D447 Women and Children - Set 2 - Part 1

Correct Answer: Drinking more water may actually worsen contractions

Option c is correct because lateral positioning prevents vena cava compression by the uterus, improves venous return, and helps restore blood pressure after epidural-induced hypotension, which is the priority intervention to maintain uteroplacental perfusion. Option a is incorrect because elevating the head of the bed would worsen hypotension by reducing venous return to the heart. This is the opposite of what is needed when blood pressure drops following epidural placement during labor. Option b is incorrect because epinephrine is not the first-line treatment for epidural-related hypotension. Standard management begins with repositioning and intravenous fluid bolus before considering vasopressor medications for cases that do not respond to initial measures. Option d is incorrect because preparing for cesarean section is premature when hypotension can typically be corrected with positioning and fluid bolus. Surgical intervention is considered only for persistent fetal distress unrespon

Correct Answer: Loss of bladder sensation

Option a is correct because epidural anesthesia blocks sensory nerve pathways in the lower body, including those from the bladder. Patients often cannot feel the urge to void, leading to urinary retention that frequently requires catheterization during labor. Option b is incorrect because epidurals do not directly increase uterine blood flow. The primary hemodynamic effect of epidural anesthesia is potential maternal hypotension from sympathetic blockade, not enhanced blood flow to the uterus or surrounding structures. Option c is incorrect because epidurals typically do not cause elevated maternal heart rate as a primary effect. Tachycardia in a patient with an epidural would more likely indicate hypotension, hemorrhage, or another complication rather than a direct epidural effect. Option d is incorrect because reduced placental perfusion is a potential complication of epidural-induced hypotension, not the mechanism causing inability to void. Bladder dysfunction results from sensory n

Correct Answer: Dural puncture during placement

Option d is correct because a postdural puncture headache occurs when the dura is accidentally punctured during epidural placement, causing cerebrospinal fluid leakage. The headache characteristically worsens with upright positioning and improves when the patient lies flat. Option a is incorrect because medication allergic reactions typically present with urticaria, itching, respiratory symptoms, or anaphylaxis rather than a positional headache. Allergic responses occur shortly after drug administration and do not follow a postural pattern. Option b is incorrect because epidural catheter infection presents with localized back pain, redness, swelling, warmth at the insertion site, and fever. Infection does not produce a headache that characteristically changes in severity based on the patient's body position. Option c is incorrect because a high spinal block causes respiratory depression, profound hypotension, and loss of motor function in the upper body. It presents acutely during

Correct Answer: Excessively high sensory block

Option b is correct because numbness extending to the upper abdomen with significant hypotension and loss of motor function indicates the epidural block has risen too high. This compromises respiratory function and cardiovascular stability, requiring immediate repositioning and provider notification. Option a is incorrect because normal epidural pain relief produces a sensory block limited to the lower abdomen and pelvis while allowing some leg movement. Complete leg paralysis with upper abdominal numbness and severe hypotension exceeds the expected therapeutic range significantly. Option c is incorrect because uterine hyperstimulation involves excessive contraction frequency or duration, typically caused by oxytocin administration. It does not cause progressive ascending numbness or complete bilateral loss of motor function in the extremities. Option d is incorrect because placental abruption presents with painful vaginal bleeding, a rigid boardlike abdomen, and uterine tenderness. It

Correct Answer: Diminished urge to push

Option a is correct because epidural anesthesia blocks the sensory nerves responsible for feeling rectal pressure during contractions. Without this sensation, the patient loses the natural urge to push, which commonly prolongs the second stage of labor. Option b is incorrect because epidurals do not increase contraction strength. Epidural anesthesia may slightly reduce uterine contraction coordination, and stronger contractions would shorten rather than prolong the pushing stage of labor and delivery. Option c is incorrect because epidurals actually reduce pelvic floor muscle tone rather than enhance it. The motor blockade relaxes pelvic musculature, which contributes to difficulty with effective pushing rather than improving the expulsive effort during delivery. Option d is incorrect because epidurals do not accelerate cervical dilation. The question describes a prolonged second stage with ineffective pushing, which results from diminished sensation rather than from any effect that wo

