Nokea
The patient presenting at 38 weeks' gestation, gravida 1, para 0, vaginal exam 4 cm, 100% effaced, +1 station vertex. What is the most likely intervention for this fetal heart rate pattern?
- A. Continue oxytocin (Pitocin) infusion.
- B. Contact the anesthesia department for epidural administration.
- C. Change maternal position.
- D. Administer Narcan to patient and prepare for immediate vaginal delivery.
Correct Answer: C
Rationale: The correct answer is C: Change maternal position. At 38 weeks' gestation with 4 cm dilation and 100% effacement, the fetal heart rate pattern suggests possible umbilical cord compression due to the +1 station vertex position. Changing maternal position can relieve this compression, improving fetal heart rate. Continuing oxytocin infusion (A) can worsen the situation by increasing contractions. Contacting anesthesia for epidural (B) is not indicated as it doesn't address the immediate concern. Administering Narcan and preparing for immediate delivery (D) is unnecessary and not supported by the given scenario.
You may also like to solve these questions
The nurses in a labor and delivery unit are concerned about the high incidence of cesarean deliveries at their facility and initiate an internal study. Which is the most likely condition the nurses will recognize as a contributor to the rate of cesarean births?
- A. The facility has a high rating for managing high-risk pregnancies.
- B. Policies and parameters for cesarean need to be reviewed and refined.
- C. Community education about the advantages of vaginal birth is deficient.
- D. The incidence of maternal requests for cesarean delivery is increasing.
Correct Answer: D
Rationale: Step 1: Maternal requests for cesarean delivery are a significant contributor to the high incidence of cesarean births.
Step 2: Maternal requests may stem from various factors such as fear of labor pain, convenience, or personal preferences.
Step 3: Nurses can address this issue by educating women on the risks and benefits of cesarean versus vaginal delivery.
Step 4: By understanding and addressing maternal requests, the facility can potentially lower the cesarean delivery rate.
Summary:
- Choice A is incorrect as high-risk pregnancies do not directly contribute to the rate of cesarean births.
- Choice B is incorrect as reviewing cesarean policies alone may not address the underlying issue of maternal requests.
- Choice C is incorrect as community education, while important, may not directly impact the rate of cesarean deliveries as compared to addressing maternal requests.
In a research study performed by Schneuder, L., Crenshaw, J., and Gilder, R. (2017), which action by the nurse will be implemented following a cesarean delivery?
- A. Allow the birth partner to hand the neonate to the mother.
- B. Assist the mother and partner to cut the umbilical cord.
- C. Move the neonate into the visual field of the mother.
- D. Encourage skin-to-skin contact between the mother and neonate.
Correct Answer: D
Rationale: The correct answer is D: Encourage skin-to-skin contact between the mother and neonate. This action is crucial following a cesarean delivery to promote bonding, regulate the baby's temperature, and facilitate breastfeeding. Skin-to-skin contact also helps stabilize the baby's heart rate, breathing, and blood sugar levels.
A: Allowing the birth partner to hand the neonate to the mother may be a good practice but is not as essential as skin-to-skin contact for immediate benefits.
B: Assisting the mother and partner to cut the umbilical cord is not typically the nurse's responsibility immediately after a cesarean delivery and does not provide the same benefits as skin-to-skin contact.
C: Moving the neonate into the visual field of the mother is important for bonding but does not offer the same physiological benefits as direct skin-to-skin contact.
The nurse is educating a gravida 1 para 0 who is 28 weeks pregnant. Which educational topics are appropriate for the nurse to discuss with the patient at this prenatal visit? Select all that apply.
- A. Discussion of prenatal classes
- B. Discussion of alcohol use
- C. Discussion of family history for pregnancy-induced hypertension
- D. Discussion of signs and symptoms of preterm labor
Correct Answer: B
Rationale: The correct answer is B, Discussion of alcohol use. This topic is important for prenatal education to ensure the well-being of the mother and baby. Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders. The other choices are incorrect because:
A: Discussion of prenatal classes is relevant, but not a priority at 28 weeks.
C: Discussion of family history for pregnancy-induced hypertension is important but not usually discussed at every prenatal visit.
D: Discussion of signs and symptoms of preterm labor is crucial, but typically discussed later in pregnancy.
Which clinical finding can be determined only by electronic fetal monitoring?
- A. Variability
- B. Tachycardia
- C. Bradycardia
- D. Fetal response to contractions
Correct Answer: D
Rationale: The correct answer is D because electronic fetal monitoring is the only method that can directly measure and display the fetal heart rate in response to contractions. Variability, tachycardia, and bradycardia can also be observed through electronic fetal monitoring, but fetal response to contractions specifically requires continuous monitoring of the fetal heart rate during contractions. Therefore, D is the only clinical finding that can be determined exclusively through electronic fetal monitoring. Variability (A), tachycardia (B), and bradycardia (C) can be identified through other means of monitoring and assessment as well.
A primipara patient who is 12 weeks gestation is being scheduled for an abdominal ultrasound. The client asks the nurse why she needs this test. What is the nurse’s best response?
- A. This test is to determine the position of the fetus.
- B. This test is to determine if there is enough amniotic fluid.
- C. This test is to determine how many weeks gestation you are.
- D. This test is to determine fetal breathing movements.
Correct Answer: C
Rationale: The correct answer is C: This test is to determine how many weeks gestation you are. At 12 weeks gestation, an ultrasound is commonly performed to accurately determine the gestational age of the fetus. This is important for monitoring fetal development and ensuring proper prenatal care.
A: This test is to determine the position of the fetus - Incorrect. The position of the fetus is usually determined in later stages of pregnancy and not the primary objective of an early pregnancy ultrasound.
B: This test is to determine if there is enough amniotic fluid - Incorrect. Amniotic fluid levels are typically assessed in later stages of pregnancy, not at 12 weeks gestation.
D: This test is to determine fetal breathing movements - Incorrect. Fetal breathing movements are typically observed in the third trimester, not at 12 weeks gestation.