# A nurse is caring for a 30-year-old primigravida client at 39 weeks gestation who is experiencing precipitous labor. Which assessment finding would be the MOST important for the nurse to monitor continuously?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543044  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is caring for a 30-year-old primigravida client at 39 weeks gestation who is experiencing precipitous labor. Which assessment finding would be the MOST important for the nurse to monitor continuously?

## 보기

1. Maternal blood pressure and pulse rate
2. Fetal movement patterns and maternal comfort level
3. Cervical dilation progression and contraction strength
4. Fetal heart rate patterns and variability **✔ 정답**

**정답: 4**

## 해설

In precipitous labor, continuous fetal heart rate monitoring is critical due to risk of fetal compromise from reduced placental perfusion. Other assessments are important but secondary to fetal well-being.

## 심화 해설

Clinical Judgment
This question assesses the nurse's prioritization in a precipitous labor situation. The core is to identify the "most important continuous monitoring" target. The greatest risk of precipitous labor is decreased uteroplacental perfusion due to strong and frequent uterine contractions, leading to fetal hypoxia. Therefore, evaluating how the fetus responds to this stress in real time is the most critical for preserving life. Other options are important for assessing labor progress or maternal status, but have a lower priority than monitoring the immediate physiological stability of the fetus.

Memory Tip: The most important thing in precipitous labor is the **F**etal **H**eart **R**ate. Remember "**F**ast labor, check the **H**eart."

KR vs US
In Korea, continuous electronic fetal monitoring may not be applied to all mothers depending on the delivery room environment and staffing. However, by US NGN/NCLEX standards, in high-risk situations such as precipitous labor, continuous fetal heart rate monitoring is the standard for early detection of fetal distress, allowing immediate capture of danger signals such as late decelerations or decreased variability.

## 임상 시나리오

Clinical Practice Guide
Nurse's role during precipitous delivery:
1.  Immediately start fetal heart monitoring and continuously assess the pattern.
2.  Calmly guide the mother in breathing techniques and manage her fear of the unexpectedly rapid labor.
3.  Prepare for delivery: Prepare the precipitous delivery kit and keep neonatal resuscitation equipment nearby.
4.  Report immediately if fetal heart abnormalities (bradycardia, loss of variability, persistent late/variable decelerations) are detected.

Caution
If it appears as a SATA (Select All That Apply) question, they may ask "what the nurse should monitor during a precipitous delivery." In this case, fetal heart rate monitoring is a core item that must be included. Items like "maternal blood pressure" or "degree of labor pain" are also important, but in a question asking you to choose the single most important one, the tool for assessing fetal well-being takes priority.

## 핵심 개념

- **Precipitous Labor** — Precipitous labor. A delivery that progresses very rapidly, from the onset of labor to expulsion of the fetus in less than 3 hours. Uterine contractions are very strong and frequent, posing a high risk of reduced placental perfusion.
- **Fetal Heart Rate (FHR) Monitoring** — Fetal heart rate monitoring. A key test that evaluates the fetal heart rate and patterns to assess intrauterine oxygen supply status and fetal well-being. Variability and deceleration patterns are particularly important.
- **Uteroplacental Insufficiency** — Uteroplacental insufficiency. A condition where blood flow to the placenta is temporarily or continuously reduced due to uterine contractions, resulting in insufficient oxygen and nutrient supply to the fetus. A major cause of complications in precipitous labor.
- **Late Decelerations** — Late deceleration. A pattern of fetal heart rate decrease that begins after the peak of a uterine contraction and persists even after the contraction ends. A sign of uteroplacental insufficiency, requiring immediate intervention.
- **Primigravida** — Primigravida. A woman experiencing her first pregnancy. Generally, labor progression is often slower than in multiparous women, but if rapid delivery occurs, preparation is needed for unexpectedly fast progression.

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