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: The correct answer is C) Maintain infusion at 6 mU/min. In this scenario, the fetal heart tracing shows a baseline of 130, moderate variability, and no accelerations or decelerations, indicating reassuring fetal status. Additionally, uterine contractions every 2 minutes for the last 30 minutes suggest effective labor progress. Maintaining the oxytocin infusion at 6 mU/min is the best action because there are currently no signs of fetal distress or hyperstimulation. Increasing the dose (option A) could lead to uterine hyperstimulation, compromising fetal oxygenation. Delaying the next increase (option B) may not be necessary since the current status is reassuring. Discontinuing the oxytocin infusion (option D) could halt labor progress, which is not indicated in this situation. Educationally, this scenario highlights the importance of assessing fetal well-being through continuous monitoring, understanding appropriate oxytocin dosing, and recognizing signs of uterine hyperstimulation. It emphasizes the nurse's critical role in optimizing maternal and fetal outcomes during labor induction.
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 is a serious complication where the placenta separates from the uterine wall before delivery, leading to severe abdominal pain, dark red bleeding, fetal distress (as indicated by low fetal heart tones), and a rigid, tender abdomen due to internal bleeding and uterine contractions. These signs indicate an emergent situation requiring immediate medical intervention to prevent harm to both the mother and the baby. The other options are incorrect in this context: - B) Placental accreta is when the placenta attaches too deeply into the uterine wall, which presents with painless bleeding in the third trimester, not the acute symptoms described. - C) Placenta previa is when the placenta partially or fully covers the cervix, causing painless bleeding, not the acute abdominal pain and tenderness seen here. - D) Placenta succenturiata is a rare variation where accessory lobes of the placenta are present, usually asymptomatic and not associated with the described symptoms. Understanding these distinctions is crucial for nurses and healthcare providers working in labor and delivery to make quick and accurate assessments, prioritize care, and respond effectively to obstetric emergencies like placental abruption. Early recognition and intervention can significantly impact outcomes for both the mother and the baby.
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. This patient has a history of cesarean section, which is a known risk factor for placenta previa. Placenta previa occurs when the placenta partially or completely covers the cervix, leading to vaginal bleeding. A history of cesarean section increases the risk of placenta previa due to scarring of the uterine wall, which can affect placental implantation in subsequent pregnancies. The other options are not directly related to the risk factors for placenta previa in this case. Maternal age of 24, twin gestation, and gestational age of 29 weeks are not specific risk factors for placenta previa. It is important to understand the unique risk factors associated with placenta previa to provide appropriate care and management for pregnant patients. Educationally, this question highlights the significance of understanding how a history of cesarean section can impact future pregnancies and the potential complications, such as placenta previa. It emphasizes the importance of recognizing risk factors in pregnant patients to provide timely interventions and ensure positive maternal and fetal outcomes.
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 option D: "A balloon catheter may be used to manually ripen my cervix, if necessary.” This answer indicates the best understanding of the nurse’s teaching by the patient because it shows awareness of the potential need for cervical ripening methods such as a balloon catheter to facilitate a trial of labor after cesarean (TOLAC). Option A is incorrect because elective induction at 39 weeks is not necessarily safer and may not be recommended without a clear medical indication. Option B is incorrect because cervical ripening with prostaglandins is not typically done the night before induction for TOLAC due to the risk of uterine rupture. Option C is incorrect as Pitocin is not always contraindicated for TOLAC, and the need for a cesarean section should not be assumed if labor does not start spontaneously. In the educational context, it is crucial for nurses and patients to understand the risks and benefits associated with TOLAC, including the potential need for cervical ripening methods like a balloon catheter. Patients should be informed about the process, possible interventions, and signs of complications to ensure a safe and informed decision-making process during labor and delivery.