Maternal and Obstetric Nursing

Why C is correct

Amniotic fluid, the water around the baby, is alkaline. Alkaline fluid turns nitrazine paper blue, so a blue strip supports a broken sac. Nitrazine paper shows only how acidic or alkaline a fluid is. So the color and the reading it stands for must both be right before a result means anything.

Why the other options are wrong

• A — "Yellow, indicating acidic fluid": Yellow, acidic fluid points to normal vaginal secretions with the sac still intact. This is a correct pairing of color and reading, but it is the result expected when the sac has not broken.
• B — "Yellow, indicating alkaline fluid": This pairing cannot happen. On nitrazine paper, yellow never goes with alkaline fluid.
• D — "Blue, indicating acidic fluid": This pairing cannot happen either. On nitrazine paper, blue never goes with acidic fluid.

Why B is correct

On the WHO partograph, the chart for plotting labor progress, the action line is drawn four hours to the right of the alert line. So reaching it means labor is about four hours behind.

The two lines do different jobs. The alert line marks slower progress and asks for closer watching. The action line asks for a decision: augment (speed up labor), treat a cause, or deliver.

Why the other options are wrong

• A — "The labor is about two hours behind the rate the chart expects": Two hours behind still leaves the plot between the lines, where closer watching is what is called for.
• C — "The labor is behind the expected rate, and closer observation is what is needed": This describes the alert line, not the action line. Closer observation is appropriate between the two lines, but the action line lies four hours further on and asks for a decision.
• D — "The labor is behind the expected rate, and a cesarean birth is now required": Surgery is one outcome the review may reach, not the automatic meaning of the line.

Why B is the answer

A pillow under the knees holds them bent and presses on the veins behind them, so blood pools in the calves instead of moving on. Clot risk after a birth comes from blood that sits still. Everything that keeps it moving helps: the leg muscles squeezing as she walks or moves her feet, and gravity draining a raised leg. Steady pressure behind the knee works the other way. That is why the knee rest of the bed is left flat and her legs stay uncrossed.

Why the other options are not the answer

• A — "Getting up to walk a little farther each time she leaves the bed": This measure helps. Walking puts the leg muscles to work, and each squeeze pushes blood up the deep veins.
• C — "Wiggling her toes and shifting her position often while she sits to feed": This measure helps. Moving the feet and changing position does the same work as walking for a woman who is sitting with her baby.
• D — "Propping her legs on a stool when she sits with them hanging down": This measure helps. A stool supports the whole leg and lets it drain. Raising the legs is standard practice when they hang down and swell, while a pillow behind the knee holds the blood there instead.

Why D is the answer

Correct this one: a rubella-containing vaccine is withheld for the whole of pregnancy, not merely the first trimester.

Vaccines in pregnancy are sorted by whether the vaccine can multiply, not by which trimester she has reached. Rubella vaccine is live and attenuated, meaning it holds a weakened live virus. The virus multiplies in the woman who receives it, and multiplying virus can in theory reach the fetus. The end of organ formation does not make a multiplying vaccine acceptable. Nothing is lost by waiting, because the dose is given in the days after delivery. It is safe while she breastfeeds. The other three vaccines cannot multiply at all.

Why the other options are not the answer

• A — "An inactivated influenza vaccine may be given in any trimester, including the first": This statement is correct as written. The word inactivated is doing the work, because a live nasal-spray influenza vaccine would not be given. Influenza in pregnancy carries a risk of severe illness, so the protection is wanted early.
• B — "A tetanus toxoid-containing vaccine may be given now to continue her series": This statement is correct as written. A tetanus toxoid vaccine contains an inactivated toxin and is safe at any point in the pregnancy. Giving a dose now is appropriate, though what she is due depends on how many doses she has already had.
• C — "A hepatitis B vaccine may be given when she is at risk of infection": This statement is correct as written. It is a recombinant vaccine, made in a laboratory from one virus protein, with nothing in it that can multiply. A full course runs over months, so a dose now is a start rather than full protection.

Why B is the answer

This statement is inaccurate: the bulbourethral glands (a pair of small glands below the prostate) add mucus and hold no sperm.

Sort the tract by job: the ducts carry the sperm, the glands add fluid. The bulbourethral pair adds the last of that fluid, just before the semen leaves.

Why the other options are not the answer

• A — "The prostate adds a fluid that supports sperm function within the female reproductive tract": This statement is accurate. Prostatic fluid enters the urethra through the gland's own ducts, joins the semen there, and supports the sperm afterward.
• C — "The seminal vesicles empty their secretion into the ejaculatory duct near the prostate": This statement is accurate. Each seminal vesicle's duct joins the vas deferens (the duct that carries sperm) to form the ejaculatory duct, so the secretion meets the sperm right there.
• D — "The bulbourethral glands release mucus that lubricates the urethra and neutralizes residual acidity": This statement is accurate. The mucus wets the urethra and neutralizes the acid left in it. This mucus plays a role just before the semen leaves, but it is fluid only, which is why the claim about stored sperm is the inaccurate one.