A pregnant woman comes in for her weekly fetal heart monitoring.
She is 35 weeks’ gestation.
After 20 minutes on the monitor, the fetal heart rate tracing shows 3 accelerations measuring 15 beats by 15 seconds.
How should the nurse report this finding to the provider?
Positive contraction stress test (CST)
Reactive nonstress test (NST)
Negative contraction stress test (CST)
Non-reactive nonstress test (NST)
The Correct Answer is A
Choice A rationale:
A positive contraction stress test (CST) indicates that the fetal heart rate decelerates late in response to uterine contractions, suggesting potential uteroplacental insufficiency. However, the scenario does not describe a CST being performed, as it does not mention any assessment of uterine contractions or their relationship to fetal heart rate changes.
Choice C rationale:
A negative contraction stress test (CST) would demonstrate no late decelerations in response to contractions, suggesting adequate placental function. However, as mentioned earlier, a CST is not the test being performed in this scenario.
Choice D rationale:
A non-reactive nonstress test (NST) means that there were not enough fetal heart rate accelerations (at least 2, each lasting at least 15 seconds and peaking at least 15 beats above baseline) within a 20-minute period. This finding sometimes warrants further evaluation of fetal well-being. However, the scenario clearly states that 3 accelerations meeting the criteria for reactivity were observed.
Choice B rationale:
A reactive nonstress test (NST) is considered reassuring and indicates that the fetal heart rate is responding appropriately to fetal movement, suggesting that the fetus is likely healthy and well-oxygenated. The presence of 3 accelerations meeting the criteria for reactivity within a 20-minute period is the hallmark of a reactive NST.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Drug/alcohol use: While substance abuse during pregnancy can lead to adverse outcomes such as preterm labor, fetal growth restriction, and birth defects, it is not considered a primary factor in determining high-risk status for this patient. The specific substances involved (cocaine and alcohol) are indeed associated with risks, but they are not as significant as other factors in this case.
Age: The patient's age of 24 is not considered a high-risk factor for pregnancy. Advanced maternal age (typically defined as 35 years or older) is associated with increased risks for chromosomal abnormalities and other complications, but this patient falls below that age threshold.
Family history: Family history of diabetes mellitus, cancer, and neural tube defects can be relevant to pregnancy risk, but in this case, other factors outweigh their significance.
Choice B rationale:
Blood pressure: The patient's blood pressure of 108/70 mm Hg is within the normal range and does not contribute to highrisk categorization. High blood pressure (hypertension) during pregnancy can lead to preeclampsia and other complications, but this patient does not present with hypertension.
Age: As explained in Choice A, the patient's age is not a high-risk factor.
BMI: A BMI of 17 is considered underweight, which can increase the risk of certain pregnancy complications such as preterm birth and low birth weight. However, in this case, other factors are more significant in determining high-risk status.
Choice C rationale:
Family history: The patient's family history of a neural tube defect (NTD) in a close relative is a significant risk factor for NTDs in her own pregnancy. NTDs are serious birth defects that affect the brain and spinal cord, and they can have lifelong implications for the child. This factor alone warrants a high-risk categorization.
BMI: The patient's underweight BMI of 17 further contributes to her high-risk status, as it can increase the likelihood of certain complications as mentioned earlier.
Drug/alcohol abuse: The patient's admission of cocaine and alcohol use, even if occasional, is a concerning factor for pregnancy. Cocaine, in particular, is a potent vasoconstrictor that can negatively impact fetal growth and development. Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders (FASDs), which can cause a range of physical, cognitive, and behavioral problems.
Choice D rationale:
Age: As explained previously, the patient's age is not a high-risk factor.
BMI: The patient's BMI is a contributing factor, but not the most significant one in this case.
Family history: The patient's family history is relevant, but the presence of a neural tube defect in a close relative is the most significant aspect of her family history in terms of pregnancy risk.
Correct Answer is A
Explanation
Choice A rationale:
Naloxone is an opioid antagonist. It works by binding to opioid receptors in the brain and body, reversing the effects of opioids. This includes respiratory depression, which is a major concern in neonates exposed to opioids during labor.
Nalbuphine is an opioid agonist-antagonist. This means that it has both agonist and antagonist effects at opioid receptors. At low doses, it acts primarily as an agonist, providing pain relief. However, at higher doses, it can also act as an antagonist, blocking the effects of other opioids.
Naloxone can effectively reverse the respiratory depression caused by nalbuphine in neonates. It is a safe and effective medication that is commonly used for this purpose.
Naloxone should be readily available whenever opioids are administered to a laboring woman. This is to ensure that it can be administered promptly if the neonate experiences respiratory depression.
Choice B rationale:
Ephedrine is a sympathomimetic drug. It works by stimulating the sympathetic nervous system. This can cause a number of effects, including increased heart rate, blood pressure, and respiratory rate.
Ephedrine is not effective in reversing the respiratory depression caused by opioids. It may even worsen the situation by increasing the neonate's oxygen demand.
Ephedrine is not a safe or effective medication for use in neonates. It can cause serious side effects, such as tachycardia, hypertension, and arrhythmias.
Choice C rationale:
Promethazine is a phenothiazine antiemetic. It is commonly used to treat nausea and vomiting.
Promethazine does not have any effects on opioid receptors. It is not effective in reversing the respiratory depression caused by opioids.
Promethazine can cause sedation and respiratory depression in neonates. It should be used with caution in this population.
Choice D rationale:
Fentanyl is a potent opioid analgesic. It is similar to nalbuphine in that it is an opioid agonist.
Fentanyl would not be effective in reversing the respiratory depression caused by nalbuphine. In fact, it would likely worsen the situation by further depressing the neonate's respiratory system.
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