Test 3

The childbirth education nurse is evaluating the learning of four women, 38 to 40 weeks' gestation, regarding when they should go to the hospital. The nurse determines that the teaching was successful when a client makes which of the following statements? Select all that apply. 1.The client who says, "If I feel a pain in my back and lower abdomen every 5 minutes." 2.The client who says, "When I feel a gush of clear fluid from my vagina." 3.The client who says, "When I go to the bathroom and see the mucous plug on the toilet tissue." 4.The client who says, "If I ever notice a greenish discharge from my vagina." 5.The client who says, "When I have felt cramping in my abdomen for 4 hours or more."

1,2,4 1. True labor contractions often begin in the back and, when the frequency of the contractions is q 5 minutes or less, it is usually appropriate for the client to proceed to the hospital. 2. Even if the woman is not having labor contractions, rupture of membranes is a reason to go to the hospital to be assessed. 4.

A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? 1. Dark brown rectal bleeding. 2. Severe nausea and vomiting. 3. Sharp unilateral pain. 4. Marked hyperthermia.

3. Sharp unilateral pain is a common symptom of a ruptured ectopic.

A patient at 41 weeks' gestation is undergoing an induction of labor with an IV administration of oxytocin (Pitocin). The fetal heart rate starts to demonstrate a recurrent pattern of late decelerations with moderate variability. What is the nurse's priority action? Stop the infusion of Pitocin. Reposition the patient from her right to her left side. Perform a vaginal exam to assess for a prolapsed cord. Prepare the patient for an emergency cesarean birth.

ANS: A There are multiple reasons for late decelerations. Address the probable cause first, such as uterine hyperstimulation with Pitocin, to alleviate the outcome of late decelerations. Repositioning can increase oxygenation to the fetus but does not address the cause of the problem. Variable decelerations are more often seen with a prolapsed cord. In the presence of moderate variability, the fetus continues to have adequate oxygen reserves. If a Category II (indeterminate) or III (abnormal) tracing is interpreted, a prompt approach to assessing oxygenation should be completed.

Which of the following is the priority intervention for the patient in a left side-lying position whose monitor strip shows a deceleration that extends beyond the end of the contraction? Administer O2 at 8 to 10 L/minute. Decrease the IV rate to 100 mL/hour. Reposition the ultrasound transducer. Perform a vaginal exam to assess for cord prolapse.

ANS: A A deceleration that returns to baseline after the end of the contraction is a late deceleration caused by placental perfusion problems. Administering oxygen will increase the patient's blood oxygen saturation, making more oxygen available to the fetus. Decreasing the IV rate, repositioning the ultrasound transducer, and performing a vaginal exam to assess for cord prolapse are not effective interventions to improve fetal oxygenation.

To determine if the patient is in true labor, the nurse would assess for changes in cervical dilation. amount of bloody show. fetal position and station. pattern of uterine contractions.

ANS: A Cervical changes are the only indication of true labor and are used to determine true and false labor. Changes in the amount of bloody show, fetal position and station, and pattern of uterine contractions are unreliable indicators of true labor.

A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developing HELLP syndrome? Platelet count of 50,000/mcL Liver enzyme levels within normal range Negative for edema No evidence of nausea or vomiting

ANS: A HELLP syndrome is characterized by Hemolysis, Elevated Liver enzyme levels, and a Low platelet count. A platelet count of 50,000/mcL indicates thrombocytopenia.

Which factor is known to increase the risk of gestational diabetes mellitus? Previous birth of large infant Maternal age younger than 25 years Underweight prior to pregnancy Previous diagnosis of type 2 diabetes mellitus

ANS: A Prior birth of a large infant suggests gestational diabetes mellitus. A patient younger than 25 is not at risk for gestational diabetes mellitus. Obesity (>90 kg [198 lb]) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on which of the following? Hemorrhage is the primary concern. She will be unable to conceive in the future. Bed rest and analgesics are the recommended treatment. A D&C will be performed to remove the products of conception.

ANS: A Severe bleeding occurs if the fallopian tube ruptures. If the tube must be removed, the patient's fertility will decrease; however, she will be able to achieve a future pregnancy. The recommended treatment is to remove the pregnancy before hemorrhage occurs. A D&C is done on the inside of the uterine cavity. The ectopic is located within the tubes.

The best time to teach nonpharmacologic pain control methods to an unprepared laboring patient is during which stage? Latent phase Active phase Second stage Transition phase

ANS: A The latent phase of labor is the best time for intrapartum teaching because the woman is usually anxious enough to be attentive yet comfortable enough to understand the teaching. During the active phase, the woman is focused internally and unable to concentrate on teaching. During the second stage, the woman is focused on pushing. She normally handles the pain better at this point because she is active in doing something to hasten the birth. During transition, the woman is focused on keeping control; she is unable to focus on anyone else or learn at this time.

A labor patient has brought in a photograph of her two children and asks the nurse to place it on the wall so that she can look at it during labor contractions. This is an example of A.focal point. B.distraction. C.effleurage. D.relaxation.

ANS: A The use of a focal point (image and/or point reference in the labor room) is an example of nonpharmacologic pain control during labor. The image of the patient's children is not serving as a method of distraction. Effleurage is the use of massage techniques to minimize pain perception. The image of the patient's children is not serving as a method of relaxation.

Which routine nursing assessment is contraindicated for a patient admitted with suspected placenta previa? Determining cervical dilation and effacement Monitoring FHR and maternal vital signs Observing vaginal bleeding or leakage of amniotic fluid Determining frequency, duration, and intensity of contractions

ANS: A Vaginal examination of the cervix may result in perforation of the placenta and subsequent hemorrhage. Monitoring FHR and maternal vital signs is a necessary part of the assessment for this patient. Monitoring for bleeding and rupture of membranes is not contraindicated with this patient. Monitoring contractions is not contraindicated with this patient.

