A nurse is caring for a pregnant client at 36 weeks of gestation who reports low back pain and pelvic pressure.
Which intervention should the nurse implement first?
Administer a dose of tocolytic medication
Encourage the client to rest in a side-lying position
Assess fetal heart rate using a Doppler device
Assess vaginal discharge for any change
The Correct Answer is C
Assess fetal heart rate using a Doppler device.
This is because low back pain and pelvic pressure at 36 weeks of gestation may indicate preterm labor, which can affect the fetal well-being. Therefore, the nurse should assess the fetal heart rate as a priority to determine if the fetus is in distress or not.
Choice A is wrong because tocolytic medication is used to stop uterine contractions, not to relieve low back pain and pelvic pressure. Choice B is wrong because resting in a side-lying position may help with blood circulation and reduce supine hypotensive syndrome, but it does not address the possible cause of low back pain and pelvic pressure. Choice D is wrong because assessing vaginal discharge for any change may indicate infection, rupture of membranes, or cervical dilation, but it is not as urgent as assessing fetal heart rate.
Some interventions for preventing and treating low back pain and pelvic pressure during pregnancy include exercise, water-based exercise, acupuncture, osteomanipulative therapy, craniosacral therapy, and pelvic support belts.
However, these interventions should be discussed with the health care provider before starting them.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Terbutaline can cause low potassium levels in the blood, which can lead to muscle weakness, cramps, and cardiac arrhythmias.
This is a potential adverse effect of the medication that should be reported to the provider.
Choice A is wrong because tachycardia is a common side effect of terbutaline that does not usually require medical attention.
Terbutaline works by stimulating beta-adrenergic receptors, which can increase the heart rate.
Choice B is wrong because hypotension is not a typical side effect of terbutaline.Terbutaline can actually cause elevated blood pressure in some cases.
Choice C is wrong because hyperglycemia is not a common side effect of terbutaline.Terbutaline can cause transient hyperglycemia in pregnant women, but this is not a reason to stop the medication.
Normal ranges for potassium are 3.5-5.0 mEq/L and for blood glucose are 70-110 mg/dL.
Correct Answer is C
Explanation
Indomethacin is contraindicated for this client because it is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate or inflame the lining of the stomach and small intestine.This can worsen the client’s peptic ulcer disease, which is a condition where open sores develop on the inner surface of the stomach or small intestine due to acid erosion.
Indomethacin can also interact with other medications that the client may be taking for pre-term labor or peptic ulcer disease.
Choice A is wrong because magnesium sulfate is not contraindicated for this client.It is a medication that can relax the smooth muscles of the uterus and prevent pre-term labor contractions.
Choice B is wrong because betamethasone is not contraindicated for this client.It is a corticosteroid that can help mature the fetal lungs and reduce the risk of respiratory distress syndrome in pre-term infants.
Choice D is wrong because terbutaline is not contraindicated for this client.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.