The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but 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?
a. This pattern reflec...
Chapter 14: Intrapartum Fetal Surveillance
Foundations of Maternal-Newborn &
Women's Health Nursing, 7th Edition
exam with complete solutions
The nurse sees a pattern on the fetal monitor that looks similar to early decelerations,
but 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?
a. This pattern reflects variable decelerations. No interventions are necessary at this
time.
b. Document this reassuring fetal heart rate pattern but decrease the rate of the
intravenous (IV) fluid.
c. Continue to monitor these early decelerations, which occur as the fetal head is
compressed during a contraction.
d. This deceleration pattern is associated with uteroplacental insufficiency, so the nurse
acts quickly to improve placental blood flow and fetal oxygen supply. - ANSWER-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 late
deceleration. Oxygen should be given via a snug face mask. Position the client 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 reassuring pattern, so the IV rate should be increased to
increase the mother's blood volume. These are late decelerations, not early; therefore,
interventions are necessary.
,Which maternal condition should be considered a contraindication for the application of
internal monitoring devices?
a. Unruptured membranes
b. Cervix dilated to 4 cm
c. Fetus has known heart defect
d. External monitors currently being used - ANSWER-ANS: A
To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation
of 4 cm would permit the insertion of fetal scalp electrodes and an intrauterine catheter.
A compromised fetus should be monitored with the most accurate monitoring devices.
The external monitor can be discontinued after the internal ones are applied.
The nurse is instructing a nursing student on the application of fetal monitoring devices.
Which method of assessing the fetal heart rate requires the use of a gel?
a. Doppler
b. Fetoscope
c. Scalp electrode
d. Tocodynamometer - ANSWER-ANS: A
Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it
requires the use of a gel. The fetoscope does not require gel because ultrasonic
transmission is not used. The scalp electrode is attached to the fetal scalp; gel is not
necessary. The tocodynamometer does not require gel. This device monitors uterine
contractions.
Proper placement of the tocotransducer for electronic fetal monitoring is:
a. inside the uterus.
b. on the fetal scalp.
c. over the uterine fundus.
d. over the mother's lower abdomen. - ANSWER-ANS: C
The tocotransducer monitors uterine activity and should be placed over the fundus,
where the most intensive uterine contractions occur. The tocotransducer is for external
use. The tocotransducer monitors uterine contractions. The most intensive uterine
contractions occur at the fundus; this is the best placement area.
Which can be determined only by electronic fetal monitoring?
a. Variability
b. Tachycardia
c. Bradycardia
, d. Fetal response to contractions - ANSWER-ANS: A
Beat-to-beat variability cannot be determined by auscultation because auscultation
provides only an average fetal heart rate (FHR) as it fluctuates. Tachycardia can be
determined by any of the FHR monitoring techniques. Bradycardia can be determined
by any of the FHR monitoring techniques. The fetal response to the contractions is
usually noted by an increase or decrease in fetal heart rate. These can be determined
by any of the FHR monitoring techniques.
Which is the most appropriate method of intrapartum fetal monitoring when a woman
has a history of hypertension during pregnancy?
a. Continuous auscultation with a fetoscope
b.Continuous electronic fetal monitoring
c. Intermittent assessment with a Doppler transducer
d. Intermittent electronic fetal monitoring for 15 minutes each hour - ANSWER-ANS: B
Maternal hypertension may reduce placental blood flow through vasospasm of the spiral
arteries. Reduced placental perfusion is best assessed with continuous electronic fetal
monitoring to identify patterns associated with this condition. It is not practical to provide
continuous auscultation with a fetoscope. This fetus needs continuous monitoring
because it is at high risk for complications.
Why is continuous electronic fetal monitoring generally used when oxytocin is
administered?
a. Fetal chemoreceptors are stimulated.
b. The mother may become hypotensive.
c. Maternal fluid volume deficit may occur.
d. Uteroplacental exchange may be compromised. - ANSWER-ANS: D
The uterus may contract more firmly and the resting tone may be increased with
oxytocin use. This response reduces the entrance of freshly oxygenated maternal blood
into the intervillous spaces, depleting fetal oxygen reserves. Oxytocin affects the uterine
muscles. Hypotension is not a common side effect of oxytocin. All laboring women are
at risk for fluid volume deficit; oxytocin administration does not increase the risk.
The nurse is concerned that a client's uterine activity is too intense and that her obesity
is preventing accurate assessment of the actual intrauterine pressure. Based on this
information, which action should the nurse take?
a. Reposition the tocotransducer.
b. Reposition the Doppler transducer.
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