labor and delivery nclex questions

labor and delivery nclex questions Related

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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.

  • A. Maternal age of 24
  • B. Twin gestation
  • C. Gestational age of 29 weeks
  • D. Previous delivery by cesarean section
Correct Answer: D

Rationale: The patient's age, history of cesarean section, and twin gestation all contribute to an increased risk of placenta previa. The most significant risk factor here is the previous cesarean section, which can cause scarring and increase the likelihood of abnormal placental implantation.

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A patient admitted to the labor unit asks the nurse to discuss the episiotomy procedure with her. Which is true regarding episiotomy?

  • A. An episiotomy is required for all vaginal births.
  • B. A midline episiotomy is associated with more third- and fourth-degree lacerations.
  • C. A mediolateral episiotomy is easier to repair than a medial episiotomy.
  • D. A midline episiotomy is associated with more blood loss.
Correct Answer: B

Rationale: A midline episiotomy is not required for all vaginal births, but it is associated with more third- and fourth-degree lacerations.

A laboring patient asks the nurse how she will know that the contraction is at its peak. The nurse explains that the contraction peaks during which stage of measurement?

  • A. The acme
  • B. The interval
  • C. The increment
  • D. The decrement
Correct Answer: B

Rationale: The peak of a contraction, also known as its highest point or intensity, is referred to as the acme. This is the stage during which the contraction reaches its maximum strength before gradually subsiding. By identifying the acme of the contraction, healthcare providers can better gauge the progress of labor and assess the intensity of contractions to determine the appropriate course of action for the laboring patient.

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?

  • A. Assess for rupture of membranes.
  • B. Assess for bloody show.
  • C. Assess for dilation of the cervix.
  • D. Assess for stool.
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.

Which clinical finding should the nurse expect to assess in the third stage of labor that indicates the placenta has separated from the uterine wall? (Select all that apply.)

  • A. A gush of blood appears.
  • B. The uterus rises upward in the abdomen.
  • C. The fundus descends below the umbilicus.
  • D. The cord descends further from the vagin
Correct Answer: C

Rationale: A. A gush of blood appears: This clinical finding is indicative of the placenta detaching from the uterine wall and the subsequent expulsion. The sudden release of a significant amount of blood is expected as the placenta separates.

Which maternal factor may inhibit fetal descent during labor?

  • A. A full bladder
  • B. Decreased peristalsis
  • C. Rupture of membranes
  • D. Reduction in internal uterine size
Correct Answer: A

Rationale: A full bladder can inhibit fetal descent during labor by obstructing the pathway for the baby to descend through the birth canal. A distended bladder can physically block the baby's head from moving down and putting pressure on the cervix, which is necessary for the progress of labor. It is important for pregnant individuals to empty their bladder regularly during labor to optimize the conditions for fetal descent and facilitate a smoother delivery process.

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