Intrapartum NCLEX questions & Answers_ Fall 2022.
The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply.
The nurse is caring for a c...
Intrapartum NCLEX questions & Answers_ Fall 2022. The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)? Select all that apply. #Correct Ans - 3. A gravida II who has just been diagnosed with dead fetus syndrome 5. A primigravida at 29 weeks of gestation who was recently d iagnosed with severe preeclampsia The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply. #Correct Ans - 3. The cervix is dilated completely. 5. The spontaneous urge to push is initiated from perineal pressure. The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monit or strip. What is the most appropriate nursing action? #Correct Ans - 1. Administer oxygen via face mask. The nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. Which assessment finding indicates the need to contact the health care provider (HCP)? #Correct Ans - 2 .Fetal heart rate of 180 beats/minut e The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the -1 station. This documented finding indicates that the fetal presenting part is located at wh ich area? Click on the image to indicate your answer. #Correct Ans - 3 A client arrives at a birthing center in active labor. Following examination, it is determined that her membranes are still intact and she is at a -2 station. The health care provider p repares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? Select all that apply. #Correct Ans - 3. Increased efficiency of contractions 5. The need for frequent fetal heart rate monitoring to de tect the presence of a prolapsed cord The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? #Correct Ans - 4. Variable decelerations A client in lab or is transported to the delivery room and prepared for a cesarean delivery. After the client is transferred to the delivery room table, the nurse should place the client in which position? #Correct Ans - 1.Supine position with a wedge under the right hip The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 beats/minute. Which nursing action is most appropr iate? #Correct Ans - 1. Notify the health care provider (HCP). The nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which action is most appropriate? #Correct Ans - 4. Document the findings and tell the mother that the pattern on the monitor indicates fetal well -being. The nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the electronic fetal monitor, what is the next nursing action? #Correct Ans - 2. Assess the baseline fetal heart rate. The nurse is reviewing true and false labor signs with a multiparous client. The nurse dete rmines that the client understands the signs of true labor if she makes which statement? #Correct Ans - 4. "My contractions will increase in duration and intensity." Which assessment following an amniotomy should be conducted first? #Correct Ans - 3. Fetal heart rate pattern The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's primary physiological need at this time? #Correct Ans - 2. Rest between contractions The nurse is assisti ng a client undergoing induction of labor at 41 weeks of gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate ha s been
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