NCLEX Prep Questions Wrong

A client newly diagnosed with deep vein thrombosis (DVT) of the left lower left extremity is on bed rest. What should the nurse instruct the unlicensed assistive personnel (UAP) providing routine morning care for the client to do? Check that the legs are in a low, dependent position. Ensure that the lower extremity is elevated. Massage the leg and foot with lotion. Place one or two pillows under the client's left knee.

Ensure that the lower extremity is elevated. Explanation: DVT causes edema; therefore, the UAP should elevate the extremity to promote venous return. Dependent positioning is appropriate for a client with arterial insufficiency. Placing a pillow under the knee would position the foot in a low position, and pressure behind the knee may obstruct venous flow. Massaging the extremity could dislodge the thrombus.

The nurse has completed instilling fluid with a bladder irrigation and does not have a return of the fluid into the catheter bag. What is the next action the nurse should do?

Ensure there are no kinks in the catheter tubing. The simplest method to ensure drainage of the catheter is to check the tubing for kinks in the tubing that would affect drainage. After this, palpating the bladder for distention, notifying the healthcare provider, and changing the urinary catheter would be the next steps in troubleshooting this situation

While hospitalized, a child develops a Clostridium difficile infection. The nurse can anticipate adding which type of precautions for this client? standard precautions airborne precautions droplet precautions contact precautions

contact precautions Explanation: Contact precautions are used for serious illnesses that are easily transmitted by direct client contact or by contact with items in the client's environment. Clostridium difficile infection is an example of an infection that is spread in this manner. Droplet precautions are used for serious illnesses transmitted by large particle droplets. Standard precautions are used for all clients. Airborne precautions are used for suspected illnesses transmitted by airborne nuclei.

A nurse working in the emergency department is concerned that a client, who is in police custody, is handcuffed to the stretcher. The nurse asks the police officer to remove the cuffs, but the officer refuses. What should be the next action by the nurse?

Continue to assess the client, allowing the officer to assume responsibility for the handcuffs In this situation, the police officer has applied the restraint and has taken responsibility for the restraint. The nurse should assess the client for any potential complication from the handcuffs, document the assessment, and provide care to the client as usual. The other options are incorrect because the police officer has assumed responsibility for the restraint. It is unlikely that a physician would order the restraint to be removed against the officer's recommendation, and if the restraints are in place and the officer is present, the nurse can provide care to the client.

The client who is receiving chemotherapy is not eating well but otherwise feels healthy. What should the nurse suggest the client eat?

broiled chicken, green beans, and cottage cheese Carbohydrates are the first substance used by the body for energy. Proteins are needed to maintain muscle mass, repair tissue, and maintain osmotic pressure in the vascular system. Fats, in a small amount, are needed for energy production. Chicken, green beans, and cottage cheese are the best selection to provide a nutritionally well-balanced diet of carbohydrate, protein, and a small amount of fat. Cereal with milk and strawberries as well as toast, gelatin dessert, and cookies have a large amount of carbohydrates and not enough protein. Steak and french fries provide some carbohydrates and a good deal of protein; however, they also provide a large amount of fat.

The charge nurse on the postpartum unit has received a report about a client who has just experienced a fetal demise and will be ready for transfer out of the labor unit in about 2 hours. The client has asked her primary nurse if she can stay on the obstetrical unit since she has found support from the nursing staff there. What action should the charge nurse on the postpartum unit take? Request a room for this client on a unit without newborns. Ask the nurse in labor and birth to discharge the mother as soon as she is physically able to leave. Talk to the mother first and decide on a location that is mutually agreeable. Admit the mother to a private room on the postpartum unit.

