A nurse is caring for a client who is at 36 weeks of gestation and is undergoing a nonstress test (NST). The test is nonreactive. Which of the following interventions should the nurse suggest based on the findings?

Kleihauer-Betke test

Amnioinfusion

Administration of terbutaline

Contraction stress test

Answer and Explanation

The Correct Answer is D

A. Kleihauer-Betke test. This test is used to detect fetal-maternal hemorrhage by identifying fetal red blood cells in maternal circulation. It is not related to a nonreactive NST, which indicates the need for further fetal well-being assessment rather than checking for fetal-maternal bleeding.
B. Amnioinfusion. This procedure involves infusing fluid into the amniotic sac to relieve umbilical cord compression or dilute meconium-stained amniotic fluid. It is not an appropriate intervention for a nonreactive NST, as it does not assess fetal oxygenation or reactivity.
C. Administration of terbutaline. Terbutaline is a tocolytic used to relax the uterus and prevent preterm labor. It is not indicated for a nonreactive NST, as the concern in this scenario is fetal well-being rather than uterine activity.
D. Contraction stress test. A nonreactive NST means that the fetal heart rate does not demonstrate adequate accelerations, which can indicate potential fetal hypoxia. A contraction stress test is performed next to evaluate how the fetal heart rate responds to contractions, helping determine if the fetus can tolerate labor.

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Correct Answer is D

Explanation

A. "Turn on fans in the facility to circulate air." Fans should not be turned on during a chemical disaster because they can spread contaminants throughout the facility, increasing exposure to toxic substances.
B. "Open the fireplace dampers in the day room." Opening fireplace dampers can allow contaminated air to enter the facility, increasing the risk of exposure. Sealing off potential entry points for hazardous chemicals is a priority in these situations.
C. "Cover the electrical outlets with wet towels." While sealing gaps and vents can help reduce chemical exposure, using wet towels over electrical outlets is not an effective protective measure. Instead, doors, windows, and ventilation systems should be sealed as much as possible to prevent outside air from entering.
D. "Move clients to a room above ground with few windows." In an external chemical disaster, sheltering in place is essential. A room above ground is preferable because many chemicals are heavier than air and can accumulate in lower levels. Selecting a space with few windows helps minimize exposure by reducing potential entry points for contaminants.

A. Tell the client to leave the group if they cannot contribute. B. Allow the client extra time to think of a response. C. Appoint the client to lead the discussion. D. Ask other group members to limit the number of responses

Correct Answer is B

Explanation

A. Tell the client to leave the group if they cannot contribute. Forcing a client to leave due to silence is inappropriate and can increase feelings of isolation and anxiety. Clients should be encouraged to participate at their own pace.
B. Allow the client extra time to think of a response. Some clients may need more time to process thoughts before speaking. Allowing extra time provides a supportive environment and respects the client’s comfort level in participation.
C. Appoint the client to lead the discussion. Assigning a leadership role to a silent client may increase anxiety and discourage participation rather than help them feel included. Participation should be encouraged but not forced.
D. Ask other group members to limit the number of responses. Restricting other members' participation does not address the silent client’s needs and may disrupt group dynamics. Instead, creating an inclusive and supportive environment is key to fostering engagement.

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A nurse is caring for a client who is at 36 weeks of gestation and is undergoing a nonstress test (NST). The test is nonreactive. Which of the following interventions should the nurse suggest based on the findings?

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Naxlex Comprehensive Predictor Exams

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