priority nursing questions

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nurse simmy

55 Posts

Since we are talking about prioritizing questions I have one. I can't remember which book I got this out of or I would cite it. I have lots of NCLEX test prep books and software. And I'm paraphrasing it.

A woman is in labor and you notice the baby's head is compressing the cord. Put the four items in order of priority:

1.Put your hand in the woman's lady parts and hold the baby's head off the cord

2.Put Sterile gloves on

3.Position a towel under her hip

4.Put O2 by mask on her

Any comments?

~Simmy

Specializes in Psych.
Since we are talking about prioritizing questions I have one. I can't remember which book I got this out of or I would cite it. I have lots of NCLEX test prep books and software. And I'm paraphrasing it.

A woman is in labor and you notice the baby's head is compressing the cord. Put the four items in order of priority:

1.Put your hand in the woman's lady parts and hold the baby's head off the cord

2.Put Sterile gloves on

3.Position a towel under her hip

4.Put O2 by mask on her

Any comments?

~Simmy

Havent had ob rotation yet, thats my special next term ( this time its psych). I would say, Put o2 on, sterile gloves, hand in lady parts, towel under hip

Amber0515

16 Posts

Specializes in Med-Surg.

4,3,2,1? i am prolbably wrong though..

nurse simmy

55 Posts

4,3,2,1? i am prolbably wrong though..

The correct answer was sterile gloves, hand up the lady parts, o2, towel under hip. I have a problem with putting o2 on and a towel under the hip while I have sterile gloves on, and stuck between her legs. It may be nice in theory, but how can I do that? Even if I could reach, I have sterile gloves on and can't touch.

~simmy

dstep102570

118 Posts

Specializes in med/surg, telemetery, gerentology.

I agree with Simmy cuz the baby is compressing the cord and cutting oxygen supply off to baby therefore you would don sterile gloves and push baby upward to get baby off cord. Then call for another nurse to call physician and to help with O2 for mother and put a towel under hip.:nurse:

sserrn, BSN

141 Posts

Specializes in Emergency, Med/Surg, Vascular Access.

2, 1, 4, 3. It's asking you to prioritize, not multitask. They don't really think you can do all four at the same time. Or they're silly if they do. Don't get trapped by thinking, "I can't do that if I'm already doing this." That's not what it's asking. It's just prioritization. Get that little head off the cord, but don't infect Mama while doing it. O2 is nice and all, but if the baby is compressing the cord, you could put a nonrebreather on and it wouldn't make a bit of difference. (I must confess, I honestly don't even understand the purpose of the towel-under-the-hip intervention. lol)

jjjoy, LPN

2,801 Posts

I'm honestly curious, if the O2 were already set up and flowing and all you had to do was put the mask on the mom... would you put the sterile gloves on and push the baby off the cord before throwing the O2 mask on? Even if that's not right for a test question, what would happen in the real world?

And here's some nitpickiness about the use of the word "priority" as well as clinical curiousity... one certainly should put on those gloves prior to putting one's hand in the lady parts, but are the gloves a higher *priority* than moving the head off the cord? If by some strange twist of fate you had to choose between putting on the gloves and holding the baby off the cord, (I don't know, an earthquake has just torn the entire room in half, and the sterile gloves are on the other side of a chasm) would you put your hand in ungloved despite the risk of infection? I know, unlikely, I'm just exploring how one prioritizes in less-than-ideal situations.

Being able to prioritize is not just about not being able to do everything at one time, but sometimes not being able to ever get to everything period.

jjjoy, LPN

2,801 Posts

bump - anyone else have an angle on this?

