A nurse is assessing a client who is in pre-term labor and has received one dose of terbutaline subcutaneously.
Which of the following findings should the nurse report to the provider?
Heart rate of 110/min
Blood pressure of 150/90 mm Hg
Blood glucose of 90 mg/dL
Temperature of 37°C (98.6°F)
The Correct Answer is B
Blood pressure of 150/90 mmHg. This is because terbutaline can cause elevated blood pressure as a side effect.
The nurse should report this finding to the provider as it may indicate hypertension or a hypertensive crisis.
Choice A is wrong because a heart rate of 110/min is not abnormal for a person who has received terbutaline. Terbutaline can cause fast or pounding heartbeats as a common side effect.
Choice C is wrong because a blood glucose of 90 mg/dL is within the normal range of 70-130 mg/dL before meals. Terbutaline can cause transient hyperglycemia (high blood sugar) as a serious side effect, but this is not the case here.
Choice D is wrong because a temperature of 37°C (98.6°F) is normal for a human being. Terbutaline does not cause fever or hypothermia as a side effect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Cervix is shortened and thinned.This indicates cervical effacement, which is the thinning and softening of the cervix in preparation for childbirth.Cervical effacement is measured in percentages, from 0% (no effacement) to 100% (fully effaced).
Choice A is wrong because cervix is soft and pliable does not necessarily mean it is effaced.The cervix can soften before it thins and shortens.
Choice C is wrong because cervix is dilated and open indicates cervical dilation, which is the opening of the cervix.Cervical dilation is measured in centimeters, from 0 cm (closed) to 10 cm (fully dilated).
Cervical dilation and effacement are related, but not the same.
Choice D is wrong because cervix is posterior and high indicates the position of the cervix in relation to the vagina.The cervix can move from posterior (back) to anterior (front) and from high to low as labor progresses.
The position of the cervix does not indicate effacement.
Correct Answer is A
Explanation
Thromboembolism.
Prolonged bed rest increases the risk of venous stasis and blood clot formation in the lower extremities, which can lead to pulmonary embolism if the clot dislodges and travels to the lungs.
This is a life-threatening complication that requires immediate treatment.
Choice B. Placental abruption is wrong because it is not caused by bed rest, but by trauma, hypertension, cocaine use, or other factors that can cause the placenta to separate from the uterine wall.
Choice C. Uterine atony is wrong because it is not caused by bed rest, but by overdistension of the uterus, prolonged labor, infection, or other factors that can impair the contraction of the uterine muscles after delivery.
Choice D. Infection is wrong because it is not caused by bed rest, but by poor hygiene, invasive procedures, or other factors that can introduce microorganisms into the reproductive tract.
Normal ranges for maternal heart rate are 60-100 beats per minute and blood pressure are 110-140/60-90 mm Hg.
Normal range for fetal heart rate is 110-160 beats per minute.
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