What are predictors for shoulder dystocia?

Correct Answer: D

Rationale: Shoulder dystocia is a medical emergency during childbirth where one or both of the baby's shoulders get stuck behind the mother's pubic bone. This can lead to serious complications for both the mother and the baby. A: Estimated birth weight of 4,000 g is a potential risk factor for shoulder dystocia, however, it is not a definitive predictor. While larger babies may increase the risk, it is not always the case, so this choice is not the best predictor for shoulder dystocia. B: Gestational diabetes is a risk factor for macrosomia (large birth weight), which can increase the risk of shoulder dystocia. However, not all babies born to mothers with gestational diabetes will experience shoulder dystocia, so it is not a direct predictor. C: Previous shoulder dystocia is a significant risk factor, as women who have had a previous shoulder dystocia are more likely to experience it again in subsequent pregnancies. However, this is not a predictor for those who have not previously had shoulder dystocia. D: Oligohydramnios, or low levels of amniotic fluid, is a known predictor for shoulder dystocia. This is because the decreased amount of fluid can lead to a higher chance of the baby getting stuck during delivery. Therefore, this choice is the correct answer as it directly correlates with the occurrence of shoulder dystocia. In conclusion, while all the choices have some association with shoulder dystocia, oligohydramnios is the most direct predictor as it directly impacts the mechanics of childbirth and increases the likelihood of shoulder dystocia occurring.

Correct Answer: A

Rationale: If bleeding cannot be stopped in spontaneous abortion, the next step should be surgery for a dilation and curettage (D&C). This procedure involves removing the remaining tissue from the uterus to stop the bleeding and prevent infection. Option B, surgery for a hysterectomy, is not the appropriate next step because a hysterectomy involves the removal of the entire uterus and is a more invasive procedure than a D&C. It is typically reserved for more serious conditions such as cancer or severe uterine bleeding that cannot be controlled by other means. Option C, administration of magnesium sulfate, is not the correct next step because magnesium sulfate is typically used to prevent seizures in pre-eclampsia/eclampsia, not to stop bleeding in spontaneous abortion. It would not address the underlying issue of tissue remaining in the uterus causing the bleeding. Option D, administration of calcium gluconate, is also not the correct next step because calcium gluconate is typically used to treat hypocalcemia or as an antidote for magnesium sulfate toxicity. It would not address the underlying issue of tissue remaining in the uterus causing the bleeding. In summary, the correct next step if bleeding cannot be stopped in spontaneous abortion is surgery for a dilation and curettage to remove the remaining tissue from the uterus and stop the bleeding.

Correct Answer: A

Rationale: Uterine inversion is a rare but serious obstetric emergency where the uterus turns inside out after childbirth. One of the main complications that make uterine inversion an emergency is shock (choice A). When the uterus inverts, it can lead to severe hemorrhage, causing rapid blood loss and ultimately leading to shock. Shock is a life-threatening condition that occurs when the body is not getting enough blood flow, which can result in organ failure and death if not promptly treated. Therefore, shock is a critical complication of uterine inversion that requires immediate medical intervention. Pain (choice B) is a common symptom associated with uterine inversion, but it is not the primary reason why this condition is considered an emergency. While pain can be severe and distressing for the patient, it is not as immediately life-threatening as shock. Retained placenta (choice C) can also occur in cases of uterine inversion, but it is not the primary complication that makes it an emergency. Retained placenta can lead to infection and hemorrhage if left untreated, but these complications typically develop over time rather than immediately. Hypertension (choice D) is not directly related to uterine inversion. While hypertension can be a serious medical condition that requires monitoring and treatment, it is not a typical complication of uterine inversion. In cases of uterine inversion, the focus is on managing shock, controlling bleeding, and restoring the uterus to its normal position. Therefore, shock is the most critical complication that makes uterine inversion an emergency, requiring immediate medical attention to prevent further complications and save the patient's life.

Correct Answer: A

Rationale: Aspiration is a serious complication that occurs when food, liquids, or stomach contents are inhaled into the lungs instead of being swallowed into the esophagus. This can lead to pneumonia, lung abscess, or even respiratory failure. Neurologic dysfunction (choice A) is the correct answer because conditions such as stroke, seizures, or impaired consciousness can lead to difficulty swallowing, increasing the risk of aspiration. Patients with neurologic dysfunction may have impaired gag reflexes or difficulty coordinating their swallowing mechanism, making them more prone to aspiration. Kidney failure (choice B) is incorrect because it does not directly relate to the risk of aspiration. While kidney failure can lead to electrolyte imbalances or fluid overload, which may impact a patient's overall health, it does not specifically increase the risk of aspiration. Gestational diabetes (choice C) is also incorrect as it is a condition related to high blood sugar levels during pregnancy. While gestational diabetes can have complications such as macrosomia (large baby) or birth complications, it does not directly impact the risk of aspiration. Postpartum hemorrhage (choice D) is not directly related to the risk of aspiration. Postpartum hemorrhage is excessive bleeding following childbirth and can lead to complications such as shock or organ failure, but it does not increase the risk of aspiration. In conclusion, monitoring for aspiration is crucial in patients with neurologic dysfunction as they are at a higher risk due to impaired swallowing mechanisms. It is important to assess these patients for signs of aspiration such as coughing while eating or drinking, altered voice quality, or respiratory distress. Regular monitoring and interventions can help prevent aspiration and its potential complications.

Correct Answer: B

Rationale: B: The client is exhibiting expected behavior for labor. This is the correct answer because during labor, it is common for clients to exhibit certain behaviors such as increased pain, restlessness, vocalization, and changes in vital signs. These are all normal responses to the physiological process of childbirth. As a nurse, it is important to recognize and differentiate between normal labor behaviors and signs of distress. A: The client had poor childbirth education. This answer is incorrect because the client's level of education about childbirth does not necessarily dictate their behavior during labor. Even clients who have received extensive childbirth education may still exhibit expected behaviors during labor. It is crucial for nurses to focus on assessing the client's current situation and response to labor rather than making assumptions based on their education level. C: The client is becoming hypoxic. This answer is incorrect because hypoxia (lack of oxygen) is a serious condition that requires immediate intervention. Signs of hypoxia include cyanosis, altered mental status, and difficulty breathing. While it is important for nurses to monitor for signs of hypoxia during labor, there is no indication in the question stem that the client is experiencing hypoxia at this time. D: The client needs alpha-fetoprotein levels checked. This answer is incorrect because alpha-fetoprotein levels are not relevant to assessing the client's situation during labor. Alpha-fetoprotein testing is typically done during pregnancy to screen for neural tube defects and chromosomal abnormalities in the fetus, not to assess the client's condition during labor. Nurses should focus on labor progress and the client's well-being during this time.