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A mother is learning how to breastfeed her newborn. tions, moderate variability The lactation nurse is assisting her with this process.
- A. Baseline FHR 140, occasional variable decelera- Which technique is correct? tions, moderate variability
- B. Have the mother stroke the infant's mouth with
- C. Baseline FHR 105, no accelerations, recurrent her nipple so the infant will turn toward the variable decelerations, minimal variability mother's breast for feeding.
- D. Baseline FHR 165, no decelerations, marked
Correct Answer: B
Rationale: Having the mother stroke the infant's mouth with her nipple so the infant will turn toward the mother's breast for feeding is the correct technique when assisting a mother in learning how to breastfeed her newborn. This technique helps stimulate the baby's rooting reflex, which is a natural reflex babies have to turn their head and open their mouth when their cheek is stroked.
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A client has just given birth, during labor the fetus was in brow presentation, but after prolonged laboring the fetus convert to occiput presentation and was delivered vaginally by vacuum extraction
- A. What should be explained
- B. Molding of the head will subside in a few days
- C. Meconium aspiration
- D. Infant will have prophylactic antibiotic
Correct Answer: A
Rationale: In this scenario, it is important to explain to the client what happened during labor and delivery. It is essential to communicate that the fetus was in a brow presentation initially, which can sometimes lead to complications during labor. However, the fetus converted to occiput presentation and was successfully delivered vaginally with the help of vacuum extraction. Providing this information to the client helps in ensuring transparency and understanding of the events that occurred, addressing any concerns or questions they may have about the delivery process.
A nurse is caring for a client who is receiving oxytocin to augment labor. The nurse notes recurrent variable decelerations...Which of the following actions should the nurse take first?
- A. Prepare the equipment necessary to initiate an amnioinfusion.
- B. Administer oxygen at 10 L/min via nonrebreather face mask.
- C. Discontinue the infusion of oxytocin.
- D. Place the client in a left lateral position.
Correct Answer: C
Rationale: Recurrent variable decelerations during labor can indicate umbilical cord compression, which can result in fetal hypoxia and distress. Discontinuing the oxytocin infusion is the priority in this situation as oxytocin can cause or exacerbate uteroplacental insufficiency leading to fetal distress. By discontinuing the oxytocin, the nurse can help improve fetal oxygenation and alleviate the variable decelerations. After stopping the oxytocin infusion, the nurse should continue to monitor the fetal heart rate pattern and follow the healthcare provider's orders for further management if needed.
The nurse is caring for a patient who could be at risk for uterine
- A. What should the nurse be monitoring the fetus closely for? SATA
- B. Loss of ability to determine fetal station
- C. Bradycardia
- D. Late decelerations
Correct Answer: A
Rationale: A. What should the nurse be monitoring the fetus closely for? SATA
The nurse is performing an assessment of a postpartum client. Which finding requires immediate action?
- A. Temperature of 100.4°F.
- B. Foul-smelling lochia.
- C. Fundus firm and midline.
- D. Breast tenderness on palpation.
Correct Answer: B
Rationale: Foul-smelling lochia may indicate an infection and requires prompt medical evaluation.
The nurse is educating a client about kick counts. What instruction is most appropriate?
- A. Perform kick counts once a week.
- B. Lie on your back to count fetal movements.
- C. Count 10 fetal movements over 2 hours.
- D. Start counting movements at 36 weeks.
Correct Answer: C
Rationale: Counting 10 fetal movements within 2 hours is a standard method to monitor fetal well-being.