The nurse notices a decreased fetal heart rate (FHR) on the fetal monitor tracing and contacts the charge nurse. The charge nurse completes a vaginal exam and can feel a portion of the umbilical cord in the vagina.
Which emergency interventions will the charge nurse implement? Select all that apply.
Prepare the client for emergency cesarean delivery
Position the client in a knee-chest position and call for help
Locate and insert a vacuum suction catheter into the vagina and push the infant back into the uterus
Keep a gloved hand in the vagina and push upward on the presenting part to keep it off the cord
Contact the provider and report a prolapsed umbilical cord
Correct Answer : A,B,D,E
A. Preparing the client for emergency cesarean delivery is often necessary when a prolapsed umbilical cord is identified.
B. Positioning the client in a knee-chest position helps alleviate pressure on the umbilical cord, improving fetal oxygenation.
C. Inserting a vacuum suction catheter into the vagina and pushing the infant back into the uterus is not a recommended intervention for a prolapsed umbilical cord; this action may cause harm to the fetus.
D. Keeping a gloved hand in the vagina and pushing upward on the presenting part helps relieve pressure on the umbilical cord.
E. Contacting the provider and reporting a prolapsed umbilical cord is essential for prompt communication and decision-making.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Industry vs. inferiority is relevant to the age range of 6 to 12 years, focusing on the development of competence and mastery in skills. However, it may not be as directly related to the immediate care following an asthma exacerbation.
B. Initiative vs. guilt is the stage where a child starts to take more initiative and responsibility for their own actions. Planning home care involves encouraging the child to take initiative in
managing their asthma, promoting a sense of control over their health.
C. Identity vs. role confusion is more applicable to adolescence and focuses on the formation of a stable self-identity.
D. Autonomy vs. shame and doubt is relevant to the toddler age range, emphasizing the development of independence. While independence is important, the immediate concern in the given scenario aligns more with the initiative and responsibility associated with the school-age child.
Correct Answer is ["0.5"]
Explanation
Dose available: 25mg/ml Ordered dose 12.5mg
Dose to administer= ordered dose/available dose
= 12.5/25 = 0.5ml
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