You are preparing a patient for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.) Administer a bolus of 500 to 1000 mL of D5 normal saline prior to catheter placement. Have ephedrine available at bedside during catheter placement. Monitor blood pressure of patient frequently during catheter insertion and for the first 15 minutes of epidural administration. Insert a Foley catheter prior to epidural catheter placement. Monitor the patient for hypertension in response to epidural insertion.

ANS: A,B,C A bolus of nondextrose fluid is recommended prior to epidural administration to prevent maternal hypotension. Ephedrine should be available at the bedside in case maternal hypotension is exhibited. Blood pressure should be monitored frequently during insertion and for the first 15 minutes of therapy. It is not necessary to insert a Foley catheter prior to epidural catheter placement. Hypertension is not a common clinical response to this treatment but hypotension is.

Induction of labor is considered an acceptable obstetric procedure if it is a safe time to deliver the fetus. The charge nurse on the labor and birth unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction, including which of the following? (Select all that apply.) A.Fetal death B.Postterm pregnancy C.Rupture of membranes at or near term D.Convenience of the patient or her health care provider E.Chorioamnionitis (inflammation of the amniotic sac)

ANS: A,B,C,EFetal death, postterm pregnancy, rupture of members, and chorioamnionitis are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for convenience of the patient or her provider are not recommended; however, they have become common. Factors such as rapid labors and living a long distance from a health care facility may be a valid reason in such a circumstance.

The nurse who elects to practice in the area of obstetrics often hears discussion regarding the four Ps. What are the four Ps that interact during childbirth? (Select all that apply.) a. Powers b. Passage c. Position d. Passenger e. Psyche

ANS: A,B,D,E Powers: The two powers of labor are uterine contractions and pushing efforts. During the first stage of labor, through full cervical dilation, uterine contractions are the primary force moving the fetus through the maternal pelvis. At some point after full dilation, the woman adds her voluntary pushing efforts to propel the fetus through the pelvis. Passage: The passage for birth of the fetus consists of the maternal pelvis and its soft tissues. The bony pelvis is more important to the successful outcome of labor because bones and joints do not yield as readily to the forces of labor. Passenger: This is the fetus plus the membranes and placenta. Fetal lie, attitude, presentation, and position are all factors that affect the fetus as passenger . Psyche: The psyche is a crucial part of childbirth. Marked anxiety, fear, or fatigue decreases the woman's ability to cope.Position is not one of the four Ps.

A patient asks the nurse how she can tell if labor is real. Which information should the nurse provide to this patient? (Select all that apply.) A.In true labor, the cervix begins to dilate. B.In true labor, the contractions are felt in the abdomen and groin. C.In true labor, contractions often resemble menstrual cramps during early labor. D.In true labor, contractions are inconsistent in frequency, duration, and intensity in the early stages. E.In true labor your contractions tend to increase in frequency, duration, and intensity with walking.

ANS: A,C,E In true labor, the cervix begins to dilate, contractions often resemble menstrual cramps in the early stage, and labor contractions increase in frequency, duration, and intensity with walking. False labor contractions are felt in the abdomen and groin and the contractions are inconsistent in frequency, duration, and intensity.

Spontaneous termination of a pregnancy is considered to be an abortion if the pregnancy is less than 20 weeks. the fetus weighs less than 1000 g. the products of conception are passed intact. there is no evidence of intrauterine infection.

ANS: AAn abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of the fetus is not considered because some fetuses of an older age may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection.

The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient's contractions. How will the nurse document these findings? Late decelerations Early decelerations Variable decelerations Proximal decelerations

ANS: ALate decelerations are similar to early decelerations in the degree of FHR slowing and lowest rate (30 to 40 bpm) but are shifted to the right in relation to the contraction. They often begin after the peak of the contraction. The FHR returns to baseline after the contraction ends. The early decelerations mirror the contraction, beginning near its onset and returning to the baseline by the end of the contraction, with the low point (nadir) of the deceleration occurring near the contraction's peak. The rate at the lowest point of the deceleration is usually no lower than 30 to 40 bpm from the baseline. Conditions that reduce flow through the umbilical cord may result in variable decelerations. These decelerations do not have the uniform appearance of early and late decelerations. Their shape, duration, and degree of fall below baseline rate vary. They fall and rise abruptly (within 30 seconds) with the onset and relief of cord compression, unlike the gradual fall and rise of early and late decelerations. Proximal deceleration is not a recognized term.

Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet? Extension Engagement Internal rotation External rotation

ANS: B Engagement occurs when the presenting part fully enters the pelvic inlet. Extension occurs when the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck stops under the symphysis. This causes the fetal head to extend. Internal rotation occurs when the fetus enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform to the longest diameter of the maternal pelvis. External rotation occurs after the birth of the head. The head then turns to the side so the shoulders can internally rotate and are positioned with their transverse diameter in the anteroposterior diameter of the pelvic outlet.

Which maternal condition always necessitates delivery by cesarean birth? Partial abruptio placentae Total placenta previa Ectopic pregnancy Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal birth occurred. If the patient has stable vital signs and the fetus is alive, a vaginal birth can be attempted. If the fetus has already expired, a vaginal birth is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

The pregnant patient expresses a desire to schedule birth during the baby's father's furlough from military service. The nurse explains that prior to induction of labor, it is essential to determine which clinical finding? Dilated cervix Fetal lung maturity Rupture of membranes Uterine hypertonia

ANS: B Reassurance of fetal lung maturity is essential before elective procedures such as induction or cesarean. The cervix must be favorable for dilation but need not be dilated prior to induction. Prior rupture of membranes is not necessary for induction. Uterine hypertonia is a risk factor associated with induction of labor.

