Question

16. The nurse cares for a client in labor. The fetal heart rate anex of a contraction that the fetal rate (FHR) is 125 and returns to baseline at the competition s 150- 160, The nurse notes at the of the contraction, Which 1. Continue to monitor the FHR. f the following actions should the nurse take FIRS(? eft side. side. 4 Administer 02 by mask at Turns the client to her min. 17. The mother of a 2-year-old and 4-year-old brings the children to the pediatric clinic for a well- child checkups. Both children will be ha mother appears tired and frustrated and save Dirthdays within the next 2 months. The feel like I have been on a to the nurse, whirlwind for over a year. I never thought two children could be so much work. If I have to set limits one more time, I think I will scream. Which of the following responses the nurse is BEST? Next year should be a more peaceful y Have you thought about preschool for "When they get more involved away from hor Do you and your husband agree on discipline? for you" children?" you will miss these days." 4 nurse auscultates the natal visit, five nurse assesses a client at 34 weeks gestation. The eart rate ( FHR) and notes that the fetal position 18. During a routine left occiput posterior (LOP). Identify the point of maximum inattentive the fetal heart tone. 19. The nurse assesses a newborn just delivered by a mother who received no prenatal care and was unsure when she became pregnant. Which of the following assessments indicates to the r that the infant is preterm? Tugo noted on upper back and shoulders. 2. Elbow ases contain vernix. 3. Nipple budr Arms and legs extended at rest easures 0.5 cm. 4 20. The clinic nurse assesses a client. The nurse is MOST concerned by which findings? 1. Weight 142 pounds. (2) Extremities warm to the touch Skin fails to tent when pinched and released. Hair thin, dull, and dry. f the following 4

Answer 1

16. Ans .1. continue to monitor fetal heart rate.

Rationale: The normal heart rate of the fetus is between 110beats to 160beats per min. So the heart rate of 125 beats is normal. During the first stage of labor, the FHR should be monitored frequently at every 15 to 30 min.

17. Ans. 4. Do you and your husband agree on discipline?

Rationale: The women thought that caring for two children is a big burden and additional responsibility will increase her burden. So she needs to get organized everything and both father and mother have to take responsibility in caring for children which will relieve the burden on her.

18. In left occiput posterior position(LOP), the fetal heart rate can be found more accurately, just below the belly's bottom to the left of the mother.

19. 1. Lanugo noted on upper back and shoulders.

Rationale: Lanugo is the unpigmented hair that grows from hair follicles of the fetus. Presence of lanugo hair at birth is the most common indication of premature babies.

20. 3. Skin fails to tend when pinch and released.

Rationale: When pinching of skin at back, and releasing it, the skin becomes returns to normal. If it fails to tend back to the normal position is an indication of dehydration. Dehydration should be treated with adequate management, otherwise, it leads to severe complications.