Which clinical finding can be determined only by electronic fetal monitoring?

Correct Answer: D

Rationale: The correct answer is D because electronic fetal monitoring is the only method that can directly measure and display the fetal heart rate in response to contractions. Variability, tachycardia, and bradycardia can also be observed through electronic fetal monitoring, but fetal response to contractions specifically requires continuous monitoring of the fetal heart rate during contractions. Therefore, D is the only clinical finding that can be determined exclusively through electronic fetal monitoring. Variability (A), tachycardia (B), and bradycardia (C) can be identified through other means of monitoring and assessment as well.

Correct Answer: D

Rationale: The correct answer is D because determining the position of the fetus before attaching the electrode is crucial for accurate monitoring. This step ensures proper placement, reducing the risk of misinterpretation of data. Lubricating the tocotransducer with gel (A) is unnecessary and may interfere with the signal. Securing the tocotransducer with a strap (B) is important but should come after determining fetal position. Informing the patient to remain in semi-Fowler position (C) is not directly related to the correct initiation of electronic fetal monitoring.

Correct Answer: C

Rationale: The correct answer is C: Change maternal position. At 38 weeks' gestation with 4 cm dilation and 100% effacement, the fetal heart rate pattern suggests possible umbilical cord compression due to the +1 station vertex position. Changing maternal position can relieve this compression, improving fetal heart rate. Continuing oxytocin infusion (A) can worsen the situation by increasing contractions. Contacting anesthesia for epidural (B) is not indicated as it doesn't address the immediate concern. Administering Narcan and preparing for immediate delivery (D) is unnecessary and not supported by the given scenario.

Correct Answer: B

Rationale: The correct answer is B because the patient is a primigravida (first pregnancy) with frequent contractions (2 to 3 minutes apart, lasting 60 seconds), which indicates active labor and the need for internal monitoring with an intrauterine pressure catheter. This level of contraction frequency and duration suggests progression towards the active phase of labor, where accurate monitoring is crucial for the well-being of both the mother and the baby. Choice A is incorrect because the contractions are not as frequent or long-lasting as in active labor. Choice C is incorrect because although the contractions are frequent, the duration is longer than typical active labor. Choice D is incorrect because the contractions are irregular and mild, indicating the latent phase of labor where internal monitoring is not necessary.

Correct Answer: C

Rationale: The correct answer is C: Every 15 minutes. This is the appropriate frequency for monitoring the fetal heart rate during the first stage of labor for a low-risk patient. Monitoring every 15 minutes allows for regular assessment of the baby's well-being without being overly invasive. Monitoring every 10 minutes (choice A) would be too frequent and may lead to unnecessary interventions. Monitoring every 30 minutes (choice D) would be too infrequent and could potentially miss important changes in the fetal heart rate. Choice B is not the correct answer because monitoring every 10 minutes is too frequent for a low-risk patient and could lead to unnecessary interventions and increased stress for the laboring patient.