A patient whose cervix is dilated to 6 cm is considered to be in which phase of labor? Latent phase Active phase Second stage Third stage

ANS: B The active phase of labor is characterized by cervical dilation of 5 to 6 cm. Historically, the latent phase is from the beginning of true labor until 3 cm of cervical dilation. Recent research has suggested that the latent phase be considered to last up until 5 to 6 cm. dilated. The second stage of labor begins when the cervix is completely dilated until the birth of the baby. The third stage of labor is from the birth of the baby until the expulsion of the placenta.

Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis? a. Station b. Flexion c. Descent d. Engagement

ANS: B The anterior-posterior diameter of the head varies with how much it is flexed. In the most favorable situation, the head is fully flexed and the anterior-posterior diameter is the suboccipitobregmatic, averaging 9.5 cm. The station is the relationship of the fetal presenting part to the level of the ischial spine. Descent is the moving of the fetus through the birth canal. Engagement occurs when the largest diameter of the fetal presenting part has passed the pelvic outlet.

When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern? Early decelerations Variable decelerations Nonperiodic accelerations Increase in baseline variability

ANS: B When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern. Early declarations are considered reassuring; they are not a concern after rupture of membranes. Accelerations are considered reassuring; they are not a concern after rupture of membranes. Increase in baseline variability is not an expected occurrence after the rupture of membranes.

A patient taking magnesium sulfate has a respiratory rate of 10 breaths per minute. In addition to discontinuing the medication, which action should the nurse take? Increase the patient's IV fluids. Administer calcium gluconate. Vigorously stimulate the patient. Instruct the patient to take deep breaths.

ANS: B Calcium gluconate reverses the effects of magnesium sulfate. Increasing the patient' s IV fluids will not reverse the effects of the medication. Stimulation will not increase the respirations. Deep breaths will not be successful in reversing the effects of the magnesium sulfate.

Which finding would indicate concealed hemorrhage in abruptio placentae? Bradycardia Hard boardlike abdomen Decrease in fundal height Decrease in abdominal pain

ANS: B Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. The patient will have shock symptoms that include tachycardia. The fundal height will increase as bleeding occurs. Abdominal pain may increase significantly.

Which clinical intervention is the only known cure for preeclampsia? Magnesium sulfate Delivery of the fetus Antihypertensive medications Administration of aspirin (ASA) every day of the pregnancy

ANS: B Delivery of the infant is the only known intervention to halt the progression of preeclampsia. Magnesium sulfate is one of the medications used to treat but not cure preeclampsia. Antihypertensive medications are used to lower the dangerously elevated blood pressures in preeclampsia and eclampsia. Low doses of aspirin (81 mg/day) have been administered to women at high risk for developing preeclampsia. This intervention appears to have little benefit.

The nurse is assessing a patient in the active phase of labor. What should the nurse expect during this phase? The patient is sociable and excited. The patient is requesting pain medication. The patient begins to experience the urge to push. The patient experiences loss of control and irritability.

ANS: B During the active phase of labor, contraction intensity and discomfort increase to the point where women often request pain medication. Sociability and excitability occur during the latent phase. The urge to push occurs at the end of the transition phase or the second stage of labor. Loss of control and irritability occur during the transition phase of labor.

Which data found on a patient's health history would place her at risk for an ectopic pregnancy? Ovarian cyst 2 years ago Recurrent pelvic infections Use of oral contraceptives for 5 years Heavy menstrual flow of 4 days' duration

ANS: B Infection and subsequent scarring of the fallopian tubes prevent normal movement of the fertilized ovum into the uterus for implantation. Ovarian cysts do not cause scarring of the fallopian tubes. Oral contraceptives do not increase the risk for ectopic pregnancies. Heavy menstrual flow of 4 days' duration will not cause scarring of the fallopian tubes, which is the main risk factor for ectopic pregnancies.

Which assessment by the nurse would differentiate a placenta previa from an abruptio placentae? Saturated perineal pad in 1 hour Pain level 0 on a scale of 0 to 10 Cervical dilation at 2 cm Fetal heart rate at 160 bpm

ANS: B The classic sign of placenta previa is the sudden onset of painless uterine bleeding, whereas abruptio placentae results in abdominal pain and uterine tenderness; heavy bleeding, cervical dilation, and fetal heart rate of 160 bpm could be associated with both conditions.

Which physiologic event is the key indicator of the commencement of true labor? Bloody show Cervical dilation and effacement Fetal descent into the pelvic inlet Uterine contractions every 7 minutes

ANS: B The conclusive distinction between true and false labor is that contractions of true labor cause progressive change in the cervix. Bloody show can occur before true labor. Fetal descent can occur before true labor. False labor may have contractions that occur this frequently but is usually inconsistent.

A labor and birth nurse receives a call from the laboratory regarding a preeclamptic patient receiving an IV infusion of magnesium sulfate. The laboratory technician reports that the patient's magnesium level is 7.6 mg/dL. What is the nurse's priority action? Stop the infusion of magnesium. Assess the patient's respiratory rate. Assess the patient's deep tendon reflexes. Notify the health care provider of the magnesium level.

