A nurse is observing the internal fetal monitor readings of a laboring client.The fetal heart rate is between 130 and 138 beats per minute, with moderate beat-to-beat variability.
How should the nurse interpret this finding?
Insufficient perfusion of the placenta.
Sufficient perfusion and circulation of the fetus.
Maternal hypoxia.
Fetal hypoxia.
The Correct Answer is B
he correct answer is choice B. Sufficient perfusion and circulation of the fetus. This is because the fetal heart rate is within the normal range of 110 to 160 beats per minute, and there is moderate beat-to-beat variability, which indicates a healthy nervous system.
Choice A is wrong because insufficient perfusion of the placenta would cause fetal distress and abnormal fetal heart rate patterns, such as late decelerations or minimal variability.
Choice C is wrong because maternal hypoxia would not directly affect the fetal heart rate, unless it leads to placental insufficiency or uterine hyperstimulation.
Choice D is wrong because fetal hypoxia would cause signs of fetal distress, such as tachycardia, bradycardia, or absent variability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C. Reminding her that she should be happy that one child survived and is healthy is the least helpful nursing action in supporting the woman as she copes with her loss.
This statement minimizes her grief and implies that she should not feel sad about the deceased twin.
It also disregards her attachment to both babies and her need to mourn the loss of one of them.
Choice A is wrong because offering her the opportunity for counseling to help her grieve is a helpful nursing action that recognizes her emotional distress and provides her with professional support.
Choice B is wrong because encouraging the woman to hold the deceased twin as well as the living twin is a helpful nursing action that allows her to acknowledge and bond with both babies and to create memories that may facilitate healing.
Choice D is wrong because assisting the woman to take pictures of both babies is a helpful nursing action that provides her with tangible mementos of her twins and honors their
Correct Answer is C
Explanation
The correct answer is choice C. The reason for the patient’s visit at this time.
This information will help the nurse assess the patient’s motivation, readiness, and urgency for contraception.
It will also help the nurse tailor the education and counseling to the patient’s specific needs and preferences.
Choice A is wrong because the amount of sexual experience that the patient has had is not relevant to determine the patient’s knowledge base.
It may also make the patient feel uncomfortable or judged.
Choice B is wrong because the type of contraceptive that the patient’s friends are using is not a reliable source of information.
Different methods may have different advantages and disadvantages for different people.
The nurse should provide evidence-based information and guidance on various options.
Choice D is wrong because the method of contraception that the patient believes will provide protection from sexually transmitted diseases may not be accurate or effective.
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