Nokea
A female client at 37 weeks' gestation has just undergone a nonstress test. The results were two fetal movements with a corresponding increase in fetal heart rate (FHR) of 15 bpm lasting 15 seconds within a 20-minute period. Her results would be classified as:
- A. Reactive; needs follow-up contraction stress test
- B. Reactive; no contraction stress test required
- C. Non-reactive; needs follow-up contraction stress test
- D. Non-reactive; no contraction stress test required
Correct Answer: B
Rationale: A contraction stress test is unnecessary following a reactive (normal) nonstress test. The results are considered reactive, indicating that the fetus is not showing distress. Therefore, a contraction stress test, which is a more in-depth test for fetal distress, is unnecessary. A nonreactive test would show fewer than two fetal movements or a failure of the FHR to increase at least 15 bpm with the movements in a 20-minute period. A contraction stress test should follow a nonreactive nonstress test to validate fetal distress.
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A 12-year-old girl has been diagnosed with insulin-dependent diabetes mellitus. Which of these principles would best guide her nutritional management?
- A. Concentrated sweets are taken during increased activity.
- B. Food restriction is imposed to reduce weight.
- C. Caloric distribution should be calculated to fit activity patterns.
- D. Fat requirements are increased owing to the possibility of ketoacidosis.
Correct Answer: C
Rationale: Concentrated sweets are eliminated from diet planning. Complex carbohydrates may be taken at the time of increased activity. Food restriction is not used for diabetic control of growing children. Caloric restriction may be imposed for weight control if necessary. Total caloric intake and proportions of basic nutrients should be consistent from day to day. Distribution of these calories should fit the activity pattern. Extra food is needed for increased activity. A balance of food, exercise, and insulin should be maintained. Because of the increased risk of atherosclerosis, the fat percentage of the total caloric intake is reduced.
A client with a history of Cushing’s syndrome is admitted with complaints of weight gain. The nurse should expect the client to have:
- A. Moon face
- B. Weight loss
- C. Hypotension
- D. Bradycardia
Correct Answer: A
Rationale: Cushing’s syndrome causes excess cortisol, leading to moon face, central obesity, and weight gain.
The client is admitted with a diagnosis of molar pregnancy. Which symptom is most likely to be present?
- A. Severe nausea and vomiting
- B. Uterine size smaller than expected
- C. Fetal heart tones at 12 weeks
- D. All of the above
Correct Answer: A
Rationale: Molar pregnancy (hydatidiform mole) often causes severe nausea and vomiting due to high levels of human chorionic gonadotropin (hCG). The uterus is typically larger than expected and fetal heart tones are absent as there is no viable fetus.
The client with a history of epilepsy is prescribed valproic acid (Depakote). Which laboratory test should the nurse monitor?
- A. Liver function tests
- B. Renal function tests
- C. Complete blood count
- D. Electrolytes
Correct Answer: A
Rationale: Valproic acid can cause hepatotoxicity, so liver function tests (e.g., AST, ALT) are monitored regularly. Renal function, blood counts, and electrolytes are less commonly affected.
The nurse is caring for a client in labor. The fetal heart rate is 80 bpm with moderate variability. The most appropriate initial action by the nurse is to:
- A. Notify the physician
- B. Administer oxygen at 8-10 liters per minute
- C. Reposition the client to her left side
- D. Increase the IV fluid rate
Correct Answer: C
Rationale: A fetal heart rate of 80 bpm indicates bradycardia possibly due to cord compression or uteroplacental insufficiency. Repositioning the client to her left side improves placental perfusion and is the first action. Oxygen notifying the physician or increasing fluids are secondary.