A nurse is assisting with the care of a client who is in labour. Which of the following findings should the nurse report to the provider?
Fetal heart rate 100/min for a 10-min period.
Contraction resting period 35 seconds.
Contraction lasting 85 seconds.
Four contractions in a 10-min period.
The Correct Answer is C
Choice A rationale:
A fetal heart rate of 100/min for a 10-minute period is considered within the normal range. The normal fetal heart rate can range from 110 to 160 beats per minute, and a rate of 100 is not concerning.
Choice B rationale:
The resting period of a contraction refers to the time between contractions when the uterus is relaxed. A resting period of 35 seconds is also considered normal. In labor, the resting period between contractions allows the placenta to receive oxygen and nutrients, and 35 seconds is a rationaleable duration.
Choice C rationale:
A contraction lasting 85 seconds is abnormal and should be reported to the provider. Normally, contractions last around 60-90 seconds, but an 85-second contraction may indicate uterine hyperactivity or other issues that could potentially affect the well-being of both the mother and the baby.
Choice D rationale:
Having four contractions in a 10-minute period is considered normal during labor. In fact, an average pattern includes 3-5 contractions within a 10-minute window, so this finding is not a cause for concern.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale:
The correct answer is Choice B, which is "Newborn hypoglycemia.”. Newborn hypoglycemia is a potential complication associated with maternal gestational diabetes. When a pregnant woman has gestational diabetes, her blood glucose levels can be elevated, leading to increased insulin production in the fetus. After birth, the baby's insulin production continues at a high level, which can result in a rapid drop in blood glucose levels, causing hypoglycemia. This condition can be serious and requires close monitoring and timely intervention to prevent complications in the newborn.
Choice A rationale :
Placenta previa is not a complication associated with maternal gestational diabetes. Placenta previa occurs when the placenta partially or completely covers the cervix, which can lead to bleeding during pregnancy and delivery. However, this condition is not directly related to gestational diabetes, and there is no physiological rationale connecting the two.
Choice C rationale
Small for gestational age (SGA) newborn is not a direct complication of maternal gestational diabetes. SGA refers to babies who are smaller in size than expected for their gestational age. While poorly controlled diabetes during pregnancy can lead to large babies (macrosomia), it is not typically associated with small babies.
Choice D rationale
Oligohydramnios, which is a condition characterized by low levels of amniotic fluid, is not a common complication associated with maternal gestational diabetes. Oligohydramnios can be caused by various factors, but it is not specifically linked to gestational diabetes.
Correct Answer is B
Explanation
Choice A rationale:
Hypotension is not an expected finding in a client with severe preeclampsia. In preeclampsia, the client typically experiences hypertension (high blood pressure) rather than hypotension (low blood pressure). Hypotension may be concerning as it could indicate inadequate perfusion to vital organs.
Choice B rationale:
Headache is an expected finding in a client with severe preeclampsia. Headaches are a common symptom of preeclampsia and are often described as persistent and severe. They can result from increased blood pressure and possibly cerebral oedema.
Choice C rationale:
Tachycardia is not an expected finding in a client with severe preeclampsia. Tachycardia refers to an abnormally fast heart rate, but in preeclampsia, bradycardia (abnormally slow heart rate) or a normal heart rate is more typical. Tachycardia could indicate other underlying issues.
Choice D rationale:
Polyuria is not an expected finding in a client with severe preeclampsia. Polyuria is characterized by excessive urination, and in preeclampsia, the opposite may occur due to decreased kidney perfusion, resulting in oliguria (reduced urine output).
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