A nurse is auscultating fetal heart tones with a Doppler device for a client who is at 12 weeks of gestation. Where should the nurse expect to auscultate the fetal heart tones?

Umbilical area

Suprapubic area

Above the left iliac crest

Below the liver border on the right abdomen

Answer and Explanation

The Correct Answer is C

Rationale:

A)   Incorrect - The umbilical area is not a typical location for auscultating fetal heart tones.
B)   Incorrect - The suprapubic area is not a common location for auscultating fetal heart tones.
C)   Correct - At 12 weeks of gestation, the nurse would typically auscultate the fetal heart tones above the left iliac crest, which is in the lower abdomen. This is where the uterus is located at this stage of pregnancy.
D)   Incorrect - Auscultating below the liver border on the right abdomen is not a standard practice for fetal heart tone assessment.

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Correct Answer is B

Explanation

A) Incorrect- Foul-smelling vaginal discharge might indicate infection but is not the priority over the presence of meconium-stained amniotic fluid.
B) Correct- Fetal heart rate is important to monitor, but the presence of meconium- stained amniotic fluid has higher priority. fetal heart tones 98/min, because this indicates fetal distress and requires immediate intervention.
C) Incorrect - Amniotic fluid with meconium noted could indicate fetal hypoxia or distress, but it is not always a sign of a problem and depends on other factors such as gestational age and fetal activity.
D) Incorrect- Maternal temperature elevation might indicate infection but is not the priority over assessing the condition of the amniotic fluid and the baby.

A. Set the temperature on the water heater to 48.8° C (120° F) B. Ensure the crib has soft bumper pads on the inside. C. Wash the newborn's face with a warm, soapy washcloth D. Place a small pillow under the newborn's head during naps

Correct Answer is C

Explanation

A) Incorrect- The water heater temperature should be set to 49.4°C (120°F) or below to prevent scalding. The given temperature is slightly too high.
B) Incorrect- Soft bumper pads in cribs can pose a suffocation risk and are not recommended.
C) Correct - Washing the newborn's face with a warm, soapy washcloth is a safe way to cleanse the baby's face. Harsh chemicals or strong soaps should be avoided.
D) Incorrect- Pillows should not be placed under a newborn's head during naps to reduce the risk of suffocation. The baby's sleep environment should be free of soft bedding.

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A nurse is auscultating fetal heart tones with a Doppler device for a client who is at 12 weeks of gestation. Where should the nurse expect to auscultate the fetal heart tones?

Nursing Test Bank

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