A nurse is caring for a client who is in active labor. The nurse should notify the provider for which of the following findings?

Moderate variability in the FHR

Prolonged decelerations

Baseline FHR 115/min

Three uterine contractions within 10 min

Answer and Explanation

The Correct Answer is B

A. Moderate variability in the FHR: Incorrect. Moderate variability (6-25 bpm) is a reassuring sign of fetal well-being.

B. Prolonged decelerations: Prolonged decelerations, defined as a decrease in fetal heart rate (FHR) of at least 15 beats per minute lasting 2 to 10 minutes, indicate potential fetal hypoxia or distress and require immediate notification of the provider.

C. Baseline FHR 115/min: Incorrect. A baseline FHR of 115/min is within the normal range of 110-160 bpm.

D. Three uterine contractions within 10 min: Incorrect. This contraction pattern is within the normal range for active labor (normal is 2-5 contractions in 10 minutes).

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Correct Answer is C

Explanation

A. The NG tube should be flushed with 15-30 mL of water before and after medication administration, not 5 mL.

B. Medications should not be added directly to enteral feeding as it may alter the medication's effectiveness or cause tube clogging.

C. Using a syringe to allow medications to flow by gravity reduces the risk of pressure-related complications and ensures safe administration.

D. Medications should be dissolved separately to prevent interactions or clogging.

A. Speak in a normal voice at a natural pace. B. Pause in the middle of sentences. C. Direct statements to the interpreter. D. Use gestures when speaking with the client.

Correct Answer is A

Explanation

A. Speak in a normal voice at a natural pace: This allows the interpreter to accurately convey the nurse's message without confusion or misinterpretation. Speaking slowly or loudly is unnecessary and can be perceived as disrespectful.

B. Pause in the middle of sentences: Pausing mid-sentence may result in incomplete or confusing information being relayed to the client.

C. Direct statements to the interpreter: The nurse should direct communication to the client to maintain engagement and respect.

D. Use gestures when speaking with the client: Gestures can be misinterpreted, and relying on them reduces clear verbal communication.

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A nurse is caring for a client who is in active labor. The nurse should notify the provider for which of the following findings?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer three medications to a client who is receiving continuous enteral feeding through an NG tube. Which of the following actions is appropriate for the nurse to take?

Correct Answer is C

Explanation

A nurse is caring for a client who speaks a different language than the nurse and is using an interpreter. Which of the following actions should the nurse take when working with the interpreter?

Correct Answer is A

Explanation

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