A nurse is caring for a client in the first stage of labor who is undergoing external fetal monitoring and receiving IV fluids. The nurse observes variable decelerations in the fetal heart rate on the monitor strip.
Which of the following is the correct interpretation of this finding
Variable decelerations are related to fetal head compression.
Variable decelerations are due to umbilical cord compression.
Variable decelerations are caused by uteroplacental insufficiency.
Variable decelerations are a result of the administration of narcotic analgesics.
The Correct Answer is B
The correct answer is Choice B.
Choice A rationale
Variable decelerations are not related to fetal head compression. Fetal head compression typically results in early decelerations, not variable ones.
Choice B rationale
Variable decelerations are indeed due to umbilical cord compression. They are quick decreases in fetal heart rate that vary with uterine contractions. This can be a sign that the baby’s blood flow is reduced if variable decelerations happen over and over.
Choice C rationale
Uteroplacental insufficiency typically results in late decelerations, not variable ones. Late decelerations are a sign of fetal hypoxia and are associated with uteroplacental insufficiency.
Choice D rationale
While certain medications can affect the fetal heart rate, variable decelerations are not typically a result of the administration of narcotic analgesics.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The maternal serum alpha-fetoprotein (MSAFP) test is a screening test that measures the level of alpha-fetoprotein in the mother’s blood during pregnancy. It is used to assess the likelihood of certain birth defects, including neural tube defects such as spina bifida.
Choice B rationale
The MSAFP test does not assess fetal lung maturity. Other tests, such as amniocentesis, can be used to assess this.
Choice C rationale
The MSAFP test does not identify Rh incompatibility between the mother and fetus. Rh incompatibility is typically determined through blood typing and antibody screening.
Choice D rationale
While the MSAFP test can provide valuable information about the health of the fetus, it does not assess various markers of fetal well-being. It is specifically used to screen for certain birth defects.
Correct Answer is C
Explanation
Choice A reason:
Fetal head compression is associated with early decelerations, not late. Early decelerations are a normal finding during labor as the fetal head is compressed during contractions, leading to a vagal response that temporarily decreases the heart rate.
Choice B reason:
Umbilical cord compression leads to variable decelerations, not late. Variable decelerations can occur at any time during the contraction cycle and are caused by compression of the umbilical cord, which can restrict blood flow to the fetus.
The correct answer is C. Uteroplacental insufficiency.
Late decelerations are indicative of uteroplacental insufficiency, which is a condition where the placenta is not delivering enough oxygen and nutrients to the fetus.
Choice D reason:
Maternal bradycardia, which is a slower than normal heart rate in the mother, does not cause late decelerations in the fetus. Instead, maternal bradycardia can be a separate concern and does not directly affect the fetal heart rate pattern observed on the monitor.
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