The nurse is assessing an internal fetal heart monitor tracing of an unmedicated, full-term gravida who is in transition. Which of the following heart rate patterns would the nurse interpret as normal?

Correct Answer: B

Rationale: Choice A is incorrect because a variable baseline heart rate of 140 with V-shaped decelerations to 120 unrelated to contractions is concerning. V-shaped decelerations are usually associated with cord compression, which can lead to fetal distress. Choice C is incorrect because a flat baseline heart rate of 140 with decelerations to 120 that return to baseline after the contraction indicates fetal distress. Decelerations should not drop below the baseline heart rate, and a flat baseline can suggest fetal hypoxia. Choice D is incorrect because a flat baseline heart rate of 140 with no obvious decelerations or accelerations can be indicative of fetal compromise. A lack of variability in the heart rate can be a sign of fetal distress. Choice B is the correct answer because a variable baseline heart rate of 140 with decelerations to 100 that mirror each of the contractions is considered normal. This pattern, known as early decelerations, is typically caused by head compression during contractions and is not associated with fetal distress. It is a reassuring sign of fetal well-being during labor.

Correct Answer: B

Rationale: During the third stage of labor, the nurse should be assessing for signs of placental separation and expulsion. Choice B, "Uterus rising in the abdomen and feeling globular," is the correct answer because this is a classic sign that the placenta is detaching from the uterine wall. As the uterus rises, it indicates that the placenta is being expelled. This assessment is crucial to ensure that the placenta is delivered in its entirety and to prevent complications such as postpartum hemorrhage. Choice A, "Fetal heart assessment after each contraction," is incorrect for the third stage of labor. Fetal heart assessment is more relevant during the first and second stages of labor when monitoring fetal well-being during contractions. In the third stage, the focus shifts to the delivery of the placenta and maternal recovery. Choice C, "Rapid cervical dilation to ten centimeters," is also incorrect during the third stage of labor. Cervical dilation typically occurs during the first stage of labor, not the third stage. By this stage, the cervix should be fully dilated, and the focus should be on the delivery of the placenta. Choice D, "Maternal complaints of intense rectal pressure," is a common sign of fetal descent during the second stage of labor, not the third stage. This sensation occurs as the baby moves down the birth canal and is a signal for the mother to start pushing. In the third stage, the mother may experience mild contractions as the placenta separates, but intense rectal pressure is not typically associated with this stage. In summary, during the third stage of labor, the nurse should assess for the rising of the uterus in the abdomen, indicating placental separation and expulsion. Fetal heart assessment, cervical dilation, and complaints of rectal pressure are not typically assessed during this stage and are more relevant to earlier stages of labor.

Correct Answer: B

Rationale: In this scenario, the woman is 40 weeks gestation, with 2 cm dilation, 30% effacement, contracting every 12 minutes and 30 seconds. The fetal heart rate is in the 140s with good variability and spontaneous accelerations. Choice A: The woman is not high risk based on the information provided. Tocolytics are used to stop preterm labor, not indicated in this case. Choice C: Induction is not necessary at this point as the woman is only 2 cm dilated and 30% effaced, indicating early labor. Choice D: The woman is not in active labor as she is only 2 cm dilated and contracting every 12 minutes and 30 seconds. Correct Answer (B): The findings suggest that the woman is in early labor. With 2 cm dilation, 30% effacement, and contractions every 12 minutes and 30 seconds, she is not in active labor. The fetal heart rate is reassuring with good variability and spontaneous accelerations. The nurse can conclude that the woman is in early labor and could potentially be sent home to continue laboring until she is in active labor. This approach allows her to be in a familiar and comfortable environment until labor progresses further.

Correct Answer: A

Rationale: The correct position for a woman to be in when inserting an epidural catheter is the fetal position. This position allows for easier access to the epidural space in the lower back. The fetal position involves the patient curling up on their side with their knees drawn up towards their chest. This position helps to widen the spaces between the vertebrae, making it easier for the anesthesiologist to insert the catheter into the epidural space. Option B, the lithotomy position, is not appropriate for inserting an epidural catheter. The lithotomy position involves the patient lying on their back with their legs elevated and spread apart. This position is typically used for gynecological exams and procedures, not for epidural placement. Option C, the Trendelenburg position, is also not suitable for inserting an epidural catheter. The Trendelenburg position involves the patient lying flat on their back with the legs elevated higher than the head. This position is used to improve venous return to the heart and is not necessary or beneficial for epidural placement. Option D, the lateral recumbent position, is not the ideal position for inserting an epidural catheter either. The lateral recumbent position involves the patient lying on their side with their top leg straight and bottom leg bent. While this position may be used for certain medical procedures, it does not provide the optimal access to the epidural space for catheter insertion.

Correct Answer: B

Rationale: The correct answer is B: Fetal heart acceleration. During a fetal scalp stimulation test, the practitioner will apply pressure to the fetal scalp to stimulate the baby. A normal response to this stimulation is an acceleration in the fetal heart rate. This is because the stimulation causes an increase in sympathetic nervous system activity, leading to an increase in heart rate. This is a reassuring sign of fetal well-being as it indicates that the baby is responding appropriately to stimuli. Now, let's discuss why the other choices are incorrect: A: Spontaneous fetal movement. While fetal movement is a sign of fetal well-being, the fetal scalp stimulation test specifically looks for a response in the fetal heart rate, not fetal movement. Therefore, this choice is not the expected response during this test. C: Increase in fetal heart variability. Fetal heart rate variability is a measure of the fluctuations in the fetal heart rate over time. While variability is a positive sign of fetal well-being, it is not the expected response during a fetal scalp stimulation test. The test is specifically looking for a change in the fetal heart rate in response to stimulation, not an increase in variability. D: Resolution of late decelerations. Late decelerations are a concerning fetal heart rate pattern that indicates uteroplacental insufficiency. The fetal scalp stimulation test is not designed to resolve late decelerations. It is used to assess fetal well-being by evaluating the fetal heart rate response to stimulation. In conclusion, the correct response to a fetal scalp stimulation test is an acceleration in the fetal heart rate. This indicates that the baby is responding appropriately to stimulation and is a reassuring sign of fetal well-being.