Talk to the mother first and decide on a location that is mutually agreeable. Explanation: The nurse on the postpartum unit should discuss with the client what her wishes are and mutually agree on a location. The charge nurse better understands the current and future needs of the client experiencing this type of loss as the client may or may not be thinking well or clearly at the moment. The postpartum unit is full of sounds of infants, and although being in a room by herself may support the need for separation, it is often in the best interest of the client to locate her away from the noise of the babies. Placing the client on another unit will remove her from the support she is seeking. On the other hand, she will not be hearing crying infants. This has often been the location for someone experiencing a loss. Discharging the mother home as soon as she is stable physically is also a possibility, but the nurse must also assess the client's emotional stability and preferences for grieving.

A client has had an incisional cholecystectomy. Which of the following nursing interventions has the highest priority in postoperative care for this client? Using incentive spirometry every 2 hours while awake. Performing leg exercises every shift. Maintaining a weight-reduction diet. Promoting incisional healing.

Using incentive spirometry every 2 hours while awake. Explanation: A major goal of postoperative care for the client who has had an incisional cholecystectomy is the prevention of respiratory complications. Because of the location of the incision, the client has a difficult time breathing deeply. Use of incentive spirometry promotes chest expansion and decreases atelectasis. Performing leg exercises each shift is not frequent enough; they should be performed hourly. Maintaining a weight reduction diet may be appropriate for the client, but it is not the highest priority in the immediate postoperative phase. Promoting wound healing is important, but respiratory complications are most common after a cholecystectomy.

A nurse is caring for a client who's in labor. The health care professional still isn't present. After the neonate's head is delivered, which nursing intervention would be appropriate? checking for the umbilical cord around the neonate's neck placing antibiotic ointment in the neonate's eyes turning the neonate's head to the side to drain secretions assessing the neonate for respirations

checking for the umbilical cord around the neonate's neck Explanation: After the neonate's head is delivered, the nurse should check for the cord around the neonate's neck. If the cord is around the neck, it should be gently lifted over the neonate's head. Antibiotic ointment is administered to the neonate after birth, not during delivery of the head, to prevent gonorrheal conjunctivitis. The neonate's head isn't turned during delivery. After birth, the neonate is held with the head lowered to help with drainage of secretions. If a bulb syringe is available, it can be used to gently suction the neonate's mouth. Assessing the neonate's respiratory status should be done immediately after birth.

The family of a client who is unconscious following a stroke tells the nurse they feel "pressured" by the resident physician to insert a feeding tube. They are reluctant to agree to the procedure because they believe this action is not something the client would want. Which response by the nurse illustrates ethical practice?

"I can arrange for you to talk with the healthcare team about your loved one's situation." The nurse demonstrates ethical behavior when offering to find resources, answer questions, and provide support to the client's family. Unethical behavior would include providing inaccurate information, giving advice, discussing personal information, or implying that the medical resident is not competent.

A multigravid client admitted to the labor area is scheduled for a cesarean birth under spinal anesthesia. Which client statement indicates that teaching about spinal anesthesia has been understood?

"The anesthetic may cause a severe headache, which is treatable." Spinal anesthesia is used less commonly today because of preference for epidural block anesthesia. One of the adverse effects of spinal anesthesia is a "spinal headache" caused by leakage of spinal fluid from the needle insertion. This can be treated by applying a cool cloth to the forehead, keeping the client in a flat position, or using a blood patch that can clot and seal off any further leakage of fluid. Spinal anesthesia is administered with the client in a sitting position or side lying. Another adverse effect of spinal anesthesia is hypotension caused by vasodilation. General anesthesia provides immediate anesthesia, whereas the full effects of spinal anesthesia may not be felt for 20 to 30 minutes. General anesthesia can be discontinued quickly when the anesthesiologist administers oxygen instead of nitrous oxide. Epidural anesthesia may take 1 to 2 hours to wear off.

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving A-positive blood to an A-negative client. O-negative blood to an O-positive client. O-positive blood to an A-positive client. B-positive blood to an AB-positive client.

A-positive blood to an A-negative client. Explanation: An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.

