The most common cause of decreased variability in the FHR that lasts 20 minutes or less is:
Fetal sleep cycles.
Head compression during contractions.
Fetal hypoxemia.
Umbilical cord compression.
The Correct Answer is A
Choice A rationale
Fetal sleep cycles cause temporary decreased variability in FHR, typically lasting 20 minutes or less. FHR baseline remains normal. Normal FHR variability is 6-25 bpm.
Choice B rationale
Head compression during contractions leads to early decelerations in FHR, not decreased variability. Early decelerations are a normal response to pressure on the fetal head.
Choice C rationale
Fetal hypoxemia causes decreased variability but usually persists for longer than 20 minutes. It indicates compromised oxygen supply, requiring immediate intervention.
Choice D rationale
Umbilical cord compression leads to variable decelerations in FHR rather than decreased variability. These decelerations vary in onset, duration, and intensity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Terbutaline is a beta-agonist used to relax uterine muscles and delay preterm labor, not to augment labor in term pregnancies. It is not indicated for labor augmentation.
Choice B rationale
Betamethasone is a corticosteroid given to enhance fetal lung maturity in preterm pregnancies. It is not used to augment labor in term pregnancies, as it does not stimulate uterine contractions.
Choice C rationale
Pitocin (oxytocin) is a synthetic form of the natural hormone oxytocin. It stimulates uterine contractions and is commonly used to induce or augment labor in term pregnancies.
Choice D rationale
Magnesium sulfate is used primarily to prevent seizures in women with preeclampsia and to provide neuroprotection to preterm infants. It does not help augment labor contractions.
Correct Answer is B
Explanation
Choice A rationale
Notifying the provider is important but does not address the immediate need to assess the patient's progress and readiness for delivery. A direct intervention is required to determine the next steps.
Choice B rationale
Performing a sterile vaginal exam allows the nurse to assess cervical dilation and effacement, fetal station, and presentation, which are crucial to determine if the patient is ready to push and proceed with delivery.
Choice C rationale
Supportive words and care are essential for patient comfort, but they do not provide the necessary assessment to determine the patient's progress in labor or readiness for pushing.
Choice D rationale
Monitoring the fetal heart rate tracing is important for assessing fetal well-being but does not specifically address the patient's readiness to push or her labor progress.
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