What intervention should the nurse perform first if shoulder and face muscles tense during contractions?

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.

Correct Answer: C

Rationale: Direct sacral pressure is the most effective intervention for severe back labor because it can help alleviate the intense lower back pain experienced during labor. This technique involves applying pressure to the sacrum, the triangular bone at the base of the spine, which can help relieve the pressure on the nerves causing the pain. By providing direct sacral pressure, the mother can experience some relief and potentially progress more smoothly through labor. Assisting the mother with childbirth breathing (Choice A) is a helpful technique during labor, but it may not be the most effective intervention for severe back labor specifically. While deep breathing and relaxation techniques can help manage pain and reduce stress, they may not directly address the intense lower back pain associated with back labor. Encouraging the mother to have an epidural (Choice B) is another option for pain management during labor. However, an epidural may not specifically target the lower back pain associated with back labor. Additionally, epidurals come with potential risks and side effects that may not be necessary if direct sacral pressure can provide relief. Using a hydrotherapy tub (Choice D) can be a soothing and relaxing option for pain management during labor. However, it may not be as effective for severe back labor specifically. While warm water can help relax muscles and provide some pain relief, it may not directly target the intense lower back pain experienced during back labor. In conclusion, providing direct sacral pressure is the most effective intervention for severe back labor as it directly addresses the intense lower back pain experienced during labor. Other options such as childbirth breathing, epidurals, and hydrotherapy tubs may provide some relief but may not be as targeted or effective for severe back labor specifically.

Correct Answer: A

Rationale: A doula's role during labor is to provide emotional, physical, and informational support to the mother. Giving the mother a back rub is a key action for a doula during labor because it helps to relieve tension, promote relaxation, and provide comfort to the mother. This physical support can help the mother cope with the intensity of labor and manage pain more effectively. Assessing the fetal heart rate, checking the blood pressure, and regulating the intravenous are tasks typically performed by medical professionals such as doctors, nurses, or midwives. These tasks require specialized training and expertise to ensure the safety and well-being of both the mother and baby during labor. It is not within the scope of practice for a doula to perform these medical tasks. Therefore, giving the mother a back rub is the most appropriate action for a doula during labor as it aligns with their role of providing comfort and support to the mother. It is important for doulas to understand their role and limitations in order to provide the best possible care for the mother during labor.

Correct Answer: D

Rationale: The correct response for the nurse to make first to a client reporting bleeding at term is option D: "How much blood is there?" This is the most appropriate response because it helps the nurse assess the severity of the situation and determine the next steps in providing care for the client. Option A: "Does it burn when you void?" is incorrect because it is not relevant to the client's presenting concern of bleeding at term. This question pertains to urinary symptoms, which are not the immediate concern in this situation. Option B: "You sound frightened." is also incorrect because it focuses on the client's emotional state rather than addressing the physical symptoms of bleeding at term. While it is important to acknowledge and address the client's emotions, assessing the severity of the bleeding should take precedence. Option C: "That is just the mucus plug." is incorrect because it assumes that the bleeding is related to the mucus plug being expelled, which may not be the case. It is crucial for the nurse to gather more information about the amount and nature of the bleeding before making any assumptions about its cause. In summary, option D is the correct response because it allows the nurse to gather important information about the client's condition and determine the appropriate course of action. The other options are incorrect as they do not address the immediate concern of bleeding at term.

Correct Answer: A

Rationale: The correct order of cardinal moves of labor is internal rotation, extension, external rotation (Answer A). Firstly, internal rotation occurs when the baby's head rotates so that the widest part of the head aligns with the widest part of the pelvis. This movement helps the baby navigate through the birth canal more easily. Next, extension takes place as the baby's head extends as it passes under the mother's pubic bone. This movement allows the baby's head to move through the pelvis and be born. Finally, external rotation occurs as the baby's head rotates back to its original position, allowing the shoulders to be born. This movement facilitates the safe delivery of the baby. Now, let's discuss why the other options are incorrect: Option B (External rotation, descent, extension) is incorrect because descent typically occurs before external rotation. Descent refers to the baby's movement down the birth canal, which usually happens before external rotation. Option C (Extension, flexion, internal rotation) is incorrect because flexion typically occurs before extension. Flexion is when the baby's head is tucked into its chest, allowing it to pass through the birth canal more easily. Extension follows flexion. Option D (External rotation, internal rotation, expulsion) is incorrect because internal rotation generally occurs before external rotation. Internal rotation is necessary for the baby's head to align with the pelvis before external rotation occurs, leading to expulsion (birth). In conclusion, the correct order of cardinal moves of labor is internal rotation, extension, external rotation, making Answer A the correct choice.