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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 1/24 Exit Performance Week 4 EAQ #1 Due Feb 6, 2024 by 8:30 am Passed 13 out of 23 questions answered correctly Completed on Jan 31, 2024 5:22 pm Incorrect (10) Report content error Which intervention would the nurse perform to draw blood for an umbilical cord acid-base determination test? Administer terbutaline before the test.
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 2/24 Rationale An umbilical cord acid-base determination test is performed to assess the immediate condition of the neonate after birth, especially if there is an abnormal or confusing fetal heart rate (FHR) tracing found during labor. The nurse would collect blood from both the umbilical artery and umbilical vein to perform the test. It is not necessary to administer terbutaline before performing the test; it is administered during the time of labor if uterine contractions are too frequent. The fetal scalp stimulating technique is an indirect method to assess the fetal blood pH. This test need not be performed before the acid-base determination test. p. 371 Report content error In which way is the use of a spiral electrode different from the use of an ultrasound transducer for electronic fetal monitoring? Collect blood from both the umbilical artery and the umbilical vein. First, perform the fetal scalp stimulating technique. Only collect blood from the baby’s umbilical artery. It is used only during the antepartum period. It is used when the cervix has not yet dilated. It is applied firmly to the maternal abdomen. It is used after the membranes have ruptured.
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 3/24 Rationale A spiral electrode can be used only after the membranes have ruptured. The electrode is attached securely to the presenting fetal body part to obtain a good signal. It is only used during the intrapartum period and only if the cervix is sufficiently dilated and the membranes are ruptured. A tocotransducer is applied firmly to the maternal abdomen to monitor the frequency and duration of contractions. A spiral electrode penetrates into the presenting part by 1.5 mm. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill- in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. p. 360 Report content error Which statement by the student nurse indicates effective learning about elevated oxytocin levels? "Hemoglobin levels will decrease." "Blood glucose levels will increase." "There is a lower blood supply to the placenta." "Uterine contractions will increase."
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 4/24 Rationale An elevated oxytocin level increases uterine contractions during labor. A decreased hemoglobin level leads to a reduced oxygen supply to the fetus, but it is not a complication associated with an elevated oxytocin level. Oxytocin has no effect on blood glucose levels. A family history of diabetes may increase the risk of gestational diabetes in the client. Conditions such as hypertension in the client may lower the blood supply to the placenta but are not associated with oxytocin levels. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all examinations is not realistic, but scoring 85% may be a better goal. pp. 356, 372 Report content error The primary health care provider prescribes terbutaline for a pregnant client for which reason? Rationale Terbutaline is a tocolytic and is administered to the client who has premature labor and also to the client who has excessive UCs spontaneously. It slows down the contractions. Terbutaline has no effect on Blood volume is elevated. Hemoglobin is decreased. Blood pressure is reduced. Contractions are increased.
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 5/24 blood volume, hemoglobin, or blood pressure. Blood volume is elevated by infusing aggressive intravenous infusion or sodium and water retention. Maternal hypotension, as evidenced by reduced blood pressure, is relieved by elevating the legs during labor. Clients with decreased hemoglobin are treated with iron supplements, not terbutaline. STUDY TIP: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, the YMCA, or a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an examination. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too. pp. 371 - 372 Report content error To which condition would the nurse attribute late decelerations in the client’s fetal heart rate (FHR)? Fundal pressure Uteroplacental insufficiency Vaginal examination Fetal scalp stimulation
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 6/24 Rationale Uteroplacental insufficiency leads to disruption of the oxygen transfer from the maternal blood to the fetus. This can lead to late decelerations of the fetal heart rate. Early FHR decelerations may result from fetal head compression caused by fundal pressure or vaginal examination. Fetal scalp stimulation typically causes FHR accelerations, not late FHR decelerations. Test-Taking Tip: Do not panic while taking an examination! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question. pp. 365-367 Report content error For which reason would the nurse encourage a laboring client to breathe through the mouth and keep it open while pushing during the second stage of labor? Rationale During labor, the nurse would ask the client to breathe through the mouth and keep it open to increase both maternal and fetal oxygenation. Nasal pressure is not a complication associated with labor. Opening the mouth would not increase the pushing capability. Early decelerations are observed To avoid nasal pressure in the client To decrease efforts required for pushing To facilitate increased oxygen to the fetus To avoid deceleration in the fetal heart rate
