# A nurse is performing Leopold's maneuvers on a pregnant client at 34 weeks gestation. During the third maneuver, the nurse palpates a hard, round, movable mass in the lower uterine segment. What is the most appropriate nursing assessment to perform next?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542984  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is performing Leopold's maneuvers on a pregnant client at 34 weeks gestation. During the third maneuver, the nurse palpates a hard, round, movable mass in the lower uterine segment. What is the most appropriate nursing assessment to perform next?

## 보기

1. Perform the fourth Leopold's maneuver to assess fetal head engagement **✔ 정답**
2. Measure fundal height to confirm gestational age
3. Auscultate fetal heart tones at the umbilicus level
4. Document breech presentation and notify the physician immediately

**정답: 1**

## 해설

After palpating a hard, round, movable mass in the lower uterine segment during the third Leopold's maneuver, the next appropriate assessment is to perform the fourth maneuver to evaluate fetal head engagement and confirm the presenting part for comprehensive evaluation.

## 심화 해설

Clinical Judgment
This question evaluates the systematic application of Leopold's Maneuvers and the 'Cue Recognition' and 'Analysis' stages of the Clinical Judgment Model (CJMM). During the third maneuver, a firm, round, mobile mass was palpated in the lower uterine segment. This is a key cue indicating the fetal head (cephalic presentation) is near the pelvic inlet but not yet fully engaged. The most appropriate next nursing assessment is to perform the fourth maneuver to evaluate the degree of engagement of the fetal head, confirming this cue and gathering additional information. This completes the systematic assessment and provides critical information about readiness for labor.

Memory Tip:
Remember the sequence of Leopold's Maneuvers: **1st** (fundal palpation: identify the fetal part in the fundus), **2nd** (lateral palpation: identify the fetal lie), **3rd** (Pawlik's grip: identify the presenting part), **4th** (evaluate engagement). If you palpate the head in the 3rd maneuver, the logical next step is the **4th** to determine how far that head has descended into the pelvis (engagement).

KR vs US:
In Korea, the widespread use of ultrasound may relatively diminish the perceived importance of Leopold's Maneuvers, but the US NGN exam emphasizes its significance as a non-invasive physical assessment skill. Especially in situations where ultrasound results are unavailable or conditions are rapidly changing, a nurse's direct palpation ability forms the foundation of clinical judgment.

## 임상 시나리오

Clinical Practice Guide
Leopold's maneuvers are a standardized four-step abdominal palpation method to assess fetal position, presentation, and engagement. The third maneuver (Pawlik's grip) involves palpating just above the symphysis pubis to identify the presenting part (head or buttocks). A firm, round mass suggests the head (cephalic presentation), while a soft, irregular mass suggests the buttocks (breech presentation). In the fourth maneuver, the examiner faces the mother's feet and deeply palpates above the symphysis pubis with the fingertips of both hands to assess the degree of engagement of the fetal head (floating, dipping, engaged).

Caution:
A common pitfall in SATA (Select All That Apply) questions is the option "report the finding immediately upon discovery." Leopold's maneuvers are an assessment procedure. Palpating the head in the third maneuver does not constitute an emergency requiring immediate reporting. First, complete the systematic assessment (perform the fourth maneuver) to gather comprehensive information, then decide whether to report based on the results (e.g., discovery of breech presentation).

## 핵심 개념

- **Leopold's Maneuvers** — This is a four-step systematic abdominal palpation method to assess the fetal attitude, lie, presenting part, and degree of engagement.
- **Fetal Presentation (선진부)** — The part of the fetus closest to the mother's pelvic inlet during delivery. It is mainly the vertex (head) or the breech (buttocks).
- **Fetal Engagement (진입)** — The presenting part of the fetus (usually the head) has passed through the pelvic inlet and descended into the true pelvic cavity. The engaged head no longer moves freely above the pubic symphysis.
- **Pawlik's Maneuver (파울릭 촉진법)** — The third step of Leopold's maneuvers involves palpating just above the pubic symphysis to assess the size, shape, and movement of the presenting part.
- **Cephalic Presentation (두정위)** — Fetal head is the presenting part. This is the most common fetal position and is favorable for vaginal delivery. On Leopold's third maneuver, it is palpated as a firm, round mass.

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