Maternity Week 6 Ch. 18

The nurse caring for a laboring client is aware that maternal cardiac output can be increased by which factor?

Change in position

Which laboring client would the nurse expect to be a likely candidate for amnioinfusion?

A client with heavily meconium-stained amniotic fluid or a low amniotic fluid index (AFI)

Fetal monitoring of a pregnant client reveals a regular smooth, undulating wavelike pattern of the fetal heart rate (FHR). Which condition would the nurse infer about the fetus from these results?

Anemia

The nurse is assessing the fetal heart rate (FHR) tracing for a client and determines an FHR baseline of 175 beats/min. The nurse knows that this can be caused by which factor?

Fetal tachycardia

Which are characteristics of a uterine contraction? Select all that apply.

Frequency (how often contractions occur) Intensity (the strength of the contraction at its peak) Resting tone (the tension in the uterine muscle between contractions)

While assessing a pregnant client using a fetoscope, the nurse also palpates the client's abdomen because of which factor?

Assessment of changes in fetal heart rate during and after contraction

The nurse is auscultating and documenting the fetal heart rate (FHR) for a client intermittently with a handheld Doppler device. Which terms are appropriate for the nurse to use while documenting the FHR? Select all that apply.

Bradycardia Regular rhythm Absence of acceleration

The primary health care provider has asked the nurse to draw blood for an umbilical cord acid-base determination test. Which intervention would the nurse perform in this situation?

Collect blood from both the umbilical artery and umbilical vein.

While performing a vaginal examination for the client in active labor, the nurse notes early decelerations in the fetal heart rate (FHR) during uterine contractions. Which nursing intervention is appropriate in this situation?

Document it as a normal finding.

The nurse is palpating for uterine activity during intermittent auscultation for a client in labor. Which interventions would the nurse perform? Select all that apply.

Document the uterine resting tone as either hard or soft. Place a hand over the fundus during the contractions. Measure the uterine contraction duration in seconds. Measure the uterine contraction frequency in minutes.

The nurse is monitoring the fetal heart rate (FHR) of a client in labor. When would the nurse observe early decelerations?

During uterine contractions

While auscultating for fetal heart tones in a pregnant client, the nurse observes persistent fetal tachycardia. Which client condition would be an anticipated finding?

If the client's body temperature has increased

Which device would the nurse use for monitoring the intensity of uterine contractions in a pregnant client?

Intrauterine pressure catheter (IUPC)

The nurse is administering an amnioinfusion to a client with oligohydramnios. Which risk would the nurse primarily monitor for during administration?

Overdistension of the uterus

Which action would the nurse take when using a tocotransducer on a client during preterm labor?

Palpate to assess the contraction frequency.

Which finding would the nurse relate to normal uterine activity in the second stage of labor?

Strength of the contraction is over 80 mm Hg.

The nurse is caring for a client with electronic fetal monitoring using a spiral electrode. How is the use of a spiral electrode different from the use of an ultrasound transducer?

It is used after the membranes have ruptured.

The nurse observes late decelerations in the fetal heart rate (FHR) in the second stage of labor. After assessing the client, the nurse elevates the lower extremities. Which assessment finding would be the reason for this nursing intervention?

Maternal hypotension

The nurse caring for a client in labor understands that the cause of increased variability in fetal heart rate might be which factor?

Methamphetamines

After assessing fetal heart activity, the nurse documents the fetal heart rate (FHR) to be in category II. According to the three-tier FHR classification system, which findings would indicate a category II FHR?

Minimal variability

When assessing the fetal heart rate (FHR) of a client in labor, which would the nurse identify as normal variability of the FHR?

Moderate variability

The nurse is assessing a pregnant client and using spiral electrode monitoring to record the fetal heart rate (FHR). Under which circumstances would the nurse consider implementing this method?

The cervix is partially dilated.

When assessing uterine activity, the nurse is aware of which consideration?

The examiner's hand should be placed on the fundus before, during, and after contractions.

The nurse is using a Monica AN24 device to monitor fetal heart rate (FHR) and uterine activity for a client in labor. Which factors would the nurse consider when using this device? Select all that apply.

The monitor uses five electrodes placed on the abdomen. The device eliminates the need for abdominal belts. The device is approved for clients at 36 weeks of gestation or more.

Which statement is accurate regarding episodic accelerations in fetal heart rate (FHR) with fetal movement when caring for a laboring client?

They are reassuring of fetal well-being.

Which statement by the nurse is accurate regarding the calculation of Montevideo units for monitoring uterine activity during labor?

They can be calculated with an intrauterine pressure catheter (IUPC).

Which device can be used as a noninvasive way to assess fetal heart rate (FHR) in the client whose membranes are not ruptured?

