Sample NCLEX about Obstetrics Nursing (81-85)

Sample NCLEX about Obstetrics Nursing

81. A nurse is caring for a client in labor and prepares to auscultate the fetal heart rate by using a Doppler ultrasound device. The nurse accurately determines that the fetal heart sounds are heard by:

a) Noting whether the heart rate is greater than 140 bpm
b) placing the diaphragm of the Doppler on the mother's abdomen
c) palpating the maternal radial pulse while listening to the fetal heart rate
d) Performing Leopold's maneuver first to determine the location of the fetal heart

82. A nurse is caring for a client in labor who is receiving oxytoxin (Pitocin) by intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued?

a) increased urinary output
b) a fetal heart rate of 90 bpm
c) three contractions occurring within a 10-minute period
d) adequate resting tone of the uterus palpated between contractions

83. A nurse is reviewing the record of a client in the labor room and notes that the nurse-midwife has documented that the fetus is at negative 1 (-1) station. The nurse determines that the fetal presenting part is:

a) 1 inch below the coccyx
b) 1 inch below the iliac crest
c) 1 cm above the ischial spine
d) 1 fingerbreath below the symphysis pubis

84. nurse is monitoring a client in labor. The nurse suspects umbilical cord compression. If which of the following is noted on the external monitor tracing during a contraction?

a) late decelerations
b) early decelerations
c) short-term variability
d) variable decelerations

85. A labor and delivery room nurse has just received report on four clients. The nurse should assess which client first?
a) a primiparous client in the active stage of labor
b) a multiparous client who was admitted for induction of labor
c) a client who is not contracting but has suspected premature rupture of the membranes
d) a client who has just received an Iv loading dose of magnesium sulfate to stop preterm labor





Sample NCLEX about Obstetrics Nursing:
ANSWERS AND RATIONALE

81) C
- the nurse must simultaneously palpate the maternal radial or carotid pulse and auscultate the fetal heart rate (FHR) to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the FHR. Noting whether the heart rate is more than 140 bpm or placing the diaphragm of the Doppler on the mother's abdomen will not ensure accuracy in obtaining the FHR. Leopold's maneuver may help the examiner locate the position of the fetus but will not ensure a distinction between the heart rates

82) B
- a normal fetal heart rate is 120 to 160 bpm. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin. The goal of labor augmentation is to achieve three good-quality contractions (appropriate intensity and duration) in a 10-minute period. The uterus should return to resting tone between contractions, and there should be no evidence of fetal distress. Increased urinary output is unrelated to the use of oxytocin.

83) C
- station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, measured in centimeters, and noted as a negative number above the line and a positive number below the line. At negative 1 (-1) station, the fetal presenting part is 1 cm above the ischial spines.

84) D
- variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because they suggest uteroplacental insufficiency during a contraction. Short-term variability refers to the beat-to-beat range in fetal heart rate.

85) D
- magnesium sulfate is a central nervous system (CNS) depressant and the client could experience adverse effects that includes depressed respiratory rate (below 12 cpm), severe hypotension, and absent tendon reflexes (DTRs). This client should be seen before the clients in option A, B, and C because these clients conditions represent stable ones. 

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