On her first visit, a patient had a baseline hemoglobin of 13.0 gm and a hematocrit of 42.9%.She has been taking ferrous sulfate tablets and eating an iron-rich diet.She returned to the clinic at 30 weeks gestation and has a hemoglobin of 11.0 gm and a hematocrit of 36.3%.She is concerned and confused about why these lab values have gone down.
In responding, which physiological change during pregnancy should the nurse describe to the patient?

The increase in the level of placental hormones tends to result in chelation of maternal iron.

Fetal demand for iron is greater than the maternal intake.

During the latter half of pregnancy, the maternal intestinal absorption of iron is decreased.

The increase in maternal blood volume is greater than the increase in maternal red blood cells.

Answer and Explanation

The Correct Answer is D

The correct answer is choice D. The increase in maternal blood volume is greater than the increase in maternal red blood cells.

This means that the concentration of hemoglobin and hematocrit in the blood is diluted by the extra fluid.

This is a normal physiological adaptation to pregnancy and does not indicate iron deficiency anemia.

Choice A is wrong because placental hormones do not chelate maternal iron.

Chelation is a process of binding metal ions to organic molecules, which is not relevant to this question.

Choice B is wrong because fetal demand for iron is not greater than maternal intake.

The mother can meet the iron needs of the fetus by increasing her dietary intake and taking iron supplements.

Choice C is wrong because maternal intestinal absorption of iron is not decreased during pregnancy.

In fact, it may be increased due to higher levels of estrogen and progesterone.

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Correct Answer is B

Explanation

The correct answer is choice B. “You are doing a great job.

It’s very difficult to support someone during this part of labor.” This response acknowledges the husband’s feelings and efforts, and provides reassurance and encouragement.

It also reflects the reality that active labor can be very intense and painful for the woman, and she may not want to be touched or talked to.

Choice A is wrong because it suggests that the husband is not needed or wanted, and may make him feel rejected or useless.

Choice C is wrong because it implies that the husband is not a good support person, and may hurt his self-esteem or damage his relationship with his wife.

Choice D is wrong because it focuses on the physical aspect of labor, rather than the emotional one.

It also assumes that the woman wants medication, which may not be the case.

A. The fetal heart rate decreases after the start of a contraction and returns to the baseline 60 seconds after the end of the contraction. B. There is a six to ten beat-to-beat variability in the fetal heart rate. C. The fetal heart rate accelerates five to seven beats just prior to the beginning of a contraction. D. The fetal heart rate decreases at the start of the contraction and returns to baseline by the end of the contraction.

Correct Answer is A

Explanation

The correct answer is choice A and it indicates fetal distress because it is a sign oflate deceleration.Late decelerations are due touteroplacental insufficiencyas the result of decreased blood flow and oxygen to the fetus during the uterine contractions.This causeshypoxemiaand can lead to fetal acidosis and neurological damage.

Choice B is wrong because it indicates anormal variabilityin the fetal heart rate, which reflects a healthy autonomic nervous system.A normal fetal heart rate is 120-160 beats per minute.

Choice C is wrong because it indicates anearly accelerationin the fetal heart rate, which is a benign finding that may occur with fetal movement or stimulation.

Choice D is wrong because it indicates anearly decelerationin the fetal heart rate, which is a normal response to fetal head compression during contractions.

It does not indicate fetal distress.

Normal ranges for fetal heart rate patterns are:

• Baseline: 120-160 beats per minute

• Variability: 6-25 beats per minute

• Accelerations: at least 15 beats per minute above baseline for at least 15 seconds

• Decelerations: none or early (mirror contractions)

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Naxlex Comprehensive Predictor Exams

nurse hears a client in active labor say to her husband, “Don’t touch me. Stay away.” The husband states, “I don’t know what to do. Everything I do is wrong.” Which response by the nurse would be the most supportive?

Correct Answer is B

Explanation

A nurse caring for a patient in labor is evaluating the fetal heart monitor.Which finding would indicate fetal distress?

Correct Answer is A

Explanation

A nurse is caring for a 16-year-old primigravida who is in the last month of an uncomplicated pregnancy. Which measure is most appropriate to include in the patient’s plan of care?

A patient has been instructed to increase the protein in her diet. Which statement by the patient shows a need for further instruction?

A patient’s labor is induced using an intravenous infusion of 1,000 mL Ringer’s lactate with 10 units of oxytocin. Two hours later, the nurse notes a pattern of late fetal heart rate decelerations detected on the fetal monitor.Which action is essential for the nurse to take first?

A baby boy is circumcised on the day of discharge. Which observation should the nurse make prior to the infant’s discharge?.

When assessing a newborn, which is the best method for the nurse to use to elicit the Moro reflex?

A woman gives birth to twin girls, one of whom is stillborn. Which nursing action would be least helpful in supporting the woman as she copes with her loss?

A client who is twO weeks postpartum calls the office and tells a nurse, "l am havinga small amount of brownish discharge from my vagina." Which response is appropriate for the nurse to make?