A nurse in the labor and delivery unit is caring for a client who is undergoing external fetal monitoring. The nurse notices that the fetal heart rate starts to decrease after a contraction begins, with the lowest rate occurring after the contraction's peak. What should be the nurse's first action?
Administer oxygen using a non-rebreather mask.
Increase the rate of maintenance IV infusion.
Elevate the client's legs.
Place the client in the lateral position.
The Correct Answer is D
Choice A reason:
Administering oxygen using a non-rebreather mask is a subsequent step if initial measures do not improve fetal heart rate decelerations. It can help increase the amount of oxygen available to the fetus. Oxygen administration is a supportive measure that can be used if there are signs of fetal distress. In the scenario described, where the fetal heart rate slows after the start of a contraction with the lowest rate occurring after the peak, it suggests late decelerations, which are often associated with uteroplacental insufficiency. Administering oxygen can help increase the fetal oxygen reserve and is a common intervention during labor when there are concerns about fetal well-being.
Choice B reason:
Increasing the rate of maintenance IV infusion is typically considered when there is a concern for maternal hypotension or dehydration, which may not be the immediate cause of the observed fetal heart rate pattern. Increasing the rate of an IV infusion can help improve maternal hydration and blood pressure, which in turn can enhance placental perfusion. However, this intervention is more indirect and may not provide the immediate response needed to address fetal heart rate decelerations. It is typically considered after more direct interventions, such as repositioning the mother, have been attempted.
Choice C reason:
Elevating the client's legs can help improve venous return to the heart, potentially increasing maternal cardiac output and blood flow to the placenta. While this can be beneficial, it is not the primary intervention for late decelerations. Repositioning the mother to improve uteroplacental circulation is generally the first step.
Choice D reason:
Placing the client in the lateral position is often the first action taken when late decelerations are observed. This position helps improve uteroplacental blood flow and can quickly address potential issues related to fetal oxygenation. This position helps to relieve pressure on the inferior vena cava and aorta, which can be compressed by the gravid uterus, especially in the supine position. Relieving this pressure helps to improve uteroplacental circulation and can quickly address the cause of late decelerations, which is often related to compromised blood flow to the placenta.
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View Related questions
Correct Answer is D
Explanation
Choice a reason:
While ultrasound can be used for estimating fetal age, at 36 weeks of gestation, this is not the primary reason for performing an ultrasound before an amniocentesis. Fetal age is usually estimated earlier in the pregnancy to help with dating the pregnancy and determining the due date.
Choice b reason:
Determining if there is more than one fetus is typically established earlier in the pregnancy. By 36 weeks, the presence of multiples would already be known, so this would not be the primary reason for an ultrasound before an amniocentesis at this stage.
Choice c reason:
An ultrasound can be used as a screening tool for spina bifida, but it is not the main reason for an ultrasound before an amniocentesis at 36 weeks. Screening for spina bifida and other anomalies is usually done during the second trimester.
Choice d reason:
The primary reason for an ultrasound before an amniocentesis is to identify the location of the placenta and fetus. This information is crucial to ensure the safety of both the mother and the fetus during the procedure by avoiding injury to the placenta and ensuring the amniotic needle is inserted in a safe location.
Correct Answer is D
Explanation
Choice a reason:
Slightly below the umbilicus is not the expected location for the fundus at 22 weeks of gestation. Typically, the fundus is located at the level of the umbilicus at 20 weeks and rises about 1 cm above the umbilicus each week thereafter.
Choice b reason:
3 cm above the umbilicus would be more consistent with a gestational age of approximately 23 weeks, as the fundus rises approximately 1 cm per week after reaching the level of the umbilicus at 20 weeks.
Choice c reason:
Slightly above the umbilicus would be an expected finding slightly later in gestation, around 21 weeks, as the fundus height increases about 1 cm per week after reaching the umbilicus at 20 weeks.
Choice d reason:
3 cm below the umbilicus is the expected location for the fundus at 22 weeks of gestation. Fundal height measurements typically correspond with the number of weeks of gestation, plus or minus 2 cm. Therefore, at 22 weeks, the fundus would be expected to be slightly below the umbilicus, as it would have just recently risen to the level of the umbilicus at 20 weeks.