A nurse is performing a nonstress test (NST) for a client who is at 28 weeks of gestation and has intrauterine growth restriction (IUGR).

The nurse observes that the fetal heart rate (FHR) does not accelerate with fetal movement after 20 minutes of monitoring.

Which of the following tests should the nurse anticipate to be ordered next for this client? (Select all that apply.)

Biophysical profile (BPP)

Contraction stress test (CST)

Umbilical artery Doppler velocimetry

Amniocentesis

Fetal kick count

Answer and Explanation

Correct Answer : A,C

A biophysical profile (BPP) is a test that combines a nonstress test with an ultrasound to assess fetal well-being. A umbilical artery Doppler velocimetry is a test that measures the blood flow in the umbilical cord to detect fetal growth restriction. Both of these tests are indicated for a client who has a nonreactive nonstress test (NST), which means that the fetal heart rate does not accelerate with fetal movement after 20 minutes of monitoring.

Choice B is wrong because a contraction stress test (CST) is a test that stimulates uterine contractions to evaluate how the fetal heart rate responds to stress. It is not recommended for clients who have intrauterine growth restriction (IUGR) because it can compromise fetal oxygenation.

Choice D is wrong because an amniocentesis is a test that obtains amniotic fluid for genetic testing, fetal lung maturity, or infection. It is not used to assess fetal well-being or growth.

Choice E is wrong because a fetal kick count is a method of monitoring fetal movement at home by counting how many times the fetus kicks in a certain period of time. It is not a test that can be ordered by a health care provider.

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Correct Answer is A

Explanation

Reactive.This means that the fetal heart rate (FHR) accelerates at least 10 beats/min for at least 10 seconds two or more times in a 30-minute period.This result shows that the baby is getting enough oxygen and is doing well.

Nonreactive.

This means that the FHR does not accelerate as expected during the test.This result does not necessarily mean that there is a problem, but it may indicate that the baby is not getting enough oxygen or is asleep.

If this happens, more tests may be needed.

Unsatisfactory.This means that the test results are unclear or incomplete due to technical problems or poor quality of the recording.

If this happens, the test may need to be repeated.

Equivocal.This means that the test results are uncertain or inconclusive due to factors such as preterm gestation, fetal sleep, maternal medications, or fetal anomalies.

If this happens, more tests may be needed.

Normal ranges for FHR are between 110 and 160 beats/min at rest and between 120 and 180 beats/min during movement.

A. “You will need to fast for 8 hours before the test.” B. “You will need to drink orange juice before the test.” C. “You will need to brush your nipple with your palm for 2 minutes.” D. “You will need to lie on your back during the test.”

Correct Answer is C

Explanation

The nurse should instruct the client to brush her nipple with her palm for 2 minutes.

This will stimulate the release of oxytocin and cause uterine contractions.The fetal heart rate (FHR) will be monitored for any signs of fetal distress, such as decelerations.

Choice A is wrong because fasting is not required for a CST.Fasting may be necessary for other tests that involve anesthesia or sedation.

Choice B is wrong because drinking orange juice will not induce contractions.Orange juice may be given to increase fetal activity before a nonstress test (NST), which measures the FHR response to fetal movement.

Choice D is wrong because lying on the back can compress the inferior vena cava and reduce blood flow to the uterus and the fetus.The client should lie on her side during the test to prevent supine hypotension syndrome.

Normal ranges for FHR are 110 to 160 beats per minute, with moderate variability and no decelerations.Normal ranges for uterine contractions are less than five in a 10-minute period, lasting less than 90 seconds each.

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A nurse is conducting a nipple-stimulated contraction stress test (CST) for a client who had a nonreactive nonstress test (NST). Which of the following instructions should the nurse give to the client for this test?

Correct Answer is C

Explanation

A nurse is caring for a client who is at 34 weeks of gestation and has systemic lupus erythematosus (SLE). The provider orders a nonstress test (NST) twice a week for this client. Which of the following statements by the nurse is appropriate when educating the client about this test?

A nurse is preparing to perform a nonstress test (NST) for a client who is at 36 weeks of gestation and reports decreased fetal movement. Which of the following actions should the nurse take first?