The nurse is reviewing the client’s chart.

Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage.

Client was middle aged and married.

She was in labor for 25 hours and forceps were used to assist with the delivery.

She was given an epidural for anesthesia that was effective.

The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale.

Her vital signs were stable, and she was catheterized for 500 mL of light-yellow urine just prior to delivery.

Her spouse was at the bedside for delivery.

Choice A rationale
The cervix is effaced 1 cm is not the correct interpretation of the finding. Effacement is the thinning of the cervix during labor, and it is measured in percentage from 0% to 100%. The finding of -1 indicates the station of the presenting part, not the effacement of the cervix.

Choice B rationale
The presenting part is 1 cm below the ischial spines is not the correct interpretation of the finding. The ischial spines are bony landmarks in the pelvis that are used to measure the station of the presenting part, which is the relationship of the fetal head or buttocks to the maternal pelvis. The station is measured in centimeters from -5 to +5, with 0 being at the level of the ischial spines. A negative number means the presenting part is above the ischial spines, and a positive number means the presenting part is below the ischial spines. Therefore, a finding of -1 means the presenting part is 1 cm above the ischial spines, not below.

Choice C rationale
The presenting part is 1 cm above the ischial spines is the correct interpretation of the finding. As explained above, a finding of -1 means the presenting part is 1 cm above the ischial spines. This indicates that the fetus is descending into the pelvis, but not yet engaged.

Choice D rationale
The cervix is 1 cm dilated is not the correct interpretation of the finding. Dilation is the opening of the cervix during labor, and it is measured in centimeters from 0 to 10. The finding of -1 does not indicate the dilation of the cervix, but the station of the presenting part.

Choice A rationale
This is incorrect because repaglinide is not recommended for the treatment of gestational diabetes mellitus. Repaglinide is an oral antidiabetic agent that stimulates the release of insulin from the pancreas. However, it has not been adequately studied in pregnant women and may cause hypoglycemia or fetal harm.

Choice B rationale
This is correct because insulin is the preferred medication for the treatment of gestational diabetes mellitus. Insulin is a hormone that lowers the blood glucose levels by facilitating its uptake by the cells. Insulin does not cross the placenta and does not affect the fetal development. Insulin can be administered by injection or infusion, depending on the type and severity of the diabetes.

Choice C rationale
This is incorrect because glipizide is not recommended for the treatment of gestational diabetes mellitus. Glipizide is an oral antidiabetic agent that stimulates the release of insulin from the pancreas. However, it may cross the placenta and cause hypoglycemia or fetal abnormalities.

Choice D rationale
This is incorrect because acarbose is not recommended for the treatment of gestational diabetes mellitus. Acarbose is an oral antidiabetic agent that inhibits the digestion and absorption of carbohydrates in the intestine. However, it may cause gastrointestinal side effects, such as bloating, diarrhea, or flatulence, and it has not been proven to be safe or effective in pregnant women.