Module 3

The nurse is developing a plan of care for a child with a fractured femur in Bryant's traction. The nurse is aware that planned intervention should focus on assessing for what major complication? 1. Infection at the pin sites. 2. Slipping counter traction. 3. Neurovascular impairment. 4. Skin breakdown and decubiti.

3. CORRECT: Bryant traction is a type of skin traction with the potential for several complications. Though the traction is important, this child is being treated for a fractured femur. The major complication with any fracture is neurovascular integrity. 1. INCORRECT: bryant traction is a type of skin traction, not skeletal traction. skin traction is non-invasive so there are no pin sites or invasive wires. 2. INCORRECT: any type of traction has the potential for slippage of knots since the pulley weights are attached by ropes or are held by tape to the skin. While the nurse needs to frequently verify those attachments are secure, loss of counter traction is not the worst complication. 4. INCORRECT: because the client is kept supine in this traction, there is a high potential for skin breakdown to the buttocks or sacral area.

The client has been admitted with advanced cirrhosis. The nurses assessment reveals an abdominal girth increase of 5 inches and weight increase of 6 pounds since yesterday's measurements. What further assessment findings would the nurse expect? SATA 1. Hypotension. 2. Cool extremities. 3. Bradycardia. 4. CVP reading of 8 mmHg. 5. Radial pulses 4+/4+

1 & 2 CORRECT: these are signs and symptoms of fluid volume deficit due to third spacing and shock. 3. INCORRECT: we would expect the heart rate to increase in fluid volume deficit in an effort to move what little volume you have left through the system. 4. INCORRECT: this is a high CVP and with FVD you would expect it to be low. 5. Pulses are evaluated on a four point scale, so four would be a bounding pulse which would indicate fluid volume excess.

A client is preparing to be discharged after a total hip replacement. Which client statement would indicate further teaching is needed regarding prevention of hip prosthesis dislocation? SATA. 1. "When crossing my legs, I should only cross my unaffected leg over my affected leg." 2. "Exercise includes bending over to touch my toes several times a day." 3. "While lying in bed I should not turn my infected leg inward." 4. "It is necessary to keep my knees together at all times." 5. "I should not place a pillow between my legs when I sleep."

1, 2, 4, & 5. CORRECT: these statements are false, so further teaching is needed. The knees could be kept apart to prevent dislocation. Crossing the legs is prohibited as it can cause the hip to pop out of joint. Bending over to touch the toes (over 90 degrees) can cause the hip to pop out of place. Keep legs apart while sleeping. Placing a pillow between the legs will help keep the legs separated. 3. INCORRECT: this is an appropriate action to prevent hip prosthesis dislocation. Until the hip prosthesis stabilizes it is necessary to keep the leg in neutral position. Do not rotate the leg inward or outward.

A client who has been receiving care for cirrhosis arrives to the clinic for follow-up care. Which new signs and symptoms noted by the nurse would indicate that the client has developed hepatic encephalopathy? SATA. 1. A musty breath odor. 2. Inability to perform basic math. 3. Spider angiomas. 4. Sluggish movements. 5. Asterixis. 6. Myoclonus.

1, 2, 4, 5, & 6 CORRECT: these are signs and symptoms of hepatic encephalopathy, a severe complication of hepatitis and cirrhosis: a musty or sweet breath odor, poor concentration (such as inability to perform basic math), fatigue, slow movement, asterixis (an abnormal tremor consisting of involuntary jerking movements, especially in the hands). Their muscles major involuntarily or after people are exposed to a sudden noise, light, movement, or another stimulus. This jerking is called Myoclonus. These occur due to increasing ammonia levels in the blood. 3. INCORRECT: spider angiomas are the most classical vascular lesions that is sometimes a presenting sign of chronic liver disease such as cirrhosis. The presence of spider angiomas does not indicate that the client has progressed to hepatic encephalopathy.

