What presenting part questions the nurse's judgment of a vertical lie?

Correct Answer: D

Rationale: The correct answer is D: Scapula. When determining the presenting part of the fetus, the nurse must consider the lie of the baby in the uterus. In a vertical lie, the fetus is positioned vertically in the uterus, which can raise questions about the nurse's judgment due to the unusual positioning. The scapula, located on the back of the baby, is not a typical presenting part and would prompt the nurse to reevaluate their assessment. Choice A, the sacrum, is a common presenting part in a vertex presentation where the baby's head is down. Choice B, the occiput, is also a common presenting part in a vertex presentation where the baby's head is down and is the ideal position for vaginal delivery. Choice C, the menton, is the chin and is typically associated with the face presentation, which can occur in a transverse lie but not necessarily a vertical lie. In conclusion, the scapula is the correct answer as it is an unusual presenting part that would question the nurse's judgment of a vertical lie. The other choices are more common presenting parts in different fetal positions and would not typically raise concerns about the nurse's assessment.

Correct Answer: A

Rationale: Choice A is the correct answer because a right to left shunt between the atria is consistent with normal fetal circulation. During fetal development, a fetus has a hole in the heart called the foramen ovale which allows blood to bypass the lungs and flow directly from the right atrium to the left atrium. This is important as the lungs are not yet functioning in utero. Therefore, seeing a right to left shunt between the atria on an ultrasound report is normal and indicates that blood is flowing as it should in a fetus. Choice B is incorrect because a right to left shunt between the umbilical arteries would not be consistent with normal fetal circulation. The umbilical arteries carry deoxygenated blood from the fetus to the placenta for oxygenation, so a shunt in this direction would not be normal. Choice C is incorrect because blood returning to the placenta via the umbilical vein is part of fetal circulation but it is not indicative of normal fetal circulation. In a normal fetus, oxygenated blood returns to the fetus from the placenta via the umbilical vein, but this statement does not specifically address the shunting of blood within the heart. Choice D is incorrect because blood returning to the right atrium from the pulmonary system is indicative of postnatal circulation, not fetal circulation. In a fetus, blood bypasses the lungs through the foramen ovale and ductus arteriosus, so seeing blood returning to the right atrium from the pulmonary system on an ultrasound report would not be consistent with normal fetal circulation.

Correct Answer: D

Rationale: Option D is the correct answer because the woman is likely experiencing symptoms of supine hypotensive syndrome, which occurs when the weight of the uterus compresses the vena cava when lying on the back, leading to decreased blood flow to the heart and brain. This can result in dizziness and lightheadedness. Teaching the woman to avoid lying on her back and to rise slowly can help alleviate these symptoms and prevent further complications. Option A, ordering a nonstress test to assess fetal well-being, is incorrect because the woman's symptoms are likely related to her position rather than fetal distress. While monitoring fetal well-being is important during pregnancy, it is not the most appropriate action in this situation. Option B, ordering an EKG, is also incorrect because the woman's symptoms are likely not cardiac-related. Supine hypotensive syndrome is a common issue in pregnancy and can be managed without the need for an EKG. Option C, reporting the abnormal finding immediately to her care provider, is not the most appropriate action in this situation. While it is important to communicate any concerns to the care provider, educating the woman on how to manage her symptoms is a more immediate and practical intervention in this case.

Correct Answer: B

Rationale: B: The nurse stabilizes the base of the uterus with one hand while massaging the fundus. This is the correct action because it ensures that the fundus is properly supported and allows for accurate assessment of the fundal height. Massaging the fundus also helps to prevent postpartum hemorrhage by promoting contractions of the uterus to reduce bleeding. A: The nurse measures the fundal height using a paper tape. This is an incorrect action because measuring the fundal height with a paper tape is not necessary during the immediate postpartum period. The focus should be on assessing the firmness, position, and height of the fundus to ensure proper involution of the uterus. C: The nurse palpates the fundus with the tips of his or her fingers. This action is incorrect because palpating the fundus with the fingertips may not provide enough support to accurately assess the fundal height. It is important to use the palm of the hand to provide adequate support and pressure while assessing the fundus. D: The nurse precedes the assessment with a sterile vaginal exam. This action is incorrect because a sterile vaginal exam is not necessary for assessing the fundus during the immediate postpartum period. The focus should be on assessing the fundus externally to ensure proper involution and prevent complications such as postpartum hemorrhage.

Correct Answer: B

Rationale: Lochia serosa is a type of postpartum vaginal discharge that typically occurs from days 3 to 10 after delivery. This discharge is pinkish-brown in color and contains leukocytes, erythrocytes, serous fluid, and cervical mucus. Choice A (Days 3 and 4 PP) is incorrect because lochia serosa does not start as early as day 3; it typically begins around day 3 and can last up to day 10. Choice C (Days 10-14 PP) is incorrect because lochia serosa usually stops around day 10, so it would not be present up to day 14. Choice D (Days 14 to 42 PP) is incorrect because lochia serosa is not present beyond day 10. After lochia serosa, the discharge transitions to lochia alba, which is a creamy white or light yellow color. Therefore, the correct answer is B (Days 3 to 10 PP) as this is the timeframe during which the client can expect to experience lochia serosa.