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The patient is having fetal heart rate decelerations. An amnioinfusion has been ordered for the patient to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is:
Select one:
Late decelerations.
Moderate decelerations.
Variable decelerations.
Early decelerations.
The Correct Answer is C
Choice A Reason: Late decelerations. This is an incorrect answer that refers to a different type of fetal heart rate patern that indicates uteroplacental insufficiency, which can reduce blood flow and oxygen delivery to the fetus. Late decelerations are characterized by gradual decreases in fetal heart rate that begin after the peak of uterine contractions and return to baseline after the end of contractions. Amnioinfusion is not effective for late decelerations, as it does not address the underlying cause of uteroplacental insufficiency, which may be due to maternal hypertension, diabetes, preeclampsia, or placental abruption.
Choice B Reason: Moderate decelerations. This is an incorrect answer that refers to a non-existent type of fetal heart rate patern, as there is no such term as moderate decelerations. The term moderate refers to the category of fetal heart rate variability, which is a measure of the fluctuations in fetal heart rate around the baseline. Moderate variability indicates normal fetal oxygenation and well-being, while absent or minimal variability indicates fetal hypoxia or distress.
Choice C Reason: Variable decelerations. This is because variable decelerations are a type of fetal heart rate patern that indicates cord compression, which can reduce blood flow and oxygen delivery to the fetus. Variable decelerations are characterized by abrupt decreases in fetal heart rate that vary in onset, depth, and duration, and do not have a consistent relationship with uterine contractions. Amnioinfusion is a procedure that involves infusing saline or lactated Ringer's solution into the amniotic cavity through a transcervical catheter, which can relieve cord compression by increasing the volume of amniotic fluid and cushioning the cord. Amnioinfusion can improve fetal oxygenation and reduce variable decelerations.
Choice D Reason: Early decelerations. This is an incorrect answer that refers to a different type of fetal heart rate patern that indicates head compression, which can stimulate the vagus nerve and slow down the fetal heart rate. Early decelerations are characterized by gradual decreases in fetal heart rate that begin with the onset of uterine contractions and return to baseline with the end of contractions. Early decelerations are benign and do not require intervention, as they reflect normal fetal head descent and progress of labor. Amnioinfusion is not indicated for early decelerations, as it does not affect head compression or vagal stimulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason: Milia. This is an incorrect answer that describes a different skin condition. Milia are tiny white or yellow cysts that appear on the nose, chin, or cheeks of newborns. They are caused by the retention of keratin in the sebaceous glands or hair follicles. They usually disappear within a few weeks without treatment.
Choice B Reason: Dermal melanosis. This is a correct answer that explains the finding of bluish markings across the newborn's lower back. Dermal melanosis. This is because dermal melanosis, also known as Mongolian spots, is a common benign skin condition that affects newborns of Asian, African, or Hispanic descent. It is characterized by bluish-gray or brown patches of pigmentation on the lower back, butocks, or extremities. It is caused by the migration of melanocytes from the neural crest to the dermis during embryonic development. It usually fades by 2 to 4 years of age.
Choice C Reason: Stork bites. This is an incorrect answer that refers to another skin condition. Stork bites, also known as salmon patches or nevus simplex, are flat pink or red marks that appear on the forehead, eyelids, nose, upper lip, or nape of the neck of newborns. They are caused by dilated capillaries in the superficial dermis. They usually fade by 18 months of age.
Choice D Reason: Birth trauma. This is an incorrect answer that implies an injury or damage to the newborn's skin or tissues during labor and delivery. Birth trauma can cause bruises, abrasions, lacerations, fractures, or nerve injuries. It is not related to bluish markings on the lower back.
Correct Answer is D
Explanation
Choice A Reason: Respiratory rate of 16. This is an incorrect answer that indicates a normal finding that does not suggest magnesium sulfate toxicity. Respiratory rate is a measure of the number of breaths per minute, which reflects the respiratory function and oxygenation status. Respiratory rate of 16 is within the normal range for adults, which is 12 to 20 breaths per minute. Respiratory rate of 16 does not indicate magnesium sulfate toxicity, which can cause respiratory rate below 12 breaths per minute.
Choice B Reason: Complaints by the client of feeling flushed and warm. This is an incorrect answer that indicates a common side effect that does not indicate magnesium sulfate toxicity. Feeling flushed and warm are sensations that are caused by vasodilation (widening of blood vessels), which can occur as a result of magnesium sulfate administration. Feeling flushed and warm are not signs of magnesium sulfate toxicity, but rather expected and mild reactions that usually subside within a few hours.
Choice C Reason: Fetal heart rate of 120. This is an incorrect answer that indicates a normal finding that does not suggest magnesium sulfate toxicity. Fetal heart rate is a measure of the number of beats per minute of the fetal heart, which reflects the fetal well-being and oxygenation status. Fetal heart rate of 120 is within the normal range for fetuses, which is 110 to 160 beats per minute. Fetal heart rate of 120 does not indicate magnesium sulfate toxicity, which can cause fetal heart rate below 110 beats per minute or above 160 beats per minute.
Choice D Reason: Patellar reflexes are absent. This is because absent patellar reflexes are a sign of magnesium sulfate toxicity, which is a condition where the level of magnesium in the blood is too high, which can cause adverse effects on the neuromuscular and cardiovascular systems. Magnesium sulfate is a medication that is used to prevent or treat preterm labor, which is labor that occurs before 37 weeks of gestation. Magnesium sulfate works by relaxing the uterine muscles and inhibiting uterine contractions. However, magnesium sulfate can also affect other muscles and nerves in the body, and cause symptoms such as muscle weakness, respiratory depression, hypotension, or cardiac arrest.
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