When interpreting fetal heart rate patterns, what other information is considered in addition to baseline and variability?

Maternal heart rate

Gestational age

Uterine contractions

Presence of accelerations and decelerations

Answer and Explanation

The Correct Answer is C

A. Maternal heart rate: While the maternal heart rate is important, it is not directly related to interpreting FHR patterns. However, it is necessary to differentiate between the maternal and fetal heart rate on the monitor.

B. Gestational age: While gestational age affects fetal heart rate (younger fetuses tend to have higher baseline rates), it is not a direct component of FHR interpretation.

C. Uterine contractions: Uterine contractions are crucial in FHR interpretation because they influence perfusion to the fetus. Decelerations occurring with contractions may indicate fetal distress (e.g., late decelerations suggest uteroplacental insufficiency).

D. Presence of accelerations and decelerations: Accelerations and decelerations provide key information about fetal well-being. Accelerations indicate fetal well-being, while decelerations may signal hypoxia, cord compression, or uteroplacental insufficiency.

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Correct Answer is A

Explanation

A. Variable decelerations are due to umbilical cord compression. Variable decelerations are characterized by abrupt decreases in FHR, often with a "V" or "U" shape. They are caused by umbilical cord compression, which disrupts fetal oxygenation.

B. Variable decelerations are a result of the administration of IV narcotic analgesics. Narcotic analgesics (e.g., morphine, fentanyl) cause decreased FHR variability and prolonged decelerations, not variable decelerations.

C. Variable decelerations are caused by uteroplacental insufficiency. Uteroplacental insufficiency causes late decelerations, not variable decelerations.

D. Variable decelerations are related to fetal head compression. Fetal head compression causes early decelerations, which are gradual and mirror contractions, unlike variable decelerations.

A. First stage, latent phase B. Second stage of labor C. First stage, active phase D. First stage, transition phase

Correct Answer is A

Explanation

A. First stage, latent phase: The first stage of labor consists of the latent, active, and transition phases. Latent phase: Cervical dilation 0-3 cm, contractions mild and irregular (every 5-10 minutes, lasting 30-45 seconds). Client in this scenario matches these criteria.

B. Second stage of labor: The second stage of labor begins at full cervical dilation (10 cm) and ends with birth. The client is only 2 cm dilated, so she is still in the first stage.

C. First stage, active phase: The active phase of labor occurs when the cervix is 4-7 cm dilated and contractions are stronger, longer, and more frequent (every 3-5 minutes). The client is only 2 cm dilated, so she is still in the latent phase.

D. First stage, transition phase: The transition phase occurs when the cervix is 8-10 cm dilated, and contractions occur every 2-3 minutes, lasting 60-90 seconds. The client is far from this stage.

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When interpreting fetal heart rate patterns, what other information is considered in addition to baseline and variability?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is in the first stage of labor, undergoing external fetal monitoring, and receiving IV fluid. The nurse observes variable decelerations in the fetal heart rate on the monitor strip. Which of the following is a correct interpretation of this finding?

Correct Answer is A

Explanation

A nurse is caring for a client having contractions every 8 min that are 30 to 40 seconds in duration. The client's cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station with a FHR around 140/min. Which of the following stages and phases of labor is the client experiencing?

Correct Answer is A

Explanation

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