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 7/24 by pushing, which would not require any intervention. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test, and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question. p. 372 Report content error When monitoring the client in labor, the nurse knows the likely cause of variable decelerations in the fetal heart rate (FHR) is which factor? Rationale Variable decelerations are usually transient and correctable. They can occur at any time during the uterine contraction phase and are caused by umbilical cord compression. Uterine tachysystole is a condition that causes frequent uterine contractions, often more than five contractions in 10 minutes. This causes disruption of oxygen transfer from the environment to the fetus, leading to late decelerations. Maternal hypertension leads to late FHR decelerations caused by reduced oxygen transfer to the fetus. Uterine tachysystole Maternal hypertension Umbilical cord compression Epidural or spinal anesthesia
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 8/24 Epidural or spinal anesthesia reduces blood flow through maternal vessels, causing late decelerations. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. pp. 367-368 Report content error Which intervention might the obstetric health care practitioner use if variable decelerations are present in the fetal heart rate? Rationale Infusion of lactated Ringer solution into the uterine cavity, known as amnioinfusion, helps to increase the volume of amniotic fluid in a client with oligohydramnios. Reduced amniotic fluid results in compression of Administration of terbutaline into the uterine cavity Intravenous infusion of oxytocin Infusion of lactated Ringer solution into the uterine cavity Oral intake of the nonsteroidal anti-inflammatory drug indomethacin
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 9/24 the umbilical cord during contraction, thereby resulting in variable decelerations. Administration of terbutaline is given intravenously and is done to reduce the frequency of contractions. It is usually given when uterine tachysystole is observed. An intravenous infusion of oxytocin to a pregnant female with low amniotic fluid would increase contractions, which could cause variable decelerations due to cord compression and would not be done if variable decelerations are already present. Oral intake of the nonsteroidal anti-inflammatory drug indomethacin is recommended in case of excess amniotic fluid to reduce it by lowering the fetal urine output. pp. 371-372 Report content error In which stage of labor would intermittent auscultation (IA) technique be done every 10 minutes? Rationale The Association of Women’s Health, Obstetric, and Neonatal Nurses recommends different frequencies for using the IA technique based on the stage of labor. A client in the second stage of labor who is actively pushing is recommended to have IA at an interval of every 5 to 15 minutes. An interval of 15 minutes is suggested in the second stage of labor in which First stage, latent phase (dilation <4 cm) First stage, active phase (dilation ≥6 cm) Second stage, active pushing Second stage, passive fetal descent
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 10/24 the fetus shows passive descent and there is no active pushing. Insufficient evidence is available to recommend a proper interval for the latent phase of the first stage of labor with cervical dilation less than 4 cm. Fifteen minutes is suggested for the active phase of the first stage of labor in which cervical dilation is more than 6 cm. p. 359 Report content error
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 11/24 Which observation related to the fetal heart rate (FHR) might lead to severe fetal hypoxia? Rationale Monitoring the FHR during labor alerts to the presence or absence of any abnormality. A sinusoidal pattern is grouped under Category III of FHR tracings; it indicates fetal compromise during labor and might cause severe fetal hypoxia. The presence of moderate variability in the baseline and a baseline heart rate of 130 beats per minute are considered normal patterns. The observation of fetal tachycardia is a Category II FHR tracing and is considered an intermediate finding. pp. 356, 357 Moderate baseline variability Baseline rate of 130 beats per minute Baseline rate indicates tachycardia Presence of sinusoidal pattern Correct (13) Report content error Which measure would the nurse take to obtain the most accurate baseline fetal heart rate (FHR) of a full-term client in labor? Record or monitor a 10-minute segment of tracing.
