Fetal Heart Rate and Assessment

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Questions and Answers

Why must the nurse monitor the patient's fluid intake and output closely during oxytocin administration?

Oxytocin is toxic to the kidneys

Oxytocin has a diuretic effect

Oxytocin causes water intoxication (correct)

Oxytocin causes excessive thirst

Rh isoimmunization in a pregnant client develops when which condition occurs?

Rh-positive maternal blood crosses into fetal blood

Rh-negative maternal blood crosses into fetal blood

Rh-negative fetal blood crosses into maternal blood

Rh-positive fetal blood crosses into maternal blood (correct)

Which laboratory test would likely be ordered for a newborn of an Rh (-) maternal blood?

Platelet count

Direct Coomb's (correct)

Blood culture

Indirect Coomb's

Which assessment finding should the nurse expect in a patient with abruptio placentae?

Uterine tenderness Signup and view all the answers

Which prescription should the nurse question for a client suspected of having placenta previa?

Obtain equipment for a manual pelvic examination Signup and view all the answers

Upon finding abruptio placentae during an ultrasound, which prescription should the nurse anticipate?

Delivery of the fetus Signup and view all the answers

What is a common complication associated with Rh-negative mothers during pregnancy?

Hemolytic disease of the newborn Signup and view all the answers

What assessment finding is typically NOT associated with abruptio placentae?

Painless vaginal bleeding Signup and view all the answers

Which finding would lead a nurse to suspect a miscarriage in an 8-week pregnant patient?

Dropping hCG level Signup and view all the answers

Which medication is indicated for medical management of abortion by causing cervical ripening?

Misoprostol Signup and view all the answers

What complication should the nurse suspect in a 17-week pregnant patient with fast, fresh vaginal bleeding and a larger than expected fundic height?

Gestational trophoblastic disease Signup and view all the answers

Which of the following is not typically associated with hydatidiform mole?

Excessive fetal activity Signup and view all the answers

What dietary adjustment should a nurse recommend for a diabetic pregnant client in the second half of pregnancy?

Increased caloric intake Signup and view all the answers

What is the most appropriate nursing action for a postpartum client feeling faint and dizzy?

Obtain hemoglobin and hematocrit levels Signup and view all the answers

Where would you hear the fetal heartbeat best when the fetal back is at the left side of the mother in breech presentation?

Left lower quadrant Signup and view all the answers

What does a soft, broad mass that moves with the rest of the presenting part most likely indicate during fundal grip?

Fetal buttocks Signup and view all the answers

What is the expected time frame for the return of bowel function after giving birth?

3 days postpartum Signup and view all the answers

What should be the priority nursing consideration for a postpartum client who had an episiotomy and hemorrhoids?

Client's pain level Signup and view all the answers

In a left-anterior breech presentation, where would the fetal heart rate be most audible?

Above the maternal umbilicus and to the left of midline Signup and view all the answers

What does a presenting part at station plus two indicate during labor?

Presenting part is 2 cm above the plane of the ischial spines Signup and view all the answers

What is the most appropriate nursing intervention when the uterine fundus is noted to be soft and boggy after delivery?

Massage the fundus until it is firm. Signup and view all the answers

When a fetal heart rate of 90 bpm is noted during auscultation, what is the most appropriate first action?

Notify the doctor immediately Signup and view all the answers

When observing clots in the lochia larger than 1 cm during a postpartum assessment, which nursing action is appropriate?

Notify the doctor. Signup and view all the answers

How should the result of a negative contraction stress test (CST) be interpreted?

Normal test result Signup and view all the answers

Which of the following decelerations is considered normal during a contraction stress test?

Early deceleration Signup and view all the answers

What should the nurse's initial response be for a client who has saturated a perineal pad in 15 minutes, 2 hours postpartum?

Contact the obstetrician and inform him or her of this finding. Signup and view all the answers

Which sign is considered an early indication of excessive blood loss in the immediate postpartum period?

Both B and C. Signup and view all the answers

What would the nurse interpret if a late decrease in fetal heart rhythm was noted during a contraction stress test?

Indication of uteroplacental insufficiency Signup and view all the answers

Which self-care instruction should be included for a postpartum client diagnosed with mastitis?

Maintain a fluid intake of at least 3000 mL/day. Signup and view all the answers

Which statement by the client indicates a need for further instruction regarding mastitis prevention?

I should pump breast milk at least once a day. Signup and view all the answers

Which of the following instructions should be emphasized for a client to prevent postpartum complications?

