HESI - OB, Leopolds Maneuvers
When performing Leopold maneuvers, the nurse uses what part of the hand to gently palpate the uterus? A. Palmar surface with fingers together B. Palmar surface with the fingers spread C. Fingertips with the fingers spread D. Fingertips with the fingers together
A. Palmar surface with fingers together Rationale: The nurse should use the palmar surface of the hand with the fingers together. Using the palmar surface of the hand with the fingers spread or the fingertips with the fingers spread or together does not allow for adequate palpation and accurate identification of fetal parts.
The nurse is preparing to perform Leopold maneuvers. Before starting the maneuvers, the nurse visually inspects the patient's abdomen for bulges, knobby areas, and fetal movement. What additional information does this visual inspection give the nurse? A. Whether the bladder is distended B. Whether there is a decrease in fetal movement C. Location of the fetal back, hands, elbows, knees, and feet D. Whether the uterus is relaxed or contracting
C. Location of the fetal back, hands, elbows, knees, and feet Rationale: The additional information obtained during the visual inspection assists with determining the location of the fetal back, hands, elbows, knees, and feet. Identifying a distended bladder through visual inspection is possible; however, this is not the main purpose of the visual inspection. The visual inspection does not reveal whether there is a decrease in fetal movement. Although determining whether or not a patient is contracting may be possible during visual inspection, this determination is best accomplished by palpation and is not the reason for the visual inspection.
The nurse performing Leopold maneuvers on a patient at 37 weeks' gestation determines that the fetus has a cephalic presentation. While performing the fourth Leopold maneuver, the nurse finds the fetal head flexed. When the fetal head is flexed, what does this indicate about the cephalic prominence? A. The cephalic prominence is found on the opposite side as the fetal small parts. B. The cephalic prominence is found on the same side as the fetal back. C. The cephalic prominence may be in military attitude. D. The cephalic prominence is found on the same side as the fetal small parts
D. The cephalic prominence is found on the same side as the fetal small parts Rationale: When the fetal head is flexed, the cephalic prominence is found on the same side as the fetal small parts—not on the side opposite the fetal small parts, and not on the same side as the fetal back. When the cephalic prominence is in the military attitude, the fetal head is felt equally on each side and is not in a flexed or extended position.
After performing Leopold maneuvers, the nurse describes the fetal lie, and attitude as longitudinal and flexed. The fetal back is located on the patient's left with a cephalic presentation. What is the best area to obtain fetal heart tones? A. The left lower abdomen closest to the fetal heart B. The left upper abdomen closest to the fetal heart C. The right upper abdomen closest to the fetal heart D. The middle of the abdomen above the umbilicus closest to the fetal heart
A. The left lower abdomen closest to the fetal heart Rationale: FHR is best heard over the fetal back. The findings in this scenario describe a longitudinal fetal lie with the fetal back located in the mother's left abdomen and a cephalic presentation; therefore, the left lower abdomen would be closest to the fetal heart. All other abdominal quadrants are inappropriate based on the fetal lie, attitude, and presentation described
During Leopold maneuvers, a firm, round, movable fetal body part is palpated behind the patient's symphysis pubis, and a softer, round fetal body part is palpated in the fundus. What is the most appropriate documentation? A. The presenting part is the fetal head, the presentation is cephalic, and the fetus is not engaged. B. The presenting part is the fetal head, the presentation is cephalic, and the fetus is engaged. C. The presenting part is the fetal buttocks, the presentation is breech, and the fetus is engaged. D. The presenting part is the fetal buttocks, the presentation is breech, and the fetus is not engaged.
A. The presenting part is the fetal head, the presentation is cephalic, and the fetus is not engaged. Rationale: The fetal head is palpated as a firm, regular, round surface. As described in this scenario, it is behind the symphysis pubis. The fetal buttocks as palpated are described as irregularly shaped and softer than the fetal head within the fundal area; they are not the presenting part. Because the presenting part is movable, it indicates that the fetus is not engaged. This fetus is not in the breech presentation.
While performing Leopold maneuvers on a patient at 40 weeks' gestation, the nurse is explaining to a new nurse about fetal lie, which is the relationship of the long axis of the fetus to the long axis of the patient's body. How is fetal lie described? A. Transverse, longitudinal, or oblique B. Anterior, posterior, or transverse C. Cephalic, shoulder, or breech D. Vertex, sinciput, brow, or face
A. Transverse, longitudinal, or oblique Rationale: Fetal lie can be described as transverse, longitudinal, or oblique. Fetal position is determined by the relationship between the presenting part and the quadrants of the pelvis, and is described as anterior, posterior, or transverse. Fetal presentation refers to the fetal body part entering the pelvis, and can be described as cephalic, shoulder, or breech. A cephalic presentation is further subdivided as vertex, sinciput, brow, or face, depending upon the degree of flexion or extension of the fetal head.
