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Which of the following is theN pUriRorSitIy NinGteTrvBen.tiConO fMor the patient in a left side-lying position whose monitor strip shows a deceleration that extends beyond the end of the contraction?
- A. Administer O at 8 to 10 L/minut
- B. Decrease the IV rate to 100 mL/hour.
- C. Reposition the ultrasound transducer.
- D. Perform a vaginal exam to assess for cord prolaps
Correct Answer: A
Rationale: The correct answer is A: Administer O at 8 to 10 L/minut. In a left side-lying position, this deceleration indicates possible umbilical cord compression, reducing oxygen supply to the fetus. Administering oxygen at 8 to 10 L/min can help improve fetal oxygenation. Decreasing the IV rate (B) wouldn't directly address the fetal distress. Repositioning the ultrasound transducer (C) is irrelevant to the situation. Performing a vaginal exam (D) could worsen the cord compression if the cord is prolapsed.
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The physician has ordered an amnioinfusion for the laboring patient. Which data supports the use of this therapeutic procedure?
- A. Presenting part not engaged
- B. +4 meconium-stained amniotic fluid on artificial rupture of membranes (AROM)
- C. Breech position of fetus
- D. Twin gestation
Correct Answer: B
Rationale: The correct answer is B because +4 meconium-stained amniotic fluid on AROM indicates meconium passage by the fetus, which can lead to meconium aspiration syndrome. Amnioinfusion can help dilute the meconium, reducing the risk of respiratory complications for the newborn.
A: Presenting part not engaged is not a direct indication for amnioinfusion.
C: Breech position of the fetus does not specifically warrant amnioinfusion.
D: Twin gestation alone is not a direct indication for amnioinfusion.
When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated?
- A. Reposition the patient.
- B. Apply a fetal scalp electrode.
- C. Record this normal pattern.
- D. Administer oxygen by nasal cannula.
Correct Answer: C
Rationale: Rationale for correct answer (C): Recording the normal pattern is indicated because the deceleration pattern mirroring uterine contractions is a reassuring sign of fetal well-being. It indicates a physiologic response to labor. Repositioning the patient (A) is unnecessary as the pattern is normal. Applying a fetal scalp electrode (B) is invasive and unnecessary in this scenario. Administering oxygen (D) is not indicated as the fetal heart rate pattern is normal.
What is a potential complication when the fetus is footling breech?
- A. prolapsed cord
- B. oligohydramnios
- C. low biophysical profile score
- D. meconium-stained fluid
Correct Answer: A
Rationale: The correct answer is A: prolapsed cord. In a footling breech presentation, the feet or legs of the fetus are positioned to deliver first, increasing the risk of the umbilical cord slipping down before the fetus during labor, leading to a prolapsed cord. This is a serious emergency as it can compromise fetal blood flow and oxygen supply.
Choice B: Oligohydramnios is a decreased level of amniotic fluid and is not directly related to a footling breech presentation.
Choice C: Low biophysical profile score indicates fetal well-being based on specific parameters and is not a direct complication of a footling breech presentation.
Choice D: Meconium-stained fluid can occur due to fetal distress but is not specific to a footling breech presentation.
A multigravida patient comes into the clinic for one of her second-trimester prenatal visits. The nurse reviews her laboratories that were drawn prior to the visit. Which laboratories results should concern the nurse most?
- A. Platelet count of 200,000 per μL (microliter) of blood
- B. Hemoglobin 9.5 g/dL
- C. White blood cell count of 11,000/μL
- D. Rubella titer ratio of 1:10
Correct Answer: B
Rationale: The correct answer is B: Hemoglobin 9.5 g/dL. This result indicates the patient is anemic, which is concerning during pregnancy as it can lead to complications like preterm birth or low birth weight. Anemia can also affect the mother's health. Platelet count of 200,000/μL is within the normal range, not a cause for concern. White blood cell count of 11,000/μL may indicate infection but is not as critical as anemia in pregnancy. Rubella titer ratio of 1:10 suggests immunity to rubella, which is not an immediate concern during the prenatal visit.
With what has maternal hypertension been associated?
- A. anorexia
- B. low birth weight
- C. macrosomia
- D. symphysis pubis dysfunction
Correct Answer: B
Rationale: Maternal hypertension can lead to decreased blood flow to the placenta, resulting in restricted growth and low birth weight in the baby. This association is well-documented in research and clinical practice. Low birth weight is a common consequence of maternal hypertension due to inadequate nutrient and oxygen supply to the fetus. Therefore, choice B is the correct answer. Choices A, C, and D are not directly associated with maternal hypertension. Anorexia is a psychological disorder related to eating habits, macrosomia refers to excessive birth weight, and symphysis pubis dysfunction is a musculoskeletal issue during pregnancy.