A client who has apnea during sleep would require which of the following interventions? Select all that apply.

Refer to primary healthcare provider Assess sleep routine/hours Have client keep a sleep diary The client with periods of apnea may require a more thorough assessment including a sleep routine/hour and sleep diary as well as a referral to a primary healthcare provider. Pursed-lip breathing has no influence on sleep apnea. Family may sleep in the same room.

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave PR interval QRS complex T wave

P wave Explanation: The P wave depicts atrial depolarization or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization.

The nurse is delegating activities to a recently graduated licensed practical/vocational nurse (LPN/VN) at a skilled nursing facility. Which activities are appropriate to delegate to the LPN/VN? Select all that apply.

Cleansing a leg wound and applying antibiotic ointment. Recording percentage of meal completion. Assisting an unlicensed assistive personnel (UAP) with a weight. According to the LPN/VN scope of practice, the LPN/VN can cleanse a leg wound and apply antibiotic ointment, record percentage of meal completion, and assist a UAP with weighing a client. The scope of practice of a LPN/VN varies by state, but it usually does not include administering an intravenous medication unless the nurse has obtained a certification establishing competency with IV medication administration. Even then, administering a sedative may be outside the scope of practice. An admission body assessment must be performed by an RN.

The nurse is counseling a client with osteoporosis about dietary choices to slow bone loss. What foods should the nurse teach the client to avoid? Soy beans and soy products such as tofu Canned fish such as salmon or tuna Foods and beverages high in caffeine Foods high in purines such as organ meats

Foods and beverages high in caffeine Explanation: Caffeine may decrease calcium absorption and contribute to bone loss so should be avoided in high amounts. To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it is 1,500 mg. Foods high in calcium included canned fish (especially with bones) and dairy products. Uric acid levels are controlled with decreased purine intake, and this is related to risk for gout and does not relate to osteoporosis. Soy products have not been proven to reduce bone loss but may confer some benefits and do not need to be avoided.

A client is receiving fluid replacement with lactated Ringer's after 40% of the body was burned 10 hours ago. The assessment reveals temperature 97.1°F (36.2°C), heart rate 122 bpm, blood pressure 84/42 mm Hg, central venous pressure (CVP) 2 mm Hg, and urine output 25 mL for the last 2 hours. The IV rate is currently at 375 mL/h. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, what prescription should the nurse request from the health care provider?

IV rate increase The decreased urine output, low blood pressure, low CVP, and high heart rate indicate hypovolemia and the need to increase fluid volume replacement. Furosemide is a diuretic that should not be given due to the existing fluid volume deficit. Fresh frozen plasma is not indicated. It is given for clients with deficient clotting factors who are bleeding. Fluid replacement used for burns is Lactated Ringer's solution, normal saline, or albumin.

A nurse explains the process of cane usage to a hospitalized client with left-sided weakness. Place the steps of teaching proper cane usage in the correct order. All options must be used.

Perform hand hygiene. Secure a gait belt around client's waist. Place the cane in the right hand. Have client advance the cane and the left leg. Have client advance the right leg.

A nurse administers incorrect medication to a client. After assessing the client, and completing an incident report, which is the priority action by the nurse?

Report the incident to risk management. Explanation: The incident should be reported to risk management in order to evaluate care, and determine potential risks or system problems that contributed to the error. This type of error will not be reported to the nursing regulatory agency, or result in the nurse's suspension. Some facilities track the number of errors made by a nurse, or that occur on a particular unit, in order to provide appropriate education, and to improve the nursing process. Adverse drug reaction forms are used to report a client's reaction to a medication, not errors.

A nurse is conducting a physical assessment on an adolescent who does not want her parents informed that she had an abortion in the past. Which statement best describes the information security measures the nurse would implement in this situation?

