A nurse is caring for a client who is at 36 weeks of gestation and experiencing hypertension. Which of the following tests should the nurse use to monitor fetal well-being?

Maternal Hgb and Hct

Coombs test

Biophysical profile

Alpha fetoprotein

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Maternal hemoglobin and hematocrit levels are important indicators of the mother's health but are not direct indicators of fetal well-being.

Choice B rationale:

A Coombs test is performed on newborns to assess for hemolytic disease, not to monitor fetal well-being.

Choice C rationale:

A biophysical profile assesses multiple parameters of fetal well-being, including fetal heart rate, fetal movement, fetal breathing, amniotic fluid volume, and fetal tone.

Choice D rationale:

An alpha-fetoprotein test is a screening test for neural tube defects and chromosomal abnormalities but is not typically used to monitor fetal well-being in hypertensive pregnancies.

Nursing Test Bank

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Correct Answer is B

Explanation

Choice A rationale:

Referring the client to crisis intervention services might be necessary, but before doing so, the nurse should gather information to understand the client's current situation and coping mechanisms.

Choice B rationale:

Assessing the client's previous coping methods helps the nurse understand the client's strengths and provides insights into potential strategies for managing the crisis effectively.

Choice C rationale:

Discussing the cause of the crisis might be helpful, but it's important to first assess the client's current coping abilities and resources.

Choice D rationale:

Assisting the client in developing strategies to overcome the crisis is important, but it should come after a thorough assessment of the client's current coping mechanisms and situation.

A. Client report of back pain of 7 on a 0 to 10 scale B. Excoriated folds of the client's panniculus C. Hypoactive bowel sounds upon auscultation D. urine output of 80 mL in the past hour

Correct Answer is A

Explanation

Choice A rationale:

Postoperative pain management is crucial for the client's comfort and recovery.

Choice B rationale:

Excoriated folds of the client's panniculus might be related to skin irritation and can be addressed without immediate provider notification.

Choice C rationale:

Hypoactive bowel sounds can be expected after surgery and might not require immediate reporting.

Choice D rationale:

Urine output of 80 mL in the past hour might be influenced by various factors and is not as high a priority as severe pain.

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A nurse is caring for a client who is at 36 weeks of gestation and experiencing hypertension. Which of the following tests should the nurse use to monitor fetal well-being?

Nursing Test Bank

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