ANS: B The therapeutic serum level for magnesium is 4 to 8 mg/dL although it is elevated in terms of normal lab values. Adverse reactions to magnesium sulfate usually occur if the serum level becomes too high. The most important is CNS depression, including depression of the respiratory center. Magnesium is excreted solely by the kidneys, and the reduced urine output that often occurs in preeclampsia allows magnesium to accumulate to toxic levels in the woman. Frequent assessment of serum magnesium levels, deep tendon reflexes, respiratory rate, and oxygen saturation can identify CNS depression before it progresses to respiratory depression or cardiac dysfunction. Monitoring urine output identifies oliguria that would allow magnesium to accumulate and reach excessive levels. Discontinue magnesium if the respiratory rate is below 12 breaths per minute, a low pulse oximeter level (<95%) persists, or deep tendon reflexes are absent. Additional magnesium will make the condition worse.

The nurse is monitoring a patient with severe preeclampsia who is on IV magnesium sulfate. Which signs of magnesium toxicity should the nurse monitor for? (Select all that apply.) Cool, clammy skin Altered sensorium Pulse oximeter reading of 95% Respiratory rate of less than 12 breaths per minute Absence of deep tendon reflexes

ANS: B,D,ESigns of magnesium toxicity include the following: Respiratory rate of less than 12 breaths per minute (hospitals may specify a rate <14 breaths per minute) Maternal pulse oximeter reading lower than 95% Absence of deep tendon reflexes Sweating, flushing Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented) Hypotension Serum magnesium value above the therapeutic range of 4 to 8 mg/dLCold, clammy skin and a pulse oximeter reading of 95% would not be signs of toxicity.

An abortion when the fetus dies but is retained in the uterus is called a. inevitable. b. missed. c. incomplete. d. threatened.

ANS: BA missed abortion refers to a dead fetus being retained in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all the products of conception were expelled. With a threatened abortion, the patient has cramping and bleeding but not cervical dilation.

The nurse is reviewing the instructions given to a patient at 24 weeks' gestation for a glucose challenge test (GCT). The nurse determines that the patient understands the teaching when she makes which statement? "I have to fast the night before the test." "I will drink a sugary solution containing 100 g of glucose." "I will have blood drawn at 1 hour after I drink the glucose solution." "I should keep track of my baby's movements between now and the test."

ANS: C A GCT is administered between 24 and 28 weeks of gestation, often to low- and high-risk antepartum patients. Fasting is not necessary for a GCT, and the woman is not required to follow any pretest dietary instructions. The woman should ingest 50 g of oral glucose solution, and 1 hour later a blood sample is taken. Fetal surveillance with kick counts is an ongoing evaluation for pregnant women; they should contact their health care provider if there is a noticeable decrease in fetal movement.

The clinic nurse is performing a prenatal assessment on a pregnant patient at risk for preeclampsia. Which clinical sign would not present as a symptom of preeclampsia? a. Edema b. Proteinuria c. Glucosuria d. Hypertension

ANS: C Glucose into the urine is not one of the three classic symptoms of preeclampsia. The first sign noted by the pregnant patient is rapid weight gain and edema of the hands and face. Proteinuria usually develops later than the edema and hypertension. The first indication of preeclampsia is usually an increase in the maternal blood pressure.

Which assessment in a patient diagnosed with preeclampsia who is taking magnesium sulfate would indicate a therapeutic level of medication? Drowsiness Urinary output of 20 mL/hour Normal deep tendon reflexes Respiratory rate of 10 to 12 breaths per minute

ANS: C Magnesium sulfate is administered for preeclampsia to reduce the risk of seizures from cerebral irritability. Hyperreflexia (deep tendon reflexes above normal) is a symptom of cerebral irritability. If the dosage of magnesium sulfate is effective, reflexes should decrease to normal or slightly below normal levels. Drowsiness is another sign of CNS depression from magnesium toxicity. A urinary output of 20 mL/hour is inadequate output. A respiratory rate of 10 to 12 breaths per minute is too slow and could be indicative of magnesium toxicity.

A patient who is receiving oxytocin (Pitocin) infusion for the augmentation of labor is experiencing a contraction pattern of more than eight contractions in a 10-minute period. Which intervention would be a priority? A.Increase rate of Pitocin infusion to help spread out contraction pattern. B.Place oxygen on patient at 8 to 10 L/minute via face mask and turn patient to left side. C.Stop Pitocin infusion. D.Call physician to obtain an order for initiation of magnesium sulfate.

ANS: C The patient is exhibiting uterine tachysystole (uterine tetany). Priority intervention is to stop the infusion. The next course of action is to place oxygen on the patient and reposition and increase the flow rate of the primary infusion. If the condition does not improve, the physician may be called for additional orders.

When a Category II pattern of the fetal heart rate is noted and the patient is lying on her left side, which nursing action is indicated? Lower the head of the bed. Place a wedge under the left hip. Change her position to the right side. Place the mother in Trendelenburg position.

ANS: C A Category II pattern indicates an indeterminate fetal heart rate. Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta. Lowering the head of the bed would not be the first position change choice. The woman is already on her left side, so a wedge on that side would not be an appropriate choice. Repositioning to the opposite side is the first intervention. If unsuccessful with improving the FHR pattern, further changes in position can be attempted; the Trendelenburg position might be the choice.

A patient presents to the labor and birth area for emergent birth. Vaginal exam reveals that the patient is fully dilated, vertex, +2 station, with ruptured membranes. The patient is extremely apprehensive because this is her first childbirth experience and asks for an epidural to be administered now. What is the priority nursing response based on this patient assessment? Use contact anesthesia for an epidural and prepare the patient per protocol. Tell the patient that she will not need any pain medication because the birth will be over in a matter of minutes and the pain will stop. Assist the patient with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth. Call the physician for admitting orders.

ANS: C By assisting the patient with nonpharmacologic methods of pain distraction, the nurse is focusing on the patient's needs while still preparing for vaginal birth. The patient presents in an emergent situation with birth being imminent. Thus there is not enough time to administer an epidural. Telling the patient that she will not need any pain medication because the birth will be over soon does not address the patient's concerns of apprehension and therefore is not therapeutic. Because this is an emergency birth situation, the nurse should be attending to the patient. If needed, another nurse and/or supervisor can contact the physician.

