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WorksheetsNCLEX - LABOR AND DELIVERY Day1
Total questions: 20
Worksheet time: 20mins
Name
Class
Date
1.
The nurse reviews the external fetal monitoring tracing of a client receiving an oxytocin infusion for labor augmentation. The health care provider (HCP) asks the nurse to increase the oxytocin infusion rate. Which action by the nurse is appropriate at this time?
a)
Ask the charge nurse to speak with the HCP.
b)
Increase the oxytocin infusion rate as requested by the HCP.
c)
Recommend to the HCP that the infusion rate be decreased at this time.
d)
Request that the current infusion rate be maintained due to the client's contraction pattern.
e)
--
2.
A client at 38 weeks gestation is in latent labor with ruptured membranes and is receiving an oxytocin infusion for labor augmentation. The client is requesting IV pain medication. When administering an IV narcotic during labor, which nursing action is appropriate?
a)
Discontinue the oxytocin infusion prior to giving the medication.
b)
Give the medication slowly during the peak of the next contraction.
c)
Hold until contractions are occurring at least every 4 minutes for an hour.
d)
Withdraw 5 mL of lactated Ringer from the IV tubing to dilute the medication.
e)
--
3.
A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction?
a)
Bishop score of 10.
b)
Firm and posterior cervix.
c)
History of precipitous labor.
d)
Reactive nonstress test.
e)
--
4.
The precepting nurse is supervising a new obstetric nurse performing a labor admission assessment on a client with suspected spontaneous rupture of membranes. Which action by the new nurse would cause the precepting nurse to intervene?
a)
Documents a positive nitrazine test result when the test strip turns blue.
b)
Palpates the client's abdomen before applying external fetal monitors.
c)
Provides the client with a variety of clear liquids to drink.
d)
Puts on nonsterile gloves and uses soluble gel for vaginal examination.
e)
--
5.
The nurse is reviewing fetal heart rate monitor tracings for clients who are in labor. The nurse should recognize that a client may be experiencing uterine tachysystole if contractions are
a)
1-1.5 minutes apart.
b)
2 minutes apart.
c)
2-3 minutes apart.
d)
5 minutes apart.
e)
--
6.
The nurse is preparing to administer oxytocin to induce labor in a client at term gestation. Which of the following nursing actions are appropriate during oxytocin infusion? Select all that apply.
a)
Administer oxytocin through the primary IV line.
b)
Assess the uterine contraction pattern.
c)
Initiate continuous fetal heart rate monitoring.
d)
Titrate oxytocin to achieve cervical dilation of 1 cm every 2 hours.
e)
Use an electronic infusion pump to administer IV oxytocin.
7.
The nurse is caring for a client with spontaneous rupture of membranes. The nurse notes a loop of umbilical cord protruding from the vagina. Which of the following actions should the nurse take?
a)
Apply suprapubic pressure.
b)
Perform Leopold maneuvers.
c)
Perform the McRoberts maneuver.
d)
Assist the client to the knee-chest position.
e)
--
8.
The nurse is performing a vaginal examination to assess cervical dilation and effacement for a client in labor. While palpating the fetal presenting part, the nurse notes a diamond-shaped structure that feels soft in the middle. Which of the following actions should the nurse take?
a)
Anticipate cesarean birth and prepare the client for surgery.
b)
Request that the health care provider verify fetal presentation.
c)
Document fetal presentation as cephalic in the medical record.
d)
Keep a gloved hand in place to elevate the fetal presenting part.
e)
--
9.
The nurse is caring for a client at 39 weeks gestation who is receiving an IV oxytocin infusion for induction of labor. The nurse notes recurrent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply.
a)
Administer an IV fluid bolus.
b)
Reposition the client laterally.
c)
Discontinue the IV oxytocin infusion.
d)
Prepare the client for an amnioinfusion.
e)
Apply abdominal vibroacoustic stimulation.
10.
The nurse is caring for a client in active labor who is 8 cm dilated, trembling, and reporting the urge to push. Which of the following actions should the nurse take?
a)
Administer IV meperidine.
b)
Place the client in the supine position.
c)
Instruct the client to bear down and push.
d)
Provide coaching for breathing techniques.
e)
--
11.
