A nurse caring for a client during a non-stress test (NST) notes fetal movement. Each deceleration lasts 30 seconds.
Which of the following results are in?
Negative test.
Positive test.
Reactive test.
Non-reactive deceleration of rising in the fetal heart rate during a period.
The Correct Answer is C
Choice A rationale:
A negative test implies a non-reactive NST, meaning the fetal heart rate (FHR) did not demonstrate the expected accelerations in response to fetal movements.
However, the scenario states that fetal movements were noted, and decelerations were observed. Decelerations, even lasting 30 seconds, are not consistent with a negative test.
Choice B rationale:
A positive test is not a standard term used in the context of NST results.
The term "positive" is more often associated with tests that identify a specific condition or abnormality.
NST results are typically classified as reactive or non-reactive, with further interpretation based on the presence or absence of decelerations and other FHR patterns.
Choice C rationale:
A reactive NST is the desired outcome, indicating a healthy fetal response to movement.
It requires two or more FHR accelerations of at least 15 beats per minute for a minimum of 15 seconds, each within a 20- minute period.
Although the decelerations lasting 30 seconds warrant further assessment, they do not negate the presence of the required accelerations, making the test reactive.
Choice D rationale:
"Non-reactive deceleration of rising in the fetal heart rate during a period" is not a standard NST result terminology.
It incorrectly combines elements of non-reactivity (lack of accelerations) with a description of decelerations, which are distinct FHR patterns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is Choice D.
Choice A rationale: The client's age, being 20 years old, is not a contraindication to the use of a diaphragm. Diaphragms can be used by individuals of reproductive age, provided there are no other contraindications.
Choice B rationale: Having a vaginal birth 6 months ago is not a contraindication to using a diaphragm. The diaphragm's fit may need adjustment, but it can still be used safely postpartum.
Choice C rationale: Smoking cigarettes is a risk factor for several health conditions but is not a specific contraindication for the use of a diaphragm. However, smoking cessation should be encouraged for overall health benefits.
Choice D rationale: Having more than one sex partner increases the risk of sexually transmitted infections (STIs). Diaphragms do not protect against STIs, making it important to use condoms in conjunction with the diaphragm for clients with multiple sex partners.
Correct Answer is C
Explanation
Choice A:
While an ultrasound can indeed determine if there are multiple fetuses, this is not the primary reason for performing it prior to amniocentesis. The number of fetuses is typically established earlier in pregnancy through routine ultrasounds.
Focusing solely on multiple fetuses might lead the client to believe that ultrasounds are only conducted in such cases, which is not accurate.
Choice B:
Determining fetal age is a crucial aspect of prenatal care, but it's not the main reason for an ultrasound before amniocentesis. Fetal age is typically assessed through earlier ultrasounds, often in the first trimester.
Highlighting fetal age might misinform the client about the specific purpose of the ultrasound in this context.
Choice C:
This is the most appropriate response because it accurately identifies the primary purpose of the ultrasound.
Amniocentesis involves inserting a needle into the amniotic sac to collect a sample of amniotic fluid. To ensure the safety of the procedure and minimize risks to the fetus, it's essential to accurately visualize the location of the amniotic sac and placenta, as well as assess the position of the fetus.
Ultrasound provides real-time imaging that allows the healthcare provider to visualize these structures with precision, guiding the needle insertion and reducing the risk of complications.
Choice D:
While stating that the ultrasound is for imaging is technically correct, it's too general and doesn't provide the specific reason for its use in this context.
A more informative response would clarify the specific imaging goals for amniocentesis, as outlined in Choice C.
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