When does the active phase of labor begin according to ACOG?

Correct Answer: A

Rationale: The active phase of labor is defined as the phase in which cervical dilation progresses more rapidly. According to ACOG (American College of Obstetricians and Gynecologists), the active phase of labor begins when the cervix is dilated to 6 cm. Choice B (3 cm) is incorrect because 3 cm dilation is typically considered to be in the early phase of labor, where contractions are usually less intense and frequent compared to the active phase. Choice C (5 cm) is incorrect because while 5 cm dilation is closer to the active phase, it is still considered to be in the early phase of labor. The active phase is characterized by more rapid dilation and stronger, more frequent contractions. Choice D (10 cm) is incorrect because 10 cm dilation marks the end of the active phase and the beginning of the second stage of labor, where the woman is fully dilated and can begin pushing. Therefore, the correct answer is A (6 cm) because this is the point at which the active phase of labor officially begins, as defined by ACOG.

Correct Answer: B

Rationale: During the third stage of labor, the birthing person will experience the expulsion of the placenta. Choice A is incorrect because the fetus is already delivered during the second stage of labor, not the third stage. Choice B is correct because the birthing person will indeed experience cramping, a gush of fresh vaginal bleeding, and lengthening of the umbilical cord during the third stage of labor. The cramping is caused by the uterus contracting to expel the placenta, the gush of fresh vaginal bleeding is due to the separation of the placenta from the uterine wall, and the lengthening of the umbilical cord occurs as the placenta is delivered. Choice C is incorrect because dyspnea, which refers to difficulty breathing, is not a common symptom experienced during the third stage of labor. Choice D is incorrect because increased blood pressure and pain due to expulsive efforts are more commonly associated with the first and second stages of labor, not the third stage when the placenta is being delivered. In conclusion, choice B is the correct answer as it accurately describes what the birthing person may experience during the third stage of labor, while the other choices do not accurately reflect this stage of labor.

Correct Answer: D

Rationale: Anticipatory guidance for new parents is essential to help them navigate the sociologic changes that come with having a newborn. Choice A, explaining that roles will not change at home, is incorrect because the arrival of a new baby often necessitates a redistribution of responsibilities and roles within the household. This can lead to significant changes in dynamics which the nurse should prepare the parents for. Choice B, explaining that stresses will be over now that the newborn is born, is also incorrect. In reality, the stresses of parenthood often increase after the baby is born as parents adjust to the demands of caring for a newborn. It is important for parents to be aware of and prepared for these potential stressors. Choice C, telling the parents not to stress over household changes, is not the best approach. While it is important to reassure parents and provide support, dismissing potential stressors related to household changes can leave parents feeling unprepared and overwhelmed when these changes do occur. The correct answer is D, preparing new parents for possible strains on relationships. The arrival of a new baby can put strain on relationships due to changes in roles, responsibilities, sleep deprivation, and overall adjustment to parenthood. By providing anticipatory guidance on this topic, the nurse can help parents navigate these challenges and maintain a healthy relationship during this transition period.

Correct Answer: C

Rationale: A doula is a trained professional who provides physical, emotional, and informational support to women before, during, and after childbirth. The correct answer is C because suggesting a doula when the support person is in the military and unable to attend the birth ensures that the patient has continuous support during labor. This is important as having a supportive presence during childbirth has been shown to improve outcomes for both the mother and baby. Option A is incorrect because suggesting a doula solely based on the patient asking for an epidural does not address the patient's need for continuous support throughout labor. While a doula can certainly help with pain management techniques, their role is much broader than just assisting with pain relief. Option B is incorrect because if the nurse is unable to provide adequate support, it is their responsibility to seek additional resources or assistance within the healthcare team, rather than passing this responsibility onto a doula. The primary role of a nurse is to ensure the safety and well-being of the patient, so they should not rely on a doula to fulfill their own responsibilities. Option D is incorrect because suggesting a doula solely based on the patient having an emergency cesarean birth does not address the patient's need for support during labor. While a doula can certainly provide emotional support during a cesarean birth, their role is not limited to specific circumstances but rather to support the patient throughout the entire childbirth experience.

Correct Answer: A

Rationale: Early decelerations are a type of FHR deceleration that are considered benign and are actually a sign of possible fetal descent. These decelerations typically mirror the contractions during labor, meaning they start and end at the same time as the contraction. This is because early decelerations are caused by head compression during contractions, which stimulates the vagus nerve and leads to a reflex slowing of the fetal heart rate. Late decelerations, on the other hand, are a concerning type of FHR deceleration that occur after the peak of the contraction. They are often associated with uteroplacental insufficiency and are not a sign of fetal descent, but rather a sign of fetal distress. Variable decelerations are another type of FHR deceleration that are caused by cord compression. They are characterized by an abrupt and sharp decrease in the fetal heart rate, followed by a rapid return to baseline. Variable decelerations are typically not associated with fetal descent. Prolonged decelerations are FHR decelerations that last longer than 2 minutes but less than 10 minutes. They are often caused by various factors such as cord compression, maternal hypotension, or uterine hyperstimulation. Prolonged decelerations are not specifically indicative of fetal descent.