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During the second stage of labor, the fetal head has just been born and the nurse observes the immediate retraction of the head against the perineum.
What action should the nurse anticipate performing to assist the healthcare provider?

A.

Prepare vacuum.

B.

Apply suprapubic pressure.

C.

Apply fundal pressure.

D.

Prepare forceps.

E.

Prepare forceps.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Preparing a vacuum is not the first action to take when the fetal head retracts against the perineum during the second stage of labor.

Choice B rationale

Applying suprapubic pressure can help guide the baby’s head out. This is a common practice during the second stage of labor when the baby’s head retracts against the perineum.

Choice C rationale

Applying fundal pressure is not typically done when the fetal head retracts against the perineum. Fundal pressure can be used to assist in the delivery of the baby, but it’s not the first action to take in this situation.

Choice D rationale

Preparing forceps is not the first action to take when the fetal head retracts against the perineum. Forceps are used to assist in the delivery of a baby, but only when necessary.


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Related Questions

Correct Answer is ["B","E"]

Explanation

Choice A rationale
Both mother and daughter shedding tears of joy and gratitude may not necessarily indicate a healthy psychosocial adaptation. While it could be a sign of relief or happiness, it could also be a response to stress or fear.
Choice B rationale
The mother expressing her full support for her daughter can be a positive sign of psychosocial adaptation. Support from family members can play a crucial role in coping with and adapting to health-related challenges.
Choice C rationale
The mother appearing sad does not necessarily indicate a healthy psychosocial adaptation. It could be a normal reaction to her daughter’s discomfort, but it could also suggest that she is struggling to cope with the situation.
Choice D rationale
The patient giving birth to a healthy baby boy is not relevant to the question as it does not provide information about the psychosocial adaptation of the mother or the daughter.
Choice E rationale
The mother commending her daughter can be a positive sign of psychosocial adaptation. Positive reinforcement can help individuals cope with challenging situations and foster a sense of self-efficacy.
Choice F rationale
Both mother and daughter gently touching the baby’s cheek is not relevant to the question as it does not provide information about the psychosocial adaptation of the mother or the daughter.

Correct Answer is C

Explanation

Choice A rationale

Variance in blood pressure across extremities is not typically associated with ventricular septal defects (VSDs). VSDs are characterized by a hole in the heart that allows oxygen-rich blood to move back into the lungs instead of being pumped to the rest of the body.

Choice B rationale

Hypotension is not a common symptom of VSDs. Instead, these defects can cause increased blood pressure in the lungs due to the abnormal flow of blood.

Choice C rationale

Tachycardia, or a rapid heart rate, is a common symptom of VSDs, especially in cases where the defect is medium or large. This is because the heart needs to work harder to pump blood, leading to an increased heart rate.

Choice D rationale

While pulse oximetry readings within defined limits could be seen in small VSDs, in larger defects or those causing heart failure, oxygen saturation levels might be lower due to the abnormal circulation of blood.

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