Health Promotion and Maintenance
18. A client presents to a labor and delivery unit at 38 weeks' gestation. Before applying an external fetal monitor, an RN performs Leopold's maneuver and finds a hard, distinct mass in the upper right quadrant of the client's uterus. Where should the RN anticipate finding the fetal heart tones?
. Below the umbilicus on the client's left side.
. Above the umbilicus on the client's left side.
. Below the umbilicus on the client's right side.
. Above the umbilicus on the client's right side.
Test-Taking Tip
Picture the position of the fetus and the heart on the side where the head is palpable.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Assessment; Cognitive Level: Application; Client Need/Subneed: Health Promotion and Maintenance/Ante/Intra/Postpartum and Newborn Care
Health Promotion and Maintenance
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Answer 1 is incorrect because, when the fetal head is in the upper right quadrant, the body will be on the right side with the fetal hands and feet on the left side. The heart tones would not be audible on the left side. Answer 2 is incorrect because the fetus is in a breech position, so the heart tones would be upper quadrant on the right side, not the left side, because the hands and feet are on the left side. Answer 3 is incorrect because the fetal head is in the upper right quadrant; the body will be on the right side with the heart tones in the upper quadrant above the umbilicus, not below the umbilicus, which would be a vertex position. Answer 4 is correct because the fetal head is in the upper right quadrant, the body will be on the right side with the heart tones in the upper quadrant above the umbilicus.