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 12/24 Rationale The baseline fetal heart rate is the average rate during a 10-minute segment. To determine a baseline heart rate, the 10-minute segment should not include periods of marked variability or periodic or episodic changes. The nurse would ensure there are at least 2 minutes of interpretable baseline data in a 10-minute segment of tracing. p. 362 Report content error Which location on the fetus would the nurse utilize to assess and hear loud, clear fetal heart sounds? Rationale The nurse would locate the fetal back to listen and count the heart sounds. The heart sounds are loudest and clearest over the fetal back. It is difficult for the nurse to count the heart sounds over the fetal head, neck, or Include periods of marked variability in the segment. Include episodic changes in the segment of tracing. Obtain at least 5 minutes of interpretable data in the segment. Head Back Neck Abdomen
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 13/24 abdomen because the heart sounds are not loud and clear in these areas. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 358 Report content error Which device would the nurse use for monitoring the intensity of uterine contractions in a laboring client? Rationale An IUPC measures the frequency, duration, and intensity of contractions during the intrapartum period. The device records the pressure at the catheter tip, and values are expressed in mm Hg. However, for accurate readings, the membranes would be ruptured, and the cervix would be dilated. A tocotransducer monitors the frequency and duration of contractions for both antepartum and intrapartum care but does not measure intensity. This device is placed on the client’s abdomen. Spiral electrodes and ultrasound transducers are used to assess fetal heart rate, Tocotransducer Spiral electrode Ultrasound transducer Intrauterine pressure catheter (IUPC)
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 14/24 not the intensity of contractions. A spiral electrode is an invasive mode, whereas an ultrasound transducer is a noninvasive mode. p. 360 Report content error Which laboring client would the nurse expect to be a likely candidate for amnioinfusion? Rationale Amnioinfusion is the infusion of room-temperature isotonic fluid into the uterine cavity when the volume of amniotic fluid is low. Clients with premature rupture of membranes may receive an amnioinfusion due to low amniotic fluid index, which can cause intermittent umbilical cord compression that results in variable decelerations and transient fetal hypoxemia. The amnioinfusion would restore the amniotic fluid volume to a normal or near-normal level. The nurse would discontinue the administration of oxytocin for a client with increased uterine activity. Hypertension and diabetes are not factors that indicate the need for amnioinfusion. Clients receiving amnioinfusion are at a risk for overdistention of the uterine cavity because amnioinfusion increases the amniotic fluid volume. A client with low amniotic fluid index (AFI) A client with an increase in uterine activity A client with hypertension and diabetes during the third trimester A client with an overdistended uterine cavity during the second stage of labor
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 15/24 pp. 371-372 Report content error To determine the placental function of a laboring client, which part of the umbilical cord acid-base report would the nurse review? Rationale Umbilical acid-base determination helps determine the immediate condition of the newborn after birth. The nurse would check the umbilical vein report to determine the placental functioning. The umbilical artery report is used to determine the physiologic functioning of the newborn. Amniotic fluid concentrations are monitored during labor but not after birth. Blood glucose levels in the fetus are not assessed with the umbilical cord test. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards (or in your electronic device) and carry them with you in your pocket. When you are waiting for an appointment, just pull out the cards/electronic device and review again. This "found" time may add points to your test scores that you have lost in the past. p. 371 Umbilical vein report Umbilical artery report Amniotic fluid concentrations Blood glucose concentrations
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 16/24 Report content error Which statement accurately describes episodic accelerations in fetal heart rate (FHR) while monitoring a laboring client? Rationale Episodic accelerations in FHR occur during fetal movement and are indications of fetal well-being. Umbilical cord compression results in variable decelerations in FHR. Accelerations in FHR are an indication of fetal well-being and do not warrant close observation. Uteroplacental insufficiency would result in late decelerations in FHR. STUDY TIP: A helpful method for decreasing test stress is to practice self- affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently. They are a normal fetal heart rate pattern. They are caused by umbilical cord compression. They warrant close observation of the fetus. They result from uteroplacental insufficiency.
