A nurse is assessing a client who is in preterm labor and has a new prescription for terbutaline 0.25 mg subcutaneous.
For which of the following findings should the nurse withhold the medication and report to the provider?

BP 88/58 mm Hg

Urinary output 40 mL/hr

FHR 120/min.

Fasting blood glucose 75 mg/dL

Answer and Explanation

The Correct Answer is A

Terbutaline is a medication that can cause serious side eﬀects such as ante (low blood pressure).
A blood pressure reading of 88/58 mm Hg is considered low and could be a sign
of hypotension.

The nurse should withhold the medication and report this ﬁnding to the provider.

Choice B is not an answer because a urinary output of 40 mL/hr is within the
normal range.

Choice C is not an answer because a fetal heart rate (FHR) of 120/min is within the normal range.

Choice D is not an answer because a fasting blood glucose level of 75 mg/dL is
within the normal range.

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Correct Answer is C

Explanation

A nurse caring for a client who is at 36 weeks of gestation and has methicillin- resistant Staphylococcus aureus (MRSA) should initiate Contact Precautions.

Choice A is incorrect because Droplet Precautions are not necessary for MRSA.
Choice B is incorrect because a Protective Environment is not necessary for MRSA.
Choice D is incorrect because Airborne Precautions are not necessary for MRSA.

A. Decrease in frequency of contractions. B. Urinary output 35 mL/hr. C. Absent deep-tendon reﬂexes. D. BP 150/100 mm Hg.

Correct Answer is C

Explanation

A nurse should report absent deep-tendon reﬂexes to the provider when a client is receiving magnesium sulfate via continuous IV infusion.

This is because reduced tendon reﬂexes can be a side eﬀect of magnesium sulfate use during pregnancy.

Choice A is not correct because a decrease in the frequency of contractions is an expected outcome of magnesium sulfate use as a tocolytic to stop preterm labor.

Choice B is not correct because a urinary output of 35 mL/hr is within the normal range.

Choice D is not correct because an elevated blood pressure is not a known side eﬀect of magnesium sulfate use during pregnancy.

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A nurse is assessing a client who is in preterm labor and has a new prescription for terbutaline 0.25 mg subcutaneous. For which of the following findings should the nurse withhold the medication and report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is at 36 weeks of gestation and has methicillin- resistant Staphylococcus aureus. Which of the following types of isolation precautions should the nurse initiate?

Correct Answer is C

Explanation

A nurse is assessing a client who is at 32 weeks of gestation and is receiving magnesium sulfate via continuous IV infusion. Which of the following findings should the nurse report to the provider?

Correct Answer is C

Explanation

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A nurse is assessing a client who is in preterm labor and has a new prescription for terbutaline 0.25 mg subcutaneous.
For which of the following findings should the nurse withhold the medication and report to the provider?