A nurse is preparing to perform Leopold maneuvers on a client who is at 36 weeks of gestation. Identify the sequence of actions the nurse should take.

Position the client supine with knees flexed and place a small, rolled towel under one of their hips.

Palpate the fetal part positioned above the symphysis pubis.

Instruct the client to empty their bladder.

Palpate the fetal part positioned in the fundus.

Palpate the fetal parts along both sides of the uterus.

Answer and Explanation

The Correct Answer is C, A, D, E, B

The Leopold maneuvers are a common and systematic way to determine the position of a fetus inside the woman’s uterus. They are typically performed at prenatal examinations during the third trimester of pregnancy. Here is the correct sequence of actions a nurse should take: Instruct the client to empty their bladder. This is done to make the examination easier and more comfortable for the client ©. Position the client supine with knees flexed and place a small, rolled towel under one of their hips. This position helps relax the abdominal muscles and displaces the uterus to the side, reducing the risk of supine hypotensive syndrome (a). Palpate the fetal part positioned in the fundus. This helps determine the fetal lie and presentation (d). Palpate the fetal parts along both sides of the uterus. This helps identify the location of the fetal back and small parts (e). Palpate the fetal part positioned above the symphysis pubis. This helps determine the fetal attitude and degree of extension or flexion of the fetal head (b). Remember, these maneuvers should be performed gently and respectfully, with the nurse explaining each step to the client. The goal is to assess the position and presentation of the fetus, as well as estimate fetal weight, not to change the position of the fetus. If the nurse is unsure about the position or presentation of the fetus, an ultrasound may be needed for confirmation.

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Correct Answer is B

Explanation

Choice A rationale
A WBC count of 11,000/mm is slightly above the normal range (5,000 to 10,000/mm), but it is not uncommon for the WBC count to increase during pregnancy due to physiological changes and increased stress on the body. However, a significantly elevated WBC count could indicate an infection or other medical condition, so it should be monitored closely.
Choice B rationale
A fasting blood glucose level of 180 mg/dL is significantly above the normal range (74 to 106 mg/dL), indicating hyperglycemia. This could be a sign of gestational diabetes, a condition that can develop during pregnancy and cause high blood sugar levels. Gestational diabetes can increase the risk of various pregnancy complications, including preeclampsia, premature birth, and having a baby with a high birth weight. Therefore, this finding should be reported to the provider immediately.
Choice C rationale
A hematocrit level of 37% is within the normal range (37% to 47%), so it would not typically be a cause for concern.
Choice D rationale
A creatinine level of 0.9 mg/dL is within the normal range (0.5 to 1 mg/dL), so it would not typically be a cause for concern.

A. Administer an IV bolus of lactated Ringer’s. B. Assess blood pressure twice daily. C. Restrict daily oral fluid intake. D. Obtain a prescription for misoprostol.

Correct Answer is C

Explanation

Choice A rationale
Administering an IV bolus of lactated Ringer’s is not the best action for a client with peripartum cardiomyopathy. This condition is a form of heart failure that occurs during the last month of pregnancy or up to five months postpartum. It can lead to fluid overload, so giving an IV bolus of lactated Ringer’s could exacerbate the client’s condition.
Choice B rationale
Assessing blood pressure twice daily is important for any postpartum client, but it is not the most critical action for a client with peripartum cardiomyopathy. This condition can lead to fluid overload and heart failure, so while monitoring blood pressure is important, it is not the primary intervention.
Choice C rationale
Restricting daily oral fluid intake is the correct action. Peripartum cardiomyopathy can lead to fluid overload and heart failure. Restricting fluid intake can help manage the client’s fluid status and prevent exacerbation of heart failure.
Choice D rationale
Obtaining a prescription for misoprostol is not relevant in this context. Misoprostol is a medication used to prevent stomach ulcers in patients taking NSAIDs and to induce labor or cause an abortion. It has no role in the management of peripartum cardiomyopathy.

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A nurse is preparing to perform Leopold maneuvers on a client who is at 36 weeks of gestation. Identify the sequence of actions the nurse should take.

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