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Practice Question

The nurse, working in labor and delivery, performs a sterile vaginal exam on a laboring woman. During the exam, she feels a loop of pulsating cord in the vagina. The nurse would anticipate: Select one:

Answer Choices:

Correct Answer:

With a sterile glove, maintaining pressure to lift the presenting part and emergently notifying the provider for a STAT C-section.

Rationale:

🔴 Feeling a loop of pulsating umbilical cord during a vaginal exam confirms a diagnosis of prolapsed cord, a life-threatening obstetric emergency.

🔴 The immediate and priority action is to use a sterile gloved hand to elevate the presenting fetal part off the cord, thereby restoring blood flow and oxygen to the fetus.

🔴 Simultaneously, the nurse must call for help and notify the provider immediately to prepare for an emergency cesarean delivery, which is the only definitive treatment.

🔴 While oxygen and positioning can help optimize maternal-fetal oxygenation, they do not replace manual relief of cord compression as the first action.

🔴 Delaying intervention can result in fetal hypoxia, acidosis, or death due to umbilical cord occlusion.

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This question is from RN ATI Maternity Exam III which contains 55 questions.

More Questions from This Exam
A client who is breastfeeding her newborn tells the nurse, "l notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?' Which response by the nurse would be most appropriate? Select one:

Answer Choices:

A. "Your body is responding to the events of labor, just like after a tough workout.
B. "This could be a sign that your body is trying to get rid of retained placental fragments."
C. "Let me check your vaginal discharge just to make sure everything is fine."
D. "The baby's sucking releases oxytocin which causes your uterus to contract."
A couple who has had difficulty conceiving confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions that face them. Which of the following nursing strategies would be most appropriate and therapeutic? Select one:

Answer Choices:

A. Provide compassionate and accurate information throughout the process and support them to make their own decisions.
B. Inquire about the names they have chosen for their baby to get their mind off their stress.
C. Express sympathy and provide directive advice to the couple about what they should do.
D. Refer them to a marriage counselor in the same building to help them with the decisions.
The nurse administers vitamin K intramuscularly as prophylaxis to the newborn based on which of the following rationales? Select one:

Answer Choices:

A. Vitamin K will increase erythropoiesis.
B. Vitamin K will enhance bilirubin breakdown.
C. Vitamin K will stop Rh sensitization.
D. Vitamin K will promote blood clotting ability.
The nurse at a shelter is counseling a group of women experiencing domestic violence. What is most important for the nurse to emphasize? Select one:

Answer Choices:

A. About 1 of every 5 women will experience abuse in her lifetime.
B. When women go back to the situation after the abuser has calmed down, things will be better.
C. The victimized woman can easily leave the situation.
D. The violence will not stop or decrease if the woman becomes pregnant.
From Exam
RN ATI Maternity Exam III

55 Questions

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Question Details
  • Category: RN Nursing Exam(s)
  • Subcategory: ATI Exam(s)
  • Domain: RN ATI Maternal & Newborn Care
  • Answer Choices: 4
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