Ultrasound transducer

When monitoring the client in labor, the nurse knows that the likely cause of variable fetal heart rate (FHR) decelerations is which factor?

Umbilical cord compression

The nurse is monitoring the client's fetal heart rate (FHR) and notices late decelerations associated with uterine contractions, including a gradual decrease in and return to baseline. To which condition would the nurse attribute this pattern?

Uteroplacental insufficiency

While monitoring fetal heart rate (FHR), the nurse instructs the client to change her position and lie in the knee-to-chest position for which reason?

Variable FHR decelerations

While monitoring the fetal heart rate (FHR) of a pregnant client, the nurse notes a regular, smooth, undulating wavelike pattern. Which condition would the nurse suspect when observing this pattern?

Fetal anemia

Which location would the nurse utilize to assess and hear loud, clear fetal heart sounds?

Fetal back

The nurse is teaching a group of student nurses about fetal oxygenation. The nurse asks a student, "What happens when oxytocin levels are elevated in the client?" Which statement by the student nurse indicates effective learning related to the client's condition?

"Uterine contractions will increase."

The nurse is evaluating the fetal monitor tracing of a client who is in active labor and notes a sudden drop in fetal heart rate (FHR) from its baseline of 125 down to 80. The nurse repositions the client, provides oxygen, increases intravenous (IV) fluid, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. Which additional measure would the nurse take?

Immediately notify the primary health care provider.

The nurse knows to document the fetal heart rate (FHR) tracing as category III under which condition?

Presence of a sinusoidal pattern

While caring for a client receiving a nonstress test (NST), the nurse does not observe accelerations in fetal heart rate (FHR) after 30 minutes of FHR monitoring. Which intervention would the nurse perform to elicit FHR accelerations?

Provide vibroacoustic stimulation.

The nurse assesses fetal well-being during labor by monitoring which factor?

Response of the fetal heart rate (FHR) to uterine contractions

Which assessment would the nurse make after assessing an electronic fetal heart tracing that indicates umbilical cord compression?

Variable decelerations

The nurse is caring for a client in labor who presents with variable decelerations in fetal heart rate (FHR). Arrange the nursing interventions in the order in which they would be performed for this client.

1. Assist the client in changing position. 2. Discontinue oxytocin administration. 3. Administer oxygen at 8 to 10 L/min. 4. Notify the primary health care provider or nurse-midwife. 5. Assist with a vaginal or speculum examination. 6. Assist with amnioinfusion if prescribed. 7. Assist with cesarean or assisted vaginal delivery.

The nurse is performing intermittent auscultation using Doppler ultrasonography to determine the fetal heart rate (FHR) for a client in labor. Arrange the steps in the order in which the nurse would perform the procedure.

1. Palpate the maternal abdomen to identify the fetal presentation and position. 2. Apply ultrasonic gel to the device, and place it over an area of maximal clarity. 3. Count the maternal radial pulse while listening to the FHR to discern between the two. 4. Check for uterine activity to count FHR between contractions. 5. Count the maternal radial pulse while listening to the FHR to discern between the two. 6. Determine the need for another mode of FHR monitoring if there are discrepancies.

The nurse is monitoring the fetal heart rate (FHR) of a client in term labor. The FHR varies between 120 and 130 beats/min over a 10-minute period. How would the nurse record the baseline? Record your answer using a whole number. ________ beats/min

125

At which interval during the first stage of labor would the nurse assess the fetal heart rate (FHR) tracing in a pregnant client with diabetes?

15 minutes

The nurse instructs a laboring client to breathe through the mouth and keep it open while pushing during the second stage of labor. Which is the rationale for this nursing intervention?

Facilitating increased oxygen to the fetus

The nurse is using auscultation to determine fetal heart rate (FHR) during the first stage of labor. Which measures would the nurse use to reassure the client if it takes considerable time to locate and count the heartbeats?

Allow the client to listen to the heartbeat.

The nurse is assessing the fetal heart rate (FHR) of a pregnant client and finds minimal FHR variability. The nurse reassesses the client 30 minutes later and finds moderate variability. What would the nurse infer from these two observations?

Baseline heart rate is 150 beats/min

The primary health care provider prescribes terbutaline for a pregnant client. After assessing the client's record, the nurse knows the rationale for this prescription should be which condition?

Contractions are increased.

The nurse is helping a pregnant client during labor by applying fundal pressure. What alteration in the fetal heart rate (FHR) pattern would result from this intervention?

Early decelerations

Which fetal heart rate tracing characteristics are considered reassuring or normal (category I)?

Early decelerations, either present or absent

While monitoring the fetal heart rate (FHR) of a client in labor, the nurse notes tachycardia. Which is a probable cause for this condition?

Early signs of fetal distress