A nurse is caring for a client who is in active labor and notes the FHR baseline has been 100/min for the past 15 min.
The nurse should identify which of the following conditions as a possible cause of fetal bradycardia?
Maternal hypoglycemia.
Maternal fever.
Chorioamnionitis.
Fetal anemia.
The Correct Answer is A
The correct answer is choice a. Maternal hypoglycemia.
Choice A rationale:
Maternal hypoglycemia can lead to fetal bradycardia, causing a sustained low fetal heart rate. Hypoglycemia in the mother can affect the fetus by reducing the availability of glucose, which is essential for fetal metabolism and heart function.
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Choice B rationale:
Maternal fever is more commonly associated with fetal tachycardia rather than bradycardia. Fever in the mother can lead to an increased fetal heart rate, not a decreased one.
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Choice C rationale:
Chorioamnionitis is an infection of the fetal membranes and amniotic fluid, which can lead to fetal distress and tachycardia rather than bradycardia.
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Choice D rationale:
Fetal anemia can also cause bradycardia, but in this scenario, maternal hypoglycemia is a more immediate concern as it directly affects the fetal heart rate by impacting the fetal metabolic processes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Explanation:
"I will use a cool-mist vaporizer in my baby's room." This statement demonstrates an understanding of the teaching. Using a cool-mist vaporizer can help maintain moisture in the air and alleviate nasal congestion in infants.
Incorrect:
B- "I will leave my baby's bib on while he is sleeping." This statement indicates a lack of understanding. It is not safe to leave a bib on an infant while they are sleeping as it can pose a suffocation risk.
C- "I will leave the plastic covering on the crib mattress." This statement indicates a lack of understanding. The plastic covering on the crib mattress should be removed as it can pose a suffocation hazard.
D- "I will lay my baby's head on a pillow while he is in the crib." This statement indicates a lack of understanding. Pillows should not be used in the crib for infants as they can increase the risk of suffocation and SIDS (Sudden Infant Death Syndrome).
Correct Answer is A
Explanation
The correct answer is choice A. Measure gastric residual volumes every 4 hr.
This is because continuous enteral feedings through an NG tube can increase the risk of aspiration, which is the inhalation of food or fluids into the lungs. Measuring gastric residual volumes (GRV) can help monitor the tolerance and absorption of the feedings and prevent overfeeding. GRV is the amount of fluid aspirated from the stomach via an enteral tube to check for gastric emptying. The normal range of GRV is less than 200 ml.
Choice B is wrong because advancing the rate of the feeding every 2 hr can lead to overfeeding, abdominal distension, nausea, vomiting and diarrhea.
The rate of the feeding should be adjusted according to the client’s nutritional needs and tolerance.
Choice C is wrong because maintaining the head of the bed at a 20° angle is not enough to prevent aspiration. The head of the bed should be elevated at least 30° to 45° during and for at least one hour after feeding.
Choice D is wrong because flushing the NG tube with 30 mL 0.9% sodium chloride before and after medication is not related to continuous enteral feedings. This is a practice to prevent clogging of the tube and ensure proper delivery of medication. Flushing the tube with water before and after feeding is also recommended to maintain patency and hydration.
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