What type of dystocia should the nurse prepare for if she palpates prominent ischial spines during the vaginal exam?

Correct Answer: A

Rationale: The correct answer is A: pelvic dystocia. Prominent ischial spines indicate a contracted pelvis, which can obstruct the baby's passage during labor, leading to pelvic dystocia. Pelvic dystocia involves the bony pelvis causing difficulty in the descent of the fetus. Choices B, C, and D are incorrect because fetal dystocia refers to issues related to the fetus, contraction dystocia involves ineffective contractions, and uterine dystocia pertains to abnormalities of the uterus itself, none of which are indicated by prominent ischial spines.

Correct Answer: D

Rationale: The correct answer is D: polyhydramnios. Polyhydramnios is a condition characterized by an excessive amount of amniotic fluid surrounding the fetus. This can occur due to various reasons such as fetal malformations, multiple gestations, or maternal diabetes. The excess fluid can lead to complications such as preterm labor or fetal malpresentation. A: Amniotic fluid embolism is a rare and life-threatening condition where amniotic fluid enters the maternal bloodstream, causing an allergic reaction. B: Gestational diabetes is a condition where high blood sugar levels develop during pregnancy, but it is not directly related to the amount of amniotic fluid. C: Oligohydramnios is the opposite of polyhydramnios, characterized by a deficiency of amniotic fluid, which can also lead to complications.

Correct Answer: B

Rationale: The correct answer is B: macrosomia. Gestational diabetes can lead to fetal macrosomia, where the baby is larger than average, increasing the risk of complications during labor such as shoulder dystocia. This is due to the excess glucose crossing the placenta and stimulating the baby's pancreas to produce more insulin, resulting in increased growth. Choice A, breech presentation, is not directly associated with gestational diabetes. Choice C is a duplicate of the correct answer. Choice D, precipitous birth, is not a common complication of gestational diabetes but rather refers to an extremely rapid labor process.

Correct Answer: C

Rationale: The correct answer is C: skull fracture. When obstetric forceps are used during delivery, there is a risk of excessive pressure on the fetal skull, leading to a potential complication such as a skull fracture. This occurs due to the force exerted by the instrument during the delivery process, which can cause trauma to the baby's delicate skull bones. Flexion of the head (choice A) is a normal part of the birthing process and not a complication of forceps use. Abdominal complications (choice B) and femur fracture (choice D) are not typically associated with obstetric forceps use.

Correct Answer: D

Rationale: The correct answer is D: vasa previa. This condition occurs when the umbilical cord vessels cross the cervix, making them vulnerable to compression during labor. This can lead to fetal blood vessel rupture and potentially life-threatening bleeding. Placenta previa (A) is when the placenta partially or fully covers the cervix, unrelated to the cord position. Placenta cervix (B) is not a recognized medical term. Velamentous insertion (C) is when the blood vessels of the umbilical cord insert into the fetal membranes before reaching the placenta, also not directly related to cord position over the cervix.