1. Which of the following is a characteristic of a reassuring fetal heart rate pattern?
A. A fetal heart rate of 180bpm
B. A baseline variability of 35bpm
C. A fetal heart rate of 90 at the baseline
D. Acceleration of FHR with fetal movements
Answer D is correct. Answers A, B, and C indicate ominous findings on the fetal heart monitor and so are incorrect in this instance. Accelerations with movement are normal, so answer D is the reassuring pattern.
2. A gravida II para 0 is admitted to the labor and delivery unit. The doctor performs an amniotomy. Which observation would the nurse expect to make immediately after the amniotomy?
A. Fetal heart tones 160 beats per minute
B. A moderate amount of clear fluid
C. A small amount of greenish fluid
D. A small segment of the umbilical cord
Answer B is correct. Normal amniotic fluid is straw colored and odorless, so this is the observation the nurse should expect. An amniotomy is artificial rupture of membranes, causing a straw-colored fluid to appear in the vaginal area. Fetal heart tones of 160 indicate tachycardia, and this is not the observation to watch for. Greenish fluid is indicative of meconium, not amniotic fluid. If the nurse notes the umbilical cord, the client is experiencing a prolapsed cord. This would need to be reported immediately. For this question, answers A, C, and D are incorrect.
3. The nurse is caring for a client admitted with acute laryngotracheobronchitis (LTB). Because of the possibility of complete obstruction of the airway, which of the following should the nurse have available?
A. Intravenous access supplies
B. Emergency intubation equipment
A. A fetal heart rate of 180bpm
B. A baseline variability of 35bpm
C. A fetal heart rate of 90 at the baseline
D. Acceleration of FHR with fetal movements
Answer D is correct. Answers A, B, and C indicate ominous findings on the fetal heart monitor and so are incorrect in this instance. Accelerations with movement are normal, so answer D is the reassuring pattern.
2. A gravida II para 0 is admitted to the labor and delivery unit. The doctor performs an amniotomy. Which observation would the nurse expect to make immediately after the amniotomy?
A. Fetal heart tones 160 beats per minute
B. A moderate amount of clear fluid
C. A small amount of greenish fluid
D. A small segment of the umbilical cord
Answer B is correct. Normal amniotic fluid is straw colored and odorless, so this is the observation the nurse should expect. An amniotomy is artificial rupture of membranes, causing a straw-colored fluid to appear in the vaginal area. Fetal heart tones of 160 indicate tachycardia, and this is not the observation to watch for. Greenish fluid is indicative of meconium, not amniotic fluid. If the nurse notes the umbilical cord, the client is experiencing a prolapsed cord. This would need to be reported immediately. For this question, answers A, C, and D are incorrect.
3. The nurse is caring for a client admitted with acute laryngotracheobronchitis (LTB). Because of the possibility of complete obstruction of the airway, which of the following should the nurse have available?
A. Intravenous access supplies
B. Emergency intubation equipment
