ATI RN
labor and delivery nclex questions Questions
Question 1 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 2 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 3 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.
Question 4 of 5
A 24-year-old G4 T1 A2 L1 presents to obstetric triage with complaints of contractions every 3 minutes, accompanied by bright red vaginal bleeding. The woman is 29 weeks gestation with a twin pregnancy. She has had three urinary tract infections during this pregnancy and is currently taking Microbid daily as prophylaxis. Her last baby was born via cesarean section for breech malpresentation. She denies any other significant medical history. What risk factors for placenta previa does this patient have? Select all that apply.
Correct Answer: D
Rationale: In this scenario, the correct answer is D) Previous delivery by cesarean section. A history of cesarean section is a known risk factor for placenta previa due to the potential for abnormal placentation over the scarred area of the uterus. This can lead to placenta previa, where the placenta partially or completely covers the cervix, causing bleeding. Maternal age of 24, twin gestation, and gestational age of 29 weeks are not direct risk factors for placenta previa. While advanced maternal age and twin gestation can pose their own set of risks during pregnancy, they are not specifically associated with an increased risk of placenta previa. Additionally, gestational age alone does not contribute to the development of placenta previa. Educationally, understanding the risk factors for placenta previa is crucial for healthcare providers working in labor and delivery settings. Recognizing these risk factors can aid in early identification, appropriate management, and timely intervention to prevent complications such as hemorrhage and preterm birth in pregnant individuals. It highlights the importance of thorough obstetric history-taking and risk assessment in the care of pregnant women.
Question 5 of 5
A woman has chosen a trial of labor after cesarean. Which findings indicate the best understanding of the nurse’s teaching by the patient?
Correct Answer: D
Rationale: The correct answer is D) "A balloon catheter may be used to manually ripen my cervix, if necessary.” This option demonstrates the best understanding of the nurse’s teaching by the patient because it shows knowledge of the potential need for cervical ripening methods like a balloon catheter in the trial of labor after cesarean (TOLAC) process. Option A is incorrect because while induction can be part of TOLAC, it does not necessarily mean it is safer than spontaneous labor. Option B is incorrect as ripening with prostaglandins is not always the first step in TOLAC. Option C is incorrect because Pitocin is not always contraindicated in TOLAC; its use depends on the individual's situation. In an educational context, understanding the process of TOLAC is crucial for patients to make informed decisions and actively participate in their care. Knowing the different methods of cervical ripening, like a balloon catheter, empowers patients to engage in discussions with healthcare providers and advocate for their preferences during labor and delivery.