Which finding in the exam of a patient with a diagnosis of threatened abortion would change the diagnosis to inevitable abortion? Presence of backache Rise in hCG level Clear fluid from vagina Pelvic pressure

ANS: C Clear fluid from the vagina indicates rupture of the membranes. Abortion is usually inevitable (cannot be stopped) when the membranes rupture, the presence of backache and pelvic pressure are common symptoms in threatened abortion, and a rise in the hCG level is consistent with a viable pregnancy.

To clarify the fetal condition when baseline variability is absent, the nurse should first monitor fetal oxygen saturation using fetal pulse oximetry. notify the physician so that a fetal scalp blood sample can be obtained. apply pressure to the fetal scalp with a glove finger using a circular motion. increase the rate of nonadditive IV fluid to expand the mother's blood volume.

ANS: C Fetal scalp stimulation helps identify whether the fetus responds to gentle massage. An acceleration in response to the massage suggests that the fetus is in normal oxygen and acid-base balance. Monitoring fetal oxygen saturation using fetal pulse oximetry is no longer available in the United States. Obtaining a fetal scalp blood sample is invasive and the results are not immediately available. Increasing the rate of nonadditive IV fluid would not clarify the fetal condition.

What is the priority nursing intervention for the patient who has had an incomplete abortion? Methylergonovine (Methergine), 0.2 mg IM Preoperative teaching for surgery Insertion of IV line for fluid replacement d. Positioning of patient in left side-lying position

ANS: C Initial treatment of an incomplete abortion should be focused on stabilizing the patient's cardiovascular state. Methylergonovine would be administered after surgical treatment, preoperative teaching is not a priority until the patient is stabilized, and the left side-lying position provides no benefit to the patient in this situation.

Which patient will be most receptive to teaching about nonpharmacologic pain control methods? Gravida 1, para 0, in transition Gravida 2, para 1, admitted at 8 cm c. Gravida 1, para 0, dilated 2 cm, 80% effacedd. Gravida 3, para 2, complaining of intense perineal pressure

ANS: C The latent phase of labor is the best time for intrapartum teaching; the latent phase of labor is the first centimeter of cervical dilation. Patients in the transition phase (8 to 10 cm) are experiencing intense pain and are not receptive to teaching. A multigravida complaining of intense perineal pressure indicates a patient whose birth is imminent.

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated? Reposition the patient. Apply a fetal scalp electrode. Record this normal pattern. Administer oxygen by nasal cannula.

ANS: C The periodic pattern described is early deceleration that is not associated with fetal compromise and requires no intervention. This is a Category I tracing which is a normal pattern. Repositioning the patient, applying a fetal scalp electrode, or administering oxygen would be interventions performed for Category II or III patterns.

When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated? Reposition the patient. Apply a fetal scalp electrode. Record this normal pattern. Administer oxygen by nasal cannula.

ANS: C The periodic pattern described is early deceleration that is not associated with fetal compromise and requires no intervention. This is a Category I tracing which is a normal pattern. Repositioning the patient, applying a fetal scalp electrode, or administering oxygen would be interventions performed for Category II or III patterns.

The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply.) Encourage the patient to drink fluids. Place the patient in a Trendelenburg position. Administer a normal saline bolus as prescribed. Administer oxygen at 8 to 10 L/minute per face mask. Administer IV ephedrine in 5- to 10-mg increments as prescribed.

ANS: C,D,E If hypotension occurs after an epidural has been placed, techniques such as a rapid nondextrose IV fluid bolus, maternal repositioning, and oxygen administration are implemented. If those interventions are ineffective, IV ephedrine in 5- to 10-mg increments can be prescribed to promote vasoconstriction to raise the blood pressure. The patient in active labor should not be encouraged to drink fluids. In a Trendelenburg position, the body is flat, with the feet elevated. This would not be a position to use for a pregnant patient.

If a notation on the patient's health record states that the fetal position is LSP, this indicates that the head is in the right posterior quadrant of the pelvis. head is in the left anterior quadrant of the pelvis. buttocks are in the left posterior quadrant of the pelvis. buttocks are in the right upper quadrant of the abdomen.

ANS: CLSP explains the position of the fetus in the maternal pelvis. L = left side of the pelvis, S = sacrum (fetus is in breech presentation), P = posterior quadrants of the pelvis. When the head is in the right posterior quadrant of the pelvis, the position is ROP. When the head is in the left anterior quadrant of the pelvis, the position is ROA. When the buttocks are in the upper quadrant of the abdomen, the position would be ROA, ROP, LOA, LOP, LOT, or ROT.

The labor and birth nurse is reviewing the risk factors for placenta previa with a group of nursing students. The nurse determines that the students understood the discussion when they identify which patient being at the highest risk for developing a placenta previa? Female fetus, Mexican-American, primigravida Male fetus, Asian-American, previous preterm birth Male fetus, African-American, previous cesarean birth Female fetus, European-American, previous spontaneous abortion

ANS: CThe rate of placenta previa is increasing. It is more common in older women, multiparous women, women who have had cesarean births, and women who had suction curettage for an induced or spontaneous abortion. It is also more likely to recur if a woman has had a placenta previa. African or Asian ethnicity also increases the risk. Cigarette smoking and cocaine use are personal habits that add to a woman's risk for a previa. Previa is more likely if the fetus is male. The Mexican-American primipara has no risk factors for developing a placenta previa. The Asian-American multipara has two risk factors for developing a previa. The African-American multipara has three risk factors for developing a previa. The European-American multigravida has one risk factor for developing a placenta previa.