Respect the adolescent's wishes and maintain her confidentiality. Explanation: The nurse should respect the rights of minors who do not want parents informed of medical situations; the nurse should not tell parents about an adolescent's past procedures. Many states have laws that emancipate minors for healthcare visits involving pregnancy, abortion, or sexually transmitted diseases.

The nurse is assessing a client's arterial pulses. Which photo illustrates the appropriate site for palpating the dorsalis pedis pulse?

To palpate the dorsalis pedis pulse, the nurse places the fingers on the medial dorsum of the foot while the client points the toes down. The first photo illustrates palpation of the femoral, located along the crease, midway between the pubic bone and the anterior iliac crest. The second photo illustrates palpation of the popliteal pulse in the popliteal fossa of the back of the knee. The third photo illustrates palpation of the posterior tibial pulse, slightly below the malleolus of the ankle.

An 8-year-old child is receiving moderate sedation for a medical procedure. The nurse is assessing the child's level of sedation. The child's gag reflex is intact. The child is breathing comfortably unassisted and opens eyes on verbal request. The nurse recognizes that the child is: undersedated. appropriately sedated. deeply sedated. oversedated.

appropriately sedated. Explanation: Moderate sedation is an induced state of depressed consciousness. While under moderate sedation, the child should maintain protective reflexes (such as the gag reflex), maintain a patent airway independently, and respond to physical stimuli or verbal commands such as, "Open your eyes." In this scenario, the nurse assesses that the child is under moderate sedation. An undersedated child would likely be anxious and would complain of pain. In deep sedation, the child isn't as easily aroused and doesn't have protective reflexes or the ability to maintain a patent airway; this type of sedation is closer to general anesthesia. With oversedation, the child is difficult to rouse but is able to maintain a patent airway independently.

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of right-sided heart failure. acute pulmonary edema. pneumonia. cardiogenic shock.

acute pulmonary edema. Explanation: Shortness of breath, agitation, and pink-tinged, foamy sputum signal acute pulmonary edema. This condition results when decreased contractility and increased fluid volume and pressure in clients with heart failure drive fluid from the pulmonary capillary beds into the alveoli. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock is indicated by signs of hypotension and tachycardia.

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings contradicts the estimated gestational age of the newborn? meconium aspiration absence of lanugo hypoglycemia increased amounts of vernix

increased amounts of vernix Explanation: Vernix caseosa is a whitish substance that serves as a protective covering over the fetal body throughout the pregnancy. Vernix usually disappears by term gestation. It is highly unusual for a 12-day postmature baby to have increased amounts of vernix. A discrepancy between the estimated date of conception and gestational age by physical examination must have occurred. Meconium aspiration is a sign of fetal distress but does not coincide with gestation. The presence of lanugo is greatest at 28-30 weeks and begins to disappear as term gestation approaches. Therefore, an absence of lanugo on assessment would be expected with a postmature infant. Hypoglycemia can occur at any gestation, although it is associated with other conditions, including prematurity and small size for gestational age.

A client has severe arterial occlusive disease and gangrene of the left great toe. Which finding is expected?

loss of hair on the lower leg The client with severe arterial occlusive disease and gangrene of the left great toe would have lost the hair on the leg due to decreased circulation to the skin. Edema around the ankle and lower leg would indicate venous insufficiency of the lower extremity. Thin, soft toenails (i.e., not thickened and brittle) are a normal finding. Warmth in the foot indicates adequate circulation to the extremity. Typically, the foot would be cool to cold if a severe arterial occlusion were present.

A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on these findings, the nurse should further assess the client for which complication?

peritonitis Complications of acute appendicitis are perforation, peritonitis, and abscess development. Signs of the development of peritonitis include abdominal pain and distention, tachycardia, tachypnea, nausea, vomiting, and fever. Because peritonitis can cause hypovolemic shock, hypotension can develop. Deficient fluid volume would not cause a fever. Intestinal obstruction would cause abdominal distention, diminished or absent bowel sounds, and abdominal pain. Bowel ischemia has signs and symptoms similar to those found with intestinal obstruction.

