The nurse is evaluating the fetal monitor tracing of the patient who is in active labor.

Suddenly, the nurse sees the FHR drop from its baseline of 125 down to 80. The nurse repositions the mother, provides oxygen, increases intravenous fluids, and performs a vaginal exam.

The cervix has not changed.

Two minutes have passed, and the fetal heart rate remains in the 70s.

What additional nursing measures should the nurse take?

Call for help and notify the care provider.

Immediately get help and have the operating room ready.

Start Pitocin.

Insert a Foley catheter.

Repeat the uterine resuscitation.

Answer and Explanation

Correct Answer : A,B

Choice A rationale
Calling for help and notifying the care provider ensures that expert medical assistance is available promptly for any emergency interventions required.
Choice B rationale
Getting help and preparing the operating room ensures readiness for an immediate cesarean section if fetal distress persists and the situation does not improve rapidly.
Choice C rationale
Starting Pitocin is inappropriate during fetal distress as it may further stress the fetus by increasing contraction frequency and intensity, potentially worsening the situation.
Choice D rationale
Inserting a Foley catheter does not address the immediate concern of fetal distress and would not provide immediate benefit in improving fetal heart rate.
Choice E rationale
Repeating uterine resuscitation measures (e.g., repositioning, oxygen, IV fluids) is essential, but if they are ineffective, additional interventions, such as preparing for possible surgical delivery, are needed.

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Correct Answer is A

Explanation

Choice A rationale
Inadequate weight gain during pregnancy can lead to intrauterine growth restriction (IUGR), where the fetus does not grow as expected.
Choice B rationale
Excess weight gain is not solely due to overeating; it can result from edema, gestational diabetes, or other metabolic factors.
Choice C rationale
Height is a factor in determining a pregnant woman’s target weight range, influencing the overall recommended weight gain.
Choice D rationale
Obese women have higher risks of complications, including gestational diabetes and hypertensive disorders, differing from normal weight women.

A. Paceritation. B. Shoulder dystocia. C. Infection. D. Meconium aspiration.

Correct Answer is C

Explanation

Choice A rationale
Paceritation is a term not commonly recognized in obstetrics. It lacks clinical relevance and does not correlate with increased risk during labor when membranes rupture.
Choice B rationale
Shoulder dystocia occurs during delivery when the baby's shoulder gets stuck after the head is delivered. It is unrelated to ruptured membranes and does not increase the associated risk.
Choice C rationale
Infection risk increases significantly after membranes rupture due to potential bacterial entry into the uterine cavity. Normal WBC count is 4,000-11,000 cells/mcL.
Choice D rationale
Meconium aspiration occurs when the newborn inhales meconium-stained amniotic fluid, typically in post-term pregnancies or fetal distress. It is not directly linked to ruptured membranes.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

With regard to weight gain during pregnancy, the nurse should be aware of which important information?

Correct Answer is A

Explanation

When planning the care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman’s risk for has increased.

Correct Answer is C

Explanation

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is:

When providing care for the laboring woman should understand that accelerations with fetal movement:

A woman attends a prenatal visit and is told to start taking a folic acid supplement. The Nurse Practitioner explains that this is to prevent:

The fetal monitor tracing shown is associated with:

The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse’s instructions if she states that a positive sign of pregnancy is:

The factors that affect the process of labor and birth, known commonly as the five Ps, include all except:

The nurse places a Toco (tocodynamometer) on a client admitted in early labor. The nurse explains to the client that this device provides an accurate assessment of which of the following: