Which of the following is a common cause of uterine atony?

Correct Answer: A

Rationale: The correct answer is A: uterine overdistention. Uterine atony is when the uterus fails to contract effectively after childbirth. Overdistention, such as from multiple gestation or large baby, can stretch the uterus, leading to poor muscle tone. This results in inadequate contractions to control bleeding. Excessive uterine contractions (B) are not a common cause but rather can lead to other issues like uterine rupture. Placental abruption (C) is the premature separation of the placenta from the uterus, causing bleeding but not directly related to atony. Infection or retained placenta (D) can contribute to uterine atony but are not common primary causes.

Correct Answer: B

Rationale: The correct answer is B: administer epidural analgesia. In the first stage of labor, epidural analgesia is the most appropriate option for pain relief as it provides effective and continuous pain management without compromising maternal and fetal well-being. Epidural analgesia allows the laboring person to remain alert and actively participate in the birthing process. Non-pharmacological pain relief methods may not provide sufficient pain relief during the intense contractions of the first stage of labor. Administering IV analgesics may not effectively manage the pain in the first stage and can have sedative effects on the laboring person and newborn. Administering pain medication as requested without considering the most appropriate option may not provide optimal pain relief and may not be in the best interest of the laboring person and their baby.

Correct Answer: A

Rationale: The correct answer is A: keep the cord dry and clean. This is because keeping the umbilical cord dry and clean helps prevent infection and promotes healing. Applying a sterile dressing (B) is unnecessary and may trap moisture, leading to infection. Using alcohol or iodine (C) is outdated and can delay cord separation. Applying a sterile dressing to the umbilicus (D) is not recommended as it can interfere with air circulation and healing. In summary, choice A is correct as it aligns with current best practices for umbilical cord care.

Correct Answer: A

Rationale: The correct answer is A: increase the IV fluid rate. This intervention helps to increase blood volume and improve blood pressure, addressing hypotension commonly caused by epidural anesthesia. Administering an epidural bolus (B) can worsen hypotension. Administering an analgesic (C) is not the priority in this situation. Increasing monitoring frequency (D) is important but addressing the underlying cause of low blood pressure is crucial.

Correct Answer: B

Rationale: The correct answer is B: apply gentle pressure to the perineum. This intervention helps to support the perineum and reduce the risk of perineal tearing during childbirth. Applying gentle pressure can slow down the baby's descent and allow the perineum to stretch gradually, reducing the likelihood of severe tearing. This intervention is important to promote a safe and controlled delivery. Incorrect answer explanations: A: Applying warm compresses may provide some comfort but does not specifically address the need to support the perineum during childbirth. C: Episiotomy should be considered only when necessary and not as a routine intervention when the perineum bulges. D: Perineal massage is typically done during the prenatal period to help prepare the perineum for childbirth but is not the most appropriate intervention when the perineum starts to bulge during labor.