A nurse is walking by a client's room and can hear the fetal heart rate dropping.
The nurse observes the heartbeat and interprets the monitor strip as indicating which of the following?
Uteroplacental insufficiency.
Umbilical cord compression.
Maternal bradycardia.
Fetal head compression.
The Correct Answer is B
Choice A rationale
Uteroplacental insufficiency typically results in late decelerations, not a sudden drop in fetal heart rate, which is more commonly caused by umbilical cord compression.
Choice B rationale
Umbilical cord compression can cause variable decelerations, which are characterized by a sudden drop in fetal heart rate. This occurs due to the umbilical cord being compressed,
leading to decreased blood flow and oxygen to the fetus.
Choice C rationale
Maternal bradycardia refers to a slow maternal heart rate and does not directly cause changes in the fetal heart rate pattern.
Choice D rationale
Fetal head compression typically causes early decelerations, which are gradual decreases in fetal heart rate that occur with contractions and are usually benign.
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Correct Answer is D
Explanation
Choice A rationale
GBS can be transmitted to the baby during both vaginal and cesarean deliveries if the mother is colonized with the bacteria. It is not limited to cesarean sections, hence why appropriate screening and treatment are essential.
Choice B rationale
GBS, although often harmless in the general population, can cause severe infections in newborns. This bacterium can be a source of severe neonatal infections like sepsis, pneumonia, and meningitis, necessitating preventive measures during pregnancy and delivery.
Choice C rationale
Screening for GBS is typically performed between 35 and 37 weeks of gestation, not at the first prenatal visit. This timing ensures accurate detection of the bacteria closer to the time of delivery.
Choice D rationale
Intravenous antibiotics during labor are recommended for mothers who test positive for GBS to prevent transmission to the baby. This intervention significantly reduces the risk of neonatal GBS infection.
Correct Answer is C
Explanation
Choice A rationale
A maternal blood pressure of 128/88 mm Hg is within normal limits for a pregnant woman. Regular monitoring is necessary, but no immediate follow-up is required unless symptoms
of preeclampsia appear.
Choice B rationale
A fetal heart rate baseline of 115 bpm is within the normal range (110-160 bpm). This does not require immediate follow-up and is a reassuring sign of fetal well-being.
Choice C rationale
A maternal heart rate of 128 bpm is elevated (tachycardia) and may indicate distress, infection, dehydration, or other underlying conditions. This requires immediate follow-up to identify and address the cause.
Choice D rationale
A maternal respiratory rate of 18 breaths per minute is within the normal range (12-20 breaths per minute) and does not require immediate follow-up.