A nurse is caring for a woman in labor whose fetal heart rate ...

[craiczarry]

A nurse is caring for a woman in labor whose fetal heart rate tracings show late decelerations. What observation by the nurse indicates that an important outcome for the nursing diagnosis of impaired fetal gas exchange has been met?
 
  A.
  Fetal heart monitor shows accelerations to contractions.
  B.
  Fetal heart monitor shows variable decelerations.
  C.
  Fetal heart rate rises to180 beats/minute.
  D.
  Maternal heart rate returns to baseline between contractions.

Question 2

During the second stage of labor, a nurse encourages effective pushing by the woman. What directions from the nurse best achieve this?
 
  A.
  Hold your breath and push as hard as you can.
  B.
  Now that you are fully dilated, start pushing.
  C.
  Push when you feel the urge and breathe between attempts.
  D.
  When you feel a contraction, push with your mouth closed.

[jgranad15]

Answer to Question 1

ANS: A
Accelerations in response to contractions are generally considered a sign of fetal well-being, and this variability is an important predictor of adequate fetal oxygenation. If nursing actions for late decelerations have been effective, the nurse should note encouraging fetal signs. The other options do not indicate encouraging fetal signs, nor do they indicate that impaired fetal gas exchange has been resolved.

Answer to Question 2

ANS: C
Open-glottis pushing is the recommended technique of pushing during contractions. When the woman feels the urge to push, she is instructed to bear down while continuing to breathe between contractions. She is encouraged to only hold her breath for 5 to 6 seconds at a time so that air escapes during the pushing. This process facilitates maternal-fetal circulation and gradual fetal descent. The other instructions are not consistent with this method.