The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of her patient. With which patient should the nurse question the use of vaginal prostaglandin as a cervical ripening agent? The patient who has a Bishop's score of 5 The patient who is at 42 weeks of gestation The patient who had a previous low transverse cesarean birth The patient who had previous surgery in the upper uterus

ANS: D Prostaglandins are contraindicated in patients who have had a previous surgery in the upper uterus, such as a previous classic cesarean incision or extensive surgery for uterine fibroids. A side effect of prostaglandin administration is hyperstimulation of the uterus. A Bishop's score of 5, 42 weeks of gestation, or a previous low transverse cesarean birth are not contraindications for cervical ripening.

When a pattern of variable decelerations occur, the nurse should immediately administer O2 at 8 to 10 L/minute. place a wedge under the right hip. increase the IV fluids to 150 mL/hour. position patient in a knee-chest position.

ANS: D Variable decelerations are caused by conditions that reduce flow through the umbilical cord. The patient should be repositioned when the FHR pattern is associated with cord compression. The knee-chest position uses gravity to shift the fetus out of the pelvis to relieve cord compression. Administering oxygen will not be effective until cord compression is relieved. Increasing the IV fluids and placing a wedge under the right hip are not effective interventions for cord compression.

1. The nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. The deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? This pattern reflects variable decelerations. No interventions are necessary at this time. Document this Category I fetal heart rate pattern and decrease the rate of the intravenous (IV) fluid. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction. This deceleration pattern is associated with uteroplacental insufficiency. The nurse must act quickly to improve placental blood flow and fetal oxygen supply.

ANS: D A pattern similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction, describes a latedeceleration. Oxygen should be given via a snug face mask. Position the patient on her left side to increase placental blood flow. Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This is not a normal pattern, rather it is a Category III tracing, predictive of abnormal fetal acid status at the time of observation. The IV rate should be increased in order to add to the mother's blood volume. These are late decelerations, not early; therefore interventions are necessary.

A major advantage of nonpharmacologic pain management is a more rapid labor is likely. more complete pain relief is possible. the woman remains fully alert at all times. there are no side effects or risks to the fetus.

ANS: D Because nonpharmacologic pain management does not include analgesics, adjunct drugs, or anesthesia, it is harmless to the mother and the fetus. There is less pain relief with nonpharmacologic pain management during childbirth. Pain management may or may not alter the length of labor. At times, when pain is decreased, the mother relaxes and labor progresses at a quicker pace. The woman's alertness is not altered by medication, but the increase in pain will decrease alertness.

Which patient presentation is an acceptable indication for serial oxytocin induction of labor? Multiple fetuses Polyhydramnios History of long labors Past 42 weeks of gestation

ANS: D Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus, making induction of labor high risk. Polyhydramnios also overdistends the uterus, creating a high risk for induction. A history of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.

A patient with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted. When the patient is questioned, she relates that there is history of heart disease in her family; but, that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the patient is discharged. The patient returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension is the patient is exhibiting? Pregnancy-induced hypertension (PIH) Gestational hypertension Preeclampsia superimposed on chronic hypertension Undiagnosed chronic hypertension

ANS: D Even though the patient has no documented prenatal care or medical history, she does relate a family history that is positive for heart disease. Additionally, the patient's blood pressure increased following birth and was treated in the hospital and resolved. Now the patient appears at the 6-week checkup with hypertension. Typically, gestational hypertension resolves by the end of the 6-week postpartum period. The fact that this has not resolved is suspicious for undiagnosed chronic hypertension. There is no evidence to suggest that the patient was preeclamptic prior to the birth.

A patient with preeclampsia is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs indicate gastrointestinal upset. effects of magnesium sulfate. anxiety caused by hospitalization. worsening disease and impending convulsion.

ANS: D Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. Gastrointestinal upset is not an indication as severe as the headache and visual disturbance. She has not yet been started on magnesium sulfate as a treatment. The signs and symptoms do not describe anxiety.

A patient in active labor requests an epidural for pain management. What is the nurse's most appropriate intervention at this juncture? Assess the fetal heart rate pattern over the next 30 minutes. Take the patient's blood pressure every 5 minutes for 15 minutes. Determine the patient's contraction pattern for the next 30 minutes. Initiate an IV infusion of lactated Ringer's solution at 2000 mL/hour over 30 minutes.

ANS: D Rapid infusion of a nondextrose IV solution, often warmed, such as lactated Ringer's or normal saline, before initiation of the block fills the vascular system to offset vasodilation. Preload IV quantities are at least 500 to 1000 mL infused rapidly. Vasodilation with corresponding hypotension can reduce placental perfusion and is most likely to occur within the first 15 minutes after the initiation of the epidural. Determining the fetal heart rate every 30 minutes is the standard of care. The patient is in active labor, which indicates a contraction pattern resulting in cervical dilation.

Which is the method of childbirth that helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor? a. Bradley b. Lamaze c. Leboyer d. Dick-Read

ANS: D The Dick-Read method helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor. The Lamaze method involves concentration and conditioning to help the woman respond to contractions with relaxation to decrease pain. Viewing childbirth as a traumatic experience, the Leboyer method uses decreased light and noise to help the newborn adapt to extrauterine life more easily. The Bradley method teaches women to use abdominal muscles to increase relaxation and breath control; it emphasizes avoidance of all medications and interventions.

