What complication makes uterine inversion an emergency?

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: 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.

Correct Answer: B

Rationale: To assess fetal station, the nurse should palpate the ischial spines. The ischial spines are bony landmarks in the pelvis that indicate the level of the fetal head in relation to the mother's pelvis. Palpating the ischial spines helps determine the descent of the fetal head during labor and assess the progress of labor. The sacral promontory is not the correct structure to palpate to assess fetal station. The sacral promontory is located at the top of the sacrum and is not a reliable indicator of fetal station. Palpating the sacral promontory may provide information about the position of the baby's head in relation to the mother's pelvis but is not as accurate as palpating the ischial spines. The cervix is not the correct structure to palpate to assess fetal station. The cervix is the lower part of the uterus that opens during labor to allow the baby to pass through the birth canal. Palpating the cervix can help determine the dilation and effacement of the cervix but does not provide information about the descent of the fetal head in relation to the mother's pelvis. The symphysis pubis is not the correct structure to palpate to assess fetal station. The symphysis pubis is the bony joint at the front of the pelvis where the two pubic bones meet. Palpating the symphysis pubis does not provide information about the descent of the fetal head in relation to the mother's pelvis. It is important to palpate the ischial spines for an accurate assessment of fetal station during labor.

Correct Answer: C

Rationale: During labor, intense back pain is often associated with the baby being in the occiput posterior position. This means that the baby's head is facing the mother's abdomen, with the back of the head against the mother's spine. Choice A, Mentum anterior, refers to the baby's chin being positioned towards the mother's spine. This position is actually ideal for childbirth as it allows for easier passage through the birth canal and is not typically associated with intense back pain during contractions. Choice B, Sacrum posterior, refers to the baby's back being positioned towards the mother's spine. While this position can cause back pain during labor, it is not typically described as intense and is less common than occiput posterior. Choice D, Scapula anterior, refers to the baby's shoulder blade being positioned towards the mother's spine. This position is not typically associated with intense back pain during contractions, as the baby's head position is more critical in determining the experience of back pain during labor. In summary, the correct answer is C (Occiput posterior) because this position is most likely to cause intense back pain during contractions due to the baby's head pressing against the mother's spine. Choices A, B, and D are incorrect because they do not align with the typical presentation of intense back pain during labor associated with occiput posterior positioning.

Correct Answer: C

Rationale: C: Muscle relaxation is a key technique that should be included for a Lamaze-trained nulliparous client. This technique involves teaching the client how to relax their muscles during labor, which can help reduce pain and tension. Lamaze focuses on using breathing techniques and muscle relaxation to cope with labor pain, making it an essential component for a nulliparous client who is new to childbirth. A: Hypnotic suggestion is not typically a technique included in Lamaze training. While some individuals may find hypnosis helpful for pain management during labor, it is not a standard component of Lamaze education. Therefore, this technique would not be recommended for a Lamaze-trained nulliparous client. B: Rhythmic chanting is also not a technique commonly included in Lamaze training. While some women may find chanting or other forms of vocalization helpful during labor, it is not a primary focus of Lamaze techniques. Therefore, this would not be a necessary technique to include for a Lamaze-trained nulliparous client. D: Abdominal massage is not a standard technique taught in Lamaze training. While massage can be a helpful form of pain relief during labor, specifically focusing on the abdominal area may not be a primary focus of Lamaze education. Therefore, this technique would not be essential for a Lamaze-trained nulliparous client.