What is the primary goal of fetal heart rate monitoring during the second stage?

Correct Answer: C

Rationale: Fetal heart rate monitoring during the second stage of labor is primarily done to evaluate fetal well-being. This is because during the second stage, the baby is moving through the birth canal and experiencing increased stress, so monitoring the fetal heart rate is crucial to ensure the baby is tolerating labor well. Choice A, predicting when to bear down during contractions, is incorrect because fetal heart rate monitoring is not used to determine the timing of pushing. This is typically guided by the healthcare provider based on the progress of labor and the position of the baby. Choice B, determining the strength of uterine contractions, is incorrect as this is typically assessed through palpation of the abdomen or by using a tocodynamometer to measure the frequency and duration of contractions. Fetal heart rate monitoring is specifically used to assess the baby's well-being. Choice D, monitoring vital signs of the birthing person, is incorrect because fetal heart rate monitoring is focused on the well-being of the baby, not the birthing person. The birthing person's vital signs are typically monitored separately during labor and delivery. In summary, the primary goal of fetal heart rate monitoring during the second stage of labor is to evaluate fetal well-being and ensure the baby is tolerating labor effectively. It is not used to predict pushing, assess uterine contractions, or monitor the vital signs of the birthing person.

Correct Answer: C

Rationale: Performing fundal massage to promote uterine firmness is the correct immediate action for a boggy uterus. A boggy uterus is a uterus that feels soft and relaxed instead of firm and contracted after childbirth, which can lead to excessive bleeding. Fundal massage helps to stimulate uterine contractions, which can help prevent or treat postpartum hemorrhage. Choice A, documenting the findings as normal, is incorrect because simply documenting the findings does not address the issue of a boggy uterus and the potential for postpartum hemorrhage. Immediate action is needed to promote uterine firmness. Choice B, continuing to administer the uterotonic medication, may be necessary in some cases, but the immediate action for a boggy uterus is fundal massage. Uterotonic medications can help promote uterine contractions, but fundal massage is a more direct and immediate intervention. Choice D, administering an analgesic for the birthing person's pain, is not the priority when dealing with a boggy uterus. While pain management is important, addressing the boggy uterus and potential postpartum hemorrhage takes precedence to ensure the birthing person's safety and well-being.

Correct Answer: C

Rationale: Assessing the perineum after birth is primarily done to detect any signs of perineal trauma. This is because perineal trauma, such as tears or lacerations, is a common occurrence during childbirth and can lead to complications if not identified and treated promptly. By assessing the perineum, healthcare providers can determine the extent of any trauma and provide appropriate interventions to promote healing and prevent infection. Option A, to evaluate the birthing person's readiness for discharge, is incorrect because assessing the perineum is not solely about determining readiness for discharge. While the condition of the perineum may factor into discharge decisions, the primary purpose is to assess for trauma. Option B, to ensure the birthing person can ambulate safely, is also incorrect because assessing the perineum is not directly related to the birthing person's ability to walk safely. While perineal trauma may impact mobility, the main focus is on identifying and treating any trauma present. Option D, to assess the status of cervical dilation, is incorrect because cervical dilation is not related to assessing the perineum after birth. Cervical dilation is typically monitored during labor to track progress and guide interventions, but it is not relevant to assessing perineal trauma post-birth.

Correct Answer: B

Rationale: Labor dystocia refers to difficult or prolonged labor, which can increase the risk of complications for both the mother and baby. A 41-year-old woman is at high risk for labor dystocia due to advanced maternal age. As women age, their uterine muscles may not contract as effectively, leading to inefficient labor progress. This can result in prolonged labor, increased risk of instrumental deliveries (forceps or vacuum), and higher rates of cesarean sections. Choice A, 38-week gestation, is not necessarily a risk factor for labor dystocia. Full-term pregnancy is considered to be between 37-42 weeks, so a 38-week gestation is within the normal range and does not inherently increase the risk of labor dystocia. Choice C, prenatal anemia, can contribute to maternal fatigue and weakness during labor, but it is not a direct risk factor for labor dystocia. Anemia can be managed with appropriate prenatal care and iron supplementation to reduce its impact on labor. Choice D, no prenatal care, is a significant risk factor for various complications during pregnancy and labor, but it is not directly associated with labor dystocia. Lack of prenatal care can lead to undiagnosed medical conditions, inadequate monitoring of fetal well-being, and missed opportunities for interventions that could prevent labor dystocia. In conclusion, a 41-year-old woman is at high risk for labor dystocia due to advanced maternal age, while the other choices are not directly linked to this specific complication. It is important for healthcare providers to recognize these risk factors and provide appropriate management to optimize outcomes for both the mother and baby.

Correct Answer: B

Rationale: Amniotomy is a procedure where the amniotic sac is artificially ruptured to induce or accelerate labor. Choice A, a six-hour decrease of labor, is incorrect because while amniotomy can sometimes speed up labor, it is not guaranteed to reduce labor by a specific amount of time. It may vary depending on individual factors. Choice C, elevated blood pressure, is also incorrect. Amniotomy does not directly cause elevated blood pressure. Elevated blood pressure during labor can be a sign of other complications such as preeclampsia, but it is not a direct result of amniotomy. Choice D, second stage labor dystocia, is also incorrect. Amniotomy is more commonly associated with the first stage of labor rather than the second stage. Second stage labor dystocia is usually related to issues with the baby's position or maternal pushing efforts, not the rupture of the amniotic sac. The correct answer is B, chorioamnionitis. Amniotomy increases the risk of chorioamnionitis, which is an infection of the fetal membranes. This is because the protective barrier of the amniotic sac is broken, providing a pathway for bacteria to enter and infect the amniotic fluid. Chorioamnionitis can lead to serious complications for both the mother and baby, including sepsis and preterm birth. It is important for healthcare providers to closely monitor for signs of infection after an amniotomy.