What information should the nurse note from the prenatal record before proceeding with the physical assessment? Select all that apply.

Correct Answer: B

Rationale: Ethnicity and religion are important factors for the nurse to note from the prenatal record before proceeding with the physical assessment. Ethnicity can provide valuable information about potential genetic predispositions to certain health conditions or diseases that may impact the pregnancy. Additionally, cultural beliefs and practices related to pregnancy and childbirth can influence the care that the nurse provides to the patient. Weight gain is not necessarily crucial information to note before the physical assessment. While weight gain during pregnancy is important to monitor, it is typically a part of the physical assessment itself rather than a prerequisite for proceeding with the assessment. Age is also not essential information to note before the physical assessment. While maternal age can impact pregnancy outcomes, it is not a prerequisite for conducting a physical assessment. Gravidity and parity are important pieces of information to gather from the prenatal record, but they are not necessary before proceeding with the physical assessment. Gravidity refers to the number of times a woman has been pregnant, while parity refers to the number of times a woman has given birth to a viable offspring. This information is important for understanding the patient's obstetric history, but it is not required before conducting the physical assessment.

Correct Answer: A

Rationale: In the second stage of labor, the cervix is fully dilated at 10 centimeters and the baby is pushed through the birth canal. Option A, bulging perineum, is a sign that indicates progression into the second stage of labor. This occurs as the baby's head descends and puts pressure on the perineum, causing it to bulge outward. This is a clear indication that the second stage of labor has begun. Option B, increased bloody show, is not necessarily a sign of progression into the second stage of labor. Bloody show is a common sign of labor but it can occur in the first stage as well. It is caused by the release of the mucus plug that seals the cervix during pregnancy. Option C, spontaneous rupture of membranes, is also not a definitive sign of progression into the second stage of labor. This can happen at any point during labor and does not necessarily indicate the beginning of the second stage. Option D, inability to breathe through contractions, is not a sign of progression into the second stage of labor. While contractions can become more intense and frequent in the second stage, breathing techniques can still be used to help manage the pain and discomfort. In summary, the bulging perineum is the most reliable sign that indicates progression into the second stage of labor. Other signs mentioned in the options can occur at various points during labor and are not specific to the second stage.

Correct Answer: A

Rationale: The correct answer is A. Descent is progressing well. This is because the primipara is in active labor, 7 cm dilated, and at +3 station. At this point, the fetus is descending through the birth canal, which indicates progress in labor. The +3 station means that the fetal head is 3 cm below the ischial spines in the pelvis, which is a good sign that descent is occurring as expected. Therefore, it is important for the nurse to report that descent is progressing well. Choice B, fetal head is not yet engaged, is incorrect. The fact that the fetus is at +3 station indicates that the fetal head is engaged and descending into the pelvis. This is a positive sign of progress in labor. Choice C, vaginal delivery is imminent, is incorrect. While the primipara is at 7 cm dilated and at +3 station, it is not guaranteed that delivery is imminent. Labor can still take some time to progress further before delivery occurs. Choice D, external rotation is complete, is incorrect. External rotation occurs during the second stage of labor, not during active labor. At this point, the focus is on descent and dilation, rather than rotation of the fetus.

Correct Answer: C

Rationale: During the second stage of labor, the most appropriate breathing technique is to push down with an open glottis, which is option C. This technique is also known as the "pushing" stage of labor, where the mother actively works to push the baby through the birth canal. Option A, alternately pant and blow, is not the most appropriate technique during the second stage of labor. Panting and blowing are more commonly used during the first stage of labor to help manage contractions and stay relaxed. Option B, taking rhythmic, shallow breaths, is also not the most appropriate technique during the second stage of labor. This type of breathing may not provide enough power and force to effectively push the baby out. Option D, doing slow chest breathing, is not suitable for the second stage of labor either. Slow chest breathing is usually used for relaxation and pain management, rather than actively pushing during labor. In conclusion, pushing down with an open glottis is the most appropriate breathing technique during the second stage of labor because it helps the mother effectively push the baby through the birth canal.

Correct Answer: D

Rationale: During labor, tense shoulder and face muscles can be a sign of increased anxiety or pain. Encouraging the woman to perform next-level breathing is the most appropriate first intervention in this situation. Next-level breathing involves deep, slow breaths that help the woman relax and focus during contractions. This can help alleviate some of the tension in the shoulder and face muscles. It also promotes better oxygenation, which can be beneficial for both the mother and the baby during labor. Encouraging an epidural (choice A) or intravenous analgesia (choice B) may be appropriate interventions for pain relief in labor, but they should not be the first step when dealing with tense shoulder and face muscles. These interventions are more invasive and should be considered after less invasive interventions have been tried. Assisting the woman in changing position (choice C) can also help relieve tension and discomfort during labor. However, next-level breathing is a more immediate and easily implementable intervention that can be performed at any time during labor. Changing positions may require more time and effort, so it may not be the most appropriate first step in this situation. In conclusion, urging the woman to perform next-level breathing is the best initial intervention for tense shoulder and face muscles during contractions because it is non-invasive, can be done immediately, and promotes relaxation and focus during labor.