high risk labor and delivery nclex questions

high risk labor and delivery nclex questions Related

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The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session? (Select all that apply.)

  • A. Progesterone levels become higher than estrogen levels.
  • B. Natural oxytocin in conjunction with other substances plays a role
  • C. Stretching, pressure, and irritation of the uterus and cervix increase
  • D. The secretion of prostaglandins from the fetal membranes decreases.
Correct Answer: B

Rationale: The correct answer is B: Natural oxytocin in conjunction with other substances plays a role in the initiation of labor. Oxytocin is a key hormone that stimulates uterine contractions during labor. Its release is crucial for the progression of labor. Other substances, such as prostaglandins, also play a role in initiating labor by softening the cervix and promoting contractions.

Rationale:
1. Oxytocin is a well-known hormone that directly stimulates uterine contractions, leading to the initiation of labor.
2. Prostaglandins are also important in preparing the cervix for labor and promoting contractions, which contradicts option D.
3. Progesterone levels decreasing and estrogen levels increasing typically signal the onset of labor, which contradicts option A.
4. Factors like stretching, pressure, and irritation of the uterus and cervix are more related to the progression of labor rather than the initiation, which contradicts option C.

In summary

You may also like to solve these questions

What is a direct influence on cervical dilation? Select all that apply.

  • A. positioning of the pregnant person
  • B. strength of uterine contractions
  • C. length of time since ROM
  • D. fetal presentation
Correct Answer: A

Rationale: The correct answer is A because the positioning of the pregnant person affects the alignment of the baby's head in the pelvis, directly influencing cervical dilation. Proper positioning helps the baby apply pressure to the cervix, promoting dilation. In contrast, the strength of uterine contractions (B) affects labor progress but not cervical dilation specifically. The length of time since ruptured membranes (C) may increase infection risk but does not directly impact dilation. Fetal presentation (D) affects the descent of the baby, not cervical dilation.

Which is the cervical exam that most indicates the use of misoprostol?

  • A. 1 cm dilated, 20% effaced, -3 station, firm and posterior
  • B. 3-4 cm dilated, 50% effaced, -2 station, firm and midposition
  • C. 5 cm dilated, 80% effaced, 0 station, soft and midposition
  • D. 6 cm dilated, 100% effaced, +1 station, soft and anterior
Correct Answer: A

Rationale: The correct answer is A: 1 cm dilated, 20% effaced, -3 station, firm and posterior. Misoprostol is commonly used for cervical ripening in preparation for labor induction. This choice indicates an unfavorable cervix, which would benefit from cervical ripening agents like misoprostol. The cervix is minimally dilated (1 cm), partially effaced (20%), high (-3 station), firm, and posterior. This profile suggests that the cervix is not yet ripe and may require assistance in ripening for labor induction.

Choice B: 3-4 cm dilated, 50% effaced, -2 station, firm and midposition - this indicates a more favorable cervix for labor and would not typically require misoprostol for cervical ripening.

Choice C: 5 cm dilated, 80% effaced, 0 station, soft and midposition - this indicates an even more favorable cervix for labor,

Which physiologic event is the key indicator of the commencement of true labor?

  • A. Bloody show
  • B. Cervical dilation and effacement
  • C. Fetal descent into the pelvic inlet
  • D. Uterine contractions every 7 minutes
Correct Answer: B

Rationale: The correct answer is B: Cervical dilation and effacement. This is the key indicator of true labor as it signifies the physiological changes needed for the cervix to open and thin out, allowing the baby to pass through the birth canal. Bloody show (A) can be present in early labor but is not a definitive sign. Fetal descent (C) and regular uterine contractions (D) are important, but cervical changes are the most reliable indicator of true labor initiation.

The nurse is caring for a 34-year-old gravida 4, para 3 experiencing a prolonged labor. The physician performed an amniotomy 3 hours ago to stimulate the progression of labor. The patient’s most recent vaginal exam was 8/80%/0. Which assessment finding should the nurse should be most concerned about?

  • A. Pain score of 7/10
  • B. FHR baseline of 165
  • C. Mild variable decelerations
  • D. Increased bloody mucous discharge
Correct Answer: B

Rationale: The correct answer is B: FHR baseline of 165. In this scenario, a FHR baseline of 165 is concerning as it is higher than the normal range (110-160 bpm) for a term fetus. This may indicate fetal distress or hypoxia, possibly due to cord compression or placental insufficiency. High baseline FHR can lead to fetal complications like acidosis or asphyxia. The other choices are less concerning: A is subjective and manageable, C indicates a common response to labor and is usually transient, and D is expected after amniotomy. Monitoring and addressing the abnormal FHR is crucial for fetal well-being.

What is a direct influence on cervical dilation? Select all that apply.

  • A. positioning of the pregnant person
  • B. strength of uterine contractions
  • C. length of time since ROM
  • D. fetal presentation
Correct Answer: A

Rationale: The correct answer is A: positioning of the pregnant person. The position of the pregnant person can directly influence cervical dilation by affecting the alignment of the uterus and baby, allowing for optimal pressure on the cervix. Proper positioning can facilitate the descent of the baby's head onto the cervix, promoting dilation.

Summary of why other choices are incorrect:
B: The strength of uterine contractions indirectly influences cervical dilation by aiding in the effacement and descent of the baby, but it does not directly impact dilation.
C: The length of time since ROM (rupture of membranes) can affect the risk of infection but does not directly influence cervical dilation.
D: Fetal presentation refers to the position of the baby in the uterus and can affect labor progress, but it does not directly impact cervical dilation.

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