The nurses to administer oxytocin 0.5 milliunits/minu IV to a client admitted for labor induction. Oxytocin is available at 10 units/1000 mL of 0.9% normal saline. How many milliliters per hour of the oxytocin should be administered? 1.. 3 mL/hr 2.. 6 mL/hr 3.. 10 mL/hr 4.. 12 ml/hr

1. CORRECT: 3 mL/hr

A client at 28 weeks gestation report swollen hands and feet during her prenatal visit. Which additional signs and symptoms would be of concern to the nurse? SATA. 1. Decreased deep tendon reflexes. 2. proteinuria. 3. One week weight gain of 1 kg (2.2 lbs). 4. Muscle weakness 5. Light sensitivity

2 & 5 CORRECT: protein urea, another sign of preeclampsia, is the result of proteins, normally confined to the blood by the filtering role of your kidney, spilling into your urine. This is because preeclampsia temporary damage is this filter. albumin as well as many other proteins, are lost this way. Vision changes are one of the most serious symptoms of preeclampsia. They may be associated with central nervous system irritation or be an indication of swelling of the brain. Common vision changes include sensations of flashing lights, aruas, light sensitivity, or blurry vision or spots. This patient is going into preeclampsia. 1. INCORRECT: deep tendon reflexes will be increased with preeclampsia, not decreased. 3. INCORRECT: Weight gain of more than 3 to 5 pounds in a week may be an indicator of preeclampsia. Damaged blood vessels allow more water to leak into and stay in your body's tissues and do not pass through the kidneys to be excreted. 5. INCORRECT: muscle spasms, rather than weakness will occur. This indicates nerve/muscle irritation.

The nurse cares for a client after a gastroscopy examination. Which nursing interventions are appropriate post procedure? SATA. 1. Administer small sip of water to assess gag reflex. 2. Monitor for throat pain. 3. Observe for hematemesisis. 4. Evaluate bowel elimination frequency. 5. Monitor respiratory effort. 6. Assess oxygen saturation level.

2, 3, 5, & 6. CORRECT: a gastroscopy examination uses a flexible fiber-optic two to visualize the esophagus and or stomach. Accidental perforation of the esophagus may occur during the endoscopy. If pain or bleeding occurred following the procedure, notify the primary healthcare provider. The nurse should monitor for hematemesis, respirations, and oxygen saturation to ensure the scope did not damage any structures like the esophagus or lungs. 1. INCORRECT: the throat is numbed before the procedure to inhibit the gag reflex and to allow the scope to pass freely. Therefore it is important to remain NPO status until the gag reflex returns. 4. INCORRECT: because the bells are not affected during this procedure, it is not an important intervention.

A nurse is planning care for a client admitted to the unit after application of a halo apparatus to immobilize the cervical spine. What intervention should the nurse include? SATA. 1. Clean around pins once daily with a small brush. 2. Use the log roll technique when turning the client in bed. 3. Assist the client with daily shower. 4. Have clients set up slowly with assistance. 5. Inspect for skin breakdown under halo vest.

2, 4, & 5 CORRECT: turn the client in bed every two hours by means of a triple log roll technique, and which three nurses role the client. first nurse stands behind the head of the bed and place his hands firmly on the clients head and neck, turning them as one unit. second nurse stands at the client side and moves the shoulders. third nurse stands at the clients side and moves the clients hips and legs. all three nurses turn the cry at the same time into desired position and onto previously positioned pillow. administer mild analgesics to control headache and discomfort around the pin site. Begin setting and ambulating by assessing the clients tolerance to upright position, accompany the client when ambulating, and consider the clients use of a walker. Inspect skin under halo vest looking for skin breakdown. 1. INCORRECT: being around pins at least twice daily with sterile Q-tips. A brush because abrasions on the skin. 3. INCORRECT: assist client with a sponge bath to help keep the vest dry. showers will cause the vest to become wet and should not be taken. This can lead to skin breakdown.

An elderly client with early dementia is being admitted to a long-term care facility. When orienting the client to the environment, what are the priority actions for the nurse to take? SATA. 1. Provide nurses name upon entering the clients room. 2. Orient client to the arrangement of needed items in the room. 3. Provide a tour of the facility and grounds. 4. Instruct the client on the location of emergency exits. 5. Demonstrate how to use the call bell. 6. Provide opportunity client to return demonstrate use of Call bell.

2, 5, 6. CORRECT: changes can be very overwhelming for an elderly client, particularly in the presence of dementia. The most important issue is to be sure the client understands how to summon staff at any point. Demonstrating the use of the call bell and allowing the client to provide a return demonstration is the most important action. Also the client must be oriented to the needed items in their room. These are all safety issues and take priority. 1. INCORRECT: this client has dementia and therefore may not be able to process to remember names. This is an appropriate action, but remember safety first. 3. INCORRECT: the orientation to a new environment would be important, this clients mental status can be easily overwhelmed with too much information. The focus should be restricted to the most basic safety information that the client needs to know.

