A patient in labor has a fetal heart rate with late decelerations.
Which of the following are appropriate intrauterine resuscitation measures? Select all that apply.
Check urinary output.
Begin CPR.
Reposition the mother onto her side.
Increase IV fluids.
Apply an oxygen mask to the mother.
Correct Answer : C,D,E
Choice A rationale
Checking urinary output is an important part of overall patient care to assess hydration status and kidney function. However, it is not a direct or immediate intrauterine resuscitation measure for addressing late decelerations, which are a sign of uteroplacental insufficiency and require interventions to improve oxygenation and blood flow to the fetus.
Choice B rationale
Cardiopulmonary resuscitation (CPR) is a life-saving procedure performed when a person's heart stops beating or they stop breathing. It is not an appropriate intervention for a laboring mother with late decelerations unless she experiences a cardiopulmonary arrest herself, which is not indicated by this fetal heart rate pattern.
Choice C rationale
Repositioning the mother onto her side, especially the left side, shifts the weight of the gravid uterus off the inferior vena cava and aorta. This action scientifically improves venous return to the heart and increases cardiac output, thereby enhancing blood flow and oxygen delivery to the placenta and fetus, which can resolve late decelerations.
Choice D rationale
Increasing IV fluids expands the maternal circulating blood volume, which can improve placental perfusion. This increase in intravascular fluid volume leads to a rise in maternal cardiac output and blood pressure, thereby increasing the flow of oxygenated blood to the intervillous spaces of the placenta, addressing the root cause of late decelerations.
Choice E rationale
Applying a non-rebreather oxygen mask to the mother at a flow rate of 8 to 10 liters per minute increases the oxygen saturation of the maternal blood. This higher concentration of oxygen is then delivered to the placenta, increasing the oxygen available for transfer to the fetus and thereby addressing the fetal hypoxemia that is causing the late decelerations. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Vacuum extraction involves applying a suction cup to the fetal scalp to assist with delivery. The pressure from the vacuum can cause a collection of blood between the periosteum and the skull, known as a cephalohematoma. This condition is confined to one cranial bone and does not cross suture lines. It typically resolves on its own over weeks to months.
Choice B rationale
A depressed fontanelle is a sign of dehydration or sunken sutures. In a vacuum-assisted delivery, the opposite often occurs, with the suction creating a "chignon" or caput succedaneum (scalp swelling) that can make the fontanelles appear full or even bulging, but not depressed. A depressed fontanelle is not a complication of this procedure.
Choice C rationale
A ruptured uterus is a rare but severe complication of labor. While it can be associated with oxytocin use or a history of previous uterine surgery, it is not a direct complication of vacuum extraction itself. The risk factors for uterine rupture are different and not directly related to the application of the vacuum cup to the fetal head.
Choice D rationale
Down syndrome is a chromosomal disorder (trisomy 21) that occurs at conception. It is not caused by labor or delivery methods, including vacuum extraction. This is a congenital condition resulting from an extra copy of chromosome 21. A vacuum delivery has no impact on the genetic makeup of the fetus.
Correct Answer is B
Explanation
Choice A rationale
A fetus in a longitudinal lie, cephalic presentation, is positioned with its long axis parallel to the mother's spine, with the head presenting first. This is the most common and favorable position for vaginal delivery. The illustration depicts a vertical alignment of the fetus within the uterus.
Choice B rationale
A transverse lie is a fetal malpresentation where the long axis of the fetus is perpendicular to the long axis of the mother. The fetus's head and buttocks are positioned to the sides of the mother's abdomen, with the shoulder or trunk presenting first.
Choice C rationale
A fetus in a longitudinal lie, breech presentation, is positioned with its long axis parallel to the mother's spine. The fetal buttocks or feet are presenting first into the pelvic inlet. The illustration depicts a vertical alignment of the fetus with the head at the top of the uterus.
Choice D rationale
An oblique lie is an unstable fetal position where the fetal long axis is at an angle to the maternal long axis. This position often converts to a longitudinal or transverse lie during labor. The illustration depicts an angled fetal position, but it is not a true transverse lie. .
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