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A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain.
Which of the following nursing interventions are appropriate to reduce pain? (Select all that apply.)

Perform Leopold maneuvers.

Apply counterpressure to the sacral area

Ambulate the client in the hallway

Administer 70-90% nitrous oxide mixed with oxygen

Answer and Explanation

Correct Answer : B,C,D,E

Applying counterpressure to the sacral area can help alleviate back pain during labor.

Ambulating the client in the hallway can help with pain management and facilitate labor progress.

Administering nitrous oxide mixed with oxygen can provide pain relief during labor.

Having the client sit upright can help with pain management and facilitate labor progress.

Choice A is incorrect because performing Leopold maneuvers is a technique used to assess fetal position and presentation and is not a pain management technique.

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Correct Answer is D

Explanation

A nurse caring for a client following a vaginal delivery of a term fetal demise should oﬀer the client the option to bathe and dress their baby if they would like to.

Choice A is incorrect because it is not appropriate for the nurse to suggest that the client should name the baby.

Choice B is incorrect because it is not appropriate for the nurse to suggest that not holding the baby will make letting go much harder.

Choice C is incorrect because it is not appropriate for the nurse to make assumptions about future pregnancies.

A. An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40-min testing period. B. No late decelerations noted with three uterine contractions of 60 seconds in C. duration within a 10-min testing period. D. Irregular contractions of 10 to 20 seconds in duration that are not felt by the E. client.

Correct Answer is C

Explanation

A nurse assessing the results of a nonstress test for an antepartal client at 35 weeks of gestation should indicate the need for further diagnostic testing if there are no late decelerations noted with three uterine contractions of 60 seconds in duration within a 10-min testing period.

Choice A is incorrect because an increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40-min testing period is a normal result.
Choice B is incorrect because irregular contractions of 10 to 20 seconds in duration that are not felt by the client do not indicate the need for further diagnostic testing.
Choice D is incorrect because three fetal movements perceived by the client in a 20-min testing period do not indicate the need for further diagnostic testing.

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A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain. Which of the following nursing interventions are appropriate to reduce pain? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client following a vaginal delivery of a term fetal demise. Which of the following statements should the nurse make?

Correct Answer is D

Explanation

A nurse is assessing the results of a nonstress test for an antepartal client at 35 weeks of gestation. Which of the following findings should indicate to the nurse the need for further diagnostic testing?

Correct Answer is C

Explanation

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A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain.
Which of the following nursing interventions are appropriate to reduce pain? (Select all that apply.)