The patient who has received a dose of preservative- free morphine (Duramorph) is beginning to experience pruritus. Which medication is used to treat this?

Correct Answer: B

Rationale: The correct answer is B: Diphenhydramine. Pruritus is a common side effect of opioid medications like morphine. Diphenhydramine, an antihistamine, can help relieve itching. Low-dose naloxone infusion (A) is used for opioid overdose, not pruritus. Dilaudid (C) and Sublimaze (D) are other opioid medications similar to morphine, and using them would not address the pruritus. Diphenhydramine is the most appropriate choice to alleviate the itching without interfering with the pain relief provided by the morphine.

Correct Answer: A

Rationale: The correct answer is A: Fetal malpresentation. This is a risk factor for cesarean section because the baby's position can impact the ability to deliver vaginally. If the baby is in a breech or transverse position, a cesarean section may be necessary to ensure a safe delivery. Choice B, spontaneous labor, is not a risk factor for cesarean section as it is a natural part of childbirth. Choice C, low maternal age, is also not a risk factor as age alone does not determine the need for a cesarean section. Choice D, no previous pregnancies, is not a risk factor as it does not directly impact the likelihood of needing a cesarean section.

Correct Answer: A

Rationale: The correct answer is A: Administer an epidural block. In the active phase of labor, the pain is typically intense and continuous. Administering an epidural block can provide effective pain relief by blocking nerve signals, allowing the patient to rest and conserve energy for the pushing phase. It does not affect the ability to push and can improve maternal satisfaction. Non-pharmacological methods (B) may not provide sufficient relief at this stage. Narcotic analgesics (C) can cross the placenta and affect the baby's respiratory system. Encouraging the patient to push (D) is appropriate during the second stage of labor, not the active phase.

Correct Answer: A

Rationale: The correct answer is A: Uterine rupture. The most important factor to monitor in a woman with a history of previous cesarean section is the risk of uterine rupture during labor. Uterine rupture is a serious complication that can lead to life-threatening hemorrhage for both the mother and the baby. Monitoring for signs such as sudden onset of severe abdominal pain, abnormal fetal heart rate patterns, and cessation of contractions is crucial. Maternal hypotension (Choice B) is important but not as critical as uterine rupture. Fetal malpresentation (Choice C) and prolonged labor (Choice D) are important factors to monitor but do not pose the same level of immediate risk as uterine rupture in this situation.

Correct Answer: B

Rationale: The correct answer is B: Position the patient on her hands and knees. This position, known as the all-fours position, can help rotate the baby from an occiput posterior position to a more favorable position for delivery. Gravity assists in the rotation of the baby, making delivery easier. Encouraging the patient to push vigorously (option A) may not be effective in this situation as the baby may be facing the wrong way. Performing a cesarean section (option C and D) should be considered only if other interventions fail or if there are complications that necessitate surgical delivery.