The nurse auscultates the fetal heart rate (FHR) and determines a ...

[faduma]

The nurse auscultates the fetal heart rate (FHR) and determines a rate of 152 . Which nursing intervention is appropriate?
 
  a. Inform the mother that the rate is normal.
  b. Reassess the FHR in 5 minutes because the rate is too high.
  c. Report the FHR to the physician or nurse-midwife immediately.
  d. Tell the mother that she is going to have a boy because the heart rate is fast.

Question 2

Which method of assessment would best indicate that a client has a urinary complication?
 
  1. Urine pH
  2. Calculation of output
  3. Urine-specific gravity
  4. Calculation of intake

[sierrahalpin]

Answer to Question 1

A
Feedback
A The FHR is within the normal range, so no other action is indicated at this time.
B The FHR is within the expected range; reassessment should occur, but not in 5
minutes.
C The FHR is within the expected range; no further action is necessary at this
point.
D The sex of the baby cannot be determined by the FHR.

Answer to Question 2

2
Rationale:
1. Urine pH can be used to identify certain conditions, but would not be part of the initial assessment.
2. Calculation of output would provide a better assessment of complete emptying of the bladder because overdistention can cause trauma to the bladder, displace the uterus, and cause infection.
3. Urine-specific gravity can be used to identify certain conditions but would not be part of the initial assessment.
4. Calculation of intake is incorrect.

[faduma]

Thanks for the timely response, appreciate it

[hramirez205]

Gracias!