Question

The pregnant neighbor calls the LPN and states Please come quick. Hurry, I'm not going to make it to the hospital! Upon arrival, the LPN sees that the woman's perineum is bulging. What action should the LPN do FIRST?

a) Encourage the woman to push
b) Elevate the woman's legs
c) Apply counterpressure to the perineum
d) Assist the woman into a hands-and-knees position

Answer 1

The LPN should immediately apply counterpressure to the perineum when assisting a woman whose perineum is bulging and birth is imminent. In the scenarios, Devin is sent home because she is not yet in active labor, and Janine is given pitocin to stimulate contractions for labor that is not progressing.

Step-by-step explanation:

When an LPN arrives to assist a pregnant woman whose perineum is bulging, indicating that the baby is likely to be born imminently, the first action should be to apply counterpressure to the perineum. This step helps to support the perineum and prevent tears as the baby's head emerges. It is not the time to encourage the woman to push as this could speed up delivery when not fully prepared and might contribute to tearing. Elevating a woman's legs or repositioning her is not the immediate priority when birth is imminent.

Regarding the scenarios mentioned:

• Devin at 35 weeks is not in active labor because her cervix is not dilated, and the mucus plug is intact. She should return home and wait for more definitive signs of labor.
• Janine is overdue at 41 weeks and showing signs of labor that is not progressing normally. The administration of pitocin is to induce or augment contractions and progress labor stages effectively.