This test quesiton is driving me nuts! What is the right answer

~Mi Vida Loca~RN, ASN, RN · Mar 20, 2009

Well I am not in NS until August but I pick C just from having 4 kids and being involved in 5 other births. I know they didn't tell me all their findings, and I know A and B are wrong. But maybe they were supposed to tell me their findings and just didn't.

Jolie, BSN · Mar 20, 2009

The correct answer is D.

lady partsl exams should be performed no more than absolutely necessary due to increasing risk of infection with each additional exam, so A is wrong.

lady partsl bleeding is often a contraindication for a lady partsl exam, so B is wrong.

lady partsl exams should be done under as sterile conditions as possible, so C is wrong.

Patients and their partners need to be kept updated, so D is correct. Telling the patient and her partner the dilation, effacement, station and presenting part is within the scope of nursing practice. It does not involve making a diagnosis.

shann106 · Mar 20, 2009

Thanks Jolie,

I went back and forth between C and D. What kept me from picking D was "all" The book says that before membranes are ruptured use clean gloves, after ROM then use sterile gloves, since it did not say one way or the other I was torn. I changed my answer several times. Urg! I hate when I change answers

~Mi Vida Loca~RN, ASN, RN · Mar 20, 2009

The correct answer is D.
lady partsl exams should be performed no more than absolutely necessary due to increasing risk of infection with each additional exam, so A is wrong.
lady partsl bleeding is often a contraindication for a lady partsl exam, so B is wrong.
lady partsl exams should be done under as sterile conditions as possible, so C is wrong.
Patients and their partners need to be kept updated, so D is correct. Telling the patient and her partner the dilation, effacement, station and presenting part is within the scope of nursing practice. It does not involve making a diagnosis.

Ahhhh so i just had a RN that didn't follow procedure. I figured it was one or the other LOL.

Daytonite, BSN, RN · Mar 20, 2009

when doing an internal lady partsl exam on a laboring woman which of the following is true?

a. perform internal exam every hour

b. if their is lady partsl bleeding significantly increase the frequency of internal exams

c. use 2 clean gloves each time

d. tell the mother and father all your findings

the answer is "d". there are no specific rules about frequency of these exams. lady partsl bleeding is a contraindication. sterile gloves are always to be used. my ob procedure book specifically lists the last step of this procedure as "share your results of the exam with the mother". results are going to be determining if the amniotic sac is intact, the presenting part, how many millimeter of dilation (that's what most moms want to know), % effacement and fetal station. the information that is going to change is the dilation, eg=ffacement and station.

jjjoy, LPN · Mar 20, 2009

I just did a quick on-line search and many references do say to use sterile gloves. Double gloving usually was referenced regarding a non-pregnancy related lady partsl exam where a rectal exam was also going to be done, so you could just pull one glove off and continue the exam.

However, if your book says to use clean gloves on a laboring patient's internal lady partsl exam, that would be a very confusing question, since I imagine there might be some situation out there where the nurse might avoid telling "all of the findings" immediately to the mother and father.

lilbeans · Mar 20, 2009

I am no expert but I don't know if you should have to tell the father. Isn't the only patient the mother and the baby? Isn't their HIPPA? I am not saying the father isn't important but I think that D is wrong. I am still a student, so I would like an explanation too. Maybe I am reading too much into the question.

truern · Mar 20, 2009

Had my 2nd OB test today and one question is driving me crazy.
When doing an internal lady partsl exam on a laboring woman which of the following is true?
a. Perform internal exam every hour
b. If their is lady partsl bleeding significantly increase the frequency of internal exams
c. use 2 clean gloves each time
d. tell the mother and father all your findings
How would you answer?

The only correct answer is d. Hourly exams aren't necessary. You definately wouldn't increase frequency of exams if bleeding. Sterile gloves are used and even then there's the chance of introducing bacteria into the lady parts when the gloved fingers enter the lady parts.

To the poster wondering about fathers and HIPAA....there's consent from the mother or he wouldn't be present in the room :)

lilbeans · Mar 20, 2009

I hate arguing but, there have been patients in the room that do not have consent to know everything about the patient. And why are we assuming that the father is in the room. My husband is a little squeamish. He was not in the room for a lot of things. Sorry.

Jolie, BSN · Mar 20, 2009

However, if your book says to use clean gloves on a laboring patient's internal lady partsl exam, that would be a very confusing question...

There are sources that state that clean gloves are acceptable for an exam on a mother whose membranes are intact. Let's assume that is an acceptable option. The key to the question on the OP's test is that it states that 2 gloves are necessary for every exam. This is untrue. A skilled nurse can (and often does) perform a lady partsl exam with only a single glove on one hand. The non-dominant hand does not touch the patient, so it is not necessary to glove that hand.

As for sharing information with the patient's partner...if he is present during the very intimate act of a lady partsl exam, and the patient has not specified otherwise, then it is appropriate to immediately share information with both the patient and her supporting partner. Frankly, it would be cruel not to.

truern · Mar 20, 2009

I hate arguing but, there have been patients in the room that do not have consent to know everything about the patient. And why are we assuming that the father is in the room. My husband is a little squeamish. He was not in the room for a lot of things. Sorry.

We're not assuming...the answer states give the information to the mother and father, therefore he must be in the room.

I don't understand your first point. Other patients as in semi-private rooms?? I've never seen mothers labor in anything but private rooms.

Besides, we're discussing the most correct answer to the test question from the answers provided. None of the others are even remotely correct so the obvious choice is d.