A nurse is providing information to a client immediately before his scheduled Romberg test.
Which of the following statements should the nurse make?
"You will be standing with your feet 1 foot apart."
"You will place and hold your hands on your hips."
"I will be standing across the room from you to evaluate your sense of balance."
"I will be checking you once with your eyes open and once with them closed."
The Correct Answer is D
A is incorrect because the client should stand with their feet together, not 1 foot apart, for the Romberg test.
B is incorrect because the client should hold their arms at their sides, not on their hips, for the Romberg test.
C is incorrect because the nurse should stand close to the client, not across the room, to prevent injury in case of a fall.
D is correct because the Romberg test involves checking the client's balance with their eyes open and then with their eyes closed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Preeclampsia is not a contraindication for the administration of misoprostol for induction of labor. Misoprostol is a prostaglandin E1 analog used for cervical ripening and induction of labor. It is not contraindicated in patients with preeclampsia. However, its use should be carefully monitored in patients with hypertensive disorders of pregnancy due to the potential impact on blood pressure.
Choice B rationale:
Transverse fetal lie is a contraindication for the administration of misoprostol for induction of labor. Misoprostol should not be used when the baby is in a transverse position because it can lead to complications during delivery. Induction methods should be chosen carefully based on the fetal presentation to ensure a safe delivery process.
Choice C rationale:
Intrauterine growth restriction (IUGR) is not a contraindication for the administration of misoprostol for induction of labor. IUGR refers to a condition where a fetus does not grow at the expected rate inside the uterus. While the cause of IUGR needs to be addressed, misoprostol itself is not contraindicated in these cases. However, the healthcare provider should assess the overall fetal well-being before deciding on the induction method.
Choice D rationale:
Postterm pregnancy is not a contraindication for the administration of misoprostol for induction of labor. In postterm pregnancies, where the pregnancy has extended beyond 42 weeks, healthcare providers may consider inducing labor to prevent complications associated with prolonged gestation. Misoprostol is one of the options for induction in postterm pregnancies, although the choice of induction method may vary based on various factors.
Correct Answer is ["A","B","C","E"]
Explanation
Correct answer: A, B, C, E
Rationale:
- A: Alternate eating solid foods and liquids is recommended. This can help prevent dehydration and malnutrition, as well as reduce the risk of vomiting by avoiding overfilling the stomach.
- B: Eat every 2 to 3 hr is recommended. This can help maintain blood glucose levels and prevent hunger-induced nausea.
- C: Drink warm ginger ale when nauseated is recommended. Ginger has antiemetic properties and can help soothe the stomach and reduce nausea.
- E: Recommended actions is correct. The nurse should indicate which actions are recommended for the client.
- D: Increase intake of high-fat foods is contraindicated. High-fat foods can delay gastric emptying and worsen nausea and vomiting. The client should eat low-fat, bland, and easy-todigest foods instead.
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