Correct Answer: Worsened impaction or uterine rupture

Option d is correct because fundal pressure during shoulder dystocia is absolutely contraindicated. It forces the impacted shoulder further against the pubic bone, worsening the obstruction, and can cause uterine rupture creating a life-threatening emergency for both mother and infant. Option a is incorrect because while placental abruption is a serious obstetric complication, the primary danger of fundal pressure during shoulder dystocia is worsening the shoulder impaction and risking uterine rupture, not premature separation of the placenta from the wall. Option b is incorrect because prolonged second stage of labor is not the immediate danger of applying fundal pressure during shoulder dystocia. The critical risk is mechanical worsening of the bony impaction and potential catastrophic uterine rupture requiring emergency intervention. Option c is incorrect because although neonatal respiratory depression may occur from prolonged delivery, the immediate danger of fundal pressure durin

Correct Answer: Hyperflexing the maternal thighs to abdomen

Option b is correct because the McRoberts maneuver involves sharply flexing the mother's thighs against her abdomen. This flattens the sacral promontory and rotates the pubic symphysis, changing the pelvic angle to help release the impacted anterior shoulder. Option a is incorrect because rolling the patient prone is not the McRoberts maneuver and would make delivery extremely difficult in this position. The McRoberts maneuver requires the patient to remain supine with her thighs hyperflexed toward the abdomen. Option c is incorrect because Trendelenburg position, with the head lower than the feet, is used for umbilical cord prolapse to relieve pressure on the cord. It does not change the pelvic angle needed to release an impacted shoulder during dystocia. Option d is incorrect because extending both legs flat on the bed does not alter the pelvic angle and could actually make the shoulder dystocia more difficult to resolve. The McRoberts maneuver specifically requires sharp flexio

Correct Answer: Umbilical cord compression

Option c is correct because variable decelerations on fetal heart monitoring indicate intermittent umbilical cord compression. Their abrupt onset and variable timing with contractions distinguish them from other deceleration patterns and require immediate maternal repositioning to relieve cord pressure. Option a is incorrect because uteroplacental insufficiency causes late decelerations, which are gradual in onset and occur after the contraction peak. Variable decelerations have an abrupt onset and inconsistent timing that specifically indicates cord compression rather than placental problems. Option b is incorrect because fetal head compression causes early decelerations, which mirror the contraction pattern with a gradual onset and return to baseline. Variable decelerations differ in their abrupt and unpredictable pattern, indicating cord involvement rather than head compression. Option d is incorrect because maternal fever and infection can cause fetal tachycardia with a sustained e

Correct Answer: Manually elevate the presenting part off cord

Option a is correct because in umbilical cord prolapse, manually lifting the presenting part off the compressed cord restores fetal blood flow. The nurse must keep a gloved hand in place continuously while the team prepares for emergency cesarean delivery. Option b is incorrect because clamping and cutting an exposed prolapsed cord would completely eliminate all fetal blood supply and cause immediate fetal death. The goal is to relieve pressure on the cord to maintain blood flow until emergency surgical delivery can occur. Option c is incorrect because administering oxytocin during cord prolapse would stimulate stronger contractions that increase pressure on the prolapsed cord. This would further compress the umbilical vessels and worsen fetal compromise rather than improving the situation. Option d is incorrect because a flat supine position does not relieve pressure on a prolapsed cord. The correct positioning is Trendelenburg or knee-chest, which uses gravity to shift the presenting

Correct Answer: Meconium passage suggesting fetal distress

Option d is correct because thick greenish-brown amniotic fluid indicates meconium staining, which occurs when the fetus passes stool in utero. This is associated with fetal distress and requires close monitoring and possible suctioning at delivery to prevent aspiration. Option a is incorrect because normal amniotic fluid is clear to slightly yellowish and does not have a greenish-brown color. The presence of thick discolored fluid is an abnormal finding requiring immediate provider notification and enhanced fetal heart rate monitoring. Option b is incorrect because bacterial infection of the membranes, or chorioamnionitis, is indicated by foul-smelling amniotic fluid along with maternal fever and uterine tenderness. Greenish-brown coloration without foul odor specifically indicates meconium passage rather than infection. Option c is incorrect because maternal urinary incontinence produces clear to pale yellow fluid that tests negative on fern and nitrazine testing. Meconium-stained am

