What can the nurse conclude about the fetal position if a hard round mass is felt in the fundal area and a soft round mass is felt above the symphysis?

Correct Answer: C

Rationale: If a hard round mass is felt in the fundal area and a soft round mass is felt above the symphysis, the nurse can conclude that the fetal position is in a vertical lie. This is because the hard round mass in the fundal area indicates the head of the fetus, which is the presenting part in a vertical lie. The soft round mass above the symphysis is likely the buttocks or back of the fetus, further supporting the vertical lie position. Choice A, transverse position, is incorrect because in a transverse position, the fetus would be lying sideways across the abdomen, not with a hard round mass in the fundal area and a soft round mass above the symphysis. Choice B, vertex presentation, is also incorrect because a vertex presentation refers to the head of the fetus being the presenting part, which would not explain the soft round mass felt above the symphysis. Choice D, attitude is difficult to determine, is not the correct answer because based on the description provided, the nurse can actually make a conclusion about the fetal position being in a vertical lie based on the different characteristics of the masses felt in the fundal area and above the symphysis.

Correct Answer: A

Rationale: A presenting part at -3 station indicates that the fetal head is still relatively high in the pelvis and has not descended well into the birth canal. Choice B, stating that the fetal head is not engaged, is incorrect because the term "engagement" refers to the widest part of the presenting part (usually the biparietal diameter of the fetal head) passing through the pelvic inlet. -3 station would indicate that the head has not yet descended to the level of the ischial spines, which is typically considered engaged. Choice C, suggesting that the woman is close to delivery, is also incorrect. Typically, the station of the presenting part is measured in relation to the ischial spines, with 0 station being at the level of the spines. Negative numbers indicate that the presenting part is above the spines, while positive numbers indicate that it is below. -3 station is relatively high in the pelvis, so the woman is not close to delivery. Choice D, stating that external rotation has occurred, is also incorrect. External rotation typically occurs after the birth of the baby, not when the presenting part is at -3 station. Overall, a presenting part at -3 station indicates that descent is not progressing well and further descent is needed before the woman is likely to deliver.

Correct Answer: C

Rationale: During stage 2 of labor, the correct breathing technique is open glottal pushing (Choice C). This technique involves taking a deep breath, holding it, and pushing downward as if having a bowel movement. This pushing technique helps in the descent and delivery of the baby. Choice A: Alternate pant-blow is not the correct breathing technique for stage 2 of labor. This technique involves short, quick breaths which are more suitable for managing pain during contractions but not for pushing during delivery. Choice B: Rhythmic shallow breaths are also not the correct breathing technique for stage 2 of labor. These breaths are typically used during the early stages of labor to help women relax and manage pain, but they are not effective for pushing during delivery. Choice D: Slow chest breathing is not the correct breathing technique for stage 2 of labor either. This type of breathing involves slow, deep breaths which are useful for relaxation and pain management but not for effective pushing during delivery. In conclusion, open glottal pushing is the correct breathing technique during stage 2 of labor as it helps in the descent and delivery of the baby. The other choices are incorrect as they are more suitable for managing pain and relaxation during labor rather than pushing during delivery.

Correct Answer: D

Rationale: In active labor, it is essential for the nurse to encourage the woman to shift to the next level of breathing techniques. This is because transitioning to a different breathing pattern can help the woman manage her pain and discomfort more effectively during labor. By focusing on her breathing, the woman can stay relaxed and in control, which can ultimately help progress labor. Option A, requesting an epidural, may provide pain relief but does not address the importance of breathing techniques in managing labor pain. It also involves medical intervention that may not be necessary if the woman can effectively utilize breathing techniques. Option B, requesting IV analgesics, also provides pain relief but does not address the holistic approach of incorporating breathing techniques for pain management. IV analgesics may have side effects that could affect the labor process. Option C, changing positions, is important during labor to help facilitate the progression of labor, but it does not specifically address the importance of breathing techniques. While changing positions can help alleviate pain and discomfort, it is not as directly related to pain management through breathing techniques as option D. Therefore, the best option for the nurse to encourage a woman in active labor to do is to shift to the next level of breathing techniques to help her effectively manage pain and discomfort during labor.

Correct Answer: A

Rationale: A fetal heart rate of 152 bpm falls within the normal range for a healthy fetus. The normal fetal heart rate typically ranges from 120 to 160 bpm. Therefore, choice A is the correct answer because the nurse should document this finding as a normal result. Choice B, assessing every 5 minutes, is unnecessary in this situation as a heart rate of 152 bpm is considered normal. Assessing every 5 minutes would be excessive and potentially cause unnecessary stress to the mother. Choice C, reporting to the health care practitioner, is not necessary for a normal fetal heart rate of 152 bpm. It is within the normal range and does not require any further intervention or consultation with the healthcare provider. Choice D, instituting emergency measures, is not appropriate for a fetal heart rate of 152 bpm. Emergency measures are only necessary in situations where there is a significant deviation from the normal fetal heart rate range, such as bradycardia (heart rate <120 bpm) or tachycardia (heart rate >160 bpm). In conclusion, the nurse should document a fetal heart rate of 152 bpm as a normal finding and continue to monitor the fetus for any changes or deviations from the normal range.