A nurse is performing an external nonstress test for a client who is at 41 weeks of gestation and has oligohydramnios.

The nurse notes that there are no accelerations in the fetal heart rate tracing after applying an acoustic stimulator to the maternal abdomen for several seconds.

Which of the following actions should the nurse take?

Repeat the acoustic stimulation after 1 minute

Document the finding as a nonreactive NST

Perform a contraction stress test (CST)

Notify the provider and prepare for delivery

Answer and Explanation

The Correct Answer is D

Notify the provider and prepare for delivery. Oligohydramnios is a condition where the amniotic fluid volume is less than expected for gestational age and it is associated with maternal and fetal complications.

The nonstress test (NST) is a method of fetal surveillance that measures the fetal heart rate response to fetal movement. A reactive NST is defined as at least two accelerations of 15 beats per minute or more above the baseline, lasting 15 seconds or more, within a 20-minute period.

A nonreactive NST indicates fetal hypoxia or acidosis and requires further evaluation. An acoustic stimulator can be used to elicit fetal movement and accelerations, but it should not be repeated more than once in a 10-minute period.

Therefore, choice A is wrong because repeating the acoustic stimulation after 1 minute is too soon and may cause fetal distress.

Choice B is wrong because documenting the finding as a nonreactive NST is not enough to address the situation. Choice C is wrong because performing a contraction stress test (CST) is contraindicated in oligohydramnios because it may cause umbilical cord compression and fetal compromise.

The CST involves inducing uterine contractions with oxytocin or nipple stimulation and monitoring the fetal heart rate for signs of intolerance.

A negative CST means that there

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Correct Answer is B

Explanation

NST is less time-consuming and more comfortable than CST.This is because NST does not require any external stimulation of the uterus, while CST involves giving oxytocin to induce contractions.NST also does not pose any risk of preterm labor or fetal distress, which are possible complications of CST.

Choice A is wrong because NST does not provide more information about fetal status than CST.In fact, CST can detect fetal hypoxia more accurately than NST.

Choice C is wrong because NST does not have fewer contraindications than CST.Both tests have similar contraindications, such as placenta previa, multiple gestation, and previous cesarean section.

Choice D is wrong because NST does not have higher sensitivity and specificity than CST.

Sensitivity refers to the ability of a test to correctly identify positive cases, while specificity refers to the ability of a test to correctly identify negative cases.

NST has a high sensitivity but a low specificity, meaning it can detect most fetuses with hypoxia but also has many false positives.CST has a low sensitivity but a high specificity, meaning it can miss some fetuses with hypoxia but also has few false negatives.

A. Category I. B. Category II. C. Category III. D. Category IV.

Correct Answer is C

Explanation

Category III.This category of FHR tracing represents an abnormal pattern that is predictive of fetal acidemia and requires prompt evaluation and intervention.A category III pattern is defined by any of the following criteria:

• Absent baseline FHR variability and any of the following:

➤ Recurrent late decelerations

➤ Recurrent variable decelerations

➤ Bradycardia

• Sinusoidal pattern

Choice A is wrong because category I is a normal pattern that is predictive of normal fetal acid-base balance at the time of observation.A category I pattern is defined by all of the following criteria:

• Baseline rate of 110 to 160 bpm

• Moderate baseline FHR variability

• No late or variable decelerations

• Early decelerations may be present or absent

• Accelerations may be present or absent

Choice B is wrong because category II is an indeterminate pattern that is not predictive of abnormal fetal acid-base balance but requires continued surveillance and reevaluation.A category II pattern includes all FHR tracings that are not category I or III.

Choice D is wrong because there is no category IV in the NICHD classification system for FHR tracings.

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Naxlex Comprehensive Predictor Exams

A nurse is comparing nonstress test (NST) and contraction stress test (CST) for assessing fetal well-being. What is an advantage of NST over CST?

Correct Answer is B

Explanation

A nurse is assessing a fetal heart rate (FHR) tracing for a client who is in active labor. The nurse notes that the baseline FHR is 150 bpm with absent variability and recurrent variable decelerations with slow return to baseline. What category of FHR tracing does this represent?

Correct Answer is C

Explanation

A nurse is reviewing the findings of a biophysical profile (BPP) for a client who is at 40 weeks of gestation. The BPP score is 6 out of 10 points. Which of the following components are included in this score? (Select all that apply.)

A nurse is caring for a client in labor who has an internal fetal scalp electrode applied for continuous fetal heart rate (FHR) monitoring. The nurse notes a pattern of late decelerations on the FHR tracing. What is the priority nursing intervention?

A nurse is interpreting the results of a contraction stress test (CST) for a client who is at 38 weeks of gestation. The nurse notes that there are no late or significant variable decelerations of the fetal heart rate (FHR). How should the nurse document this finding?

(Select all that apply) A nurse is performing a nonstress test (NST) for a client who is at 32 weeks of gestation and has gestational diabetes mellitus. The nurse uses vibroacoustic stimulation to elicit fetal movement and acceleration of FHR. What are the indications for using this method?

A nurse is caring for a client who is scheduled for an amniocentesis at 35 weeks of gestation to assess fetal lung maturity. Which of the following laboratory tests will provide this information?

A nurse is using vibroacoustic stimulation (VAS) to stimulate fetal movement during a nonstress test (NST). What action should the nurse take when applying VAS?