Nokea
The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel?
- A. Doppler
- B. Fetoscope
- C. Scalp electrode
- D. Tocodynamometer
Correct Answer: A
Rationale: The correct answer is A: Doppler. Doppler requires the use of a gel to enhance the transmission of sound waves for accurate assessment of the fetal heart rate. Gel helps to eliminate air between the Doppler probe and the skin, improving signal quality. Fetoscope (B) is a direct listening device; Scalp electrode (C) and Tocodynamometer (D) do not require gel for fetal heart rate assessment.
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What pregnant person is at high risk for labor dystocia?
- A. 38-week gestation
- B. 41-year-old
- C. prenatal anemia
- D. no prenatal care
Correct Answer: B
Rationale: The correct answer is B: 41-year-old. Advanced maternal age increases the risk of labor dystocia due to reduced uterine muscle tone and coordination. Older individuals are more likely to experience prolonged labor or difficulty with fetal descent. Choice A (38-week gestation) is not a risk factor for labor dystocia. Prenatal anemia (Choice C) may lead to complications during pregnancy but is not directly linked to labor dystocia. Lack of prenatal care (Choice D) can increase the risk of complications but is not a specific risk factor for labor dystocia.
In a spontaneous abortion, if bleeding from the retained products of conception cannot be stopped, what is the next course of action?
- A. surgery for a dilation and curettage
- B. surgery for a hysterectomy
- C. administration of magnesium sulfate
- D. administration of calcium gluconate
Correct Answer: C
Rationale: The correct answer is C: administration of magnesium sulfate. This is because magnesium sulfate is used to control bleeding in cases of retained products of conception in a spontaneous abortion. It works by causing uterine contractions, which help expel the remaining tissue and stop the bleeding. Surgery for dilation and curettage (choice A) is typically performed if bleeding persists after medical management. Surgery for a hysterectomy (choice B) is not necessary for managing bleeding in this situation. Administration of calcium gluconate (choice D) is not indicated for controlling bleeding in cases of retained products of conception.
The fetal heart rate baseline increases 20 bpm after vibroacoustic stimulation. The best interpretation of this is that the fetus is showing
- A. a worsening hypoxi
- B. progressive acidosis.
- C. an expected respons
- D. parasympathetic stimulation.
Correct Answer: C
Rationale: The correct answer is C. After vibroacoustic stimulation, an increase in fetal heart rate baseline indicates an expected response, showing the fetus is healthy and responding appropriately to the stimulus. This increase is a sign of fetal well-being and does not suggest worsening hypoxia (choice A) or progressive acidosis (choice B). Additionally, parasympathetic stimulation (choice D) would typically lead to a decrease in heart rate, not an increase as observed in this scenario. Therefore, choice C is the best interpretation based on the positive response of the fetal heart rate to the stimulation, indicating a healthy and expected reaction.
The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient's contractions. How will the nurse document these findings?
- A. Late decelerations
- B. Early decelerations
- C. Variable decelerations
- D. Proximal decelerations
Correct Answer: B
Rationale: The correct answer is B: Early decelerations. Early decelerations occur in response to fetal head compression during contractions, resulting in a gradual decrease in the fetal heart rate that mirrors the timing of contractions. In this scenario, the fetal heart rate drops to 20 bpm below the baseline during contractions and returns to baseline after contractions, indicating a benign pattern. Late decelerations (choice A) occur after the peak of the contraction and are associated with uteroplacental insufficiency. Variable decelerations (choice C) are abrupt decreases in fetal heart rate without a consistent timing in relation to contractions, often due to cord compression. Proximal decelerations (choice D) are not a recognized classification of decelerations in fetal monitoring.
The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply.
- A. Fetuses in breech position unable to deliver vaginally
- B. Increased number of elective or maternal request cesareans
- C. Incidences of women of older maternal age getting pregnant
- D. Decreasing rate of malpractice litigation with cesarean birth
Correct Answer: B
Rationale: The correct answer is B: Increased number of elective or maternal request cesareans. This is correct because the rise in elective cesarean births, often due to patient preference or convenience, can contribute to the overall high rates of cesarean births.
A: Fetuses in breech position unable to deliver vaginally - This is a valid reason for cesarean births, but it does not address the question about high rates of cesarean births.
C: Incidences of women of older maternal age getting pregnant - While advanced maternal age can be a factor in cesarean births, it is not directly related to the high rates of cesarean births at the facility.
D: Decreasing rate of malpractice litigation with cesarean birth - This is an irrelevant factor in determining the reasons for high rates of cesarean births at the facility.