The nurse discovers a loop of the umbilical cord protruding through the vagina when preparing to perform a vaginal examination. The priority intervention is to:

Perform vaginal exam and apply upward digital pressure to the presenting part.

Immediately turn the client to her side.

Call the physician immediately.

Place a moist, clean towel over the cord to prevent drying.

Answer and Explanation

The Correct Answer is A

A. Perform vaginal exam and apply upward digital pressure to the presenting part. A prolapsed umbilical cord is an obstetric emergency that can lead to cord compression and fetal hypoxia. The priority intervention is for the nurse to manually lift the presenting part (usually the fetal head) off the cord to relieve pressure and restore blood flow. The nurse should maintain this position until an emergency cesarean section is performed.

B. Immediately turn the client to her side. Positioning changes, such as the knee-chest or Trendelenburg position, can help relieve pressure on the cord, but they are secondary to manually lifting the presenting part. While turning the client may assist, it is not the most immediate life-saving action.

C. Call the physician immediately. While notifying the provider is essential, relieving pressure on the umbilical cord takes priority. Delaying intervention to make a call could result in prolonged fetal hypoxia and compromise.

D. Place a moist, clean towel over the cord to prevent drying. Covering the cord with a moist towel helps prevent vasospasm and drying, but it does not relieve the compression that is cutting off oxygen to the fetus. The priority is to relieve pressure on the cord first before taking other measures.

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

Explanation

A. Obtain equipment to start a 24-hour urine test on the patient. A 24-hour urine test is not necessary for placenta previa. It is more commonly used for preeclampsia to assess proteinuria, which is unrelated to placenta previa.

B. Obtain equipment for a manual pelvic exam. A manual pelvic exam is contraindicated in placenta previa because it can cause further disruption of the placenta, leading to severe hemorrhage. Instead, diagnosis should be confirmed using ultrasound.

C. Prepare to draw blood for a hemoglobin and hematocrit. Hemoglobin and hematocrit levels must be monitored due to the risk of maternal hemorrhage in placenta previa. Significant blood loss can lead to anemia and may require blood transfusions.

D. Obtain equipment for external electronic fetal heart rate monitoring. Continuous fetal monitoring is essential in placenta previa to assess for signs of fetal distress. External monitoring is preferred to avoid vaginal examinations, which could worsen bleeding.

E. Prepare the patient for an ultrasound. Ultrasound is the diagnostic test of choice for placenta previa. It helps determine the exact location of the placenta and confirms whether it is covering the cervix. A transabdominal ultrasound is performed first, followed by a transvaginal ultrasound if necessary.

A. True B. False

Correct Answer is B

Explanation

While many women are able to get pregnant again after an ectopic pregnancy, it is not guaranteed. The ability to conceive again depends on various factors, such as:

The extent of damage to the fallopian tube.
Whether one or both tubes are still functional.
The treatment used (e.g., methotrexate vs. surgery).
Any underlying fertility issues.

It is important to be honest but reassuring, explaining that many women do go on to have healthy pregnancies, but future fertility can be affected and should be discussed with a healthcare provider. Saying she "absolutely will" get pregnant again is inaccurate and potentially misleading.

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The nurse discovers a loop of the umbilical cord protruding through the vagina when preparing to perform a vaginal examination. The priority intervention is to:

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Naxlex Comprehensive Predictor Exams

The nurse is preparing for the admission of a 30 weeks' gestation patient experiencing vaginal bleeding with a suspected diagnosis of placenta previa. In anticipating the patient's needs, which of the following would be most appropriate for the nurse to include? Select all that apply.

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

Explanation

A woman is admitted due to a suspected ectopic pregnancy. While explaining treatment the patient asks if she will be able to get pregnant again. You answer that she absolutely will get pregnant again. Is this the correct thing to say?

Correct Answer is B

Explanation

The nurse recognizes that a woman is in true labor when she states…., and finds that her cervix has dilated and effaced on examination.

During a vaginal delivery the midwife tells you that a shoulder dystocia has occurred. Which of the following initial nursing actions is appropriate at this time?

A woman with preeclampsia gave birth vaginally 1 hour ago. She is still receiving a magnesium sulfate infusion at 1 gm/hr. A major concern regarding the administration of magnesium sulfate at this time would be:

The least common cause of long. difficult, or abnormal labor (dystocia) is:

A client who is 32 weeks pregnant calls the clinic complaining of an increase in vaginal discharge, pelvic pressure, and low back and abdominal pain. Based on this information, what action will the nurse take?

When working with a woman who has just experienced a fetal demise you should offer supportive care, give her the opportunity to grieve, and provide for a chaplain to come in if the patient wants one. You know that the Chaplain is non-denominational and can also provide comforting words.