What information should the nurse include when preparing discharge education for a client diagnosed with gastroesophageal reflux disease (GERD)? SATA 1. Foods that may trigger an attack may include apple juice, cream cheese, and oatmeal. 2. Lose weight slowly at a rate of 1 kg per week. 3. Only eat three small meals per day. 5. Avoid tight fitting clothing. 6. Wait at least one hour after eating to lie down.

2. & 4, CORRECT: excess pounds put pressure on the abdomen, pushing up the stomach and causing acid to back up into the esophagus. Work to slowly lose weight no more than 1 to 2 pounds per week. Avoid tight fitting clothing because clothes that fit tightly around the waist put pressure on the abdomen and the lower esophageal sphincter. 1. INCORRECT: these Foods are safe for the client with GERD to eat. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. 3. INCORRECT: eat 6 small meals per day. Avoid eating 3 large meals. 5. INCORRECT: don't lie down immediately after a meal. Wait at least three hours after eating.

Which postpartum client should the nurse assign to the last private room in the women's health center? 1. Foggy fundus five hours post delivery. 2. Term stillborn. 3. Placenta previa during delivery 14 hours ago. 4. WBC count is 12,000 mm³ at 24 hours postpartum.

2. CORRECT: a private room for the mom who lost a baby provides a place where family and friends can open up and share their feelings without restrictions. 1. INCORRECT: boggy fundus... Doesn't have anything to do with a private room. This can be taken care of in a shared room. 3. INCORRECT: people who are at risk for bleeding and shock do not require private rooms. 4. INCORRECT: this is the one most people jump on... Most postpartum clients have elevated white count post delivery. Normal white count is 5000 to 10,000 mm³

Immediately following a below-the-knee amputation, the nurse positions to client to prevent complications. What intervention related to position of the residual limb is a priority at this time? 1. Flat on the bed. 2. Elevate foot of bed. 3. Position of comfort. 4. Dependent position.

2. CORRECT: it is normal to experience post operative swelling after a BKA. Immediately after surgery, the foot of the bed should be elevated to reduce swelling. An ACE compression bandage will be used to reduce swelling and prevent hemorrhage. The other positions would not be as appropriate since swelling is an issue after a below the knee amputation. 1. INCORRECT: flat on the bed will not relieve swelling. Postoperatively for a BKA, hemorrhage and swelling are the biggest concerns immediately following surgery. 3. INCORRECT: position of comfort may increase swelling. Positioning for comfort is not important. 4. INCORRECT: placing it in a dependent position will increase swelling. Swelling postoperatively is a normal occurrence, and elevating the foot of the bed along with the use of an ACE wrap will help prevent swelling.

In which client should the nurse initiate a prescription for a contraction stress test? SATA. 1. Client at 26 weeks gestation. 2. Client with a history of 4 cesarean section deliveries. 3. Client at 38 weeks with gestational diabetes. 4. Client at 37 weeks gestation. 5. Client with placenta previa. 6. Client with preterm membrane rupture.

3 & 4 CORRECT: there is no reason to suspect complication from a contraction stress test for these clients. The nurse should proceed with the test. 1. INCORRECT: six weeks is too early to stimulate contractions. This could lead to a preterm delivery. 2. INCORRECT: stimulating contractions in a client with previous cesarean deliveries is not recommended. This may lead to uterine rupture. 5. INCORRECT: stimulating contractions in a client with placenta previa is not recommended. This may lead to hemorrhage. 6. INCORRECT: conditions such as preterm membrane rupture may increase risk of preterm labor and delivery.

A nurse is caring for a client with a suspected myocardial infarction. What lab work or diagnostics should the nurse anticipate the primary healthcare provider prescribing to specifically confirm the diagnosis? SATA. 1. ECG 2. Troponin level 3. Echocardiogram 4. Metabolic Panel 5. CPK-MB 6. CPK-BB

1, 2, 3, & 5. CORRECT: the client is suspected of having an MI, the client needs an ECG troponins and CPK - MB level. Remember troponin is our favorite, because it will confirm if an MI occurred , even when the client delay seeking care. CPK - MB is right because it is cardiac specific. With an echocardiogram, sound waves create images of the moving heart to see how the heart chambers and valves are pumping blood throughout. An echocardiogram can help identify whether an area of the heart has been damaged. 4. INCORRECT: no but what if you just don't know about this answer? Look at it; a metabolic panel will tell you about metabolism and that is not what I am concerned about here. 6. INCORRECT: no, CPK - BB is used to assess for brain damage, not cardiac damage.

