The laboring patient has experienced spontaneous rupture of ...

[WhattoUnderstand]

The laboring patient has experienced spontaneous rupture of membranes. The fluid is meconium-stained. The fetal heart tones are 100105. Which nursing action is most important?
 
  1. Change the mother's position from Fowler's to left lateral.
  2. Insert a Foley catheter with the assistance of another nurse.
  3. Notify the surgical team of an impending cesarean.
  4. Decrease the IV of lactated Ringer's solution to 50 ml/hour.

Question 2

The multiparous patient at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold's maneuver indicates the fetus is in a transverse lie with a shoulder presentation. What physician order is most important?
 
  1. Artificially rupture membranes.
  2. Apply internal fetal scalp electrode.
  3. Monitor maternal blood pressure every 15 minutes.
  4. Alert the surgical team of urgent cesarean.

[courtney_bruh]

Answer to Question 1

Correct Answer: 1
Rationale 1: Improving uterine blood flow to increase fetal oxygenation is the top priority when fetal bradycardia is present. Left lateral position increases uterine blood flow.
Rationale 2: If a cesarean is needed, a Foley catheter will be needed. But at this time, this is a low priority.
Rationale 3: The decision to go to cesarean birth is a medical decision. The nurse may not make medical decisions.
Rationale 4: Increasing IV fluids will facilitate uterine blood flow and fetal oxygenation if the patient is hypotensive. Decreasing the IV rate will not improve fetal heart tones.

Answer to Question 2

Correct Answer: 4
Rationale 1: Artificial rupture of membranes is contraindicated with a transverse lie because of the high risk for prolapsed cord.
Rationale 2: An internal fetal scalp electrode cannot be applied until membranes have ruptured. Artificial rupture of membranes is contraindicated with a transverse lie because of the high risk for prolapsed cord.
Rationale 3: The fetus is at risk for hypoxia secondary to prolapsed cord if the membranes rupture. The maternal blood pressure is less important than getting the cesarean under way.
Rationale 4: This is the highest priority because of the transverse lie and the risk of fetal hypoxia secondary to prolapsed cord if the membranes rupture.

[WhattoUnderstand]

Thank you

[courtney_bruh]

Happy to help you