I am studying to writen the NCLEX RN in Canada and I have used the NCSBN and uworld resources to study. I came across the question of, "what do you do in priority sequence when a the fetal heart monitor is showing late decels?". Both resources have given different orders for intervention and I want to know what the right answer is haha HELP
NCSBN says the order should be:
1) turn client to left side
2) administer IV bolus
3) give oxygen
4) discontinue oxytocin
5) notify HCP
uWorld says the order should be:
1) discontinue oxytocin
2) turn client to left side
3) administer oxygen via nonrebreather mask
4) administer prescribed IV bolus of Ringers or NS
5) notify HCP
To me I think that uWorld makes the most sense but definitely want to hear some opinions so I don't get the answer wrong. Thanks :)
Did you read the rationales? NCBSN makes more sense
Reading rationales to answers you get incorrect is a first step in understanding the information.
Also, when I was studying for the NCLEX, I found that even some books and sources have a few errors in their rationale (like the answer that they designed is incorrect, and another option has the accurate rationale) or not updated information; you have to discern what answer makes the most sense based on the key words.
Agree with the others with the NCSBN answer. In my maternity class the acronym we learned for intervention on late decels was LION Pit, left lateral position, IV, oxygen, (turn off pitocin). I have also seen the same acronym given in several other resources that I have looked at while studying for the NCLEX.
I was always taught discontinue oxytocin then turn on left side. I took an ATI review class for my school and they said the same thing. But, I'm finding they were wrong on a couple of things so far. I'm very confused.
If you could only do one thing and then go home is... to stop what's causing it all: Pitocin, to many contractions, too much uterine stimulation.
Then turn the patient, O2 and then IV bolus (remember Pitocin acts like an antidiuretic hormone, therefore there will be some risk of fluid retention so do not give additional IV fluids if it isn't necessary, try all other interventions first). If you only turn the patient to the left side while Pitocin is still running, it will only relieve late decels briefly.
If you could only do one thing and then go home is... to stop what's causing it all: Pitocin, to many contractions, too much uterine stimulation.
Then turn the patient, O2 and then IV bolus (remember Pitocin acts like an antidiuretic hormone, therefore there will be some risk of fluid retention so do not give additional IV fluids if it isn't necessary, try all other interventions first). If you only turn the patient to the left side while Pitocin is still running, it will only relieve late decels briefly.
But in your own response, you actually answered the NCSBN answer:
Hi everyone,
I am studying to writen the NCLEX RN in Canada and I have used the NCSBN and uworld resources to study. I came across the question of, "what do you do in ***priority*** sequence when a the fetal heart monitor is showing late decels?". Both resources have given different orders for intervention and I want to know what the right answer is haha HELP
NCSBN says the order should be:
1) turn client to left side
2) administer IV bolus
3) give oxygen
4) discontinue oxytocin
5) notify HCP
uWorld says the order should be:
1) discontinue oxytocin
2) turn client to left side
3) administer oxygen via nonrebreather mask
4) administer prescribed IV bolus of Ringers or NS
5) notify HCP
To me I think that uWorld makes the most sense but definitely want to hear some opinions so I don't get the answer wrong. Thanks :)
Don't always get caught up in the knowledge content; the key word in the question was PRIORITY, so if the initial, meaning the FIRST thing to do is turn the pt on the side, then that follows would be correct; although Pitocin acts like an antidiuretic; the side effects of water retention is NOT immediate; the issue is resolving the late decels not managing the PItocin-fluids and oxygen on board would be the priority; setting up and managing and minimizing the symptoms BEFORE the oxytocin is stopped promotes safety; so you have to prioritize all those pieces as well, especially if fluids and O2 stops the late decels FIRST-remember, priority is the key....the fluids and O2 also address the basic ABC needs as well, and think of OTHER issues that are causing it-do not get fixed on the medicine, rather look at the entire picture and go from there.
The link posted by LadyFree28 basically describes the same rational that we were taught in class. Depending on what is causing the late decels will make a difference of what interventions may work. If the issue is insufficient exchange at the placenta turning the woman onto her side and taking pressure off of the vena cava be enough to increase exchange at the placenta to stop the decels, same with giving the IV bolus to increase blood volume. We were taught in class even though this might be the order that you would follow, there are situations in which all of these things would be happening at the same time if not close to each other.
Agree with the others with the NCSBN answer. In my maternity class the acronym we learned for intervention on late decels was LION Pit, left lateral position, IV, oxygen, (turn off pitocin). I have also seen the same acronym given in several other resources that I have looked at while studying for the NCLEX.
Studying for my NCLEX and I keep coming across mentions of LION Pit. What on earth is this? I assume its an acronym but for the life of me I can't figure it out!
Knowing my luck I'll get this question and all I'll remember is LION Pit and be so pissed at myself lol
Larry2016
157 Posts
Did you read the rationales? NCBSN makes more sense