After a cholecystectomy, a client experiences palpitations, weakness and diarrhea following meals. Which teachings would be appropriate for the nurse to provide the client?. SATA. 1. Add a serving of fat to meals such as butter. 2. Include a protein with each meal. 3. Take adequate vitamins, iron and calcium. 4. Lie down on left side after meals. 5. Eat at least five small meals per day. 6. Include a nutritional supplement drink with meals.

1, 2, 3, 4, & 5 CORRECT: dumping syndrome is associated with meals having a hyperosmolar composition. To decrease hyperosmolar components, you decrease the carbs and electrolytes. Add a serving a fat to meals and snacks such as butter, margarine, gravy, vegetable oils and salad dressings. Fats slow stomach emptying and may help prevent dumping syndrome. Proteins digest slower and stay in the stomach longer. Vitamins, iron, and calcium may become depleted after stomach surgery and due to dumping syndrome so taking days will help to maintain good health. Lying down on the left side slow emptying of the stomach. Five or six small frequent meals decrease the extremes of the hyperosmolar content and keep a steady blood sugar. 6. INCORRECT: High sugar foods and carbs speed through the G.I. tract.

The nurse recognizes that Rho(D) immune globulin would be indicated for which Rh negative client? SATA 1. Miscarriage at 12 weeks gestation. 2. Abdominal trauma. 3. Undergoes chronic villus sampling (CVS). 4. Diagnosed with an a ectopic pregnancy. 5. 72 hours post delivery of term RH negative baby. 6. 28 weeks gestation.

1, 2, 3, 4, & 6 CORRECT: all of these clients may need to receive the Rho(D) immune globulin because they could have some bleeding and therefore develop antibodies against a Rh positive fetus. An optional dose may have been given during pregnancy by the practitioner at 28 weeks. 5. INCORRECT: an Rh negative newborn does not need the immune globulin because the Rh negative mom does not have antibodies against the Rh factor.

What sign and symptoms should the nurse expect to find during the physical assessment of a client who has a history of rheumatoid arthritis? SATA 1. Nodules over bony prominences. 2. Reports of bedtime stiffness lasting over one hour. 3. Reports weight loss. 4. Cool, swollen joints. 5. Joint deformity. 6. Low-grade fever.

1, 3, 5, & 6 CORRECT: bumps of tissue (nodules) over bony prominences, such as on an elbow, or called rheumatoid nodules, and are a sign of rheumatoid arthritis. Overtime, rheumatoid arthritis king cause joints to deform and shift out of place. Weight loss is a common symptom of rheumatoid arthritis. Inflammation is a normal part of the immune response. However, inflammation from RNAlumps of tissue nodules over bony prominences, such as on an elbow, are called rheumatoid nodules, and are a sign of rheumatoid arthritis. Overtime, rheumatoid arthritis can cause joints to do form and shift out of place. Weight loss is a common symptom of rheumatoid arthritis. Inflammation is a normal part of the immune response. However, inflammation from RA is a part of the problem. The same substances that cause inflammation of the joints can also cause a fever. Rheumatoid arthritis also causes an increase in metabolic rate, which can also result in a fever. 2. INCORRECT: morning stiffness that can last for hours is a symptom of rheumatoid arthritis. 4. INCORRECT: affected joints will be tender, red, warm and swollen.

A client who is 34 weeks pregnant is admitted to the OB/GYN unit with a diagnosis of pregnancy induced hypertension. During the admission process, the client suddenly reports continuous abdominal pain and the nurse notes and abdominal firmness. What interventions should the nurse implement? 1. Reassure the client that the baby will be fine. 2. Evaluate fetal heart tones. 3. Monitor amount of vaginal bleeding. 4. Notify primary healthcare provider. 5. Prepare for vaginal delivery.

