A pregnant woman comes in for her weekly fetal heart monitoring.
She is 35 weeks’ gestation.
After 20 minutes on the monitor, the fetal heart rate tracing shows 3 accelerations measuring 15 beats by 15 seconds.
How should the nurse report this finding to the provider?
Positive contraction stress test (CST)
Reactive nonstress test (NST)
Negative contraction stress test (CST)
Non-reactive nonstress test (NST)
The Correct Answer is A
Choice A rationale:
A positive contraction stress test (CST) indicates that the fetal heart rate decelerates late in response to uterine contractions, suggesting potential uteroplacental insufficiency. However, the scenario does not describe a CST being performed, as it does not mention any assessment of uterine contractions or their relationship to fetal heart rate changes.
Choice C rationale:
A negative contraction stress test (CST) would demonstrate no late decelerations in response to contractions, suggesting adequate placental function. However, as mentioned earlier, a CST is not the test being performed in this scenario.
Choice D rationale:
A non-reactive nonstress test (NST) means that there were not enough fetal heart rate accelerations (at least 2, each lasting at least 15 seconds and peaking at least 15 beats above baseline) within a 20-minute period. This finding sometimes warrants further evaluation of fetal well-being. However, the scenario clearly states that 3 accelerations meeting the criteria for reactivity were observed.
Choice B rationale:
A reactive nonstress test (NST) is considered reassuring and indicates that the fetal heart rate is responding appropriately to fetal movement, suggesting that the fetus is likely healthy and well-oxygenated. The presence of 3 accelerations meeting the criteria for reactivity within a 20-minute period is the hallmark of a reactive NST.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
A positive contraction stress test (CST) indicates a potential problem with the fetal heart's response to uterine contractions, not spontaneous accelerations.
It's not consistent with the findings in this scenario.
Choice C rationale:
A negative CST would show no late decelerations in response to contractions, but it's not relevant here because contractions weren't induced.
Choice D rationale:
A non-reactive NST lacks the required accelerations, which are present in this case.
Choice B rationale:
Definition of reactive NST: A reactive NST is a reassuring fetal heart test that demonstrates a healthy fetal heart rate response to fetal movement. It's characterized by two or more fetal heart rate accelerations of at least 15 beats per minute (bpm) lasting at least 15 seconds within a 20-minute period.
Significance of the findings: The presence of three accelerations measuring 15 bpm by 15 seconds within 20 minutes meets the criteria for a reactive NST. This suggests that the fetal nervous system is functioning well and responding appropriately to stimuli, indicating a healthy fetal heart rate pattern.
Nurse's reporting: The nurse should accurately report this finding to the provider as a "reactive nonstress test (NST)." This information is crucial for clinical decision-making regarding the ongoing management of the pregnancy.
Correct Answer is ["A","D"]
Explanation
correct answer/s is A and D.
Choice A rationale:
Prostaglandins:
Mechanism of action: Prostaglandins are hormone-like substances that play a crucial role in labor initiation. They act by softening and ripening the cervix, stimulating uterine contractions, and rupturing the amniotic sac.
Types: Prostaglandins used for labor induction include:
Dinoprostone (Cervidil, Prepidil): Inserted into the vagina as a gel or pessary.
Misoprostol (Cytotec): Administered orally or vaginally.
Effectiveness: Generally effective in initiating labor within 24 hours, with success rates ranging from 60-85%.
Advantages:
Can be used when the cervix is unfavorable (not ripe).
Can be administered in a variety of ways to suit the patient's preferences.
May have a lower risk of uterine hyperstimulation compared to oxytocin.
Disadvantages:
Can cause side effects such as nausea, vomiting, diarrhea, and fever.
May increase the risk of uterine rupture, especially in women with a history of cesarean delivery.
Choice D rationale:
Amnioinfusion:
Procedure: Involves the infusion of sterile saline solution into the amniotic sac through a small catheter.
Mechanism of action: Not fully understood, but it's thought to work by:
Increasing amniotic fluid volume, which can help to stimulate contractions.
Stretching the uterine walls, which may trigger the release of prostaglandins.
Reducing pressure on the umbilical cord, which can improve fetal oxygenation.
Effectiveness: Usually used in conjunction with other induction methods, such as oxytocin or prostaglandins. Has a success rate of about 50-60% in initiating labor within 24 hours.
Advantages:
May be helpful in cases of low amniotic fluid (oligohydramnios).
Can decrease the risk of umbilical cord compression.
Disadvantages:
Requires the insertion of a catheter into the uterus, which carries a small risk of infection.
May cause discomfort for the mother.
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