Correct Answer: Firmly massage the uterine fundus

Option b is correct because a boggy soft uterus indicates uterine atony, the most common cause of postpartum hemorrhage. Immediate fundal massage stimulates the myometrium to contract, compressing blood vessels at the placental site and reducing hemorrhage effectively. Option a is incorrect because while intravenous oxytocin is an important intervention for uterine atony, the immediate first action is fundal massage. Medications support uterine contraction, but physical stimulation of the fundus is the priority first-line nursing response. Option c is incorrect because emergency hysterectomy is the last resort when all other interventions for postpartum hemorrhage have failed. The stepwise approach begins with fundal massage, then uterotonics, then bimanual compression before considering surgical removal of the uterus. Option d is incorrect because while emptying the bladder is an important supportive intervention since a full bladder can prevent uterine contraction, it is not the imme

Correct Answer: Methylergonovine given intramuscularly

Option c is correct because methylergonovine, also known as Methergine, is contraindicated in patients with hypertension. It causes vasoconstriction that can dangerously elevate blood pressure, making it unsafe for this patient with chronic hypertension and active hemorrhage. Option a is incorrect because misoprostol is considered safe for patients with hypertension. It can be administered rectally or orally for postpartum hemorrhage and does not cause the potent vasoconstriction that makes methylergonovine dangerous for hypertensive patients. Option b is incorrect because oxytocin is the first-line uterotonic for postpartum hemorrhage and has no contraindication related to hypertension. It is safe for virtually all postpartum patients and works by directly stimulating uterine smooth muscle contraction. Option d is incorrect because oral prostaglandin medications used for postpartum hemorrhage are not specifically contraindicated in hypertension. The uterotonic that is specifically con

Correct Answer: Hypovolemic shock from hemorrhage

Option a is correct because tachycardia, hypotension, pale clammy skin, and decreased urine output together indicate hypovolemic shock from significant blood loss. These systemic signs show the body is decompensating, and immediate fluid resuscitation and hemorrhage control are critical. Option b is incorrect because postpartum preeclampsia presents with hypertension rather than hypotension, along with headache, visual changes, and proteinuria. The low blood pressure and tachycardia in this scenario are consistent with volume depletion, not a hypertensive crisis. Option c is incorrect because while some medications can cause hypotension, the complete clinical picture of tachycardia, hypotension, pallor, clamminess, and oliguria following heavy bleeding specifically points to hypovolemic shock from hemorrhage rather than an isolated drug reaction. Option d is incorrect because normal postpartum cardiovascular changes include gradual heart rate normalization and stable blood pressure. Si

Correct Answer: Tissue from retained placental fragments

Option d is correct because when the uterus is firm and well-contracted, atony is ruled out. The next most likely cause to assess is retained placental tissue, which prevents complete uterine involution and causes continued bleeding from the open placental site. Option a is incorrect because thrombin-related coagulopathies are the least common of the four T's and are typically assessed after ruling out tone, tissue, and trauma. Checking for retained placental fragments is the appropriate next step before evaluating for coagulation disorders. Option b is incorrect because tone refers to uterine atony, which has already been ruled out since the uterus is firm and well-contracted. Reassessing for atony when the fundus is firm would be redundant and would delay identifying the actual cause of hemorrhage. Option c is incorrect because temperature is not one of the four T's of postpartum hemorrhage. The four T's are Tone, Tissue, Trauma, and Thrombin. Infection is a separate p

Correct Answer: Asthma or reactive airway disease

Option b is correct because carboprost, also known as Hemabate, is a prostaglandin that causes bronchospasm and is absolutely contraindicated in patients with asthma. Administering it to an asthmatic patient could trigger severe bronchoconstriction and potentially fatal respiratory failure. Option a is incorrect because chronic hypertension is the contraindication for methylergonovine, not carboprost. Confusing the contraindications of different uterotonics is a common exam pitfall, so remember that carboprost's specific danger involves respiratory conditions exclusively. Option c is incorrect because type two diabetes mellitus is not a contraindication for carboprost or any standard uterotonic medication used for postpartum hemorrhage. Diabetes management continues independently and does not affect the choice of hemorrhage treatment medications. Option d is incorrect because a history of cesarean delivery is not a contraindication for carboprost administration. While cesarean pat