2, 3, & 4 CORRECT: the client symptoms indicate that she is experiencing abruptio placentae. The nurse must evaluate the mother's well-being by assessing vital signs, and monitoring blood loss. The nurse must also evaluate the fetus' well-being by auscultating fetal heart tones. A cesarean delivery is indicated if the fetus and or mom is in distress, so the primary healthcare provider must be notified immediately. 1. INCORRECT: do not get false assurance. The baby may or may not be fine. 5. INCORRECT: a cesarean delivery is indicated for this client.

A client who is 34 weeks pregnant is admitted to the OB/GYN unit with a diagnosis of pregnancy induced hypertension. During the admission process, the client suddenly reports continuous abdominal pain and the nurse notes and abdominal firmness. What intervention should the nurse implement? SATA. 1. Reassure the client that the baby will be fine. 2. Evaluate fetal heart tones. 3. Monitor mount a vaginal bleeding. 4. Notify primary healthcare provider. 5. Prepare for vaginal delivery.

2, 3, & 4. CORRECT: the client symptoms indicate that she is experiencing abruptio placenta the nurse must evaluate the mothers wellbeing by assessing vital signs, and monitoring blood loss. The nurse must also evaluate the fetal well-being by auscultating fetal heart tones. A cesarean delivery is indicated if the fetus and/or mom is in distress, so the primary healthcare provider must be notified immediately. 1. INCORRECT: do not give false assurance. The baby may or may not be fine. 5. INCORRECT: cesarean delivery is indicated for this client.

A client diagnosed with ulcerative colitis has a new prescription for a biologic agent what is the priority education the nurse needs to make certain the client receives? 1. If you miss a dose, take it as soon as you remember. 2. Stay away from people who are sick. 3. Do not receive a live vaccine while using a biologic agent. 4. Common side effects include headache and cold symptoms.

2. CORRECT: biologics are amino modulators which means they alter the body's immune response. These agents can suppress the immune system, making the client more prone to infection. Biologics are used to treat many inflammatory conditions, such as ulcerative colitis, rheumatoid arthritis, and psoriatic arthritis. They can also be used in adults and children to treat Crohn's disease or juvenile idiopathic arthritis. 1. INCORRECT: if the client misses a dose of medicine, they should take it as soon as they remember, and then go back to the regular injection schedule. Do not use extra medicine to make the missed dose. But this is not the priority of the options available. 3. INCORRECT: although clients taking a biologic agent should not receive a live vaccine, this is not the priority. The vaccine may not work as well during this time, it may not fully protect the client from the disease. 4. INCORRECT: common side effects do include headache and cold symptoms. However, this is not priority for client education.

What can an occupational health nurse discuss with the client in an effort to improve lateral epicondylitis (tennis elbow) pain? SATA. 1. Physical therapy consultation. 2. A oral, nonsteroidal, anti-inflammatory drug may be prescribed. 3. Use of forearm brace. 4. If pain persists, a quarter zone injection into the inflamed area may be recommended. 5. Apply ice for 30 minutes, six times a day.

1, 2, 3, & 4. CORRECT: the goal of physical therapy is to improve the strength and flexibility of forearm muscles so the client won't be bothered with tennis elbow again. The physical therapist may also teach ways to change the activity that is causing elbow troubles. Physical therapy can also help improve blood flow to the tendons, which don't get the same level of blood and oxygen suppliers muscles normally receive. Oral, nonsteroidal, anti-inflammatory drugs are very helpful in controlling the pain and inflammation of tennis elbow. The medicine is taken daily for at least 4 to 6 weeks when treating severe cases. For less severe cases, these medicines baby taken only when needed. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscle and tendons. Cortizone injections are considered when the other measures have not worked and the pain is severe. The Cortizone is injected into the area of the inflamed tendons in order to decrease the inflammation. 5. INCORRECT: it is recommended to apply ice to the area 2 to 3 times a day, for 20 to 30 minutes each time.

A client scheduled for a total hysterectomy for advanced cervical cancer, is crying in states "I want to have more children! I do not know if I should have this procedure." Which response by the nurse is most appropriate? 1. "Cryotherapy may be a treatment option for you." 2. "Tell me more about your concerns." 3. "You might want to delay surgery until you are sure this is the option for you." 4. "Your health should be priority right now. You need to have the surgery to live."

