ATI RN
labor and delivery nclex questions Questions
Question 1 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 2 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 3 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.
Question 4 of 5
If the fetal attitude is assessed to be completely deflexed on sonogram or via Leopold's maneuvers, what presenting part do you anticipate palpating in a vaginal exam?
Correct Answer: D
Rationale: If the fetal attitude is assessed to be completely deflexed on sonogram or via Leopold's maneuvers, it means the baby is presenting in an extended position with the occiput being the lead point of the presenting part during a vaginal exam. This position is known as occiput posterior. The fetal occiput is the back of the head, and it is the optimal position for vaginal delivery as the smallest diameter of the baby's head will be presenting at the cervix, facilitating an easier descent through the birth canal.
Question 5 of 5
The nurse hears the laboring patient making grunting noises. How will the nurse determine if the person is in the active second stage of labor?
Correct Answer: C
Rationale: In the active second stage of labor, the cervix is fully dilated to 10 centimeters. Grunting noises can be a sign of the transition to the pushing stage, which occurs in the active second stage of labor. Therefore, assessing for dilation of the cervix is crucial to determine if the laboring person is in the active second stage of labor.