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 17/24 p. 365 Report content error According to the three-tier fetal heart rate (FHR) classification system, which finding would indicate a category II FHR? Rationale Minimal variability in FHR indicates that there is insufficient oxygen supply to the fetus. This is categorized as a category II in the three-tiered FHR classification system. Moderate variability in FHR indicates normal cardiac activity, which is classified as category I. Bradycardia (FHR less than 110 beats/min) is classified as category III. FHR acceleration is completely absent in category II and is present in category I. p. 357 Report content error Minimal variability Moderate variability Less than 110 beats/min Accelerations present
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 18/24 Which device can be used as a noninvasive way to assess fetal heart rate (FHR) in a client whose membranes are not ruptured? Rationale An ultrasound transducer is used to assess FHR by an external mode of electronic fetal monitoring. It does not require membrane rupture and cervical dilation. A tocotransducer can be used to assess uterine activity in a laboring client whose cervix is not sufficiently dilated, but it does not assess FHR. A spiral electrode is used in the internal mode of electronic fetal monitoring to assess FHR. It is used only when membranes are ruptured and the cervix is dilated during the intrapartum period. An IUPC is used to assess uterine activity in internal mode. It is used only when membranes are ruptured and the cervix is dilated during the intrapartum period. p. 360 Report content error Tocotransducer Spiral electrode Ultrasound transducer Intrauterine pressure catheter (IUPC)
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 19/24 Which method allows for fetal heart rate (FHR) monitoring by obtaining an electrocardiogram (ECG) of the fetus during labor? Rationale A spiral electrode is an internal method of fetal monitoring that can convert fetal ECG readings into FHR during labor. The ultrasound transducer is an external monitoring device that utilizes high-frequency sound waves to analyze the mechanical action of the fetal heart. An intrauterine pressure catheter is also used for internal monitoring of the frequency, duration, and intensity of contractions during labor. A tocotransducer is used externally to monitor the frequency and duration of contractions through a pressure-sensing device placed on the abdomen of the pregnant client. p. 360 Report content error Ultrasound transducer Intrauterine pressure catheter Tocotransducer Spiral electrode
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 20/24 Which question from an equipment checklist would be useful when evaluating the functional efficiency of the ultrasound transducer? Rationale The functional efficiency of the ultrasound transducer can be assessed by checking the FHR and comparing it with the maternal pulse. This will ensure that the FHR is accurate. Other checks for a transducer include making sure gel was applied and if the belt is comfortably secured around the client. Checking if the paper is correctly inserted helps in noting the function of the monitor. Noting if the monitor is set to zero as per the manufacturer’s instructions and if the uterus’ baseline resting tone is properly documented helps in evaluating the internal catheter or strain gauge. p. 370 Report content error Is the paper inserted correctly (if using paper)? Was the fetal heart rate (FHR) checked with the maternal pulse? Has the monitor been set to zero according to the manufacturer’s instructions? Is the baseline resting tone of the uterus documented?
2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 21/24 Which intervention would the nurse perform to draw blood for an umbilical cord acid-base determination test? Rationale An umbilical cord acid-base determination test is performed to assess the immediate condition of the neonate after birth, especially if there is an abnormal or confusing fetal heart rate (FHR) tracing found during labor. The nurse would collect blood from both the umbilical artery and umbilical vein to perform the test. It is not necessary to administer terbutaline before performing the test; it is administered during the time of labor if uterine contractions are too frequent. The fetal scalp stimulating technique is an indirect method to assess the fetal blood pH. This test need not be performed before the acid-base determination test. p. 371 Report content error Administer terbutaline before the test. Collect blood from both the umbilical artery and the umbilical vein. First, perform the fetal scalp stimulating technique. Only collect blood from the baby’s umbilical artery.
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 22/24 In which way is the use of a spiral electrode different from the use of an ultrasound transducer for electronic fetal monitoring? Rationale A spiral electrode can be used only after the membranes have ruptured. The electrode is attached securely to the presenting fetal body part to obtain a good signal. It is only used during the intrapartum period and only if the cervix is sufficiently dilated and the membranes are ruptured. A tocotransducer is applied firmly to the maternal abdomen to monitor the frequency and duration of contractions. A spiral electrode penetrates into the presenting part by 1.5 mm. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill- in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. p. 360 Report content error It is used only during the antepartum period. It is used when the cervix has not yet dilated. It is applied firmly to the maternal abdomen. It is used after the membranes have ruptured.
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 23/24 1 topics covered Chapter 18, Fetal Assessment During Labor Lowdermilk: Maternity and Women's Health Care, 13th edition Novice Which statement by the student nurse indicates effective learning about elevated oxytocin levels? Rationale An elevated oxytocin level increases uterine contractions during labor. A decreased hemoglobin level leads to a reduced oxygen supply to the fetus, but it is not a complication associated with an elevated oxytocin level. Oxytocin has no effect on blood glucose levels. A family history of diabetes may increase the risk of gestational diabetes in the client. Conditions such as hypertension in the client may lower the blood supply to the placenta but are not associated with oxytocin levels. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all examinations is not realistic, but scoring 85% may be a better goal. pp. 356, 372 "Hemoglobin levels will decrease." "Blood glucose levels will increase." "There is a lower blood supply to the placenta." "Uterine contractions will increase."
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2/3/24, 11:06 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/50941410 24/24 You Quiz me on this topic Novice Intermediate Proficient Questions answered 29
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