A nurse is caring for a 29-year-old female client who is 35 weeks gestation in the triage area of the maternity ward. The client presents with complaints of decreased fetal movement. Below are the exhibits relevant to the case:

Exhibits

What is the most appropriate next step in the management of this client?

Discharge the client with instructions to monitor fetal movements at home.

Admit the client for continuous fetal monitoring.

Schedule an immediate cesarean section.

Administer corticosteroids to enhance fetal lung maturity.

Answer and Explanation

The Correct Answer is A

Choice A rationale
•   The non-stress test (NST) is reactive, indicating normal fetal heart rate patterns with adequate accelerations.
•   The ultrasound shows normal amniotic fluid index and fetal movements, with no abnormalities detected.
•   The client has no significant medical history and is generally feeling well.
These findings suggest that the fetus is currently well, and there is no immediate need for further intervention. However, the client should be instructed to monitor fetal movements at home and return if there are any concerns or if decreased fetal movement persists. This approach balances the need for vigilance with the reassurance provided by the normal test results.
.
Choice B rationale
Continuous fetal monitoring is typically reserved for cases where there is a significant concern for fetal distress or other complications. In this case, both the non-stress test (NST) and ultrasound results are normal, indicating that the fetus is currently well. Therefore, continuous monitoring in a hospital setting is not necessary.
Choice C rationale
An immediate cesarean section is a major surgical procedure that is usually performed when there is an urgent risk to the mother or baby. Given the normal NST and ultrasound findings, there is no indication of fetal distress or other complications that would warrant such an intervention at this time.
Choice D rationale
Corticosteroids are given to enhance fetal lung maturity in cases where preterm delivery is anticipated, typically before 34 weeks of gestation. Since the client is already at 35 weeks and there is no indication of imminent preterm labor or other complications, administering corticosteroids is not necessary.

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Correct Answer is A

Explanation

Choice A rationale
The occiput anterior (OA) position is considered the optimal fetal position for vaginal birth. In this position, the baby’s head is down, and the back of the head (occiput) is facing the mother’s front. This position allows for the most efficient passage through the birth canal.
Choice B rationale
The occiput posterior (OP) position, where the baby’s head is down but facing the mother’s back, can lead to a longer and more painful labor. It is not considered optimal for vaginal birth.
Choice C rationale
Breech positions, where the baby’s buttocks or feet are positioned to come out first, are not optimal for vaginal birth and often require a cesarean section due to the increased risk of complications.
Choice D rationale
The transverse position, where the baby is lying sideways across the uterus, is not suitable for vaginal birth. This position typically requires a cesarean section to safely deliver the baby.

A. Category I. B. Category II. C. Category III. D. Category IV.

Correct Answer is B

Explanation

Choice A rationale
Category I tracings are normal and indicate no fetal hypoxia or acidemia. They include a baseline heart rate of 110-160 bpm, moderate variability, and no late or variable decelerations.
Choice B rationale
Category II tracings are indeterminate and include any of the following: baseline heart rate changes, minimal or marked variability, absence of accelerations, or periodic decelerations. A baseline heart rate of 175 bpm with moderate variability and absent accelerations fits this category.
Choice C rationale
Category III tracings are abnormal and indicate possible fetal hypoxia or acidemia. They include absent variability with recurrent late or variable decelerations, bradycardia, or a sinusoidal pattern.
Choice D rationale
Category IV is not a standard classification in fetal heart rate monitoring. The correct categories are I, II, and III6.

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Naxlex Comprehensive Predictor Exams

During the delivery, which fetal position would be considered optimal for a vaginal birth?

Correct Answer is A

Explanation

The labor and delivery nurse is caring for a client in active labor. The nurse notes the fetal heart rate baseline is 175 bpm, moderate variability. Accelerations are absent and no decelerations noted. How should the nurse describe this tracing to the medical provider?

Correct Answer is B

Explanation

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