After teaching the parents of a 15-month-old child who has undergone cleft palate repair how to use elbow restraints, which statement by the parents indicates effective teaching?

"We'll remove the restraints temporarily, one at a time, at least three times a day to check his skin, then put them right back on." Elbow restraints help to keep the child from placing fingers or any other object in the mouth that would cause injury to the operative site. The restraints are worn at all times except when they are removed to check the skin. Because of the risk for skin breakdown, the restraints are removed periodically during the day to assess the child's underlying skin. It is advisable to remove only one restraint at a time while keeping hold of the child's hand on the unrestrained side. Toddlers are quick and usually want to explore the area in the mouth that the surgery has made feel different. The restraints should be in place at all times during sleep and play to prevent inadvertent injury to the operative site. Taping the restraints directly to the skin is not advised because skin breakdown can occur when tape is reapplied to the same area over several weeks. The restraints can be fastened to clothing to keep them from slipping.

A client comes to the emergency department with symptoms of chest pain radiating down the left arm, dyspnea, and diaphoresis. An electrocardiogram (EKG) shows ST segment elevation and the client is diagnosed with an ST segment-elevation myocardial infarction (STEMI). To determine if the client is a candidate for thrombolytic therapy, which question should the nurse ask?

"What time did your chest pain start?" Thrombolytic therapy must be started within 6 hours of the onset of the myocardial infarction (MI). The time the chest pain started is the priority. The nurse can assess for allergies once the time is determined. Nitroglycerine will not impact the administration of thrombolytic therapy.

When discussing advance directives during an admission assessment, a young client asks the nurse, "Do you have an advance directive?" What is the nurse's best response? "It was a required document during my military service." "Yes, I completed it after graduation and review it annually." "I plan to do it when I can find the time to do it correctly." "I'm single and healthy, so I don't need one at this time."

"Yes, I completed it after graduation and review it annually." Explanation: The nurse is in a unique position to serve as a role model and teacher for others of the need to make these decisions when well, and to have this emergency document in place. Also known as "living wills," advance directives are generally thought to be necessary only for the elderly and seriously ill. Ideally the nurse did complete it upon initially learning of its importance, and reviews it for accuracy and possible revision on a regular basis. Advance directives are not related to being single and healthy, or having served in the military. It is best to take the time to complete this vital document.

A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? potassium B-type natriuretic peptide (BNP) C-reactive protein (CRP) platelet count

B-type natriuretic peptide (BNP) Explanation: The client's symptoms suggest heart failure. BNP is a neurohormone that's released from the ventricles when the ventricles experience increased pressure and stretch, such as in heart failure. A BNP level greater than 51 pg/ml is commonly associated with mild heart failure. As the BNP level increases, the severity of heart failure increases. Potassium levels aren't affected by heart failure. CRP is an indicator of inflammation. It's used to help predict the risk of coronary artery disease. There is no indication that the client has an increased CRP. There is no indication that the client is experiencing bleeding abnormalities, such as those seen with an abnormal platelet count.

When attempting to check the pupils of a client scheduled to receive general anesthesia, the nurse notices that the client has trouble tilting the head back. What is the primary concern related to this finding? The client has limited movement of the neck. The client may have postoperative neck pain. The client is at risk for difficult intubation. The ability to assess the client's pupils is limited.

The client is at risk for difficult intubation. Explanation: The client is at risk for a difficult intubation because the neck must be hyperextended to pass the endotracheal tube. Assessment of the pupils should not be limited. If the client is positioned appropriately during surgery, there is no risk of postoperative neck pain or limited neck movement.

