A nurse is caring for a client who is in active labor. The nurse should notify the provider for which of the following findings?

Moderate variability in the FHR

Prolonged decelerations

Baseline FHR 115/min

Three uterine contractions within 10 min

Answer and Explanation

The Correct Answer is B

A. Moderate variability in the FHR: Incorrect. Moderate variability (6-25 bpm) is a reassuring sign of fetal well-being.

B. Prolonged decelerations: Prolonged decelerations, defined as a decrease in fetal heart rate (FHR) of at least 15 beats per minute lasting 2 to 10 minutes, indicate potential fetal hypoxia or distress and require immediate notification of the provider.

C. Baseline FHR 115/min: Incorrect. A baseline FHR of 115/min is within the normal range of 110-160 bpm.

D. Three uterine contractions within 10 min: Incorrect. This contraction pattern is within the normal range for active labor (normal is 2-5 contractions in 10 minutes).

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. Positioning the knees higher than the hips could increase the risk of hip dislocation.

B. Keeping an abduction pillow between the legs helps maintain the hip in the correct position and prevents dislocation.

C. Raising the head of the bed to a high-Fowler’s position may strain the hip and is not recommended for dislocation prevention.

D. Elevating the affected leg on a pillow may cause internal rotation and increase the risk of dislocation.

A. Draw blood specimens for culture and sensitivity. B. Administer nitroglycerin 0.4 mg SL 30 min before the procedure. C. Obtain a CBC with differential. D. Transport the client to radiology for a CT scan.

Correct Answer is C

Explanation

A. Draw blood specimens for culture and sensitivity: Incorrect. Blood cultures are not routinely required for cardiac catheterization.

B. Administer nitroglycerin 0.4 mg SL 30 min before the procedure: Incorrect. Nitroglycerin is not typically administered before a cardiac catheterization unless specifically ordered.

C. Obtain a CBC with differential: A complete blood count (CBC) is necessary before a cardiac catheterization to assess for potential bleeding risks, infection, or anemia.

D. Transport the client to radiology for a CT scan: Incorrect. Cardiac catheterization is performed in a specialized cardiac catheterization lab, not in radiology.

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A nurse is caring for a client who is in active labor. The nurse should notify the provider for which of the following findings?

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