Avoid heavy lifting for 6 weeks. Signup and view all the answers

When assessing a client for signs of postpartum complications, which observation is most concerning?

Fever of 39°C occurring on day 3 postpartum. Signup and view all the answers

What is the most likely cause of a late deceleration in fetal heart rate?

Insufficient placental circulation Signup and view all the answers

Which action is most appropriate when late decelerations are noted during a contraction stress test (CST)?

All of the above Signup and view all the answers

What is Leila's GTPAL score given her obstetric history?

G3 T2 PO A1 L2 Signup and view all the answers

What is Sheila's GTPAL score considering her pregnancy history?

G6 T5 P1 A1 L5 Signup and view all the answers

What is Meila's GTPALI score based on her obstetric history?

G5 T2 P1 A2 L3 Signup and view all the answers

How should the nurse record the obstetrical history for a patient who had a son at 38 weeks, a daughter at 30 weeks, and a miscarriage at 8 weeks?

G3 T2 PO AO L2 Signup and view all the answers

What instruction should the nurse provide to a pregnant patient scheduled for amniocentesis?

An informed consent must be signed prior to the procedure. Signup and view all the answers

Which of the following values is considered a normal lecithin-sphingomyelin ratio for assessing fetal lung maturity?

2:1 Signup and view all the answers

Study Notes

Fetal Heart Rate Auscultation

In a breech presentation with the fetal back on the left side of the mother, the fetal heart rate will be best heard in the left lower quadrant.

Leopold's Maneuvers

During fundal grip, a soft, broad mass that moves with the presenting part is likely the fetal buttocks.

Fetal Positioning

A fetus in the left-anterior breech presentation will have the fetal heart rate most audible above the maternal umbilicus and to the left of midline.

Station

Station plus two means the presenting part is 2 cm below the plane of the ischial spines.

Fetal Heart Rate Assessment

A fetal heart rate of 90 bpm in one full minute is abnormal and requires immediate notification of the doctor.

Contraction Stress Test

A negative Contraction Stress Test (CST) indicates a normal test result.
Late decelerations during CST are considered abnormal and are most likely caused by insufficient placental circulation.
In response to a late deceleration, the most appropriate action is to stop the test, place the patient on the left side-lying position, and provide oxygen support.

GTPAL

GTPAL: Gravidity, Term, Premature, Abortions, Living
A woman who is 26 weeks pregnant with her third pregnancy, has had two term deliveries, no premature deliveries, one abortion, and two living children would have a GTPAL score of G3 T2 P0 A1 L2.
A woman who is 25 weeks pregnant with twins, has had five children born at term, one born prematurely, one abortion, and five living children would have a GTPAL score of G6 T5 P1 A1 L5.
A woman who is 13 weeks pregnant with her fifth pregnancy, has had one term delivery, one premature delivery, two abortions, and three living children would have a GTPAL score of G5 T1 P1 A2 L3.
A woman who has had two children born at term and one miscarriage would have a GTPAL score of G3 T2 P0 A0 L2.

Amniocentesis

Informed consent must be signed prior to the procedure.
A normal lecithin-sphingomyelin (L/S) ratio for fetal lung maturity is 2:1.

Naegele's Rule

Naegele's rule calculates the expected date of delivery by adding 280 days to the first day of the last menstrual period.

Oxytocin Administration

Oxytocin can cause water intoxication, so monitoring fluid intake and output is crucial during administration.

Rh Isoimmunization

Rh isoimmunization occurs when Rh-positive fetal blood crosses into Rh-negative maternal blood, stimulating the production of maternal antibodies.

Newborn Testing

A direct Coomb's test is performed on a newborn of an Rh-negative mother to determine if the baby has been affected by Rh isoimmunization.

Abruptio Placentae

Abruptio placentae is characterized by uterine tenderness and abdominal pain due to bleeding behind the placenta.

Placenta Previa

A manual pelvic examination is contraindicated for patients with suspected placenta previa.

Postpartum Hemorrhage

An increase in pulse rate and a decrease in blood pressure are early signs of postpartum hemorrhage.

Postpartum Mastitis

To prevent postpartum mastitis, women should breast-feed every 2 to 3 hours, change breast pads frequently, wash hands well before breast-feeding, and avoid decompression of the breasts by breast-feeding or breast pump.

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Description

This quiz focuses on fetal heart rate auscultation, Leopold's maneuvers, and fetal positioning. It addresses key concepts such as the identification of abnormal heart rates and the interpretation of contraction stress tests. Test your knowledge on these essential topics in obstetrics.