A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?
The lowermost portion of the fetus is at the level of the ischial spines.
The largest fetal diameter has passed through the pelvic outlet.
The posterior fontanel is palpable.
The fetal head is in the left occiput posterior positions
The Correct Answer is A
A. The lowermost portion of the fetus is at the level of the ischial spines.
A. The lowermost portion of the fetus being at the level of the ischial spines is the correct interpretation of 0 station. In the station system, when the presenting part is at the level of the ischial spines, it is referred to as 0 station.
B. The largest fetal diameter passing through the pelvic outlet is generally represented by the complete passage of the fetus through the birth canal. This is more indicative of full cervical dilation (10 cm) rather than a specific station.
C. The posterior fontanel being palpable is not directly related to the concept of station. Fontanel palpation is more associated with determining fetal head position.
D. The fetal head being in the left occiput posterior position is related to fetal position, not station. The station describes the descent of the presenting part in relation to the ischial spines.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is D. Prolonged labor
A. Umbilical cord prolapse is more commonly associated with breech presentations or other abnormal fetal positions. It is not a typical complication of occipital brow presentation.
B. Precipitous labor refers to an unusually rapid labor, and it is not a typical complication associated with occipital brow presentation. Prolonged labor is more likely.
C. Hypertonic uterine dysfunction involves excessive uterine contractions, and it is not specifically associated with occipital brow presentation. It is more commonly associated with other factors, such as maternal anxiety or use of oxytocin.
D. Prolonged labor is a complication that can be associated with occipital brow presentation.
Occipital brow presentation involves the fetal head being partially extended, and it can lead to difficulties in descending through the birth canal. This may result in a prolonged labor process.
Correct Answer is B
Explanation
The correct answer is B. Explain to the client this is an expected occurrence.
A. Tell the client to follow up with a dermatologist: While it's always good to encourage clients to seek professional advice if they have concerns, in the context of melasma during pregnancy, it is generally a normal physiological change. A dermatologist may not be needed specifically for this condition unless there are other unusual symptoms.
B. Explain to the client this is an expected occurrence: This is the correct action. It's important for the nurse to reassure the client that blotchy hyperpigmentation on the forehead is a common and expected change during pregnancy. Providing education and support can help alleviate the client's concerns.
C. Instruct the client to increase her intake of vitamin D: Blotchy hyperpigmentation is not typically addressed by increasing vitamin D intake. While adequate nutrition is important during pregnancy, this specific concern is related more to hormonal changes than nutritional deficiencies.
D. Inform the client she might have an allergy to her skin care products: Melasma is primarily related to hormonal changes in pregnancy rather than an allergic reaction to skin care products. While assessing for allergies is essential in certain situations, it may not be the primary concern in this case.
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