Maternal-Newborn chapter 14

MATERNAL-NEWBORN CHAPTER 14 EXAM 2024 WITH 100% CORRECT ANSWERS The nurse evaluates a pattern on the fetal monitor that appears similar to early decelerations. The deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? A: this pattern reflects variable decelerations. no interventions are necessary at this time. B: document this Category I fetal heart rate pattern and decrease the rate of the IV fluid C: continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction D: this deceleration pattern is associated with uteroplacental insufficiency. the nurse must act quickly to improve placental blood flow and fetal oxygen supply. - correct answer D: this deceleration pattern is associated with uteroplacental insufficiency. the nurse must act quickly to improve placental blood flow and fetal oxygen supply. A pattern similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction, describes a late deceleration. Oxygen should be given via a snug face mask. Position the patient on her left side to increase placental blood flow. Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. This is not a normal pattern, rather it is a Category III tracing, predictive of abnormal fetal acid status at the time of observation. The IV rate should be increased in order to add to the mother's blood volume. These are late decelerations, not early; therefore interventions are necessary. Which maternal condition should be considered a contraindication for the application of internal monitoring devices? A: unruptured membranes B: cervix dilated to 4 cm C: fetus has known heart defect D: maternal HIV - correct answer A: unruptured membranes To apply internal monitoring devices, the membranes must be ruptured. Cervical dilation of 4 cm would permit the insertion of fetal scalp electrodes and an intrauterine catheter. A compromised fetus should be monitored with the most accurate monitoring devices. An internal electrode should not be placed if the patient has hemophilia, maternal HIV, or genital herpes. The nurse is instructing a nursing student on the application of fetal monitoring devices. Which method of assessing the fetal heart rate requires the use of a gel? A: doppler B: fetoscope C: scalp electrode D: tocodynamometer - correct answer A: doppler Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires the use of a gel. The fetoscope does not require gel because ultrasonic transmission is not used. The scalp electrode is attached to the fetal scalp; gel is not necessary. The tocodynamometer does not require gel. This device monitors uterine contractions. Proper placement of the tocotransducer for electronic fetal monitoring is: A: inside the uterus B: on the fetal scalp C: over the uterine fundus D: over the mother's lower abdomen - correct answer C: over the uterine fundus The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. The tocotransducer is for external use. The tocotransducer monitors uterine contractions. The most intensive uterine contractions occur at the fundus; this is the best placement area. Which clinical finding can be determined only by electronic fetal monitoring? A: variability B: tachycardia C: bradycardia D: fetal response to contractions - correct answer A: variability Beat-to-beat variability cannot be determined by auscultation because auscultation provides only an average fetal heart rate (FHR) as it fluctuates. Tachycardia can be determined by any of the FHR monitoring techniques. Bradycardia can be determined by any of the FHR monitoring techniques. The fetal response to the contractions is usually noted by an increase or decrease in fetal heart rate. These can be determined by any of the FHR monitoring techniques. Which method of intrapartum fetal monitoring is the most appropriate when a woman has a history of hypertension during pregnancy? A: continuous auscultation with a fetoscope B: continuous electronic fetal monitoring C: intermittent assessment with a Doppler transducer D: intermittent electronic fetal monitoring for 15 minutes each hour - correct answer B: continuous electronic fetal monitoring Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. It is not practical to provide continuous auscultation with a fetoscope. This fetus needs continuous monitoring because it is at high risk for complications. Why is continuous electronic fetal monitoring usually used when oxytocin is administered? A: fetal chemoreceptors are stimulated B: the mother may become hypotensive C: maternal fluid volume deficit may occur D: uteroplacental exchange may be compromised - correct answer D: uteroplacental exchange may be compromised The uterus may contract more firmly and the resting tone may be increased with oxytocin use. This response reduces the entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. Oxytocin affects the uterine muscles. Hypotension is not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. The nurse is concerned that a patient's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. Based on this information, which action should the nurse take? A: reposition the tocotransducer B: reposition the Doppler transducer C: obtain an order from the health care provider for a spiral electrode D: obtain an order from the health care provider for an intrauterine pressure catheter - correct answer D: obtain an order from the health care provider for an intrauterine pressure catheter An intrauterine pressure catheter can measure actual intrauterine pressure. The tocotransducer measures the uterine pressure externally; this would not be accurate with an obese patient, even with repositioning. A Doppler auscultates the FHR. A scalp electrode (or spiral electrode) measures the fetal heart rate (FHR). If the position of a fetus in a cephalic presentation is right occiput anterior, the nurse should assess the fetal heart rate in which quadrant of the maternal abdomen?