Walkthrough: Reduction of Risk Potential Q3 – NCLEX-RN®

00:01 A client whose at 30 weeks gestation is in the active phase of the second stage of labor.

00:07 Wo-hoo, that's a lot of information.

00:09 Which priority step does the nurse implement during this delivery? Okay, so put this in your own words.

00:16 I've got somebody at 30 weeks gestation.

00:18 That's early, right.

00:20 We would want them to go much longer than that.

00:22 So that's early.

00:23 That's the first thing I want to note.

00:25 They're in the active phase of the second stage of labor.

00:29 Okay, this baby's coming.

00:30 So, I have a preterm baby coming.

00:33 Which priority step does the nurse implement during this delivery? You're going to be looking for the thing that keeps this particular patient in this particular setting, the safest.

00:44 Now we've looked at the queues, right.

00:45 We know the 30 weeks gestation, early active phase, the second stage of labor.

00:50 That's a cue that says this baby's coming.

00:53 It's asking me to pick the best answer to keep this particular patient or patients in this particular setting, the safest.

01:02 Okay, go ahead.

01:04 We're showing you the answer choices now.

01:05 I want you to work through this question.

01:07 Remember to use your scratch paper 1, 2, 3, 4.

01:10 Eliminate answers one at a time and say why you're doing it, then come back. And we'll walk through that question together.

01:26 Okay, welcome back.

01:28 Alright, let's start with number one.

01:29 Did that one kind of weirds you out a little? Yeah. This is classic NCLEX, isn't it? So remind the client to avoid open glottis pushing? What the heck is open glottis pushing? Let me tell you.

01:43 We're looking for the priority step.

01:46 And so, what I was, does this help keep the patients safe? Avoid open glottis pushing.

01:53 Okay. I love that we have this answer choice in here for you.

01:56 Because things on the NCLEX are just worded awkward.

02:01 I mean, weird, sometimes.

02:03 No one ever says this.

02:04 "I've never heard this in a hospital." I mean, I don't hang out labor and delivery a lot.

02:08 But I don't know what it is.

02:09 So you have to think open glottis pushing? Well, this is just like if you've ever worked out or lifted heavy weights.

02:17 Remember, you're not supposed to hold your breath when you're straining.

02:20 So that's all they're saying is don't hold your breath, leave your glottis open, so you're still taking air in.

02:26 So number one, that's not my priority step during the delivery.

02:30 I want her to have open glottis pushing.

02:34 It's really open glottis breathing while you're pushing.

02:36 But there you go.

02:38 So, great reminder.

02:40 Words and phrases on the NCLEX may be unlike anything you've ever seen before.

02:44 So slow down and think about what does that really mean? And don't waste any energy thinking I would never word it that way.

02:53 Not worth your time. So moving on.

02:57 Okay, number two.

02:59 Notify the Neonatal Intensive Care Unit delivery team.

03:03 Alright, does that seem rational for 30 weeks gestation in the active phase of the second stage of labor? Yeah, it seems reasonable.

03:12 I know that in those types of deliveries, you're gonna have lots of specialists there.

03:16 So yeah, I'm gonna leave it in for now.

03:19 Number three. Monitor the client's bladder.

03:22 Okay, we have a preterm baby coming and she's in this phase of labor.

03:29 Why would we be worried about her bladder? I mean, I know that it can be useful because a full bladder will slow down labor, but this client is about to deliver a 30 week gestation baby.

03:40 So I'm not as worried about her bladder, as getting that NICU team into the room to help me.

03:46 Okay, so that's not my top priority.

03:49 Number three, you're out.

03:51 But see how they did that.

03:53 What they're counting on, is you thinking back, like, "Oh, I know you're supposed to have an empty bladder when you deliver." That is true.

04:00 But in your nursing clinical judgment, when you looked at the cues and you analyze them, you came up with that hypothesis that that baby's coming.

04:09 So is it more important to have the experts in the room to take care of the baby? Or to look at the client's bladder, right? That's how you start weeding out the tiny differences between things.

04:21 Now, number four.

04:22 Emphasize the importance of breastfeeding.

04:25 Okay, can we have a baby coming at 30 weeks gestation, a preemie? This moms and active phase of labor.

04:31 This is not the time to do any type of patient education that does not have to do directly with the delivery process.

04:39 So yes, education is important.

04:41 Breastfeeding is important.

04:42 And I know that's a very emotional issue for a lot of people.

04:46 But here's the deal.

04:48 That's not going to keep this particular patient and their baby, in this particular setting, the safest.

04:55 The safest answer is from these four choices, get that NICU team into the delivery room with you.

05:02 So number two.

05:04 Notify the Neonatal Intensive Care Unit delivery team.

05:07 Good work.

05:08 Now you're ready for the next question.