horizontally across the uterus. Therefore, based on the description provided in the question, the correct answer is B as it matches the specific presentation described.

Correct Answer: A

Rationale: The correct order of cardinal movements of labor is: 1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. Restitution 7. External rotation Engagement occurs first as the fetal presenting part enters the maternal pelvis. Descent is the second cardinal movement, where the fetus moves down the birth canal. Flexion follows, allowing the smallest diameter of the fetal head to present. Internal rotation positions the fetus for delivery. Extension occurs next, facilitating the passage of the head through the birth canal. Restitution aligns the fetal head with the shoulders. External rotation allows the shoulders to rotate for delivery. Therefore, Descent is the correct first cardinal movement in the sequence. Other choices like Expulsion, Extension, and External rotation occur later in the process and are not in the correct order.

Correct Answer: C

Rationale: The correct answer is C: Have the patient slow down her breathing. When a patient is 8 cm dilated and experiences circumoral numbness and dizziness, these are signs of hyperventilation caused by rapid breathing. Hyperventilation can lead to respiratory alkalosis, which can have serious implications for both the mother and baby. By having the patient slow down her breathing, it can help restore the balance of oxygen and carbon dioxide levels in the blood, reducing the risk of complications. Calling the healthcare provider immediately (choice A) may cause delay in addressing the immediate issue. Increasing intravenous fluid (choice B) is not indicated as the symptoms are not suggestive of hypovolemia. Having her start pushing (choice D) is not advisable as she is not fully dilated, and pushing prematurely can lead to complications.

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.