A nurse is reinforcing teaching with a client who is in labor about an episiotomy. Which of the following information should the nurse include?
An episiotomy is an incision that is made by the provider to facilitate delivery of the fetus.
An episiotomy is a perineal tear that is created while pushing during labor.
A mediolateral episiotomy is easier to repair than a median episiotomy
A fourth-degree episiotomy is always needed.
The Correct Answer is A
A. An episiotomy is an incision that is made by the provider to facilitate delivery of the fetus. An episiotomy is a surgical incision made in the perineum to enlarge the vaginal opening for delivery and reduce the risk of severe perineal tearing.
B. An episiotomy is a perineal tear that is created while pushing during labor. An episiotomy is an intentional incision, while a perineal tear is an unplanned, spontaneous laceration that occurs during pushing.
C. A mediolateral episiotomy is easier to repair than a median episiotomy. A median episiotomy is typically easier to repair and has less associated pain than a mediolateral incision, which is made at an angle.
D. A fourth-degree episiotomy is always needed. A fourth-degree episiotomy, which extends through the rectal mucosa, is rarely performed and is not always needed. Most episiotomies are less severe.
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Correct Answer is B
Explanation
A. Take the client's temperature. Monitoring the client's temperature for signs of infection is important, but it is not the priority immediately following an amniotomy. Infection typically develops over time.
B. Check the fetal heart rate pattern. The priority after an amniotomy is to assess the fetal heart rate to detect any signs of umbilical cord prolapse or fetal distress, which can occur immediately after rupture of membranes.
C. Observe the color and consistency of amniotic fluid. Although it is important to observe amniotic fluid for abnormalities (e.g., meconium staining), the immediate priority is fetal heart rate monitoring.
D. Evaluate the client for signs of infection. Signs of infection should be monitored, but they are not the priority right after amniotomy.
Correct Answer is A
Explanation
A. Fetal head compression. Early decelerations are typically caused by fetal head compression during contractions. This is usually a benign finding and indicates that labor is progressing.
B. Uteroplacental insufficiency. Uteroplacental insufficiency causes late decelerations, not early decelerations. Late decelerations are more concerning and indicate fetal distress.
C. Cord compression. Cord compression causes variable decelerations, not early decelerations. Variable decelerations can occur at any time during a contraction.
D. Maternal hypertension. Maternal hypertension is not a direct cause of early decelerations. It may contribute to uteroplacental insufficiency, which causes late decelerations.
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