Nursing Elites

1. During Leopold maneuvers on a client in labor, which technique should be used by the nurse to identify the fetal lie?

• A. Apply palms of both hands to sides of the uterus
• B. Palpate the fundus of the uterus
• C. Grasp the lower uterine segment between thumb and fingers
• D. Stand facing the client's feet with fingertips outlining cephalic prominence

Correct answer: B

Rationale: Palpating the fundus of the uterus during Leopold maneuvers is crucial to identify the fetal lie. This technique allows the nurse to determine the position of the baby's back and locate the fetal heart sounds, aiding in assessing the fetal lie. Choices A, C, and D are incorrect as they do not directly relate to identifying the fetal lie during Leopold maneuvers. Applying palms to the sides of the uterus or grasping the lower uterine segment do not provide the necessary information about the fetal lie. Standing facing the client's feet and outlining cephalic prominence is more related to assessing the fetal presentation, not the fetal lie.

2. A client in active labor reports back pain while being examined by a nurse who finds her to be 8 cm dilated, 100% effaced, -2 station, and in the occiput posterior position. What action should the nurse take?

• A. Perform effleurage during contractions.
• B. Place the client in lithotomy position.
• C. Assist the client to the hands and knees position.
• D. Apply a scalp electrode to the fetus.

Correct answer: C

Rationale: The nurse should assist the client into the hands and knees position during contractions to help relieve her back pain and facilitate the rotation of the fetus from the posterior to an anterior occiput position. This position can aid in optimal fetal positioning for delivery. Choice A, performing effleurage, is a massage technique that may provide comfort but does not address the fetal position. Placing the client in lithotomy position (Choice B) may not be ideal for a client experiencing back pain due to the occiput posterior position. Applying a scalp electrode to the fetus (Choice D) is not indicated solely for addressing the client's back pain.

3. A client who is at 39 weeks of gestation and is in active labor has fetal heart tones located above the umbilicus at midline. The fetus is likely in which of the following positions?

• A. Cephalic
• B. Transverse
• C. Posterior
• D. Frank breech

Correct answer: D

Rationale: Fetal heart tones above the umbilicus at midline are indicative of a breech presentation, specifically a frank breech position. In a frank breech position, the baby's buttocks are presenting first, which aligns with the fetal heart tones being above the umbilicus. This position indicates that the baby is not in the normal head-down position for birth, which can impact the delivery process and may require specific interventions. Cephalic presentation (Choice A) is the normal head-down position for birth, transverse lie (Choice B) is when the baby is positioned horizontally in the uterus, and posterior position (Choice C) refers to the baby's back being positioned towards the mother's back.

4. A client in an obstetrical clinic is discussing using an IUD for contraception with a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. An IUD should be replaced annually during a pelvic exam.
• B. I cannot get an IUD until after I've had a child.
• C. I should plan on regaining fertility 5 months after the IUD is removed.
• D. I will check to ensure the strings of the IUD are still present after my periods.

Correct answer: D

Rationale: Checking for the presence of IUD strings after each period is crucial to ensure the IUD is correctly positioned and functioning. This practice helps in confirming the effectiveness of the contraceptive method and timely detection of any displacement or issues with the IUD. Choice A is incorrect as IUDs have varying durations of effectiveness, but they do not need to be replaced annually as a routine. Choice B is incorrect as women can get an IUD even if they haven't had a child. Choice C is incorrect as fertility typically returns shortly after IUD removal, not necessarily after a specific timeframe like 5 months.

5. A client who underwent an amniotomy is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?

• A. Maintain the client in the lithotomy position.
• B. Perform vaginal examinations frequently.
• C. Remind the client to bear down with each contraction.
• D. Encourage the client to empty her bladder every 2 hours.

Correct answer: D

Rationale: Encouraging the client to empty her bladder every 2 hours is essential during labor to prevent bladder distention, which can hinder labor progress and cause discomfort. A distended bladder can also lead to potential complications such as uterine atony or increased risk of infection. Choice A is incorrect as maintaining the client in the lithotomy position is not necessary during the active phase of the first stage of labor and may not be comfortable for the client. Choice B is incorrect because performing vaginal examinations frequently can increase the risk of introducing infection and disrupt the natural progress of labor. Choice C is incorrect as bearing down with each contraction is typically reserved for the second stage of labor when the cervix is fully dilated, not during the active phase of the first stage.

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