The fetal monitor indicates that a patient is having contractions every three to four minutes with late fetal decelerations.Which action should the nurse take first?
Notify the health care provider.
Position the patient in a left lateral position.
Increase the patient’s intravenous rate.
Provide the patient with oxygen via a face mask.
The Correct Answer is B
The correct answer is choice B. Position the patient in a left lateral position. This is because late fetal decelerations indicate uteroplacental insufficiency, which means that the placenta is not delivering enough oxygen to the fetus. By positioning the patient on her left side, the blood flow to the placenta and the fetus is improved.
Choice A is wrong because notifying the health care provider is not the first action that the nurse should take. The nurse should first intervene to correct the cause of fetal distress and then inform the provider.
Choice C is wrong because increasing the patient’s intravenous rate may not help with uteroplacental insufficiency. It may also cause fluid overload or pulmonary edema in the patient.
Choice D is wrong because providing the patient with oxygen via a face mask is not the most effective way to increase fetal oxygenation. Oxygen therapy may be used as an adjunct to other interventions, but it is not sufficient by itself.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Braxton Hicks contractions are irregular, painless uterine contractions that occur throughout pregnancy, but are more noticeable in the third trimester.They do not indicate labor, but rather help in softening and ripening the cervix.
Choice A is wrong because the patient does not need to time the contractions unless they become regular, painful, and closer together, which are signs of true labor.
Choice B is wrong because documenting fetal activity daily is not related to Braxton Hicks contractions.Fetal activity is monitored to assess fetal well-being and detect any signs of fetal distress.
Choice C is wrong because losing the mucus plug is also not related to Braxton Hicks contractions.The mucus plug is a thick plug of mucus that seals the cervical canal during pregnancy and may be expelled before or during labor.
Correct Answer is D
Explanation
The correct answer is choice D. Placing warmed tea bags on the nipples is not a recommended method to avoid nipple soreness while breastfeeding.Tea bags can cause dryness and cracking of the nipples, which can increase the risk of infection and pain.
Choice A is wrong because it is better to use both breasts at each feeding and switch the starting breast at each feeding.This helps to ensure adequate milk production and drainage.
Choice B is correct because rubbing breast milk into the nipple can help to moisturize and protect the nipple from infection.Breast milk has antibacterial and healing properties.
Choice C is correct because washing the nipples with water but no soap can help to prevent irritation and dryness of the nipples.
Soap can remove the natural oils that protect the skin.Letting the nipples air dry can also help to prevent fungal growth.
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