The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instruction?

"I need to lie flat on my back to perform the procedure."

“If I count fewer than 10 kicks in a 2-hour period, I would count the kicks again over the next 2 hours."

"I need to place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks."

“I will record the number of movements or kicks."

Answer and Explanation

The Correct Answer is A

A. "I need to lie flat on my back to perform the procedure." Lying flat on the back can cause supine hypotension syndrome due to compression of the inferior vena cava. The client should lie on her left side or sit in a comfortable position to improve placental circulation.

B. “If I count fewer than 10 kicks in a 2-hour period, I would count the kicks again over the next 2 hours." If fewer than 10 movements are felt in 2 hours, the client should rest, eat, and try counting again. If movements remain low, she should contact her provider.

C. "I need to place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks." Placing hands on the abdomen helps the client feel subtle fetal movements.

D. “I will record the number of movements or kicks." Keeping a record of fetal movements helps monitor fetal well-being.

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Correct Answer is B

Explanation

A. "I should schedule the test when the baby is usually active." The test relies on fetal movements to assess heart rate responses, so scheduling it when the baby is active improves accuracy.

B. "I will have to lie on my back during the test." Lying on the back (supine) can cause supine hypotensive syndrome by compressing the inferior vena cava. The client should lie in a semi-Fowler’s or left lateral position.

C. "My baby's heart rate will be monitored during the test." The NST assesses fetal heart rate patterns in response to movement, so monitoring the fetal heart rate is essential.

D. "It will take 20 to 30 minutes to complete the test." An NST typically lasts 20-30 minutes unless additional monitoring is needed due to a nonreactive result.

A. "The test will be performed if your baby's heartbeat is heard." B. "This test requires the presence of amniotic fluid." C. "This test will determine if your baby's lungs are mature." D. "After the test, you will be given Rh, immune globulin since you are Rh positive."

Correct Answer is B

Explanation

A. "The test will be performed if your baby's heartbeat is heard." The test is performed based on the presence of sufficient amniotic fluid for sampling, not just on fetal heart activity.

B. "This test requires the presence of amniotic fluid." Amniocentesis involves extracting a sample of amniotic fluid to assess genetic conditions, fetal infections, or other concerns, making the presence of amniotic fluid essential.

C. "This test will determine if your baby's lungs are mature." Fetal lung maturity is typically assessed via amniocentesis in the third trimester, not at 15 weeks. The early amniocentesis is primarily for genetic and chromosomal testing.

D. "After the test, you will be given Rh immune globulin since you are Rh positive."Rh immune globulin (RhoGAM) is given to Rh-negative mothers after an amniocentesis to prevent Rh sensitization, not to Rh-positive mothers.

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The nurse in a health care clinic is instructing a pregnant client how to perform "kick counts." Which statement by the client indicates a need for further instruction?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching to a client who is at 30 weeks of gestation and is to have a nonstress test (NST). Which of the following statements by the client indicates a need for further teaching?

Correct Answer is B

Explanation

A nurse in a prenatal clinic is instructing a client about an amniocentesis, which is scheduled at 15 weeks of gestation. Which of the following should be included in the teaching?

Correct Answer is B

Explanation

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