Lol that mom's a trooper if an earthquake just broke the room in half. But in that case, test question wise...real world wise as well. Fix the problem. And with the 4 options given, it's pretty easy to order them. It just makes sense to do it the way the book says based on info given. You can't assume they do or do not have oxygen hooked up. But given the choices...sterile gloves aren't a priority per say. But why would you stick your hand up the hole, THEN put gloves on. Those two you can tell which one goes first based on common sense(gloves, then hole sticking). Next you have put a towel under her. It might take you 10 minutes to get a towel, a towel in no way will fix the problem or be necessary. So the towel goes behind the sticking of the hand up the hole. And you have oxygen left. Well we decided that the sticking of the hand up the hole after putting gloves on, and relieving pressure is the main priority. And what's more important?? O2 or a towel? O2. So you just put them together and you have gloves, hole, O2, towel. The question is trying to get you to focus on what's the problem..helping the baby get O2. You can pump 10590 liters of O2 into mom, but unless you take pressure of that cord, the baby won't see a breath of it. Wait til you get to studying for the NCLEX and the test questions have 8 to 9 steps to put in order. That's where it gets fun lol. But really it's not that bad if you take it 2 choices at a time. And to the OP's original question about calling the doctor..the question is trying to get you realize ok this is a change in status. You won't all of a sudden spike a temp of 102, swell, and have pain out of the blue. Tylenol just doesn't sound right. Elevate the arm, how will that fix the temp? It won't.

jjjoy, LPN

2,801 Posts

Lol that mom's a trooper if an earthquake just broke the room in half.

Yep, that would be a really bad day!

You can't assume they do or do not have oxygen hooked up.... It might take you 10 minutes to get a towel...

Are we not assuming that the sterile gloves are right there? Otherwise, like the towel, it might take 10 minutes to get the gloves. Yes, it would appropriate in this situation to have sterile gloves at the bedside already, but it would also be appropriate to have oxygen ready to go and towels at hand, right? If we're to assume that our sterile gloves won't be dropped or torn or way too small, then why can't we assume that the oxygen won't take more than 5 seconds to put on mom?

You can pump 10590 liters of O2 into mom, but unless you take pressure of that cord, the baby won't see a breath of it.

Absolutely! But how in the heck do we even know for sure before putting a hand in if the baby's head IS in fact compressing the cord? Presumably the monitor is showing the baby is in distress and cord compression is a likely culprit. But do we know that for sure at that time? And if baby is compressing the cord and must be manually shifted, is it possible that you'd need to continue holding the baby off the cord? And then you couldn't reach the oxygen to put on mom. It's better to have baby off cord than oxygen on mom, definitely. But wouldn't it be even better to have baby off cord AND oxygen on mom? That's why I was wondering if the oxygen were right there ready to go if it might ever make sense to put the oxygen on first.

But why would you stick your hand up the hole, THEN put gloves on?... If the gloves are there, though, of course, put the darn things on BEFORE touching

If any student seriously thought touch first put on gloves later, yikes! But a student might think that in the overall big picture, getting the baby's head off the cord might be a higher priority than putting on the sterile gloves in the same way that getting the baby's head off the cord is a higher priority than putting oxygen on the mom. If we put 1) sterile gloves 2) hand in , 3) oxygen 4 ) towel... then are we saying that after everything else THEN we put a towel underneath? That certainly doesn't make sense, either!

a towel in no way will fix the problem or be necessary

The sterile gloves don't fix the problem, either. But of course, reducing the risk of infection is also a priority! Is reducing the risk of infection a higher priority than getting baby off cord ASAP? Is that the real question here?

I guess what bugs me about these types of question is why not just test knowledge and understanding directly?

For this procedure, should you use sterile gloves, or are non-sterile gloves alright?

Baby in lady partsl passage is showing distress, what might be causing it?

If baby head is compressing the cord, what should the nurse do?

-----------

Thanks for the dialogue!!!

And you're right...sterile gloves won't fix the problem. BUT based on the options given(which aren't always gonna be the best or most ideal options in everyone's mind), gloves would just make sense to be first. And with the 02 taking 5 seconds, who knows if the 02 is set up or not, can't assume like you said. A lot of times when you read a question and an answer pops into your mind, that answer won't be one of the ones available. They do it not to trick you, but in a way get you outta that comfort zone and help you think more critically.

jjjoy, LPN

2,801 Posts

Hmm... the question clearly states it's about priority, not sequence...

a) Sterile Gloves - minimize risk of infection to mom

b) Put hand in to move baby off cord - get oxygen to baby ASAP

c) Put oxygen on mom - increase oxgyen available to baby via cord

d) Put towel under mom - for comfort and cleanliness only (not reducing risk of infection, skin breakdown, etc)

B is certainly higher priority than C. And both B and C are higher priority than D. So were does A fit in? If we're not successful in moving baby off the cord (if some alternate action must be taken and/or baby doesn't survive), at least mom's risk of infection has been minimized?

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