A nurse is caring for a client who is in active labor.
The nurse should notify the provider for which of the following findings?
Moderate variability in the FHR.
Prolonged decelerations.
Three uterine contractions within 10 min.
Baseline FHR 115/min.
The Correct Answer is B
Choice A rationale:
Moderate variability in the FHR is a reassuring sign of fetal well-being, indicating a responsive fetal autonomic nervous system to normal physiologic stimuli. It is considered a normal finding in active labor, suggesting that the fetus is well-oxygenated and able to cope with contractions.
Choice B rationale:
Prolonged decelerations are concerning patterns on the fetal heart rate (FHR) monitor, indicating potential fetal distress. Prolonged decelerations are defined as lasting more than 2 minutes but less than 10 minutes. These decelerations can be caused by umbilical cord compression, placental insufficiency, or maternal hypotension. Prompt intervention is required, making this choice the correct answer.
Choice C rationale:
Three uterine contractions within 10 minutes, also known as a contraction stress test (CST), is a normal finding. It assesses the fetal response to stress and is used to evaluate the placental function and fetal well-being.
Choice D rationale:
A baseline FHR of 115/min is within the normal range (110-160 beats per minute) for a term fetus. It indicates a stable fetal heart rate, and there is no immediate need for intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Including any adverse effects of the medications the client might develop is important but does not cover the entire scope of medication reconciliation. It is essential to compare new prescriptions with the list of current medications to prevent drug interactions, duplications, or omissions.
Choice B rationale:
Comparing new prescriptions with the list of medications the client reports is the correct approach to medication reconciliation. This helps identify discrepancies, ensuring that the client's current medications are accurately documented and preventing medication errors.
Choice C rationale:
Excluding nutritional supplements from the list of medications the client reports is incorrect. Nutritional supplements, herbal remedies, and over-the-counter medications are essential components of the medication list. These items can interact with prescribed medications and affect the client's overall health.
Choice D rationale:
Encouraging the client to make his own list after he returns home is not recommended. Patients might not have complete knowledge of the medications they are taking, including dosages and frequencies. Relying solely on the patient-generated list can lead to inaccuracies and potential harm.
Correct Answer is C
Explanation
Choice A rationale:
Amputation, although a significant medical history, is not a contraindication to becoming a living kidney donor. The presence of an amputation does not directly impact the person's ability to donate a kidney to their parent.
Choice B rationale:
Primary glaucoma, a condition affecting the eyes, is also not a contraindication to kidney donation. While eye conditions can affect overall health, they do not specifically prevent an individual from donating a kidney if they are otherwise healthy.
Choice C rationale:
Hypertension (high blood pressure) is a contraindication to kidney donation. Individuals with hypertension are at a higher risk of developing kidney disease themselves. Additionally, donating a kidney could exacerbate their condition, potentially leading to further complications. Therefore, this is the correct choice.
Choice D rationale:
Osteoarthritis, a condition affecting the joints, is not a contraindication to kidney donation. Joint problems do not directly impact kidney function or the ability to donate a kidney.
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