The nurse notices a decreased fetal heart rate (FHR) on the fetal monitor tracing and contacts the charge nurse. The charge nurse completes a vaginal exam and can feel a portion of the umbilical cord in the vagina.

Which emergency interventions will the charge nurse implement? Select all that apply.

The nurse is caring for a client in labor. Assessment reveals that the fetus is in a vertex presentation and at -4 station. What does the nurse determine as the position of the fetal head?

IV calculations: (rate-mL/h and gtt/min)

IV rate calculations will be rounded to nearest whole number.

Adult calculations: the calculation will be rounded to the nearest tenth. Drug Calculation safety considerations:

Examples:

5 must be answered as 0.5

5.0 must be answered as 5

To promote safety, a zero must be placed to the left of the decimal point in answers that are less than one. No zero is allowed to the right of the decimal point in answers that are whole numbers.

Labeling is not necessary

Question

The nurse received report for the client at 1400. The client was given medication through her NG tube at 1800: Ampicillin 20 mL, Pepcid 10 mL, and Reglan 15 mL. After each medication was given, there was a 30 mL flush with water. Her Hemovac drained 320 mL. Her chest tube drained 210 mL. At 2000, she drank 240 mL of water. Her IV was infusing @ 150mL/hour when report was received. She has voided 275 mL. 325 mL and 310 mL.

What is her I&O from 1400- 2200?

(Separate the answers with a comma)

The nurse is completing a fundal assessment for her postpartum clients today. What will the nurse determine when assessing the fundus?

The nurse assesses a laboring client's cervix and states it is 6 cm dilated and 70% effaced.
The client asks what it means to be effaced. Which descriptions will the nurse include when responding to the client? Select all that apply.

The nurse is caring for a client in labor and discovers late decelerations of the fetal heart rate.
What does the nurse know as the reason for this type of deceleration?

The nurse has received shift report for five clients admitted in labor. Which clients will the nurse anticipate delivering by a cesarean section? Select all that apply.

The nurse is assessing the fetal monitoring tracing below. Which type of fetal heart rate variability is pictured here in the top tracing?

The nurse is caring for a client on the postpartum unit who had a vaginal delivery with epidural anesthesia 2 hours ago. 1. The client presses the call light and tells the nurse she needs to use the bathroom 2. The nurse arrives in the client's room 5 minutes later 3.

The client is getting out of bed alone What is the best response by the nurse?

The nurse is observing the fetal monitoring tracing pictured below. What type of deceleration will the nurse document?

The nurse palpates a postpartum client's fundus two hours after birth and finds it located to the right of midline and somewhat soft. What does the nurse understand about this information?