Before performing Leopold maneuvers on a patient at 39 weeks' gestation, what does the nurse do to ensure the patient's comfort and facilitate adequate abdominal palpation? A. Place a pillow under the patient's head. B. Have the patient empty the bladder. C. Have the patient lie on the left side. D. Have the patient place arms at sides.
B. Have the patient empty the bladder. Rationale: To ensure patient comfort and facilitate adequate abdominal palpation, the nurse should have the patient empty the bladder before performing Leopold maneuvers. Placing a pillow under the patient's head will help with comfort but will not facilitate abdominal palpation. Placing the patient on the left side is not an appropriate position for performance of Leopold maneuvers and will not facilitate abdominal palpation. Having the patient's arms at the sides is appropriate; however, this positioning does not facilitate abdominal palpation.
During Leopold maneuvers, a firm, regular, and round fetal body part is palpated on the left side of the uterus and a soft, round fetal body part is palpated on the right side of the uterus. During the third Leopold maneuver, no fetal body part is palpated. What do these findings indicate about the fetal lie? A. It is oblique and not engaged. B. It is transverse and not engaged. C. It is transverse and engaged. D. It is oblique and engaged.
B. It is transverse and not engaged. Rationale: Fetal lie refers to the long axis of the fetus in relationship to the long axis of the mother, and can be described as transverse, longitudinal, or oblique. The findings in this scenario indicate a transverse fetal lie, because the head is palpated on the left side of the uterus and the buttocks are palpated on the right. The fetal head feels regular, round, and firm when palpated, and it is more movable than the fetal buttocks. The fetal buttocks are not as regular, round, or firm as the head. Transverse lies do not allow for engagement because fetal body parts are located above the maternal pelvis. This scenario does not describe the fetus as being positioned at an angle so that the spine is off-center from the patient (called oblique).
An obese patient arrives with an order for external fetal monitoring. The practitioner is unable to determine fetal presentation and suspects a breech presentation. Which interventions should be performed? A. Order an ultrasound examination, perform Leopold maneuvers, and monitor FHR. B. Perform Leopold maneuvers, insert an intrauterine pressure catheter, and arrange for an ultrasound examination. C. Perform inspection, external palpation, and Leopold maneuvers; apply external fetal monitoring; and obtain an order for ultrasound examination if indicated. D. Assess FHR, perform Leopold maneuvers, apply an internal fetal spiral electrode, and order an ultrasound examination.
C. Perform inspection, external palpation, and Leopold maneuvers; apply external fetal monitoring; and obtain an order for ultrasound examination if indicated. Rationale: Interventions to determine fetal position include performing abdominal inspection, external uterine palpation, and Leopold maneuvers; the patient should be prepared for an ultrasound examination in case Leopold maneuvers are difficult to perform. Placement of an intrauterine pressure catheter and fetal spiral electrode require ruptured amniotic membranes and are not indicated at this time. Leopold maneuvers should be performed to assess fetal lie, presentation, attitude, and engagement of the presenting part before attempting to assess the FHR. An ultrasound examination is a noninvasive procedure that requires a practitioner's order.
After Leopold maneuvers are performed on a patient admitted in labor, the patient is placed in a left lateral position. Later, the patient is found lying supine, and complaining of nausea and faintness. When the patient is repositioned on the right side and the external fetal monitors are adjusted, the symptoms resolve. What was the most likely cause of the patient's symptoms? A. Increased vena cava compression and renal perfusion caused by supine hypertension B. Increased uteroplacental and renal perfusion caused by supine hypertension C. Decreased vena cava compression and renal perfusion caused by supine hypotension D. Pressure on the aorta and inferior vena cava, causing supine hypotension
D. Pressure on the aorta and inferior vena cava, causing supine hypotension Rationale: Pressure of the gravid uterus on the aorta and inferior vena cava induces supine hypotension, resulting in decreased uteroplacental circulation. Symptoms include lightheadedness, nausea, dizziness, and syncope. Placing the patient in a side-lying or sitting position with knees slightly flexed is recommended. Supine hypertension, increased uteroplacental and renal perfusion, and reduced vena cava compression are not complications related to patient position.