A nurse is caring for a client who is receiving oxytocin to augment labor. The nurse notes recurrent variable decelerations of the FHR. Which of the following actions should the nurse take first?

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take first is to place the client in a left lateral position (Option D). This is because placing the client in a left lateral position can help improve placental perfusion and oxygenation to the fetus by relieving pressure on the maternal vena cava, thus potentially improving fetal oxygenation and reducing the variable decelerations of the fetal heart rate (FHR). Option A, preparing for an amnioinfusion, is not the first priority because it is a more invasive intervention and should be considered after initial non-invasive measures have been taken. Administering oxygen via a nonrebreather face mask (Option B) is important in cases of fetal distress, but in this situation, addressing the maternal position to improve fetal oxygenation is the priority. Discontinuing the oxytocin infusion (Option C) may eventually be necessary if the variable decelerations persist, but changing the maternal position is the initial step to attempt to improve fetal well-being before considering discontinuing the oxytocin infusion. Educationally, understanding the rationale behind positioning interventions in obstetric care is crucial for nurses to effectively manage fetal distress during labor. It is essential for nurses to prioritize interventions based on their potential to improve fetal oxygenation and minimize risks during childbirth.

Correct Answer: A

Rationale: In this scenario, option A, "You should keep the car seat rear-facing until your baby is at least 2 years old," is the correct statement for the nurse to make. This recommendation aligns with current safety guidelines from organizations like the American Academy of Pediatrics (AAP) and the National Highway Traffic Safety Administration (NHTSA). Rear-facing car seats provide the best protection for infants and young children in the event of a crash by supporting the child's head, neck, and spine. Options B, C, and D are incorrect statements. Positioning the retainer clip over the upper part of the baby's abdomen (Option B) can result in serious internal injuries in a crash. Placing the baby in the car seat at a 90-degree angle (Option C) is not necessary and may not be practical in all vehicles. Lastly, placing the shoulder harness straps in the slots above the baby's shoulders (Option D) can lead to improper fit and decreased safety in the event of a crash. Educationally, it is crucial for healthcare providers to provide evidence-based information on car seat safety to parents. By understanding and following the recommended guidelines, parents can significantly reduce the risk of injury to their child in a motor vehicle accident. Nurses play a vital role in educating families on best practices to ensure the safety and well-being of infants and children during car travel.

Correct Answer: C

Rationale: In this scenario, the nurse should prioritize option C, which is to massage the client's fundus. Massaging the fundus helps to stimulate uterine contractions, which can effectively control postpartum bleeding by promoting the expulsion of clots and initiating the process of uterine involution. This intervention is crucial in preventing postpartum hemorrhage, a potentially life-threatening complication. Option A, elevating the client's legs, is not the priority in this situation as it does not address the underlying cause of the excessive bleeding. While elevating the legs can improve venous return and circulation, it is not as directly beneficial as fundal massage in managing postpartum hemorrhage. Inserting an indwelling urinary catheter (option B) is not the priority action because the client's excessive bleeding takes precedence. Monitoring urinary output is essential but can be done after addressing the bleeding. Initiating an infusion of oxytocin (option D) is a valid intervention to help control postpartum bleeding, but it should come after fundal massage. Oxytocin can be administered after ensuring that the uterus is contracting effectively through fundal massage. In an educational context, it is crucial for nurses caring for postpartum clients to understand the significance of fundal massage in managing postpartum hemorrhage. This knowledge ensures they can provide timely and appropriate care to prevent complications and promote maternal well-being.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) "You should expect the test to take about 30 minutes." This statement is important to prepare the client for the duration of the nonstress test, ensuring they know what to expect and can plan their time accordingly. Option A is incorrect because nonstress tests do not typically require medication through an IV. Option C is also incorrect as fasting is not necessary for a nonstress test, so the client should not be advised to avoid eating or drinking before the test. Option D is incorrect because although nonstress tests are important in assessing fetal well-being, they do not specifically determine the maturity of the baby's lungs. From an educational perspective, it is crucial for nurses to provide accurate and relevant information to pregnant clients to alleviate anxiety, promote understanding, and ensure optimal prenatal care. By explaining the purpose and duration of the nonstress test, the nurse can empower the client to actively participate in their maternity care and make informed decisions regarding their health and the health of their baby.

Correct Answer: C

Rationale: The correct answer is C) Avoid having sexual intercourse for 24 hours before the Pap test. This information is crucial because sexual intercourse, as well as using certain products like douches or vaginal medications, can interfere with the accuracy of the Pap test results by affecting the quality of the sample collected. Educating the client about this guideline will help ensure the test results are reliable and effective in detecting any abnormalities in cervical cells. Option A is incorrect because the current guidelines recommend Pap testing every 3-5 years for most women aged 21-65, so a yearly test is not necessary or recommended until 70 years of age. Option B is incorrect as Pap tests are primarily used to detect abnormal cervical cells, not related to ovarian health or the removal of ovaries. Option D is also incorrect as Pap tests are specifically designed to detect abnormal cervical cell changes, not viral infections. In an educational context, it's important for nurses to provide accurate and up-to-date information to clients regarding preventive healthcare measures like the Pap test. By explaining the correct guidelines for preparing for a Pap test, nurses empower clients to take an active role in their health and well-being. This knowledge also helps clients understand the importance of following specific instructions to ensure the effectiveness of screening tests.