Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern?
Variability averages between 6 and 10 beats/min.
Mild late deceleration patterns occur with some contractions.
FHR does not change as a result of fetal activity.
Average baseline rate ranges between 100 and 140 beats/min.
The Correct Answer is A
Choice A reason: Variability refers to the fluctuations in the FHR that are irregular in amplitude and frequency. It reflects the balance between the sympathetic and parasympathetic nervous systems of the fetus. A normal variability is between 6 and 10 beats/min, which indicates a healthy and well-oxygenated fetus.
Choice B reason: Late decelerations are decreases in the FHR that begin after the peak of a contraction and return to the baseline after the contraction ends. They are caused by uteroplacental insufficiency, which means that the placenta is not delivering enough oxygen and nutrients to the fetus. Mild late decelerations are not reassuring and may indicate fetal hypoxia or acidosis².
Choice C reason: FHR should change as a result of fetal activity, such as movement, sleep, or stimulation. A change in the FHR indicates a responsive and well-oxygenated fetus. A lack of change in the FHR may indicate fetal distress or compromise.
Choice D reason: The average baseline rate is the mean FHR rounded to increments of 5 beats/min during a 10-minute window, excluding periods of marked variability, accelerations, or decelerations. A normal baseline rate is between 110 and 160 beats/min. A baseline rate between 100 and 140 beats/min is not necessarily abnormal, but it may indicate fetal bradycardia (slow heart rate) or tachycardia (fast heart rate), depending on the gestational age and other factors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","E"]
Explanation
Choice A reason: Eating three larger meals a day is not recommended for hyperemesis gravidarum, as it may increase the nausea and vomiting. Instead, the nurse should advise the woman to eat small, frequent meals throughout the day.
Choice B reason: Ice cream may stay down better than other foods, as it is cold, bland, and soothing. The nurse should encourage the woman to try foods that are appealing to her and avoid foods that trigger nausea.
Choice C reason: Eating what sounds good to the woman even if her meals are not well-balanced is acceptable for hyperemesis gravidarum, as the priority is to maintain hydration and nutrition. The nurse should reassure the woman that she can resume a balanced diet once her symptoms improve.
Choice D reason: Avoiding ginger tea or sweet drinks is not necessary for hyperemesis gravidarum, as some women may find them helpful in reducing nausea. The nurse should suggest the woman to experiment with different beverages and see what works for her.
Choice E reason: Eating a high-protein snack at bedtime is beneficial for hyperemesis gravidarum, as it can prevent low blood sugar levels and morning sickness. The nurse should recommend the woman to have a protein-rich food, such as cheese, yogurt, nuts, or eggs, before going to bed.
Correct Answer is C
Explanation
Choice A reason: Anxiety due to hospitalization is not a likely cause of the signs reported by the patient. Anxiety can cause some symptoms, such as headache, palpitations, or sweating, but it does not cause visual changes or epigastric pain. Anxiety is also not a common complication of pregnancy-induced hypertension, which is a condition characterized by high blood pressure and protein in the urine.
Choice B reason: Effects of magnesium sulfate are not a likely cause of the signs reported by the patient. Magnesium sulfate is a medication used to prevent seizures and lower blood pressure in patients with pregnancy-induced hypertension. It can cause some side effects, such as flushing, nausea, or drowsiness, but it does not cause headache, visual changes, or epigastric pain. In fact, magnesium sulfate can help relieve these symptoms by reducing the cerebral edema and vasospasm caused by pregnancy-induced hypertension.
Choice C reason: Worsening disease and impending convulsion are the most likely cause of the signs reported by the patient. These signs indicate that the patient is developing severe preeclampsia or eclampsia, which are life-threatening complications of pregnancy-induced hypertension. Preeclampsia is characterized by high blood pressure, protein in the urine, and signs of organ damage, such as headache, visual changes, epigastric pain, or decreased urine output. Eclampsia is the occurrence of seizures in a patient with preeclampsia. These conditions can lead to stroke, bleeding, placental abruption, or fetal distress, and require immediate medical attention.
Choice D reason: Gastrointestinal upset is not a likely cause of the signs reported by the patient. Gastrointestinal upset can cause some symptoms, such as nausea, vomiting, or abdominal pain, but it does not cause headache, visual changes, or epigastric pain. Gastrointestinal upset is also not a common complication of pregnancy-induced hypertension, which is a condition that affects the blood vessels and organs, not the digestive system.
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