Correct Answer: Continue breastfeeding at least eight times daily

Option c is correct because continuing frequent breastfeeding helps empty the affected breast, which promotes healing and prevents abscess formation. Breast milk remains safe for the infant, and stopping breastfeeding would actually worsen engorgement and mastitis symptoms significantly. Option a is incorrect because permanently discontinuing breastfeeding is not recommended for mastitis. Continued breast emptying through nursing or pumping is essential for treatment, and stopping abruptly would cause painful engorgement and increase the risk of abscess development. Option b is incorrect because switching entirely to formula removes the most effective method of breast emptying. Regular breastfeeding from both breasts including the affected side is therapeutic for mastitis and helps maintain the mother's milk supply throughout recovery. Option d is incorrect because pumping and discarding milk is unnecessary since breast milk from a breast with mastitis is safe for the infant to co

Correct Answer: Cesarean delivery method

Option a is correct because cesarean delivery is the single greatest risk factor for postpartum endometritis. The surgical incision creates a portal of entry for bacteria into the uterine cavity, significantly increasing infection risk compared to uncomplicated vaginal delivery. Option b is incorrect because while advanced maternal age may increase certain pregnancy complications, it is not identified as a primary risk factor for endometritis. The surgical opening of the uterus during cesarean delivery carries a much stronger association with this infection. Option c is incorrect because first-time pregnancy status is not a significant risk factor for endometritis. The condition is more strongly associated with surgical delivery, prolonged rupture of membranes, and prolonged labor rather than the number of prior pregnancies. Option d is incorrect because epidural use during labor is not a recognized primary risk factor for postpartum endometritis. While prolonged labor associated with

Correct Answer: Breast abscess requiring drainage

Option d is correct because untreated or inadequately treated mastitis can progress to a breast abscess, a walled-off collection of pus within the breast tissue. Abscesses typically require incision and drainage in addition to continued antibiotic therapy for resolution. Option a is incorrect because mastitis does not typically cause permanent loss of milk production when treated appropriately. While supply may temporarily decrease during acute illness, continued breastfeeding and proper treatment usually allow full recovery of lactation capacity. Option b is incorrect because breast milk from a mother with mastitis is generally safe for the infant to consume. The infection is localized to maternal breast tissue, and the antibodies in breast milk actually provide protective immunologic benefits to the nursing infant. Option c is incorrect because chronic breast tissue inflammation is not the primary complication of concern with untreated mastitis. The immediate and most serious risk is

Correct Answer: Colostrum rich in antibodies

Option b is correct because the thick yellowish fluid produced in the first days after birth is colostrum, which is low in volume but highly concentrated with immunoglobulins, proteins, and protective factors that provide essential immune protection for the newborn infant. Option a is incorrect because mature breast milk does not arrive until approximately two weeks postpartum, following the transitional milk phase. The thick yellowish fluid produced immediately after birth is colostrum, which has a distinctly different composition than mature milk. Option c is incorrect because the small volume of colostrum in the first days is developmentally appropriate and does not indicate a need for formula supplementation. A healthy newborn's stomach capacity is very small, and colostrum volume matches the infant's needs. Option d is incorrect because producing small amounts of thick yellowish colostrum in the first hours after birth is completely normal and expected. This is not a sig

Correct Answer: More areola visible above baby's mouth

Option c is correct because a proper latch shows asymmetric areola coverage with more areola visible above the baby's upper lip than below the lower lip. This indicates the baby has achieved a deep latch with the nipple angled toward the palate. Option a is incorrect because tightly pursed lips indicate a shallow or improper latch. A correct latch shows the baby's lips flanged outward like fish lips, creating a wide seal around the areola rather than clamping tightly on the nipple alone. Option b is incorrect because clicking sounds during breastfeeding indicate the baby is breaking suction repeatedly, which is a sign of poor or incorrect latch. Proper latching produces rhythmic sucking and swallowing sounds without any audible clicking noises. Option d is incorrect because a baby frequently turning away from the breast may indicate frustration, improper positioning, or disinterest in feeding. This is not a sign of correct latch and may suggest the mother needs additional ass