A nurse is assisting with the care of a client who is in labor.
The client's labor is difficult and prolonged and she reports a severe backache.
Which of the following factors is a contributing cause of difficult, prolonged labor?

Choice A rationale:

Elevating the client's legs can improve venous return and cardiac output, but it does not directly address the underlying cause

of late decelerations, which is uteroplacental insufficiency.

While elevating the legs may have some benefit, it's not the most effective initial action to address late decelerations.

It's important to prioritize interventions that directly improve uteroplacental blood flow.

Choice C rationale:

Increasing the infusion rate of IV fluids can expand maternal blood volume, but it may not significantly improve uteroplacental

perfusion if there's underlying placental insufficiency.

It's not the most effective initial action to address late decelerations.

It may be considered as a secondary measure if repositioning doesn't resolve the decelerations.

Choice D rationale:

Administering oxygen via face mask can improve fetal oxygenation, but it does not directly address the underlying cause of

late decelerations, which is uteroplacental insufficiency.

It's not the most effective initial action to address late decelerations.

It may be considered as an adjunct measure to improve fetal oxygenation, but it's not a primary intervention for late

decelerations.

Choice B rationale:

Positioning the client on her side is the most effective initial action to address late decelerations because it:

Relieves pressure on the vena cava, which improves venous return and cardiac output.

Increases placental perfusion by increasing blood flow to the uterus.

This can help to correct fetal hypoxia and improve fetal heart rate patterns.

It's a simple, non-invasive intervention that can be quickly implemented and has a high success rate in resolving late

decelerations.

Choice A rationale:

When breastfeeding, it’s important for the baby to latch onto not just the nipple, but also some of the areola, which is the

darker circle of skin around the nipple. This allows the baby to get a deep latch, which is necessary for effective breastfeeding.

The baby’s chin should be firmly touching the breast, and their mouth should be wide open. When they attach, you should see

much more of the darker nipple skin above the baby’s top lip than below their bottom lip.

Choice B rationale:

While it’s true that babies have certain instincts when it comes to breastfeeding, they still need guidance and proper

positioning to latch correctly. Simply relying on the baby’s instincts may not ensure a proper latch, which could lead to

ineffective breastfeeding and potential discomfort for the mother.

Choice C rationale:

The size of the baby’s mouth does not determine how much of the nipple they should take in. Regardless of the size of the

baby’s mouth, they should still latch onto the nipple and some of the areola for effective breastfeeding. Taking only part of the

nipple could lead to a shallow latch, which can cause nipple pain and may not allow the baby to get enough milk.

Choice D rationale:

While it’s important for the baby to take in a good amount of the breast tissue, including the nipple and areola, during

breastfeeding, suggesting to include some breast tissue beyond the areola might be excessive. The key is to ensure a deep

latch, which typically involves the nipple and some of the areola, rather than the entire areola and additional breast tissue.