Exam 2: NSG 432/ NSG432 (Latest 2025/ 2026 Update) Nursing Care of the Childbearing Family Complete Guide| Questions & Answers| Grade A| 100% Correct (Verified Solutions)- GCU

Exam 2: NSG 432/ NSG432 (Latest 2025/ 2026 Update) Nursing Care of the Childbearing Family Complete Guide| Questions & Answers| Grade A| 100% Correct (Verified Solutions)- GCU QUESTION fetal assessment in labor Answer: ELECTRONIC FETAL MONITORING (EFM) 1. fetal response -can detect changes in oxygenation and how the baby is responding to labor -can have decreased oxygen bc of cord compression, maternal hypertension, maternal hemorrhage 2. uterine activity: can detect normal and abnormal uterine activity -frequency: normal 2-5 every 10 mins -duration: 45-80 secs -strength: 40-70 mmHg in first stage and 80+ in second stage -resting tone: 10 mmHg in between, palpated as soft -relax time: 60 s in 1st stage and 45 s in second stage -montevideo units: 1st stage is 100-250 MVU in 2nd it is 300-400 3. fetal compromise: -can detect re-assuring and non-reassuring fetal patterns -allows us to detect these and make interventions MONITORING TECHNIQUES 1. Auscultation: -listen at intervals to determine FHR -steps: do Leopold's maneuver to determine position, count maternal pulse while listening to FHR to differentiate, listen to FHR after a contraction to establish baseline, then listen during a contraction to determine response, if there are any discrepancies listen for longer 2. External Monitoring: -ultrasound transducer: reflects sounds waves as a visual picture of FHR -tocotransducer: placed on abdomen and has a pressure plate. detect uterine activity frequency and duration but not strength 3. Internal Monitoring: -spiral electrode: placed on fetal presenting part to monitor well being -intrauterine pressure catheter: determine frequency, strength, and duration. measures in montevideo units: subtract baseline and count to peak for all contractions in 10 mins and then add it all together QUESTION reading the fetal monitoring strips Answer: -normal: 110-160 -tachycardia: 160 maternal infection, fever, or fetal anemia meds: atropine, hydralazine, meth or cocaine -bradycardia: 110 fetal cardiac problem, maternal hypothermia or hypotension, viral infection, maternal hypoglycemia VARIABILITY -fluctuation from one heart beat to the next, measures from peak and trough, excludes any episodic fluctuations 1. absent: no change 2. minimal: 1-5 bpm 3. mod: 6-25 bpm 4. marked: 25 SINUSOIDAL -wave like pattern that lasts more than 20 min that indicates severe fetal compromise -typically from fetal anemia and Rh incompatibility and narcotics ACCELERATIONS -increase by 15 bpm that lasts from 15 sec to 2 min -these are okay EARLY DECELS -mirror contraction -indicate head compression: from contraction, fundal massage, vag exam -doc and continue to monitor. dont need intervention LATE DECELS -indicate uteroplacental insufficiency-hypoxemia -decel begins after the contraction started -interventions: side lying position, oxygen, correct maternal hypotension by elevating legs, stop oxytocin VARIABLE DECELS -caused by cord compression knot in cord, prolapsed cord, cord around neck -may or may not go along w contractions -abrupt onset and quick recovery -needs intervention: stop oxytocin, give oxygen, side lying position, vaginal exam to check for prolapsed cord *decrease by 15 bpm for 15 secs to 2 mins PROLONGED DECELS -lasts 2-10 mins -immediate intervention QUESTION strip categories Answer: CATEGORY 1 -FHR: 110-160 -variability: mod -no late or variable decels -accel: present or absent -early decels: absent or present CATEGORY 2 -FHR: brady w variability, or tachy -min or marked variability -no accel -periodic decels: prolonged decels 2-10 min, recurrent lates, variable lates CATEGORY 3 -no variability w bradycardia recurrent variable decels recurrent late decels -sinusoidal QUESTION intrauterine resuscitation Answer: the interventions made when there are FHR abnormalities POISON -position change: side lying -oxygen: non rebreather 10 L 15-30 mins -increase IV infusion rate-will help restore maternal blood vol -sterile vag exam -oxytocin off -notify provider SPECIFIC INTERVENTIONS 1. maternal hypotension: -increase IV fluids -trendelberg position: head down -give epi 2. uterine tachysystole: -turn off oxytocin -start uterine relaxant: terbutaline 3. abnormal FHR in second stage of labor -open glottis pushing -less pushing efforts during contractions -push every other contraction AMNIOFUSION 1. indication: -recurrent variable decels (cord compression) -oligohydramnios: small amt of amniotic fluid 2. administration: -room temp fluid is administered into the uterine cavity to relieve cord compression -can also be warmed -either given by pump or gravity. typically a bolus is given over 20-30 min and then is slowed to maintenance -fluid admin should not exceed 1000 mL 3. nursing considerations: -monitor uterine tone, this is bc distension can occur, resting tone will be elevated during this but should not exceed 40 mmhg -monitor fluid in and fluid out. I&Os should be abt equal QUESTION EFM patient teaching Answer: -UC on the bottom and FHR on the top -show her the peak of the contraction and this is will get less severe from there. showing her that it is halfway over can help -FHR monitoring doesn't mean fetal jeopardy -breathing patterns can be enhanced by looking at UC -internal monitoring does not restrict movement, but women is confined to bed -external monitoring does require her compliance when changing positions QUESTION documentation of FHR and UA (uterine activity) Answer: -baseline FHR -baseline variability -accel -decel -UA: frequency, duration, intensity, resting tone -and trends or changes over time QUESTION nursing care during labor: first stage Answer: beginning of contractions to full dilation and effacement -nulliparous women: may go to the hospital during latent phase (0-3 cm) -multiparous women: often dont go to hospital until active phase (4-7 cm) *women who come in false labor who live close and have transportation are often sent home. women who live far or dont have transportation may be admitted TRUE LABOR CONTRACTIONS -regular, closer together, longer, stronger -felt in low back and abdomen -more intense w ambulation -not relieved w comfort measures FALSE LABOR CONTRACTIONS -irregular, or temporarily regular -felt in back or abdomen above umbilicus -often disappear w walking -may be relieved w comfort measures QUESTION first stage: assessment Answer: when a women comes into the hospital it is important that the assessment begins right away. she is moved to a LDR with her SO's