Signs and symptoms
Signs and symptoms ( 5 Questions)
A nurse is reviewing the electronic fetal monitor (EFM) tracing of a client who is in labor and has ruptured membranes.
Which of the following findings should alert the nurse to the possibility of a cord prolapse?
FHR of 160/min with accelerations is a normal finding that indicates a healthy baby. Accelerations are temporary increases in the fetal heart rate that usually occur with fetal movement or contractions.
FHR of 120/min with early decelerations is also a normal finding that indicates a well-oxygenated baby. Early decelerations are gradual decreases in the fetal heart rate that mirror contractions and are caused by head compression.
This indicates that the umbilical cord is prolapsed and compressed by the baby’s body, causing a decrease in blood and oxygen supply to the baby. A normal fetal heart rate is between 120 and 160 beats per minute. Severe variable decelerations are abrupt drops in the fetal heart rate that do not correspond to contractions.
FHR of 140/min with late decelerations is an abnormal finding that indicates uteroplacental insufficiency, not cord prolapse. Late decelerations are gradual decreases in the fetal heart rate that occur after contractions and are caused by reduced blood flow to the placenta.
The correct answer is choice C. FHR of 80/min with severe variable decelerations. This indicates that the umbilical cord is prolapsed and compressed by the baby’s body, causing a decrease in blood and oxygen supply to the baby. A normal fetal heart rate is between 120 and 160 beats per minute. Severe variable decelerations are abrupt drops in the fetal heart rate that do not correspond to contractions.
Choice A is wrong because FHR of 160/min with accelerations is a normal finding that indicates a healthy baby. Accelerations are temporary increases in the fetal heart rate that usually occur with fetal movement or contractions.
Choice B is wrong because FHR of 120/min with early decelerations is also a normal finding that indicates a well-oxygenated baby. Early decelerations are gradual decreases in the fetal heart rate that mirror contractions and are caused by head compression.
Choice D is wrong because FHR of 140/min with late decelerations is an abnormal finding that indicates uteroplacental insufficiency, not cord prolapse. Late decelerations are gradual decreases in the fetal heart rate that occur after contractions and are caused by reduced blood flow to the placenta.
