A nurse is caring for a client who is in the first stage of labor, undergoing external fetal monitoring, and receiving IV fluid. The nurse observes variable decelerations in the fetal heart rate on the monitor strip. Which of the following is a correct interpretation of this finding?

Variable decelerations are a result of the administration of IV narcotic analgesics.

Variable decelerations are related to fetal head compression.

Variable decelerations are due to umbilical cord compression.

Variable decelerations are caused by uteroplacental insufficiency.

Answer and Explanation

The Correct Answer is C

A)   Variable decelerations are a result of the administration of IV narcotic analgesics: IV narcotic analgesics can cause changes in the fetal heart rate, but they are more commonly associated with early decelerations, not variable decelerations.

B)   Variable decelerations are related to fetal head compression: Fetal head compression is associated with early decelerations, not variable decelerations.
C)   Variable decelerations are due to umbilical cord compression: This is the correct answer.

Variable decelerations occur due to compression of the umbilical cord during contractions, leading to transient decreases in fetal blood flow and oxygenation.
D) Variable decelerations are caused by uteroplacental insufficiency: Uteroplacental insufficiency is associated with late decelerations, not variable decelerations.

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Correct Answer is ["B","E"]

Explanation

Choice A: Amniocentesis is not primarily performed to determine the gender of the fetus. The main indication for this procedure is to detect genetic abnormalities or chromosomal disorders.
Choice B: The primary purpose of an amniocentesis is to detect chromosomal abnormalities such as Down syndrome (trisomy 21), trisomy 18, and trisomy 13, among others.
Choice C: Rh incompatibility is assessed through blood tests, not amniocentesis. It involves determining the Rh factor of the mother's blood and monitoring for potential Rh sensitization.

Choice D: Cephalopelvic disproportion refers to a situation where the baby's head is too large or the mother's pelvis is too small to allow for a vaginal delivery. It is not related to amniocentesis.
Choice E: While detecting neural tube defects can be done through amniocentesis, it is not the primary indication for the procedure. Neural tube defects can also be screened for through blood tests and ultrasound examinations. Amniocentesis is more commonly used for chromosomal analysis.

A. Increase the oxytocin infusion to 13 mu/min. B. Initiate a bolus of primary IV fluids. C. Place the client in a sidelying position. D. Apply oxygen at 10 L/min via a venturi mask. E. Perform a sterile vaginal examination (SVE).

Correct Answer is ["B","C","D"]

Explanation

The correct answer is B, C, and D.

Choice A: Increase the oxytocin infusion to 13 mu/min

Increasing the oxytocin infusion is not indicated in this scenario. Oxytocin is used to induce or augment labor, but if the fetal heart rate tracing is abnormal (Category 3), increasing oxytocin could exacerbate fetal distress. The priority is to stabilize the fetal condition before considering increasing oxytocin.

Choice B: Initiate a bolus of primary IV fluids

Initiating a bolus of primary IV fluids is appropriate. This action helps improve placental perfusion and maternal hydration, which can be beneficial in response to abnormal fetal heart rate tracings. Adequate hydration can enhance uteroplacental blood flow and improve fetal oxygenation.

Choice C: Place the client in a sidelying position

Placing the client in a sidelying position is recommended. This position can improve uteroplacental perfusion and fetal oxygenation, especially if there are signs of fetal distress. It helps to alleviate pressure on the inferior vena cava, enhancing blood flow to the placenta.

Choice D: Apply oxygen at 10 L/min via a venturi mask

Applying oxygen at 10 L/min via a venturi mask is indicated for improving fetal oxygenation in cases of abnormal fetal heart rate patterns. This intervention can help increase the oxygen available to the fetus, which is crucial in managing fetal distress.

Choice E: Perform a sterile vaginal examination (SVE)

Performing a sterile vaginal examination (SVE) is not indicated based on the provided assessment findings. While SVE is useful for assessing cervical dilation and labor progression, it is not a priority in this situation where the main concern is fetal well-being. Unnecessary SVEs can increase the risk of infection.

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A nurse is caring for a client who is in the first stage of labor, undergoing external fetal monitoring, and receiving IV fluid. The nurse observes variable decelerations in the fetal heart rate on the monitor strip. Which of the following is a correct interpretation of this finding?

Nursing Test Bank

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A nurse is teaching a client who is at 18 weeks of gestation and is to undergo an amniocentesis. The nurse should explain that the purpose of this test is to identify which of the following? (Select all that apply.)

Correct Answer is ["B","E"]

Explanation

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Correct Answer is ["B","C","D"]

Explanation

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