Filerook

I can certainly see where one could conclude that -- sometimes it is hard to tell the difference between head and butt. But I guess the vast majority of baby butts I have palpated have been must more "irregular" feeling than heads, and not as hard and round. The question could have been written more clearly by simply adding "ballotable" to the description. That would have clearly indicated a head rather than a butt. Valerie

hm...i agree that "firm and round" implies the head, but in the question it is said to be found in the uterine fundus, which means that it is not the presenting part. so i still feel that this baby is lst to lsa. valerie

I am glad it is helpful to you. And I am sorry that your client refused your care during delivery. I do understand the client's right to choose (and refuse) caregivers, but it is too bad that it was - apparently - based on gender. Most of those same patients don't have a problem with male OBs. When I worked L&D, the nurse in charge of our mother/baby unit education was male. He was a terrific nurse, but even he had occasional problems with patients (and doctors!) refusing his care. Anyway, let me know if I can be of any further help. Valerie

Heh, well, I am a former L&D nurse. I quit nursing for a few years in order to go to law school. But when I was working, most of the nurses I knew really had very little experience with palpation. I don't believe I ever saw anyone use a fetoscope, and even a doppler was rare. Generally, laboring women would come in and be hooked up to the fetal monitor. My experience with palpation comes more from twenty years or so of being a homebirth midwife (yeah -- I was one of THOSE -- a subject for another time). As to problems with "fetus diagrams," can you be more specific about what parts are giving you the most difficulty? Perhaps the best way to start is to keep in mind that the fetus can basically enter the pelvis in three different ways -- head first, butt first, or shoulder first. That is to say, breech, vertex, or transverse. If the baby is breech, the position is described by the relationship of the sacrum to the mother. Therefore, if the sacrum is towards the mothers front (anterior) the position would be SA - sacrum anterior. If the sacrum is towards the mother's back (posterior) it would be SP (sacrum posterior). If towards the left side of mother, it would be LST (left sacrum transverse - not to be confused with a tranverse lie, where the entire baby is lying crosswise in the uterus). If the baby's sacrum is towards the mother's left side and a little toward the front, it would be LSA (left sacrum anterior). The same rules apply to positions towards the mothers right side, and to posterior positions. The important thing to remember is that with a breech, the middle letter is always going to be an S, for sacrum. With vertex babies, this "marker" is an O, for occiput, but the same rules apply. So, another way to look at it is this way: 1. Is the baby head down or butt down? 2. Is the "marker" (actually officially called a "denominator" more towards the mother's left or right? 3. Is the "marker" more towards the mother's anterior or posterior. So, for one more example -- let's look at LOP, which you referred to in your post. For an LOP baby, we know from the O that this baby has to be head down. The L tells us that the occiput is towards the mother's left side, and the P lets us know that the occiput is also towards the mother's back. For transverse lies, the denomimator is the scapula, abbreviated Sc, but I cannot even imagine that the NCLEX is going to get into something that obscure. Anyway, I hope this is helpful -- if not, let me know and I will try to clarify! Valerie

I think the answer to your question lies in the precise wording of the suggested responses. The position of this baby would likely be either LST or LSA - left sacrum transverse, or left sacrum anterior (not LOP, as a previous poster mentioned, because the presenting part is the sacrum, not the occiput). I would expect to auscultate FHTs on the mother's left side, but probably NOT by the umbilicus, which would be more midline. So, while I agree that FHTs might be more likely to be heard above the umbilicus with a breech baby, they wouldn't be heard "by the umbilicus." It really is a poorly worded, confusing question. Valerie, former L&D RN

It can be done, really. About 3 weeks ago I passed the NCLEX in 75 questions. At the same time I am studying to take the Bar exam at the end of July (I just graduated from law school last month). And no -- I am no "spring chicken" either -- I am 57. But I found it helpful to use the CD from Saunders, and go over 50-100 questions per day. I also found it helpful to not only review why the correct answer WAS correct, but to also look closely at why the wrong answers were wrong. Eliminating wrong answers is, I think, just as essential to passing the test as is picking out the right answer.

Hello! I was in a similar situation, perhaps. I first took (and passed in 75 questions) the NCLEX ten years ago. Because my RN license was inactive for five years, I was required to retake the NCLEX in order to restore my license to active status. It had been a while since I studied all this stuff -- I graduated from nursing school in 1998 -- so I was kind of nervous about it. But I used Saunders, and tried to do 100 questions a day, and found that it really did all come back. I retook the NCLEX last Friday, and passed -- again with 75 questions. I am probably one of the few people out there who has taken and passed that test twice :) I do think it is harder than it was 10 years ago, but I think it can still be passed by anyone who can get through nursing school! Obviously, it is important to know the material, but I think it is also important to know the test -- exactly what the question is asking, how the possible answers are worded, and hints one can gain from the words that are used. Best of luck to you!