A nurse is assisting with the care of a client who is 37 weeks of gestation and is undergoing a nonstress test. Which of the following actions should the nurse take?
Assist the client into a supine position.
Explain that nonreactivity might require immediate medication administration.
Remind the client to press the button when she feels fetal movement.
Tell the client the test should take about 10 min.
The Correct Answer is C
A. Assist the client into a supine position is incorrect. A supine position can reduce uterine blood flow and may lead to hypotension. The nurse should assist the client into a left-lateral position for optimal results during a nonstress test.
B. Explain that nonreactivity might require immediate medication administration is incorrect. Nonreactivity can indicate fetal distress, but it does not necessarily require medication immediately. Further testing or evaluation would be needed first.
C. Remind the client to press the button when she feels fetal movement is correct. The purpose of the nonstress test is to monitor fetal heart rate acceleration in response to movement. The client is typically instructed to press a button when she feels fetal movement so the nurse can correlate it with fetal heart rate patterns.
D. Tell the client the test should take about 10 min is incorrect. The nonstress test typically takes 20–40 minutes, depending on fetal activity and the need for monitoring.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "It takes 2 months of scheduled use before this medication is effective." is incorrect. Montelukast is generally effective within 1-2 weeks of starting the medication, not 2 months.
B. "I will give this medication to my child once daily in the evening." is correct. Montelukast is usually administered once daily, in the evening, to help prevent asthma symptoms.
C. "I can stop giving my child this medication if he is taking a steroid." is incorrect. Montelukast and steroids can be used together to manage asthma, but stopping montelukast is not recommended unless advised by the healthcare provider.
D. "I will give this medication to my child every 2 hours if he is wheezing." is incorrect. Montelukast is a maintenance medication and should not be used as a rescue treatment for acute wheezing. For acute symptoms, a short-acting bronchodilator is typically used.
Correct Answer is A
Explanation
A. Wipe any excess medication from the inner canthus outward: This is the correct approach. When administering ophthalmic ointment, the nurse should wipe away any excess from the inner canthus to the outer canthus to prevent contamination of the unaffected eye and to avoid spreading the infection.
B. Instruct guardian to apply erythromycin ophthalmic ointment every morning for 14 days.: This is incorrect because the child has been prescribed bacitracin ophthalmic ointment, not erythromycin. The nurse should instruct the guardian to use the prescribed medication as directed.
C. Gently massage the eyelid to facilitate absorption of the medication.: Massaging the eyelid is unnecessary and could lead to irritation or injury. The medication should be allowed to be absorbed naturally without additional manipulation.
D. Place an occlusive dressing on the affected eye to prevent the spread of infection.: An occlusive dressing is not recommended as it may cause increased irritation or pressure on the eye. The best practice is to maintain proper hygiene and follow the prescribed medication regimen.
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