After a forceps-assisted birth, the patient is observed to have continuous bright red lochia and a firm fundus. Which other data would indicate the presence of a potential vaginal wall hematoma? Lack of an episiotomy Mild, intermittent perineal pain Lack of pain in the perineal area Edema and discoloration of the labia and perineum

ANS: D The nurse should monitor for edema and discoloration. Using a cold application to the labia and perineum reduces pain by numbing the area and limiting bruising and edema for the first 12 hours. An episiotomy is performed as the fetal head distends the perineum. The pain with vaginal hematoma is severe and constant. The pain associated with vaginal hematoma is severe.

A placenta previa when the placental edge just reaches the internal os is called a. total. b. partial. c. low-lying. d. marginal.

ANS: DA placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. With a partial previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete previa is termed total. The placenta completely covers the internal cervical os.

Which finding on a prenatal visit at 10 weeks might suggest a hydatidiform mole? Blood pressure of 120/80 mm Hg Complaint of frequent mild nausea Fundal height measurement of 18 cm History of bright red spotting for 1 day weeks ago

C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. A patient with a molar pregnancy may have early-onset, pregnancy-induced hypertension. Nausea increases in a molar pregnancy because of the increased production of human chorionic gonadotropin (hCG). The history of bleeding is normally described as being of a brownish color.

What should the nurse recognize as evidence that the patient is recovering from preeclampsia? 1+ protein in urine 2+ pitting edema in lower extremities Urine output >100 mL/hour Deep tendon reflexes +2

C. Rapid reduction of the edema associated with preeclampsia results in urinary output of 4 to 6 L/day as interstitial fluids shift back to the circulatory system. 1+ protein in urine and 2+ pitting edema in lower extremities are signs of continuing preeclampsia. Deep tendon reflexes are not a reliable sign, especially if the patient has been treated with magnesium.

Which of the following findings should the nurse expect when assessing a client, 8 weeks' gestation, with gestational trophoblastic disease (hydatidiform mole)? 1. Protracted pain. 2. Variable fetal heart decelerations. 3. Dark brown vaginal bleeding. 4. Suicidal ideations.

3. Dark brown vaginal bleeding. The condition is usually diagnosed after a client complains of brown vaginal discharge early in the "pregnancy."

A 29-week-gravid client is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following? 1. Leopold maneuver results. 2. Quantity of vaginal bleeding. 3. Presence of abdominal pain. 4. Maternal blood pressure.

3. Presence of abdominal pain. The most common difference between placenta previa and placenta abruption is the absence or presence of abdominal pain.r

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following laboratory values would be consistent with this diagnosis? 1. PO2 90, PCO2 35, HCO3 19 mEq/L, pH 7.3. 2. PO2 100, PCO2 30, HCO3 21 mEq/L, pH 7.5. 3. PO2 60, PCO2 50, HCO3 28 mEq/L, pH 7.3. 4. PO2 90, PCO2 45, HCO3 30 mEq/L, pH 7.5.

4. PO2 90, PCO2 45, HCO3 30 mEq/L, pH 7.5. metabolic alkalosis

A nurse is caring for a laboring woman who is in transition. Which of the following signs/symptoms would indicate that the woman is progressing into the second stage of labor? Select all that apply. 1. Bulging perineum. 2. Increased bloody show. 3. Spontaneous rupture of the membranes. 4. Uncontrollable urge to push. 5. Inability to breathe through contractions.

1, 2, and 4 are correct. As the fetal head descends through a fully dilated cervix, the perineum begins to bulge, the bloody show increases, and the laboring woman usually feels a strong urge to push.

A woman is to receive methotrexate IM for an ectopic pregnancy. The nurse should teach the woman about which of the following common side effects of the therapy? Select all that apply. 1. Nausea and vomiting. 2. Abdominal pain. 3. Fatigue. 4. Light-headedness. 5. Breast tenderness.

1,2,3,4

A client, 32 weeks' gestation with placenta previa, is on total bedrest. The physician expects her to be hospitalized on bedrest until her cesarean section, which is scheduled for 38 weeks' gestation. To prevent complications while in the hospital, the nurse should do which of the following? Select all that apply. 1. Perform passive range-of-motion exercises. 2. Restrict the fluid intake of the client. 3. Decorate the room with pictures of family. 4. Encourage the client to eat a high-fiber diet. 5. Teach the client deep-breathing exercises.

1,3,4,5

A client with a complete placenta previa is on the antepartum clinical unit in preparation for delivery. Which of the following should the nurse include in a teaching session for this client? 1. Coughing and deep breathing. 2. Phases of the first stage of labor. 3. Lamaze labor techniques. 4. Leboyer hydrobirthing.

1. Because the client will have a cesarean section with anesthesia, the woman should be taught coughing and deep- breathing exercises for the postoperative period.

A labor nurse is caring for a client, 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. Which of the following orders by the primary healthcare provider should the nurse question? 1. Begin oxytocin drip rate at 0.5 milliunit/min. 2. Assess fetal heart rate every 10 minutes. 3. Weigh all vaginal pads. 4. Assess hematocrit and hemoglobin.

1. Begin oxytocin drip rate at 0.5 milliunit/min.

A client who is 8 weeks' gestation has been diagnosed with a hydatidiform mole (gestational trophoblastic disease). In addition to vaginal loss, which of the following signs/symptoms would the nurse expect to see? 1. Hyperemesis and hypertension. 2. Diarrhea and hyperthermia. 3. Polycythemia. 4. Polydipsia.

1. Hyperemesis and hypertension are often seen in clients with hydatidiform mole.

A client is on magnesium sulfate via IV pump for severe pre-eclampsia. Other than patellar reflex assessments, which of the following noninvasive assessments should the nurse perform to monitor the client for early signs of magnesium sulfate toxicity? 1. Serial grip strengths. 2. Kernig assessments. 3. Pupillary responses. 4. Apical heart rate checks.

