A nurse is reviewing the results of a 1-hr glucose screening test for a client who is at 24 weeks of gestation. The client's glucose value is 130 mg/dL. Which of the following actions should the nurse take?

Schedule the client for a routine 1-month appointment.

Instruct the client to return for a 3-hr oral glucose tolerance test.

Have the client perform home glucose monitoring for 1 week.

Repeat the 1 hr glucose testing in 1 week.

Answer and Explanation

The Correct Answer is B

A)   Incorrect- Scheduling a routine 1-month appointment is not appropriate given the elevated glucose value. A 1-hour glucose screening test value of 130 mg/dL indicates an elevated glucose level, which suggests the need for further testing to confirm or rule out gestational diabetes.
B)   Correct - An elevated glucose value on the initial screening test requires confirmation through a more comprehensive test, such as the 3-hour oral glucose tolerance test.
C)   Incorrect- Home glucose monitoring might be indicated for gestational diabetes but is not the next step after an elevated 1-hour glucose screening test.
D)   Incorrect- Repeating the 1-hour glucose test in 1 week is not necessary; if the initial test is elevated, further testing is required.

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Correct Answer is C

Explanation

Rationale:

A) Incorrect - The umbilical area is not a typical location for auscultating fetal heart tones.
B) Incorrect - The suprapubic area is not a common location for auscultating fetal heart tones.
C) Correct - At 12 weeks of gestation, the nurse would typically auscultate the fetal heart tones above the left iliac crest, which is in the lower abdomen. This is where the uterus is located at this stage of pregnancy.
D) Incorrect - Auscultating below the liver border on the right abdomen is not a standard practice for fetal heart tone assessment.

A. Administer methylergonovine IM. B. Assist the client to empty her bladder. C. Place the client in knee-chest position. D. Give a bolus of lactated Ringers.

Correct Answer is D

Explanation

A) Incorrect- Methylergonovine is used to treat postpartum hemorrhage due to uterine atony, not hypotension.
B) Incorrect- Emptying the client's bladder can help improve blood pressure but is not the priority over treating hypotension.
C) Incorrect- The knee-chest position might be used to increase blood pressure, but it is not the first-line intervention in this situation.
D) Correct - A bolus of lactated Ringers or another appropriate intravenous

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A nurse is reviewing the results of a 1-hr glucose screening test for a client who is at 24 weeks of gestation. The client's glucose value is 130 mg/dL. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is auscultating fetal heart tones with a Doppler device for a client who is at 12 weeks of gestation. Where should the nurse expect to auscultate the fetal heart tones?

Correct Answer is C

Explanation

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