The nurse admits a laboring patient at term. On review of the prenatal record, the patient's pregnancy has been unremarkable and she is considered low risk
In planning the patient's care, at what interval will the nurse intermittently auscultate (IA) the fetal heart rate during the first stage of labor?
a. Every 10 minutes
b. Every 15 minutes
c. Every 30 minutes
d. Every 60 minutes
ANS: C
Evaluate the fetal monitoring strip systematically for the elements noted. The following are recommended assessment and documentation intervals for IA and EFM (although facility policies may be different): low-risk women, every 30 minutes during the active phase and every 15 minutes during the second stage.
You might also like to view...
Using Maslow's hierarchy of needs to prioritize nursing diagnoses, which of these nursing diagnoses should the nurse focus on LAST?
a. Airway clearance, ineffective, related to excessive secretions b. Anxiety related to unknown outcome of illness c. Coping, individual, ineffective, related to loss of independence d. Self-care deficit, feeding, related to decreased strength and endurance
The novice nurse accepts a job working on a long-term care unit. Nursing care that is required includes caring for clients at the end of life
Which behavior by the nurse indicates a healthy response to the dying client and family? A) Paying close attention to details regarding the pain and comfort measures for the client B) Delegating physical care of the client to the LPN and UAP C) Remaining out of the room at the moment of death to allow the client and family privacy D) Providing client care without explaining procedures
A nurse is analyzing fetal cord blood results. If the fetal blood pH is less than 7.25, the nurse can conclude that the fetus was:
1. Acidotic and hypoxic. 2. Alkalotic and hypoxic. 3. Well oxygenated. 4. Alkalotic but well oxygenated.
A nurse working in the emergency department is aware that the flesh-eating bug can be caused by
A. Staphylococcus aureus B. Clostridium perfringens C. Bacteroides fragilis D. All of the above