A nurse is caring for a client who is in labor. The nurse observes late decelerations of the fetal heart rate on the external fetal monitor. After placing the client in a side-lying position, which of the following actions should the nurse take?

Decrease the rate of IV fluids.

Perform fetal scalp stimulation.

Administer oxygen via a face mask.

Elevate the client's head.

Answer and Explanation

The Correct Answer is C

Choice A rationale:
Decreasing the rate of IV fluids would not address the issue of late decelerations, which indicate fetal hypoxia.

Choice B rationale:
Fetal scalp stimulation is used to assess fetal well-being, but it would not address the issue of late decelerations.
Choice C rationale:
Administering oxygen via a face mask can increase the amount of oxygen available to the fetus, potentially alleviating the hypoxia causing the late decelerations.
Choice D rationale:
Elevating the client’s head would not address the issue of late decelerations.

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Correct Answer is D

Explanation

Choice A rationale:
Administering ephedrine IV is not the appropriate action for a client experiencing an amniotic fluid embolism during labor. Ephedrine is typically used to treat hypotension during spinal anesthesia, not amniotic fluid embolism.
Choice B rationale:
Assisting the client to empty their bladder is not the appropriate action for a client experiencing an amniotic fluid embolism during labor. While bladder care is important, it is not the priority in this situation.
Choice C rationale:
Assessing for the presence of clonus is not the appropriate action for a client experiencing an amniotic fluid embolism during labor. Clonus is typically assessed in clients with preeclampsia or eclampsia, not amniotic fluid embolism.
Choice D rationale:
Preparing to initiate cardiopulmonary resuscitation is the appropriate action for a client experiencing an amniotic fluid embolism during labor. Amniotic fluid embolism can lead to cardiovascular collapse, therefore, immediate resuscitation measures should be prepared15.

A. "Hypnosis can be beneficial if you practiced it during the prenatal period.”. B. "Hypnosis does not work for controlling pain associated with labor.”. C. "Synchronized breathing will be required during hypnosis.”. D. "Focusing on controlling body functions will be helpful during hypnosis.”.

Correct Answer is A

Explanation

Choice A rationale:
Hypnosis can be beneficial if practiced during the prenatal period. It helps the woman to enter labor with a positive mindset and better control over pain.
Choice B rationale:
Hypnosis can indeed work for controlling pain associated with labor when practiced correctly.
Choice C rationale:
Synchronized breathing is not necessarily required during hypnosis. It’s more about focus and relaxation.
Choice D rationale:
Focusing on controlling body functions can be helpful during hypnosis, but it’s not the primary goal of hypnosis.

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A nurse is caring for a client who is in labor. The nurse observes late decelerations of the fetal heart rate on the external fetal monitor. After placing the client in a side-lying position, which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is experiencing an amniotic fluid embolism during labor. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following pieces of information should the nurse include?

Correct Answer is A

Explanation

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