The fetal heart rate baseline is 140 beats/min. When contractions ...

[Melani1276]

The fetal heart rate baseline is 140 beats/min. When contractions begin, the fetal heart rate drops suddenly to 120, and rapidly returns to 140 before the end of the contraction. Which nursing intervention is best?
 
  1. Assist the patient to change from Fowler's to left lateral position.
  2. Apply oxygen to the patient at 2 liters per nasal cannula.
  3. Notify the operating room of the need for a cesarean birth.
  4. Determine the color of the leaking amniotic fluid.

Question 2

The nurse is caring for a 2-hour-old newborn whose mother is diabetic. The nurse assesses that the newborn is experiencing tremors. Which nursing action has the highest priority?
 
  1. Obtain a blood calcium level.
  2. Take the newborn's temperature.
  3. Obtain a bilirubin level.
  4. Place a pulse oximeter on the newborn.

[brittanywood]

Answer to Question 1

1
Rationale 1: The fetus is exhibiting variable decelerations, which are caused by cord compression. Repositioning the patient might get the fetus off the cord and eliminate the variable decelerations.
Rationale 2: A nasal cannula is rarely used in labor and birth; face masks are preferable.
Rationale 3: There is no indication that a cesarean delivery is needed.
Rationale 4: There is no indication that the amniotic fluid is meconium-stained or bloody.

Answer to Question 2

1
Rationale 1: Tremors are the classic sign of hypocalcemia. Diabetic mothers tend to have decreased serum magnesium levels at term. This could cause secondary hypoparathyroidism in the infant.
Rationale 2: Body temperature might be necessary to monitor, but another action takes priority for this newborn.
Rationale 3: Bilirubin level might be necessary to monitor, but another action takes priority for this newborn.
Rationale 4: Oxygen saturation might be necessary to monitor, but another action takes priority for this newborn.

[Melani1276]

Excellent

[kilada]

TYSM