A nurse is assessing a client who is postpartum and is experiencing hemorrhagic shock.
Which of the following findings should the nurse expect?

Choice A rationale

Erb-Duchenne palsy, a form of brachial plexus injury (C5-C6), primarily affects the nerves controlling the shoulder and upper arm muscles. It generally does not affect cranial nerves (such as IX and X, which control swallowing) or the muscles of the mouth, thus typically preserving the ability to suck and swallow.

Choice B rationale

The Moro (startle) reflex involves symmetrical extension and abduction of the arms followed by adduction and flexion. An injury to the brachial plexus on one side impairs the motor function of that arm, resulting in the characteristic absence of the reflex in the affected extremity, which is a key diagnostic finding.

Choice C rationale

The Babinski reflex is a normal neurological finding in infants up to about 2 years old, reflecting immature corticospinal tracts. It is a foot reflex and is unrelated to a brachial plexus injury in the neck and shoulder area; thus, its presence is not a specific finding for Erb-Duchenne palsy.

Choice D rationale

Cleft palate is a congenital craniofacial malformation resulting from incomplete fusion of the palatine shelves during fetal development. It is a structural anomaly of the mouth and is not a finding or complication associated with Erb-Duchenne palsy, which is a neuromuscular injury sustained, most commonly, during birth.

Explanations

Fetal presentation The fetus is in a left occiput anterior (LOA) vertex presentation, which is the most favorable position for vaginal birth. LOA allows for optimal alignment of the fetal head with the maternal pelvis, facilitating descent and rotation during labor. Malpresentations such as breech or transverse would be unfavorable, but vertex LOA is considered ideal. Therefore, this finding is favorable for vaginal delivery at 42 weeks gestation.

Cervical findings The cervix is described as closed and thick, which is unfavorable for vaginal birth. At 42 weeks, the cervix should ideally be effaced and dilated to allow for labor progression. A closed, thick cervix indicates that the cervix has not ripened, which may necessitate induction with cervical ripening agents such as prostaglandins or mechanical methods. Thus, this finding is not favorable for vaginal birth readiness.

Uterine contraction pattern The client reports only occasional mild uterine contractions, which is not favorable for vaginal birth at 42 weeks. Effective labor requires regular, strong contractions that cause progressive cervical dilation and effacement. Occasional mild contractions are insufficient to initiate or sustain active labor. At this post-term stage, the absence of an adequate contraction pattern suggests that induction may be required. Therefore, this finding is not favorable.

FHR The fetal heart rate is 150/min, which falls within the normal baseline range of 110 to 160 beats per minute. This indicates adequate fetal oxygenation and no evidence of tachycardia or bradycardia. A normal FHR is a favorable finding for vaginal birth, as it reflects reassuring fetal status. Continuous monitoring remains important, but this specific finding supports safe progression toward vaginal delivery.