1. Serial grip strengths can be performed to monitor a client for magnesium sulfate toxicity.

A woman has gotten pregnant with a Copper T intrauterine device (IUD) in place. The physician has ordered an ultrasound to be done to evaluate the pregnancy. The client asks the nurse why this is so important. The nurse should tell the woman that the ultrasound is done primarily for which of the following reasons? 1. To assess for the presence of an ectopic pregnancy. 2. To check the baby for serious malformations. 3. To assess for pelvic inflammatory disease. 4. To check for the possibility of a twin pregnancy.

1. When pregnancy occurs with an IUDin place, an ectopic pregnancy should be ruled out.

A client is seen at 8 weeks' gestation for her first prenatal visit. During her last gynecological visit, the client's blood pressure was 100/60. Her blood pressure is now 150/90. For which of the following pregnancy-related illnesses should this client be assessed? 1. Hyperemesis gravidarum. 2. Hydatidiform mole. 3. Pre-eclampsia. 4. Gestational diabetes.

2. Unless the pregnant client developed chronic hypertension during her pregnancy, hydatidiform mole is the most likely cause of her high blood pressure.

Which of the following physical findings would lead the nurse to suspect that a client with severe pre-eclampsia has developed HELLP syndrome? Select all that apply. 1. +3 pitting edema. 2. Petechiae. 3. Jaundice. 4. +4 deep tendon reflexes. 5. Elevated specific gravity.

2, 3 Petechiae may develop when a client is thrombocytopenic, one of the signs of HELLP syndrome. 3. Hyperbilirubinemia develops when red blood cells hemolyze, one of the changes that may develop as a result of liver necrosis. Jaundice is a symptom of hyperbilirubinemia. Also, elevated liver function tests (EL) are a manifestation of HELLP syndrome.

The nurse is caring for a 32-week G8 P7007 with placenta previa. Which of the following interventions would the nurse expect to perform? Select all that apply. 1. Daily contraction stress tests. 2. Blood type and cross match. 3. Bedrest with passive range-of-motion exercises. 4. Daily serum electrolyte assessments. 5. Weekly biophysical profiles.

2, 3, and 5 are correct. 2. There should be blood available in the blood bank in case the woman begins to bleed. 3. The nurse would expect to keep the woman on bedrest with bathroom privileges only. Passive range-of-motion exercises will help to prevent atrophy of the woman's muscles. 5. The nurse would expect that weekly biophysical profiles would be done to assess fetal well-being.

A woman with a diagnosis of ectopic pregnancy is to receive medical intervention rather than a surgical interruption. Which of the following intramuscular medications would the nurse expect to administer? 1. Decadron (dexamethasone). 2. Amethopterin (methotrexate). 3. Pergonal (menotropin). 4. Prometrium (progesterone).

2. Amethopterin (methotrexate).

A gravid client, G3 P2002, was examined 5 minutes ago. Her cervix was 8 cm dilated and 90% effaced. She now states that she needs to move her bowels. Which of the following actions should the nurse perform first? 1. Offer the client the bedpan. 2. Evaluate the progress of labor. 3. Notify the physician. 4. Encourage the patient to push.

2. Evaluate the progress of labor.

A woman had a baby by normal spontaneous delivery 10 minutes ago. The nurse notes that a gush of blood was just expelled from the vagina and the umbilical cord lengthened. What should the nurse conclude? 1. The woman has an internal laceration. 2. The woman is about to deliver the placenta. 3. The woman has an atonic uterus. 4. The woman is ready to expel the cord bloods.

2.These are signs of placental delivery.

A client has been receiving magnesium sulfate for severe pre-eclampsia for 12 hours. Her reflexes are 0 and her respiratory rate is 10. Which of the following situations could be a precipitating factor in these findings? 1. Apical heart rate 104 bpm. 2. Urinary output 240 mL/12 hr. 3. Blood pressure 160/120. 4. Temperature 100°F.

2. The urinary output is the likely cause of the client's changes.

A labor nurse is caring for a client, 30 weeks' gestation, who is symptomatic from a complete placenta previa. Which of the following physician orders should the nurse question? 1. Administer betamethasone (Celestone) 12 mg IM daily times 2. 2. Maintain strict bedrest. 3. Assess cervical dilation. 4. Regulate intravenous (Ringer's lactate: drip rate to 150 mL/hr).

3

A gravid client, G6 P5005, 24 weeks' gestation, has been admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this client? 1. The client will state an understanding of need for complete bedrest. 2. The client will have a reactive nonstress test on day 2 of hospitalization. 3. The client will be symptom-free until at least 37 weeks' gestation. 4. The client will have normal vital signs on admission.

3. The client will be symptom-free until at least 37 weeks' gestation.

A 25-year-old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? 1. Cervical cerclage. 2. Amniocentesis. 3. Nonstress testing. 4. Dilation and curettage.

4. Dilation and curettage.

A 26-week-gestation woman is diagnosed with severe pre-eclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain.

4. Epigastric pain. Epigastric pain is associated with the liver involvement of HELLP syndrome.

he nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. The deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? This pattern reflects variable decelerations. No interventions are necessary at this time. Document this Category I fetal heart rate pattern and decrease the rate of the intravenous (IV) fluid. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction. This deceleration pattern is associated with uteroplacental insufficiency. The nurse must act quickly to improve placental blood flow and fetal oxygen supply.

ANS: DA pattern similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction, describes a latedeceleration. Oxygen should be given via a snug face mask. Position the patient on her left side to increase placental blood flow. Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This is not a normal pattern, rather it is a Category III tracing, predictive of abnormal fetal acid status at the time of observation. The IV rate should be increased in order to add to the mother's blood volume. These are late decelerations, not early; therefore interventions are necessary.