A patient was given a fentanyl injection during labor.
The nurse noted the expected outcome of loss of variability along with a pattern indicating uteroplacental insufficiency.
Which of the following strips illustrates this?
Normal fetal heart rate variability with no decelerations.
Fetal heart rate pattern showing early decelerations.
Fetal heart rate pattern with loss of variability and late decelerations.
Fetal heart rate pattern showing variable decelerations.
The Correct Answer is C
Choice A rationale
Normal fetal heart rate variability indicates a healthy, well-oxygenated fetus with a functioning autonomic nervous system. This is a reassuring pattern and would not be the expected outcome of a fentanyl injection, which is known to depress the central nervous system, leading to a decrease in variability.
Choice B rationale
Early decelerations are a benign physiological response caused by head compression during a contraction. They are characterized by a gradual decrease in heart rate that mirrors the contraction and are not associated with uteroplacental insufficiency or the effects of fentanyl.
Choice C rationale
The administration of a narcotic like fentanyl, a central nervous system depressant, can reduce fetal heart rate variability. Loss of variability coupled with late decelerations is a key indicator of uteroplacental insufficiency, which is a concern after some pain medication administrations and requires immediate intervention to improve fetal oxygenation.
Choice D rationale
Variable decelerations are abrupt decreases in the fetal heart rate caused by umbilical cord compression. The shape, depth, and duration of these decelerations are variable, and they are not typically the primary pattern associated with either uteroplacental insufficiency or the direct central nervous system depressant effects of fentanyl.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
This patient is not a good candidate due to the transverse fetal presentation. A fetus in a transverse lie cannot be delivered vaginally because the largest diameter of the fetus is positioned across the maternal pelvis. This presentation poses a significant risk of complications, including uterine rupture, necessitating a cesarean delivery.
Choice B rationale
This patient is not a good candidate because a history of multiple cesarean sections increases the risk of uterine rupture during a trial of labor. While a previous low-transverse uterine incision is generally considered a good candidate for TOLAC, the increased number of prior cesareans significantly raises the risk profile.
Choice C rationale
This patient is an ideal candidate for TOLAC. The previous cesarean section was for a non-recurring indication (breech presentation), not for a cephalo-pelvic disproportion. The estimated fetal weight is within a normal range, and the patient has a single previous low-transverse uterine incision, which is the safest type for a trial of labor.
Choice D rationale
This patient is not a good candidate for TOLAC because a previous classical vertical uterine incision has a significantly higher risk of uterine rupture during labor. This type of incision involves the contractile part of the uterus, and the scar is more likely to dehisce under the stress of uterine contractions, making TOLAC contraindicated.
Correct Answer is B
Explanation
Choice A rationale
True labor contractions are characterized by their persistence and increasing intensity, unlike Braxton Hicks or false labor contractions which often subside with ambulation or a change in activity. This is due to the sustained release of oxytocin and prostaglandins, which stimulate continuous uterine muscle activity, leading to cervical change.
Choice B rationale
A key differentiator of true labor contractions is that they do not diminish with comfort measures like relaxation or taking a shower. These contractions are caused by physiological changes at the myometrial cellular level that are not easily influenced by external stimuli, and their progressive nature is essential for cervical effacement and dilation.
Choice C rationale
True labor contractions follow a predictable pattern, becoming regular in frequency, duration, and intensity over time. This is in contrast to false labor contractions, which remain irregular. The increasing regularity is a result of the synchronized rhythmic firing of myometrial cells as the labor process advances.
Choice D rationale
True labor contractions typically originate in the back and radiate to the lower abdomen, often described as a cramping or tightening sensation that encompasses the entire uterus. Discomfort localized only to the top of the uterus is more characteristic of Braxton Hicks contractions, which do not contribute to cervical change.
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