While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include which of the following? (Select all that apply.)

Correct Answer: A

Rationale: Rationale: Culture can significantly impact a woman's perception and experience of pain during labor due to cultural beliefs, practices, and attitudes towards childbirth. Cultural norms and values can influence pain management preferences, coping mechanisms, and communication styles. Understanding the patient's cultural background is crucial for providing culturally competent care and addressing her psychosocial needs. Summary of other choices: B: Anxiety and fear - While anxiety and fear can influence a woman's pain experience, they are not specific to psychosocial factors related to culture. C: Support systems - Support systems can affect a woman's labor experience, but they do not specifically relate to the influence of psychosocial factors such as culture. D: Preparation for childbirth - Although preparation for childbirth can impact pain perception, it is not directly related to the influence of psychosocial factors like culture.

Correct Answer: B

Rationale: The correct answer is B. Document maternal blood pressure and fetal heart rates following medication administration and observe for any variations. This is because assessing maternal blood pressure and fetal heart rates can provide crucial information about the patient's response to the medication and the overall well-being of both the mother and the baby during labor. Any variations in these vital signs could indicate potential complications that need immediate attention. Choice A is not the priority as pain assessment, though important, may not provide immediate information on the effectiveness of the medication in this critical stage of labor. Choice C, documenting intake and output, is not as critical as monitoring vital signs in this scenario. Choice D is also not the priority as increasing fluid rate, though important for hydration, may not be the immediate concern in evaluating the clinical response to the medication.

Correct Answer: C

Rationale: The correct answer is C. In this scenario, the patient is fully dilated and at +2 station, indicating imminent birth. The priority nursing response should focus on assisting the patient with nonpharmacologic pain distraction methods as the birth is likely to occur soon. Nonpharmacologic pain management techniques such as breathing exercises, positioning changes, massage, and emotional support can help alleviate the patient's anxiety and provide comfort during this intense stage of labor. Administering an epidural at this late stage may not be feasible or effective due to the advanced stage of labor and imminent birth. Options A and D are not appropriate as they do not address the immediate needs of the patient in active labor. Option B is incorrect as it dismisses the patient's request for pain relief and fails to address her emotional and physical needs during labor.

Correct Answer: A

Rationale: The correct answer is A: Left occiput posterior. In this position, the baby's head is facing the mother's sacrum, making labor longer and more painful due to the baby's position causing more pressure on the mother's back and pelvis. Left occiput anterior (B) and Right occiput anterior (C) are favorable positions for a smoother labor. Right occiput transverse (D) can also lead to a longer and more complicated labor, but not as much as Left occiput posterior.

Correct Answer: A

Rationale: The correct answer is A: Remove the patient from the water. This is the priority intervention because the patient's safety is at risk due to feeling faint. Removing the patient from the water helps prevent potential drowning or injury. Increasing room temperature (choice B) may worsen the patient's condition by increasing heat stress. Providing additional fluids orally (choice C) may not address the immediate risk of fainting. Notifying the physician immediately (choice D) is important, but ensuring the patient's safety by removing them from the water takes precedence.