ATI RN
labor and delivery nclex questions Questions
Question 1 of 5
A patient admitted to the labor unit asks the nurse to discuss the episiotomy procedure with her. Which is true regarding episiotomy?
Correct Answer: B
Rationale: The correct answer is B) A midline episiotomy is associated with more third- and fourth-degree lacerations. Rationale: A midline episiotomy involves an incision made directly in the midline of the perineum towards the anus. This type of episiotomy is associated with a higher risk of extending into the anal sphincter, leading to third- and fourth-degree lacerations. These severe lacerations can result in long-term complications such as fecal incontinence and pelvic floor dysfunction. Explanation of other options: A) An episiotomy is not required for all vaginal births. It is only performed when deemed necessary to facilitate delivery or prevent severe perineal tearing. C) A mediolateral episiotomy is actually easier to repair than a midline episiotomy as it reduces the risk of extending into the anal sphincter. D) A midline episiotomy is not specifically associated with more blood loss compared to other types of episiotomies. Educational context: Understanding the different types of episiotomies and their associated risks is crucial for nurses working in labor and delivery. It is essential to know the implications of each type of episiotomy to provide informed and safe care to laboring women. Educating patients about episiotomy procedures empowers them to make informed decisions about their birth experience and postpartum recovery.
Question 2 of 5
The nurse is caring for a patient during induction of labor. The oxytocin is currently infusing at 6 mU/min. The fetal heart tracing displays a 130 baseline, moderate variability, and no accelerations or decelerations. Uterine contractions have been every 2 minutes for the last 30 minutes. What is the nurse’s next best action?
Correct Answer: C
Rationale: In this scenario, the nurse's next best action is to maintain the oxytocin infusion at 6 mU/min (Option C). This is because the fetal heart tracing displays a baseline of 130, moderate variability, and no accelerations or decelerations, indicating that the fetus is tolerating the current dose of oxytocin well. Additionally, the uterine contractions every 2 minutes for the last 30 minutes suggest effective labor progress. Reducing the oxytocin infusion to 3 mU/min (Option A) could potentially slow down labor progress and lead to inadequate contractions, risking fetal compromise. Delaying the next scheduled oxytocin increase (Option B) may not be necessary as the current dose is well-tolerated by the fetus and is resulting in effective contractions. Discontinuing the oxytocin infusion (Option D) would not be appropriate at this point as it may cause labor to stall, leading to the need for alternative interventions to progress labor. Educationally, this scenario highlights the importance of closely monitoring fetal and maternal well-being during labor induction, as well as the need for nurses to understand the effects of oxytocin on uterine contractions and fetal status to make informed clinical decisions.
Question 3 of 5
Cephalohematoma occurring from an operative vaginal delivery increased a newborn’s risk of developing which of the following complications?
Correct Answer: C
Rationale: Cephalohematomas are a common complication from operative vaginal deliveries. The accumulation of blood between the infant's skull and periosteum increases the risk of jaundice because of the breakdown of red blood cells, which can overwhelm the infant's immature liver and lead to hyperbilirubinemia.
Question 4 of 5
While attending the delivery of a patient with GODM, the nurse notices the retraction of the fetal head onto the perineum. What is the nurse’s next best action?
Correct Answer: D
Rationale: The retraction of the fetal head onto the perineum during labor can be indicative of shoulder dystocia or other obstructive complications, requiring immediate action. The best response is to assist the mother into hands-and-knees position, which can relieve pressure on the perineum and help with fetal descent.
Question 5 of 5
A woman presents to labor and delivery at 37 weeks plus 6 days gestation with complaints of constant abdominal pain and dark red bleeding that started 30 minutes ago. Upon examination, the woman’s abdomen is consistently rigid and tender. Fetal heart tones are noted to be in the 70s. Which are these findings are associated with?
Correct Answer: A
Rationale: In this scenario, the correct answer is A) Placental abruption. Placental abruption involves the premature separation of the placenta from the uterine wall before delivery, leading to significant complications for both the mother and the fetus. The clinical presentation of constant abdominal pain, dark red bleeding, rigid/tender abdomen, and fetal bradycardia (heart rate in the 70s) is indicative of a severe placental abruption. Option B) Placental accreta refers to abnormal adherence of the placenta to the uterine wall, which typically presents with painless bleeding in the third trimester, not the acute and severe symptoms described in the case. Option C) Placenta previa involves the implantation of the placenta over or near the cervix, leading to painless bleeding in the third trimester, not the characteristic symptoms of abdominal pain, rigidity, and fetal distress seen in placental abruption. Option D) Placenta succenturiata is a rare variation where accessory placental lobes are connected to the main placenta by blood vessels. This condition is not typically associated with the acute clinical presentation described in the case. Understanding these distinctions is crucial for healthcare providers managing pregnant patients to make timely and accurate diagnoses, initiate appropriate interventions, and prevent adverse outcomes for both the mother and the fetus. Early recognition and management of placental abruption are essential to optimize maternal and fetal outcomes in such critical situations.