2. CORRECT: this may be anticipatory grieving and being scared. Encourage the client to talk about her concerns and feelings. Let the client talk, she may need reassurance that she is making the right decision 1. INCORRECT: ternal therapy is destruction of tissue by freezing with liquid nitrogen. Cryotherapy may be used with precursor lesions (mild to moderate dysplasia). It is not an appropriate treatment for advanced cervical cancer. 3. INCORRECT: the cancer is already in an advanced stage. Will the wedding help her survive? 4. INCORRECT: this is non-therapeutic communication and will make the client feel she must defend her feelings.

The nurse is preparing a seminar for a group of clients diagnosed with irritable bowel syndrome. Which point should the nurse include? SATA. 1. Teach about a high fiber diet. 2. Encourage the client to only eat when hungry. 3. Fluid should be consumed between meals. 4. Provide relaxation techniques. 5. Keep a food diary for two weeks. 6. Chew food slowly and thoroughly.

1, 2, 4, 5, & 6 CORRECT: this client needs a high soluble fiber to help control diarrhea and constipation. dietary fiber and bulk help the client by establishing regular bowel elimination patterns with soft, bulky stools. eating at regular intervals and chewing food slowly and thoroughly will help to manage symptoms. although adequate fluid intake is necessary, fluid should not be taken with meals because this results in abdominal distention. Consume fluid between meals. Additional strategies include maintaining good dietary habits with avoidance of food triggers. Stress management via relaxation techniques, yoga, or exercise are recommended. Identify irritating foods by keeping a food diary for 1-2 weeks. 2. INCORRECT: eating only one hungry does not provide regularity. Eating at regular intervals and chewing food slowly and thoroughly will help to manage symptoms.

The house supervisor has sent an LPN to assist on a busy medical surgical unit. Which client could the charge nurse assigned to the LPN? SATA. 1. Being discharged with a newly inserted pacemaker. 2. Client with hip fracture in buck's traction. 3. One day post lap cholecystectomy requiring assistance to ambulate. 4. With total hip replacement awaiting transfer to nursing home. 5. Transfer from ICU one day post DKA.

2, 3, & 4 CORRECT: An LPN should be assigned stable clients who do not require initial teaching or frequent assessments. the LPN can take care of a stable client with a hip fracture who's in bucks traction. The client who is one day post lap Cholecystectomy and ambulating would be appropriate for an LPN. Also a client with a total hip replacement awaiting transfer to a nursing home would have the needs that could be addressed by an LPN, and therefore is a suitable assignment. 1. INCORRECT: this client has a newly implanted pacemaker which is monitoring and pacing the heart. There is a great deal of teaching necessary regarding a pacemaker. This client should be assigned to an RN. 5. INCORRECT: this client has just been transferred from the ICU and will require frequent vitals and glucose checks. This client is considered unstable upon transfer and would be assigned to an RN.

A client who is gravida 2 para 1 is visiting the obstetric clinic for a check up. The first delivery was a cesarean for failure to progress, and the client indicates a desire for vaginal delivery this time. The nurse knows the most important factor in determining the possibility of a vaginal birth after cesarean (VBAC) is what? 1. The length and difficulty of the previous labor. 2. The type of incision used for the cesarean. 3. The position of the fetus before delivery. 4. Total numbers of pregnancies desired.

2. CORRECT: A VBAC is often requested by client for a number of reasons. There is less pain after delivery with a shorter recovery, and less chance of infection. A VBAC can also potentially increase the number of pregnancies possible, since cesarean sections dramatically limit the number of children. The main factor that determines whether the client could safely have a VBAC is the type of uterine incision made for the previous C-section. Those who have had a low, transverse incision or candidates for trial of labor after cesarean. 1. INCORRECT: obviously, in the situation, the client had experienced failure to progress in the previous pregnancy, necessitating the need for a C-section. The length and difficulty of the previous attempted birth would have affected the decision to have the first C-section, but would not impact the current choice for an attempt of a VBAC. 3 INCORRECT: the position of the fetus prior to delivery does not have a significant bearing on the decision to have a VBAC. Clients who intend to try a vaginal birth are very closely monitored prior to labor. If the obstetrician determines by ultrasound at the fetus is incorrectly positioned, there is the possibility of turning the fetus prior to the onset of labor. Only in extreme circumstances would the fetal position prevent vaginal birth. 4. INCORRECT: the factor that is most important in determining the chance for a VBAC is not the number of pregnancies desired, but rather the position of the uterine incision made with the last C-section. The ability to actually have a successful VBAC may affect the total number of children desired.