During a nonstress test of a 38-week client, the practical nurse (PN) observes the fetal heart rate increases 15 beats above baseline lasting 10 seconds twice during a 20-minute tracing. Which finding should the PN document in the electronic medical record?
Acceleration.
Nonreactive pattern.
Fetal movement.
Positive tracing.
The Correct Answer is A
A. Acceleration refers to a temporary increase in the fetal heart rate of at least 15 beats per minute above the baseline for at least 10 seconds. The observation of the fetal heart rate increasing 15 beats above baseline twice during the test indicates that accelerations are present, which is a reassuring sign of fetal well-being.
B. A nonreactive pattern would indicate that the test did not meet the criteria for accelerations or fetal heart rate reactivity, which is not the case here as the fetal heart rate did exhibit accelerations.
C. Fetal movement could contribute to accelerations but is not the term used to describe the findings of the test itself. The specific observation made was an increase in fetal heart rate, which is classified as an acceleration.
D. A positive tracing indicates that the nonstress test met criteria for fetal well-being, typically with at least two accelerations, but the correct term for the specific observation here is acceleration rather than describing the overall result.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E","F"]
Explanation
A. A warning about potential charges for child neglect
This is not appropriate in a pre-discharge education context. The focus should be on providing support and education to prevent future incidents and to help the parents understand the importance of supervision and safety.
B. Information about pool safety
Providing information about pool safety is essential to prevent future drowning incidents. Parents should be educated on supervision, barriers, and emergency response measures like CPR. This helps ensure the child's safety and reduces the risk of similar accidents.
C. Instructions on how to access long-term home care
Long-term home care instructions are unnecessary unless the child has specific ongoing medical needs resulting from the submersion. Since the child is showing only minor signs of impact, this education is not relevant.
D. When to follow up with the child's pediatrician
Clear instructions on when to follow up with the pediatrician ensure ongoing monitoring for any delayed effects of the submersion injury. This follow-up helps address any emerging health concerns and reassures the parents about their child's recovery.
E. Assessment of the parent's coping skills
Assessing the parents' coping skills is important to understand their emotional and psychological state post-incident. This can help identify any need for further support or counseling, ensuring the family is equipped to handle the situation.
F. Contact information for community resources
Providing contact information for community resources offers additional support to the parents, such as access to counseling, parenting classes, or safety courses. This reinforces the safety education provided and ensures the parents have resources to turn to if needed
Correct Answer is A
Explanation
A. Acceleration refers to a temporary increase in the fetal heart rate of at least 15 beats per minute above the baseline for at least 10 seconds. The observation of the fetal heart rate increasing 15 beats above baseline twice during the test indicates that accelerations are present, which is a reassuring sign of fetal well-being.
B. A nonreactive pattern would indicate that the test did not meet the criteria for accelerations or fetal heart rate reactivity, which is not the case here as the fetal heart rate did exhibit accelerations.
C. Fetal movement could contribute to accelerations but is not the term used to describe the findings of the test itself. The specific observation made was an increase in fetal heart rate, which is classified as an acceleration.
D. A positive tracing indicates that the nonstress test met criteria for fetal well-being, typically with at least two accelerations, but the correct term for the specific observation here is acceleration rather than describing the overall result.
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