The nurse is performing telephone triage with a client at 38 weeks gestation who may be in labor. Which of the following questions would help the nurse determine whether the client is in labor? Select all that apply.
a)
Do you feel like the contractions are getting stronger?
b)
Does anything you do make the pain better?
c)
Have you lost your mucous plug?
d)
How frequent are the contractions?
e)
Where do you feel the contraction pain most?
12.
The nurse on the postpartum unit is caring for assigned clients. The nurse should first check the client who
a)
Reports that a suspicious visitor is walking up and down the hallway.
b)
Had a cesarean birth 8 hours ago and is requesting to ambulate for the first time.
c)
Has endometritis and reports that the alarm on the IV infusion pump is sounding.
d)
Reports that the newborn is crying inconsolably and having difficulty breastfeeding.
e)
--
13.
The nurse is teaching a class of expectant parents about infant safety. Which of the following statements by a participant would require follow-up?
a)
I will allow my baby to sleep with a pacifier.
b)
I will dress my baby in one-piece clothing for sleep.
c)
I will place a firm mattress and fitted sheet in my baby's crib.
d)
I will tie bumper pads to the sides of the crib to protect my baby's head.
e)
--
14.
The nurse is monitoring a client who is in active labor with a cervical dilation of 6 cm. Which finding requires intervention by the nurse?
a)
Contraction duration of 95 seconds.
b)
Contraction frequency of every 3 minutes.
c)
Contraction intensity of 45 mm Hg.
d)
Uterine resting tone of 10 mm Hg.
e)
--
15.
Following the precipitous birth of a term newborn, what is the best action by the nurse while awaiting expulsion of the placenta and arrival of the health care provider?
a)
Clean the perineal area.
b)
Gently pull on the cord.
c)
Keep the infant warm.
d)
Massage the fundus.
e)
--
16.
The nurse is caring for a baby born at 30 weeks gestation and diagnosed with necrotizing enterocolitis. Which nursing action should be implemented?
a)
Encourage parents to increase skin-to-skin care.
b)
Measure abdominal girth daily.
c)
Measure rectal temperature every 3-4 hours.
d)
Position client on side and check diaper for stool.
e)
--
17.
A nulliparous client asks about being in "real" labor. The nurse should teach the client which of the following signs are indicative of true labor? Select all that apply.
a)
Contractions that increase in frequency.
b)
Contractions that lessen after resting.
c)
Increased blood-tinged, mucoid vaginal discharge.
d)
Pain in lower back that moves to lower abdomen.
e)
Progressive cervical effacement and dilation.
18.
The nurse is admitting a client at 36 weeks gestation who experienced an intrauterine fetal demise and is scheduled for induction of labor. Which of the following actions would be a priority for the nurse to take?
a)
Initiate an oxytocin infusion to begin the induction of labor.
b)
Ask if the client and family have a desire to speak with a chaplain.
c)
Apply a tocodynamometer to evaluate the current contraction pattern.
d)
Obtain blood specimens to check coagulation studies and platelet count.
e)
--
19.
A client in active labor who received epidural anesthesia 20 minutes ago reports feeling nauseated and lightheaded. Which action should the nurse perform first?
a)
Administer IV ondansetron.
b)
Apply oxygen via simple face mask.
c)
Obtain blood pressure.
d)
Perform vaginal examination.
e)
--
20.
The graduate nurse (GN) is caring for a laboring client with epidural anesthesia. After the client pushes for 3 hours during the second stage of labor, the health care provider (HCP) decides to use forceps to assist the client to deliver secondary to maternal exhaustion. Which action by the GN requires the nurse preceptor to intervene?
a)
Begins to apply fundal pressure when the HCP applies traction to forceps.
b)
Drains the client's bladder using a catheter before the placement of forceps.
c)
Notes the exact time the forceps are applied on a card for documentation in the birth record.
d)
Palpates for contractions and notifies the HCP when they are present.
e)
--
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