A client is in active labor.

Checking the EFM tracing, the nurse notes variables that are abnormal.

What would be the nurse's first nursing intervention?

Obtain assistance to check for a compressed umbilical cord.

Prepare the woman for an emergency cesarean birth.

Document the finding.

Help the woman change positions.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Checking for a compressed umbilical cord is important as it can cause fetal distress. However, it’s not the first step in response to abnormal EFM tracing.

Choice B rationale:

Preparing for an emergency cesarean birth might be necessary if the abnormality persists and indicates fetal distress. But it’s not the immediate first step.

Choice C rationale:

Documenting the finding is part of the nursing process, but immediate interventions to address the abnormality take precedence.

Choice D rationale:

Helping the woman change positions can relieve pressure on the umbilical cord, potentially resolving the abnormality. This is often the first intervention.

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Correct Answer is ["B","C","D","E"]

Explanation

Choice A rationale:

The vagina is not part of the true pelvis. It is the canal that leads from the uterus to the exterior of the body.

Choice B rationale:

The pelvic inlet is the upper part of the lesser pelvis where the baby’s head engages during labor. It is part of the true pelvis.

Choice C rationale:

The pelvic outlet is the lower opening of the pelvis. It is part of the true pelvis.

Choice D rationale:

The mid pelvis is the part of the pelvis where the baby turns to get into the right position for birth. It is part of the true pelvis.

Choice E rationale:

The pelvic floor muscles support the pelvic organs and help in the process of childbirth. They are part of the true pelvis.

Choice F rationale:

The cervix is the lower part of the uterus that opens into the vagina. It is not part of the true pelvis. So, the correct answers are B, C, D, and E.

A. Abdominal distention B. Respiratory depression C. Hyperreflexia D. Urinary retention

Correct Answer is B

Explanation

Choice A rationale:

Abdominal distention is not a common side effect of opioids in newborns.

Choice B rationale:

Respiratory depression is a known side effect of opioid use, and newborns are particularly susceptible.

Choice C rationale:

Hyperreflexia is not typically associated with opioid use.

Choice D rationale:

Urinary retention is not a common side effect of opioids in newborns.

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A client is in active labor. Checking the EFM tracing, the nurse notes variables that are abnormal. What would be the nurse's first nursing intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["B","C","D","E"]

Explanation

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which effect?

Correct Answer is B

Explanation

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A client is in active labor.

Checking the EFM tracing, the nurse notes variables that are abnormal.

What would be the nurse's first nursing intervention?