A nurse is assisting in the care of a 28-year-old female client who is in active labor in the labor and delivery unit.
Complete the following sentence by using the lists of options.
The nurse should determine that the FHR pattern represents
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
The nurse should determine that the FHR pattern represents Early decelerations due to Fetal head compression during contractions.
Rationale for correct answers:
Early decelerations are a gradual decrease and return to baseline of the fetal heart rate (FHR) associated with uterine contractions. They mirror contractions, beginning and ending with the contraction. This pattern is physiologic and typically benign.
Fetal head compression during contractions causes a vagal response leading to early decelerations. At a station of +4 and full dilation, fetal descent is significant, making head compression the most likely cause.
Rationale for incorrect Response 1 Options:
Late decelerations occur after the peak of the contraction and are due to uteroplacental insufficiency. These are non-reassuring and do not mirror contractions, unlike what is noted in the case.
Variable decelerations are abrupt drops in FHR and vary in timing, shape, and duration. They are not mirror images and are often associated with cord compression, which is not supported by this case’s findings.
Prolonged decelerations last >2 minutes and <10 minutes. The decelerations in this case are transient (to 105 bpm) and resolve before the end of the contractions, ruling out prolonged patterns.
Rationale for incorrect Response 2 Options:
Umbilical cord compression leads to variable decelerations, which are abrupt and not aligned with contraction timing, unlike the current pattern.
Uteroplacental insufficiency results in late decelerations, which occur after the contraction ends. These are non-reassuring and not consistent with the current findings.
Maternal hypotension due to epidural could cause late decelerations from reduced placental perfusion. However, despite a BP drop at 0900 (100/52 mm Hg), the FHR deceleration pattern does not match.
Take home points:
- Early decelerations are benign and typically reflect fetal head compression during contractions.
- Differentiate early from late decelerations based on timing relative to contractions—early mirrors, late lags.
- Variable decelerations are abrupt and typically linked to umbilical cord compression, not head compression.
- Maternal hypotension from epidural requires close monitoring, but it leads to uteroplacental insufficiency and late decelerations, not early.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A sudden drop in grades, increased absenteeism, avoidance of eye contact, and flat affect are significant behavioral and emotional changes that suggest a potential underlying mental health issue. Referring the student to a school social worker, who is trained in mental health assessments and interventions, ensures a timely and appropriate professional evaluation. Early identification and intervention are crucial for improving outcomes in adolescent mental health.
Choice B rationale
Encouraging academic breaks without addressing the root cause of the student's distress is unlikely to resolve the underlying issues. While breaks can be beneficial, they do not provide the comprehensive support needed for significant behavioral and emotional changes that suggest potential mental health concerns. This approach may delay necessary professional intervention.
Choice C rationale
Contacting the child's teacher to discuss tutoring focuses solely on the academic decline and overlooks the emotional and behavioral cues. While academic support might be needed, it does not address the possible mental health component indicated by the flat affect and avoidance of eye contact, which are often symptoms of distress.
Choice D rationale
Notifying the parent to request a medical workup is a reasonable step if a physical health issue is suspected. However, the constellation of symptoms (behavioral changes, emotional blunting, social withdrawal) more strongly points towards a mental health concern rather than a purely physical one, making a referral to a mental health professional more immediately relevant.
Correct Answer is A
Explanation
Choice A rationale
NSAIDs (Nonsteroidal Anti-inflammatory Drugs) are commonly the first-line treatment for juvenile idiopathic arthritis (JIA). They work by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), thereby reducing the production of prostaglandins, which are inflammatory mediators responsible for pain, swelling, and stiffness in the joints.
Choice B rationale
Antifungal medications are used to treat fungal infections. JIA is an autoimmune inflammatory condition, not caused by fungal pathogens. Therefore, antifungal medications have no therapeutic role in the management of juvenile idiopathic arthritis.
Choice C rationale
Antibiotics are specifically designed to combat bacterial infections. JIA is an autoimmune disease where the body's immune system mistakenly attacks its own tissues, primarily joints. It is not caused by bacteria, so antibiotics are ineffective for its treatment.
Choice D rationale
Antiviral medications are used to treat viral infections. JIA is not caused by viral pathogens but rather by an autoimmune dysfunction. Therefore, antiviral medications do not play a role in the primary management of juvenile idiopathic arthritis.
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