Which medication will the nurse administer to a client who experienced a thrombotic stroke two days ago? acetaminophen aspirin alteplase methylprednisolone

aspirin Explanation: Aspirin interferes with platelet aggregation to prevent blood clots from forming or growing larger and is used in the treatment, and secondary prevention, of ischemic stroke due to thrombosis. Antiplatelet medication, such as aspirin, should be given by day two in the absence of a bleeding complication. Alteplase is a potent medication that breaks down blood clots. It is approved by the U.S. Food and Drug Administration (FDA) for treatment within three hours of the onset of ischemic stroke. When alteplase is given, the client should have a brain scan 24-hours post infusion, and prior to the initiation of anti-platelet therapy. Methylprednisolone is a steroid with mild anticoagulant properties and is not indicated in acute stroke.

When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which physiologic functions? bleeding tendencies intake and output peripheral sensation bowel function

bleeding tendencies Explanation: Aplastic anemia decreases the bone marrow production of RBCs, white blood cells, and platelets. The client is at risk for bruising and bleeding tendencies. A change in the client's intake and output is important, but assessment for the potential for bleeding takes priority. Change in the peripheral nervous system is a priority problem specific to clients with vitamin B12 deficiency. Change in bowel function is not associated with aplastic anemia.

A client with cervical cancer is undergoing internal radium implant therapy. A lead-lined container and a pair of long forceps have been placed in the client's hospital room. What should the nurse tell the client about how these will be used? The forceps and container will be used for: disposal of emesis or other bodily secretions. handling of the dislodged radiation source. disposal of the client's eating utensils. storage of the radiation dose.

handling of the dislodged radiation source. Explanation: Dislodged radioactive materials should not be touched with bare or gloved hands. Forceps are used to place the material in the lead-lined container, which shields the radiation. Exposure to radiation can occur only by direct exposure to the encased radioactive substance; it cannot result from contact with emesis or urine or from touching the client. Disposal of eating utensils cannot lead to radiation exposure. Radioactive dose materials are kept only in the radiation department.

The nurse is reviewing the content of a prescription before giving it to a client. The nurse determines that the prescription is accurately written when which information is included on the prescription? Select all that apply.

healthcare provider signature frequency dose Explanation: Information needed on the prescription includes: the date, client name, medication (trade and generic name), dose, route, frequency, quantity, and signature of prescriber. The pharmacy name and telephone number of the client are not required.

A client with a diagnosis of respiratory acidosis is experiencing renal compensation. What function does the kidney perform to assist in restoring acid-base balance? sequestering free hydrogen ions in the nephrons returning bicarbonate to the body's circulation returning acid to the body's circulation excreting bicarbonate in the urine

returning bicarbonate to the body's circulation Explanation: The kidney performs two major functions to assist in acid-base balance. The first is to reabsorb and return to the body's circulation any bicarbonate from the urinary filtrate; the second is to excrete acid in the urine. Retaining bicarbonate will counteract an acidotic state. The nephrons do not sequester free hydrogen ions.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result?

serum sodium level of 124 mEq/L In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.

The nurse is assessing a client who has been admitted to the acute care facility. The client experiences an acute onset of altered level of consciousness and recent memory loss. What does the nurse anticipate the client will be evaluated for?

delirium Delirium presents as an acute process by which the client exhibits an alteration in level of consciousness, disorientation, and recent memory loss. It may be difficult to differentiate between dementia, delirium, and depression, as many of the clinical manifestations overlap. Dementia, tertiary syphilis, and depression are chronic states and do not manifest acutely.

The nurse would question the prescription for a fetal scalp electrode on which client? client with an HIV infection client with late decelerations client with significant meconium stained fluid client with a prolonged second stage of labor

client with an HIV infection Explanation: Placement of a fetal scalp electrode should be avoided when a client has HIV because it increases the risk of transmission to the fetus. The use of a fetal scalp electrode is indicated when precise tracing are needed to monitor changes associated with fetal hypoxia and satisfactory tracing cannot be obtained with external methods. The presence of decelerations, meconium stained fluid, and prolonged second stage of labor may all be indications for placing a fetal scalp electrode.